Nick Summerton: Perils of striving for perfection in real world of NHS

Have your say

THIS week, everything at Scarborough Hospital is perfect. At least that’s the aim, anyway. For eight days starting last Sunday, the hospital intends to operate at an optimal level as part of what it’s calling The Perfect Week.

The intention is that during this period there will be none of the delays in the system that NHS workers and patients alike have become all too used to.

While I don’t want to put a damper on this worthy initiative, it does beg the question as to the quality of care that my patients currently receive. Moreover is a week, however perfect, really enough time to address the concerns many patients and general practitioners have about the standards of care being delivered by some of our local NHS hospitals?

Perfection is a dangerous aspiration. Aristotle defined it as something that is so good that nothing of the kind could be better. Thus, if an organisation does achieve perfection, then no further improvement will ever be required. For healthcare this means that new ideas and new research become, effectively, redundant and patient views can be ignored. Doctors and nurses will also have to become even more standardised to ensure that their respective life experiences, beliefs, knowledge and skills do not pull the hospital back from its pinnacle of perfection.

Harriet Braiker, a clinical psychologist and management consultant, has argued that striving for perfection demoralises because it is unattainable. Moreover, according to a recent paper from the Harvard Medical School, seeking perfection is probably more akin to a psychological problem that requires therapy rather than a sensible approach to improving performance.

On my part, I don’t expect my local hospitals to be perfect but to try to do better in relation to the things that matter to the individuals they care for. Based on the feedback I receive from my patients, top of the list should be improvements in four areas – courtesy, communications, consideration and continuity.

Courtesy is about hospital staff treating patients as they would like to be dealt with themselves

It is also courteous for health care professionals to introduce themselves to patients, making it clear what they are – whether it be doctor, nurse, physiotherapist or dietician. A nurse or psychologist with a PhD can be particularly confusing for patients if they wear a badge saying “doctor”.

Inadequate communications from hospitals remain a constant source of frustration. However, I don’t want specialists to write to me as a GP but to correspond with the patient and copy me in. It has been demonstrated that letters that are written to patients are, in general, clearer and more accurate than those sent to general practitioners. Also, delivering such communications to patients within 48 hours of their appointment would save both the patient and their GP a considerable amount of time.

Consideration is about being kind to patients and appreciating that hospitals are unfamiliar environments to many of us. If a patient gets upset or angry, hospital staff should not immediately take offence – it might simply be a reaction to the situation the individual finds themselves in.

One of my charming elderly patients was labelled as “difficult” during a recent admission as she did not understand what was going on. As I subsequently pointed out to the ward, it is simply not fair to label a 93-year-old patient as racist just because she cannot understand the accent or language of a healthcare professional trained outside the UK.

In general practice we still attach a great deal of importance to continuity; the same used to be true in hospitals. Thirty years ago, when I started work at the Royal United Hospital in Bath, doctors were grouped into “firms”. My surgical firm consisted of a consultant, a registrar, a senior house officer and myself at the bottom.

I had comprehensive knowledge of all the patients admitted under my consultant’s care and, with the support and guidance of my senior colleagues, looked after them throughout their stay. Nowadays very few patients develop any sort of relationship with the doctors who care for them in hospital.

The result is that not only has the care become disjointed and anonymised but the conversations hospital doctors used to have with a patient’s GP prior to discharge now never seem to happen.

So, I wish Scarborough well – but I can’t help thinking that if they focused more on seeking to enhance courtesy, communications, consideration and continuity rather than trying to attain perfection I am sure many of my patients would be quite content.

Last Christmas one of my patients brought me a bottle of wine. I thanked her but commented that I hadn’t really improved things for her. “I know,” she said. “No one’s perfect – but at least you keep trying.”

Dr Nick Summerton is a GP in East Yorkshire.