Nursing-The Big Differentiator

If someone was to ask me what truly differentiates one hospital from the other, I would unhesitatingly answer that it really has to be the quality of nursing. Yet most hospital managers pay scant time and attention to what is perhaps one of the most critical functions in the hospital. In India, nursing is perhaps one of the most under rated professions and in a hospital senior managers, who are busy driving patient volumes and revenue and focusing on delivering cutting edge medicine often forget that it is Nursing, which truly is the back bone of  hospital operations.

The last few months for me have been nothing less than traumatic. My father lost his battle with cancer and he continued to be in and out of hospitals virtually all of November and pretty much most of December. While, he gradually deteriorated and my worries and frustrations of doing battle with as implacable a foe as cancer, mounted I could clearly see the wonderful role nursing played in delivering round the clock care to him. My admiration for the profession has since multiplied many folds and it also led me to reflect on how we need to acknowledge and appreciate the role Nursing plays in the life of a patient and indeed that of the hospital.

If a hospital is about ”care”, truly speaking it is the Nursing, which is the face of the hospital. While a patient who is admitted in the hospital sees his doctor, usually twice in the day, (when the doctor is on his rounds), he sees nurses all through the day. While, the doctors have the largest role to play in achieving a cure, it is the nurses who deliver care and comfort in a hospital. Their role gets magnified many times, when the doctors know that they do not have a cure or sometimes when hope is in short supply, it is the brisk efficiency and the caring hand of a nurse, which makes a big difference. As my father grew progressively weaker and his condition deteriorated, we became more and more dependent on the nurses. We needed them to give him medicines, control his infusions, give him feeds, rub his back, sponge him, draw samples for tests, help him turn in the bed, decipher his almost incoherent speech and comfort him. Often, they bore the brunt of his ire – many a times he was petulant like an ill-mannered child, difficult to reason and get along with, yet those nurses never flinched, they never once walked out of the room in anger or said anything, which might be hurtful.

I watched all this and more play out in front of my eyes every day for several weeks over the last few months. The more I saw, the more ashamed I felt of how senior hospital managers like me treat nurses in the hospital. The doctors usually take them for granted, order them around, some pull them up for even small infarction, hospital managers just do not have time for them, they are just there, pretty much like hospital furniture.

Is this because the nurses that we have come from a socio-economic milieu, which is very different from our own? Is it because most nurses in our hospitals can not converse in fluent English, which is the undisputed currency of social mobility in our country? Is it because many of these nurses are not as well-educated as the doctors, hospital managers and probably most patients whom they care for slick private hospitals?

Whatever, be the reason we need to introspect about the critical role of nursing in our hospitals. I would surely like to believe that a hospital can easily have a long-lasting and sustainable competitive advantage over its competitors if it gets its nursing right. A bunch of efficient, dedicated and caring nurses are a far more precious asset than fancy equipment, smart doctors and smartly turned out-patient services executives.

Come to think of it, isn’t it strange that a hospital charges a fee for the doctors, there are charges for the use of the OT, the consumables and the medicines and even the hospital bed. Yet, no hospital that I know of charges a patient for nursing care!!!

PS: My father spent his last days at the Max Hospital in Saket in New Delhi

Pic courtesy http://acceleratednursingprograms101.com/wp-content/uploads/2011/07/Accelerated-Nursing-Programs-08.jpg

Hospitals are all about People’s Skills

skill-setsI have rarely come across an industry, which requires a range of skills, which are wider than what one sees in the people, who work in hospitals. A hospital actually is an amazing aggregation of skills and talent, which one would hardly see in any other human enterprise.

Among the medical folks, there are doctors who are hugely knowledgeable, highly educated and supremely skilled in the art and science of medicine, there are nurses and paramedics, who symbolise compassion and care and there are support folks who provide critical support for running the medical function in the hospital.

Amongst the managerial teams, there are managers who handle the front office and interact with patients and their attendants. They are the face of the hospital, well trained, well groomed very presentable folks, who help put patients at their attendants at ease. They usually have very good communication skills, are people with immense patience and a sunny optimistic disposition.

A hospital also needs a lot of technical support and thus you find high tech bio medical engineers, who ensure that all the equipment in the hospital works flawlessly. Imagine what can happen if an equipment in the OR or in the ICU malfunctions at a critical moment. Much like doctors, their role requires quick thinking, complete mastery of  technical matters and planning for any eventuality.  Most bio medical engineers are rarely seen and heard in the hospital but behind the scenes they control the levers of the hospital.

These days a modern hospital runs on state of the art software, which connects every hospital function. A doctor can not write his notes or ask for medicines till the orders have been punched in the Hospital Information System (HIS). The nurses can not dispense medicines unless requisitioned through the HIS. A patient can not be admitted or treated unless the relevant files and records have been created in the HIS. While most hospitals do have a back-up manual system, it is rarely used largely because an IT team employed by the hospital ensures that the HIS is rarely down. These people are often quintessential techies, with very sound knowledge of hospital systems and processes.

At a 180 degrees of separation from these folks are people who look after functions such as Food & Beverages, Housekeeping and Security. They are all trained individuals as much an expert in their areas as any techie. They interact with patients and their attendants and hence also have superb skills in handling patient grievances. 

While all of those mentioned above contribute towards keeping the hospital humming, another set of people are those who manage the business side of things and have a completely different set of skills. These include the sales and marketing folks, who represent the hospital to an external environment, purchase managers and store keepers, who ensure that the hospital is well stocked with all the essential supplies and the finance guys, who keep an eye on how the money is being spent. People in all these functions have unique strengths. The finance guys are very good with numbers, the sales people drive innovation and have good communication skills and the purchase folks have tremendous negotiation skills and an uncanny smell for a deal.

A good hospital will always have good Human Resources and training personnel. They are the ones who ensure harmonious working relationships amongst a very varied and highly skilled workforce. They make the rules, which govern the conduct of individuals in the hospital, play a critial role in rewards and recognition systems, act as agony aunts and handle conflicts. To my mind the most important skill they bring to the table is an ability to get on with people, understand differing point of views and manage aspirations of a very diverse bunch of people. 

If I was to select two critical skills, which an individual who aspires to work in a hospital must possess it has to be compassion and communication skills. Anyone, who works in a hospital must have loads of compassion towards fellow human beings, an innate ability to see things from the patients perspective and take decisions with empathy and  with an utmost regard for the plight of the patients. The ability to communicate well with language or through a meaningful silence or by just a touch, would be a close second. Be it a doctor, a front office manager or a sales person the ability to communicate the right thing at the right time to the right person is an immensely valuable gift.

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