There was just something about the voice that peaked my interest. Normally, announcements in a hospital are muted, measured and perhaps even staid. But this one was not any of these.
The voice over the intercom robustly and frankly welcomed the staff of the Joint Commission.
Reflexively, I thought: “how nice of us to warmly welcome the inspectors.” But one breath later, I laughed out loud. Brilliant. Wrap the “they are here” message with a warm southern welcome. Huge Grin!
Now folks, you know that writing about the day that TJC visits your hospital would be akin to riding a narrow, treacherous, “high-consequence” single-track.
A mountain-biker faced with danger has two choices:
A.) Grab the gusto, focus the mind and let it rip. Commit.
B.) The more sensible–albeit blander–way of navigating such danger is to get off and walk. Live to fight another day.
So what’s a medical blogger to do when it’s time to recap the sensations of a TJC visit?Â Ride the trail or get off and walk?
I would never write about how a normally calm, well-trained, well-meaning, all-human staff works less well when watched by people in suits. Serious people that hold the ability to–with a swath of a pen–assault something that caregivers hold precious: the self-esteem that comes from caring. Stop.
I won’t write about how it inflames my heart to see dedicated people get criticized by someone who has…Stopping here. Lots of Danger!
I would never say that a colleague described being fearful during a complicated procedure that was being observed by TJC. The worry was that the staff would do all the “right” things, but forget…Stopping again.
I would never even think that a nurse could not do two things simultaneously. Of course they can type in every box on five computer tabs AND tend to the patient. Hello. Everyone knows that we medical people can
text click and care safely. And hospitals aren’t struggling, healthcare costs not skyrocketing because we have to hire one nurse to log computer notes while the other does nursing. That we have 5 people in the room for AF ablation in the US and two in Hamburg has nothing to do with why it costs 80,000$ here and 8000$ there.
And finally friends, you won’t ever see the essay–that I have written more than three times, but never published–on how the Joint Commission disallowed our ability to use the best sedative available. The fact that we had safely (zero breathing-related problems) used propofol for more than a decade and thousands of cases mattered not. Or that non-anesthesiologists now have two choices for sedating patients:
- use anesthesia and dramatically increases the cost and limit access;
- or sedate patients with far inferior drugs. Prolonged sedation after the procedure, nausea, retching and QT-prolonging anti-vomiting medicines are all on the come back in cardiac labs across the US–in the name of quality.
No way. The pursuit of quality dose not have unintended consequences.
Was there a third way to ride that trail?
Starting to go for it, but then seeing the danger; stopping short and dabbing. At least you tried.