From time to time in our lives we are doomed to spend days and nights incarcerated in a hospital, as medical teams take care of what ails us while they set us onto the road to recovery.
Over the years I have had the dubious privilege of observing at close quarters how complex and interwoven it all is, operating 24/7 and with the very lives of patients often at stake.
And all this before Covid!
I immediately come to Covid, as I was one of those who caught the debilitating virus some weeks ago and so I have been at the Aga Khan Hospital for a long time. (Personal reflections for another day.)
There, at close quarters, I have observed so much high quality teamwork displayed by their extraordinary frontline care workers, who amazed me by their apparent assumption that they are just doing their demanding jobs like any other collection of professionals.
It’s obvious that running a hospital – certainly for inpatients – includes everything needed to manage a hotel, requiring all aspects of gracious hospitality while ensuring the high capacity utilisation that will make the entity financially sustainable. And then there’s that transformative extra: healthcare.
Those who manage hospitals must worry about catering and cleaning; security and waste management (big time).
The stocks of medicines and equipment must be available and up to date, with the labs and the testing centres fully equipped and competent to serve the medical teams.
Plus there are the usual back-office support functions: finance, audit, HR, ICT, legal, transport… not to mention dealing with medical insurers and other stakeholders.
The more I think about it the more I wonder how they manage, the more in awe I am, the more I find it hard to imagine who would wish to take on such extraordinary challenges, ones that incur such risk and require such knowledge, learning, expertise, discipline, stamina, resilience, emotional stability, judgement and goodwill.
I have occasionally acted as a consultant to hospitals, helping their people work effectively with each other in these challenging environments.
What I learned was that, at least as much as in other organisations, in hospitals there are very distinct sub-cultures.
For obvious reasons the doctors are highly influential, and traditionally the senior ones who ruled the roost were known for being insufficiently respectful or helpful to their juniors, who in turn were unhappy about the extent to which their typically more up-to-date knowledge was taken advantage of.
Then there’s the critical relationship between doctors and nurses: how flat is this pyramid, how big are the power gaps here?
My casual observation as a patient at Aga Khan Hospital is that for much of the time it works remarkably smoothly, with excellent delegation, empowerment and teamwork.
People are constantly learning about the latest developments in their fields; most are good at consulting with each other; and so their respective roles and relationships are clear.
Having said that, some of the nursing staff are inevitably bolder, more pro-active and solution-oriented than others (bearing in mind too how stretched everyone is because of Covid).
Some of the nurses are great at developing easy relationships with patients, and all are conscientious about carrying out tests, dispensing medicines and fulfilling their other technical functions.
But, partly based on their personality, partly on their expectation of the extent of their role (like going beyond the technical to include the interpersonal), what I found was that too often I was the one who initiated the brief conversations that led to easier and hence more effective partnerships between carer and patient.
Very understandably, expectations management is another challenge in hospitals (as it is with almost everyone in Kenya).
Life is so complicated, unpredictable and interlinked in hospitals that their challenges are unique.
I can comment as a patient that for much of the time it was hard to know when something was likely to happen, or the sequence. More communication would be helpful here.
All this I have been observing just as an idle patient, not knowing what I did not know, just experiencing what I was experiencing.
Inevitably though, my performance management hat remained permanently in place.
My bottom line? It is right for these healthcare workers, in whatever function and at whatever level, to be enthusiastically applauded and celebrated as our heroes.
Mr Eldon is chairman of management consultancy The DEPOT, and co-founder of the Institute for Responsible Leadedrship. [email protected]