Where there’s a will there’s a way

by Lallu Joseph
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The best part of being an assessor is the wonderful learning and often the paradigm shift in thinking out of experiences. In 2014, I was assigned to lead a team for assessment of a large multispecialty hospital at Hyderabad.  I completed the rooftop, fire drill, interviewed staff and moved to floors. The waiting area of the medical ICU had many relatives, congested, chaotic and dirty. Security was having a tough time managing the crowd. The situation inside the ICU was unbelievable with three relatives every patient. Nurses and Doctors were struggling.

The next day in management review meeting I raised my concerns to MD about visitors in the ICU and the lack of discipline in the most sensitive area of the hospital. He was apologetic and expressed his inability in handling local customs, sentiments and the lack of awareness of public about infection control and prevention. I wished him well and ended the management review with some lighter conversation and a cup of tea.

Two years later, I was allotted the same hospital and was eagerly waiting to visit the hospital. Among other memories of excellent Hyderabadi biriyani and Karachi biscuits, the scene inside and outside the medical ICU were vivid in my recollection!

After facility assessment my immediate thought steered me to visit ICU. I was pleasantly surprised to see minimal crowd outside and only one visitor with the patient with personal protective attire in ICU. Doctors and nurses were less stressed though the ICU was full.

I waited to meet the MD and my immediate response on seeing him was appreciation to the clean and disciplined ICU. We shook hands and he handed over a pack and told me that was the secret. I opened the pack and found a disposable cap, foot covers, a mask and an apron and was puzzled as to how that was the solution. He smiled and narrated how he decided to allow relatives into ICU without any number restrictions provided they were willing to buy the pack with Personal Protective Equipment(PPE) for Rs. 300, wear it and then enter, so that patient safety was not compromised.

He said the results were remarkable and since each visitor had to spend Rs. 300 and hassle of wearing all those, the numbers dropped.  He suddenly noticed a jump in visitor entry after a month and noticed one relative coming out with the PPE, removing them and handing over to the next relative, who donned and went into the ICU. He said, “I became smarter”, and I put a bin adjacent to the security and instructed him strictly that visitors must Doff and throw the PPE in the bin as soon as they move out of the ICU. He sounded very happy and proud that he was able to restrict entry and claimed that his intensivists and nurses are extremely happy that they don’t need to answer queries of multiple visitors. I realized that problem solving is an art and needed innovation, lateral thinking.

Lessons Learned

1. Top management committment is needed for problem solving

2. Lateral and out of the box thinking is the key to solving problems

3. People always find short cuts to beat a system.

4. Continuous monitoring of systems is needed for sustaining the improvement


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