Hospital Safety and Practice: non-negotiable

The modern hospital has become the centre of much attention here and across the world.  These are not facilities to be treated as yet another office building nor retail outlet.  Lots of things happen in hospitals that can, and often do, attract some unsavory characters to the premises!

I remember calling one of my colleagues several years ago and in mid-conversation, he said:  “gotta let you go; terrorists are in our ICU”!  This was not North America but could be. 

I remember getting an urgent call from our Post Partum unit one day when the nurse said a husband was there brandishing a revolver!  I also remember countless stories of persons coming while intoxicated to our emergency department, sometimes for treatment of injuries, sometimes to sleep it off.
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My staff often had to deal with persons with major psychiatric problems that manifest in belligerence and serious aggression.   There have been cases reported of babies abducted from post partum and nursery areas in some cities.

Hospitals carry large inventories of everything from tableware to highly addictive narcotics, electronics, and linens.  Over the years the theft of linens and silverware has been extraordinary and extremely expensive.  Early in my career we could not figure out what was happening to silverware only to finally conclude that we were somehow stocking the summer camping season from our inventory.  Similarly with linen, I recall getting “tips” from people who saw linens with our identifier on a neighbor’s clothesline!

Hospitals are sacred places with a duty to heal the sick and injured; corrupting that serious mission with security issues is revolting, at best.  But that is our world, one in which personal rights take priority over personal responsibilities.

Enter the issue of the huge epidemic of illicit drug use and abuse and the growth in use of various intoxicants.  Now you have an issue because those people who used to be polite and respectful now often are demanding, belligerent, disrespectful and, yes, violent.  Intoxicants do that to you, particularly those represented by highly addictive drugs.  People that I have known who have used this trash tell me that on a “high” their inhibitions are gone entirely.

Small wonder that when people who are under the influence come to Emergency Department, nurses get nervous.  They have been trained to care for the sick and injured, not to engage in Marshal Arts.  And when these folks come with weapons, not at all uncommon anymore, the risk escalates dramatically.

That is Fredericton, Moncton, and Saint John………..not Chicago.  In visiting a major hospital in Boston 30 years ago, my “welcome to the hospital” was by an armed security person who set the tone for the visit.  It was clear at the point of entry that if your business was not clearly expressed as legitimate, away with you!  Are we ready for that level in New Brunswick?  Probably not quite.  Security personnel in hospitals need more than a few hours of orientation.  Indeed, there are some discrepancies in quality in New Brunswick in that the DECRH and OPH have operated their own service very well for years.

For the most part, hospitals need security training at the level of a peace officer or an adaptation thereof combined with great on-site management.  But then they need additional training to ensure they understand the hospital environment, how it works, the chain of command, mental illness, dementia, advanced first aid, de-escalation.

Then we turn to the laundry and linen issues, written about earlier in these columns.  The creation of what appears to be a grandiose scheme with huge production and satellite warehousing in the province draws the ire of some close to the scene.  Some who have seen the development of this plan and who totally understand health care operations have expressed real concern on a number of fronts.

First is the economics of consolidating laundry and linen services in this small province; they point to the new need for huge inventories, warehousing, transport systems and personnel.  One reader had researched it pretty intelligently and concluded that there is no business case!
Then in speaking with some in long term care who already have had their service centralized, they point to the serious drop in quality of such items as facecloths and towels, pretty critical tools in the care of the elderly.

Could it be that we have created a monster?  Have we gone so far down the trail of consolidation and centralization that we have to ignore basic business facts in order to justify what is happening?  I have spoken with some informed people who think that is probably the case.

Somehow in New Brunswick we have this notion that centralization is best and that “the bigger the better”.  That theme swept through the education system in which huge schools were created that struggled to produce quality product.

On the other hand, Costco has found that bigger is better as long as you do it right!  Theirs is a model of success that is implemented with discipline.  Chick Fil A and Tim Horton’s, for instance have multiple small retail outlets but their entire inventory, production, and customer service is highly disciplined and guarantees quality of product and service to the customer.

That same thinking and discipline must be applied in health care whether you are organizing cleaning service, security, laundry and linen or any of the other essential functions that support the hospital or nursing home.  You need to start with an acute, highly developed understanding of the business.  If engineers and planners have never worked in a health care environment, if their only understanding is that which they got from their neighbor who works at the hospital or from brief meetings with hospital executives, then Houston has a problem!

What is the common denominator here?  All these essential services seem to have been moved to the control of Service NB which has grown like topsy in the last decade or more.  There is no doubt that SNB is staffed by some wonderful, dedicated civil servants.  I actually know a few who are salt of the earth people.

But health care is a specialty, described by real experts as the most complex organizations in our economy.  I understand that because I have invested over 5 decades in the sector both in formal training and “trench experience”.   So when someone, however well intentioned, tells me that he can save my organization huge sums by transferring purchasing or some other function to a central agency, my antennae go up right away.  Group buying and consolidating services has much to be said for it but, as many businessmen have painfully learned, hospitals do not operate like any other government department or like any other business.

That does not make them wrong, just different.  For instance, in hospitals, physicians play an enormously important role in virtually everything the hospital does; like it or not, that is the way it is.  One analyst reminded me one day that 80% of hospital cost is driven, directly or indirectly, by the pen of the physician.  Then you have the strong influence of unions with key managerial people actually being members of the collective bargaining unit.

These things are serious beyond measure.  In decisions about buildings, security, laundry, purchasing the influence is felt throughout the system for years.  And the way in which security has been managed, as we have seen in the press, has implications for unrest and insecurity of very highly valued professionals.

Neither Mayor Clinic nor Kaiser Permanente would stand for this.
Ken McGeorge, BS,DHA,CHE is a retired health service executive, part time consultant, and columnist for Brunswick News.  He can be reached at [email protected]