Play nicely – or you’ll drop the ball


When working in a complex organisation, especially one which is split up into different teams dealing with an overlapping number of projects, it is important to understand the rules of engagement.  This is even more so in healthcare, where conflicts over responsibility and disagreements about the roles of others can lead to significant harm for patients.

I have been on call quite a lot recently, and it has been both a wonder to behold teams coming together to solve massively complex cases in the best possible way, but also a huge disappointment to see squabbling, ping-pong, and downright obstructive behaviour have a negative impact on the experience, care and potentially (although I cannot claim to have seen this) outcomes.

The complexities of modern medicine mean that no one team or person can really be able to treat each and every patient that comes to the hospital to the highest standard, and where specialist skills are required 24/7 (to provide acute diagnostic and interventional procedures for example) it is seemingly obvious that specialist teams will be on call to provide such a service.

Recently there have been times when it has not been clear where a patient would be best cared for, or who should be providing that care.  It is at times like these that stretched teams all over the hospital can become more stretched, and tempers can flare.  I have been guilty of venting frustration at the system on occasion, and this week I have been able to look back and realize one of the key elements to the frustration:

Teams not seeming to play by the same rules…

If a football team gets on the pitch with a rugby team, and each team tries to play by their own rules – chaos would ensue.  That much is obvious, and the division of work within the medical take is not quite so obviously different as rugby and football.  It is slightly more like when two strangers play each other at squash, and may not have agreed beforehand what would constitute a let, or fully understood what each others house rules are.

For the majority of the time, they will play nicely, but, when the stakes are high, and they have invested considerable effort in winning a point and their opponent calls a let – then conflict can arise, and the game can descend into farce.

Caring for patients is not a competitive sport, but for those who care about their patients, care that they get what is required, and care that they get the best standard of care for their particular problem – the emotion invested can be of a similar order.

So what, I hear you cry – why should I be bothered if you get upset by the way some teams seem to be Teflon when it comes to admitting patients, but you have to take them all?  Well, it is not me that I am particularly worried about – I can always go home at the end of the shift, and ultimately I will be ok when the dust settles.

But in these days of increasing specialisation, and centralisation of services, we need to be sure that we do not construct a system that works perfectly for those patients that fit into diagnostic boxes nicely, but resolutely fails to address the needs of those who fall between the specialty lines.

We must remember that the focus of care should be the patient – not just the diagnosis, not just the disease, and especially not just the procedure required to sort them out.


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