The Conundrum

At intervals a new conundrum will be posted on the site and visitors are invited to participate by contributing thier views. After a period a Really Learning commentary will be added, incorporating the views of those who responded.

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Conundrum 11

Rob could see the discussion heading in a direction he didn’t want. The GPs had been so adamant that the problems lay in the discharge process from the hospital, but now that they had the opportunity to tell them so they were backing down. Instead of insisting that the consultants ensured their teams cooperated with the agreed protocol, planning the discharge on admission, they were agreeing with them that what was needed were more discharge liaison nurses. Instead of achieving significant savings in the course of providing better care, they were about to commit the PCT to even higher spending – without any evidence of the benefits of the investment. How had this happened?

At a recent meeting for all the people involved in the clinical pathway, the ward nurses had reported that the consultants weren’t monitoring their junior doctors’ observation of the protocol, even when the problems this caused were pointed out to them. It was a pity that none of the hospital medics (consultants nor juniors) could be there to hear this, and that was why today’s meeting had been arranged. An opportunity for the GPs who had been present to talk clinician-to-clinician with their hospital colleagues.

When they had been asked why they didn’t tackle the consultants and ask them to take a more active role, the ward nurses were uncomfortable. They had tried, they said, to discuss it with the junior doctors, but they always complained of being too busy, and somehow at ward rounds the moment never seemed quite right to raise it. They had talked about it with their manager, they said, but to no avail. She had a huge amount on her plate too of course, what with all the preparation for the Foundation Trust application.

Somehow or other Rob knew they had to get that Length of Stay down. Getting the discharge processes right would both reduce costs and help them maintain their success on access targets. Not to mention the better outcomes and patient satisfaction. It was important damn it! And the GPs knew it. What were they doing?!

Question
What is happening and what can Rob do to encourage the discussion in the direction he wants it to take?

Built on Wednesday, January 18, 2006 at 10:07 AM