Back in England a good twenty years ago now, I once knew a junior doctor (Hello Jeanette, how’s things?): always eager to save the National Health Service at any cost. Or at least eager to save it any actual cost.
Either way, I think she may have once stumbled across a cost saving idea which may well be hailed by all National Health Service administrators in the future, as having all the ease and clean simplicity of the Battle for Paschendale during the First World War (1917).
During the course of this piece, by the way, for those of you who like quizzes there will be occasional quiz questions, so do stay awake; and for those of you who don’t, there won’t, so don’t.
Now then, just as the famous chemist Friedrich Kekule first thought of the ring structure of the benzene molecule, while dozing in front of a fire (First quiz question: Did he? Answer: Yes he did. Score: two points for a correct answer). So this idea came to her, while she was working in the casualty department at Hope Hospital, in Salford.
And it was here that my story and that of Kekule comes to an abrupt ending; for unlike that famous German professor (1829 – 1896), she was fully awake, on a night-shift, and not at all famous. Or even German for that matter. But, by a complete coincidence, it was 18:29 on her digital watch, when a seriously injured man was brought into her department.
I must tell you straight away that this story has a happy ending, and that the man involved, made a perfect recovery, so don’t start getting all edgy and panicky about it. You simply don’t have to.
At the time however, she spotted at once that the man was suffering from a condition known to the boys in the casualty racket as ‘bleeding’. Those of you who have ever watched General Hospital, Casualty or Holby City on the telly, might better know the condition as a ‘massive haemorrhage’, but not all doctors had television in those days so she didn’t know that.
But never mind, she was still able to make this brilliant diagnosis by virtue of her incredibly thorough training. Her tutors at Hope hospital had taken her over every single aspect of emergency care in painstaking intricate and perfect detail, and she could never forget the firm clinical grounding that they gave her on bleeding. It went a bit like this…
Observations: (a) the patient is white, (b) the floor is red; Conclusion: bleeding. (Of course there may be the occasional snag with this approach. For instance, in some hospitals the floor may have been red all the time, and this can lead you somewhat astray; but in that event, a brief phone call to the hospital secretary should put you right on this point, or you could just see if it is feels any wetter than normal).
Anyway, having thus made the astute observation on her patient, she then proceeded to carry out the first step laid down in her casualty officer’s manual: that is, she panicked.
Having done that, she then set up a drip in each arm (of the patient), took some blood to find out his blood group for a transfusion, gave him some plasma to be getting on with, applied pressure dressings to the wounds, panicked some more, did a cut-down to the vein in the left ankle, cancelled her lunch, rang the X-ray department, wrote copious notes, cancelled next Tuesday’s hairdressing appointment, hooked him up to monitor his stats, wrote more notes, looked a little flustered, put the operating theatres on stand-by, panicked again, rang the duty surgeon, perspired a lot, wrote even more notes, and located him an available hospital bed less than three hundred miles away in another hospital. By now the scene was definitely beginning to resemble one of the earlier episodes of General Hospital (when they could afford larger casts, that is).
Soon, the technician from the haematology department (where they do all those clever cross-matching tests and stuff to make sure the patients get the right blood group given to them) brought in the first packets of cross-matched blood and she got three nurses to stand, each in charge of a drip, squeezing the plastic bags of blood to make them go in faster. This is called a ‘pressure transfusion’; mainly because nurses will only do it, when under extreme pressure.
Now this is where I shall give you the second quiz question (or if you didn’t notice the first, the first).
The question is this:
Do you know where blood comes from?
If your answer is ‘No, I don’t know where blood comes from’, then you are probably CORRECT, so give yourself three points and apply for a job as a doctor.
If on the other hand, you do know where blood comes from, let me tell you, you are probably INCORRECT, so give yourself five points and apply for a job as a Hospital Administrator.
The actual answer is; that blood comes from a fridge in the haematology department.
For those of you who want to know more, and may be interested in a career in haematology, before the blood gets into that fridge, it comes from a little blue van labelled ‘National Transfusion Service’. – There are not many people that know that.
Anyway, the upshot of the whole thing, is that blood ‘au natural’ in the casualty department, coming straight from the fridge, is understandably, very cold, and if you transfuse six pints of the stuff into a young chap very quickly you are, in effect installing a sort of air-conditioning from within. For that reason (do stop me if I’m going too fast for you) they have these things called ‘blood-warmers’, which are long coils of plastic tubing that sit in a warm bath at around 37 degrees centigrade and take the chill out of the stuff as it passes through – They only do this, so it doesn’t turn the blood recipient into a five litre cross-matched iced-lolly.
Well then, while everybody was doing their ‘General Hospital’ bit and pressure transfusing away like Billy-O, our junior doctor nipped out and got the next three litres of blood from the haematology fridge, tossed them to one of the nurses and said, “Righty Ho,” (She was young and hearty in those days) “let’s get this lot warmed up”.
She then carried on being terrifically busy with the X-rays, more notes, mild panicking and the anaesthetist and so on.
A few minutes later she turned back to the patient and found that both the nurse and the three litres of blood had completely disappeared. To her horror, she then noticed that the three blood warmers were also standing idle in the corner of the room, and realised at once that whatever the nurse was doing with the blood, she wasn’t putting it through the warmers like she was supposed to be.
Now all sorts of silly ideas go through your mind at times like this. She thought that maybe the nurse had nipped out to try and flog the stuff on the black market; maybe her boyfriend was a vampire, or even a barman with a novel line in cross-matched Bloody Marys.
