May is one of my hospital teaching months.
I have the privilege of taking care of patients sick and vulnerable enough to need hospital care. In addition, I have the opportunity to work with medical residents and students, who always teach me new things in exchange for the ‘wisdom and experience’ that I bring to the bargain in acting as their supervising physician.
One of the maddening things I’ve noticed about hospitals is that very little gets done on weekends. This is true from the smallest community hospitals to the major teaching meccas.
It doesn’t make any sense.
How can we work in overdrive for five days every week, madly admitting, diagnosing, and discharging patients amidst a flurry of medication, lab testing, radiology, and arranging of follow-up services, only to slow down to a crawl every Friday afternoon?
Let’s look at the airline industry for comparison. Medicine is often compared unfavorably to airlines. Airlines allow price comparisons. Airlines reward loyalty. Airlines have a blame-free culture of safety that says, “We’re all in this together. If one of us goes down, we all do. ” So anyone is empowered to call a safety check when something isn’t right.
Hospitals? Not so much.
Do airlines put their passengers on board planes every weekend only to hold them on the tarmac until Monday morning rolls around? Who would stand for that?
Americans decry how much is spent annually on health care, yet 29% of every week in a hospital runs so slowly that essentially nothing gets done. [With a long weekend, it’s 43%!]
What do I mean by ‘nothing?’
Certainly hospitalized patients get outstanding nursing care around the clock. They get good doctoring and respiratory care, too. They get excellent food service, environmental service (cleanup), and nursing aides who help with many tasks. I don’t mean to disparage any of these folks. They work hard. Medication is dispensed. Heck, some hospital patients even convalesce and start to feel better.
But hospitals aren’t in the convalescence business anymore, at least during the five days of the work week. Those days are a flurry of ultrasounds, radiology tests, physical/occupational therapy assessments, and interventional procedures–like having feeding tubes placed, biopsies done, and elective surgeries performed.
Other industries have figured out how to schedule their employees to optimally meet demand for services on weekends. Airlines. Restaurants. Factories. Retail establishments. Police and firefighters.
Why are hospitals so special?
I admit, I like to have my weekends off like most other people. It’s especially useful for those of us that are parents.
But who is the weekend slowdown really benefiting?
- Not the patients. They have stay in the hospital longer.
- Not the hospital. They have a bed that could be used for a newer, sicker patient.
- Not the doctors or trainees. They are mostly in ‘babysitting’ mode waiting for specialized services that won’t fire up again until Monday.
I’m often told that there’s a shortage of ultrasound technologists in America. Are they to blame? Try getting an ultrasound on a weekend. Cue the tumbleweed.
Radiologists, especially the kind that are good at biospying body parts or putting in invasive catheters safely, are never available past Friday mid-afternoon. Tumbleweed drifts.
I just know if I were a patient (I am), I would be pretty peeved to spend a May weekend in the hospital when I could be home with my family. Oh, did I mention that my diagnosis and plan of care depends on the biopsy or the line getting placed? Crap.
Wait ’til Monday, I guess.
Bonus points and innovation awards to the smarties who can solve this one. Doesn’t seem like rocket science to me. Could be an easy marketing advantage:
Bedrock hospital. Where 24/7 is not just a figure of speech. We figure out what’s wrong and we get you home. Faster than they other guys.