The humble hospital gown is a metaphor for how we can transform the NHS
|
Version 0 of 1. NHS England’s blueprint for the future, the Five Year Forward View, says: “Sometimes the health service has been prone to operating a ‘factory’ model of care and repair with limited engagement with the wider community” and a “short-sighted approach to partnerships”. This is certainly true when it comes to the experience of a patient having surgery. I thought that being a consultant anaesthetist familiar with the process of surgery, it would be a routine experience when I had to have a series of operations. But this was not the case at all. Patients (like prisoners) are instructed to arrive at a large, frightening institution. You aretold not to eat and to stay in the building. You are processed by name and serial number. You wait anxiously among strangers with little information, and are then told to undress. Your clothes and belongings are taken away. You are given a wristband and forced to wait an uncertain and often lengthy amount of time, without friends or family, in clothing that undermines your dignity and leaves you partially exposed to strangers. The bewildering process of being prepared for surgery feels even more complicated when you are handed the hospital gown and the elasticated pants. You open up the gown and try to figure out which way up and which way round it goes. After you put it on and tie it at the neck and waist, you suffer the embarrassment of the nurse telling you it’s back-to-front. You take it off and put it back on and try to tie it behind you at the neck and the waist. You then try to put on the foam slippers, and your untied gown promptly falls over your head as you bend over – and then the nurse comes in … again. So it struck me that there probably hasn’t been much of a partnership between patients and staff in improving this aspect of the patient experience. The gown was originally designed around 100 years ago for use on patients admitted the night before surgery, who were sedated prior to transfer to the anaesthetic room half asleep on a hospital bed. And it hasn’t really changed since. So I have conducted a project looking to improve patients’ experiences of short-stay surgery at University College London Hospitals (UCLH). We organised six staff workshops, two patient focus groups and followed 20 patients. Our research found that while the surgery experience itself was often good, admission and discharge processes needed improving. “It’s like we had a great flight, but the airports at either end were awful,” one patient said. The hospital gown was a particular bugbear – with patients complaining of feeling abandoned and exposed and left to wait too long in a draughty gown. So we have decided to try and find an alternative – and patients and staff will help to choose it. It may seem a tiny change, but the hospital gown is a metaphor for the way we can transform the NHS. The historical failures to learn from the poor experiences of patients are missed opportunities to make people – not the system – the priority. Patient feedback provides invaluable intelligence and insightful ideas about how to improve care and redesign services. Patients are our greatest assets for quality improvement – and we need to ask their help to better the care we deliver. Partnering with patients to improve their experience is the only way we will understand what matters most to our patients and how we can make things better. Our focus must shift from the perception of patients as passive recipients towards them being partners in improving the quality of their experience. Listening to their experience of the hospital gown is a good place to start! |