In increasing perplexity she wandered through the casualty department looking for her missing nurse. She wasn’t in the store-room, she wasn’t in the sluice (where by some freak chance there happened to be the only phone extension in the whole hospital on which it was possible to dial direct to Australia and a queue of free loading doctors waiting to use it), and she wasn’t in the coffee room. She was however, eventually found in the staff kitchen where she had snipped the corners off the packets and was stirring the blood in a large saucepan on the stove.
And as our junior doctor arrived, the nurse was testing the temperature of the stuff with her elbow (presumably because she thought that her fingers were too dirty for the job). She stared aghast at the nurse, and then looked into the saucepan: what they had was nothing more than a three litre, Group A, Rhesus-negative, black pudding.
But being a woman of considerable resource, our junior doctor did the only thing possible given the circumstances…
She snatched the saucepan from the wretched nurse, rushed back to the patient and slapped the whole mess onto his chest like a poultice.
Now the whole point of the story is that from the moment the ex-transfusion landed squarely on his chest, the patient did terrifically well (though he has been unable to look a black pudding in the eye ever since, and has twice been cautioned by the Commission for Racial Equality as a result). It therefore seems obvious to me, that all these complicated cross-matching and grouping tests that they do in the haematology department could be a complete waste of time.
It is clearly just a plot by haematologists the world over, to make themselves seem more important than they actually are.
So, what I’m now going to say is this: Don’t you go worrying your head about all those differing blood groups, transfusion related reactions and so on; you just go along and warm the stuff up to about gas mark Regulo 7 and slap it on the patient’s chest, and mark my words, they’ll do fine. If they’re having brain surgery, then slap it on the back of their necks; if it’s abdominal surgery, rub it on their tummies; and if its gynaecology, well… I’m sure you’ll think of something.
In fact we might even be able to organise something on an out-patient basis. We could set up a great big 20 litre cauldron of bubbling warm blood in the clinic and anybody who is a bit anaemic could come and dabble their fingers in it. It could mean the birth of a brand new speciality: ‘Homeopathic Haematology’ or ‘Faith Transfusing’.
Of course it’s not only the doctoring trade where stringent rules, practices, proceedures and unwarranted red tape gets in the way of things.
I’m sure your own chosen fields of speciality are the same too. Many well established businesses follow undocumented methodologies for no other reason than “that’s how it’s always been done”.
A little while ago, I was talking to a relative who’s a retired senior fire officer in the Isle of Man, and he told me quite an interesting story…
One day, he was out on routine fire inspection duties with his team. They walked into a branch of one of the major high street banks, asked to see the manager, and announced the purpose of their visit. The manager appeared from his office, and eyed them up and down suspiciously.
“How do I know you’re who you say you are?” he said.
As you might imagine, my friend considered this to be a somewhat strange question to ask of five men all dressed in full fire fighting gear, but he fully understood the need for caution and decided to humour the manager. He led him to the window and pointed outside, where a shiny red fire engine was parked at the roadside.
“There,” he said. “£175,000 worth of state of the art fire fighting equipment.”
“Hmm”, murmured the manager, “Have you got a card or something with your picture on it?”
See, we all do things on autopilot – without thinking. It’s how we get through the day. And one of the easiest ways to do that is to follow standard procedures, rules and regulations. What would you consider to be the most convincing form of ID? A laminated card that any self respecting crook could have forged within the hour, or five tons of fire engine? It seems obvious, doesn’t it?
And yet the bank manager’s ‘autopilot’ procedure was to insist on an ID card. He probably didn’t consciously think about the reason why he should ask for an ID card. As you know, banks need to establish identity as quickly and as certainly as possible before divulging account details. Instead, he just made the cerebral leap from Visitor to ID, without asking himself the question… ‘Why?’
Now I know you might laugh and think that you wouldn’t be so inflexible or unthinking, and maybe you wouldn’t.
But at the same time I’m sure that there are rules, regulations, procedures and ways of doing things in your job or business which you are currently following – rules which are no longer appropriate due to changed circumstances.
Whatever business or profession you’re in, I guarantee you’ll be following procedures laid down by others before you. You will be doing things using the methods established by your predecessors. And I’d wager that you’ve probably given little or no thought to – or even have no knowledge of – the thought processes that went into creating these procedures in the first place.
I know that in my business, I frequently find procedures being carried out long after there is a need for them. Maybe it’s the way we are taught. Or is it simply because nobody has really given any thought as to why the procedure is being carried out the way it is.
Imagine this scenario taking place in an older organisation like the NHS then – where many people have come and gone over the years. In these places, the methods, rules and procedures have long since become divorced from the reasons underlying them.
Nobody knows why any more – it’s just the way things are done!
So my suggestion to you today is to question all the rules, procedures and methods that you’re currently using in the important areas of your life…
* Who created them?
* What was the thinking behind them?
* Are they still relevant today?
* Has anything happened over time to make this rule or procedure obsolete?
* What do you think would happen if you broke the rule, changed the procedure, or didn’t carry out the procedure at all?
* Are you doing things this way because ‘they’ve always been done like this – or do you have a better reason?
When we start to examine everything that we do, and why we do it, I think we’ll be amazed by what we find.
I know I was. And now, I always try to work smarter with regard to rules rather than harder. Obviously without cutting corners and still leaving things compliant.
So here I shall leave you the outlines of the latest new scheme to reduce spiralling costs within the badly ailing (no pun intended) Health Service. And to some degree, in my own business… You must admit, it is remarkably simple.
But then of course, so was the restructuring of the failing British Leyland car manufacturing industry in the seventies, the culling of the coal mining industry in the eighties, the collapse of Llyods of London in the nineties, the Dot Com bust of the noughties and the re-organising of the collapsed banking systems in 2010.
And look what all that lot did for transfusion demands.
No apologies for the lack of quality images in this post by the way. The next post will be full of them 🙂