I haven’t found one nursing student who knows whats going on in their degree. these are the few who hang in to try and complete the degree. Faces I saw from two yrs ago up to several months ago are no longer here at Wintec. They were no where near completion of the degree. I only know of one who is still going hard. She has already had professional experience and is a JP so is of high standing in the community. she has no confidence of her standing in the degree.

That’s hard. I myself am going into my third year in media arts. There are aspects I know I’ll have to work doubly hard at next year but I have confidence to overcome because of my last three years in academics. But when someone of professional standing in the community has no idea, that’s not a good sign of being educated.

Hard work is hard work and we feel accomplished achieving in it. But to work hard and feel no achievement is not healthy learning.

In the health system it’s exacerbated by an almost unwillingness on the part of elements of the clinical hierarchy to see organisational efficiency to be as important in treating the health of the person as medical knowledge and skills. These are elements of the old school of doctoring who saw the hospital as their fiefdom and patients as an unfortunate byproduct of treating sickness and disease.

Luckilly, this aversion to seeing organisation as important is reducing but we seem to be replacing it with managers and bureaucracy not relevant to actually treating the patients. For instance, the reporting requirements to government bodies change (and increase) faster than many DHBs can keep up with. Even funnier (not) is that several DHBs have problems doing the reporting and cannot fully ‘recover’ funding because they cannot provide evidence they did the appropriate treatment.

We are making it worse by paying our doctors relatively badly. My cousin, a doctor, who wished to immigrate to NZ (his education and training having all been paid for the UK government), went instead to OZ as he was offered such a poor package that he didn’t think he could live off it.

On a final note, I do remember the first round of new managers going in to health back in the 90s. I had to laugh as they were typically the ones who could not cut it in the commercial world and it showed.

My husband worked as a surgeon for 18 months in a well known and hightly regarded American private charity hospital, which took patients on the seriousness and chronicness of their condition not on financial ability to pay. In other words very similar to NZ. But what a complete difference in attitude. Patients and families from all ethnic groups and socio-economic classes were represented and highly grateful to get free, top quality medical and surgical care pre and post operatively. They signed contracts agreeing to adhere to all the medical and surgical advice for an optimum outcome post-surgery, eg agreeing to attend all physiotherapy sessions, agreeing to dietary changes, agreeing to take medications, agreeing to all follow up surgial care ete etc. There was a mutual understanding between patients, families and the hospital that private donors had contributed to this hospital which has an endowment in the $US billions, and that everyone needed transparency and reassurance that money was being spent effectively and honestly. In other words it was someone elses time and dime, so play nice. I would love a bit of an attitude change here in NZ but not holding out for it.

I saw this in action a few months back, I was in hospital for scheduled orthopaedic surgery (after only a 7 month wait for an urgent operation, way to go ACC, but that’s another story), and this dumb ass turns up 6 hours late for his surgery cause he wanted to play in the snow & get his shopping done! And then wanted to be done straight away cause he had to travel back to where he came from before the roads shut with too much snow! If it had been up to me I would of said bugger off to him when he turned up, charged him the lost theatre time, and only agreed to do his surgery without anaesthetic (it was only removing a stabilising wire in his foot the nurses told me.) No wonder there is so much slack in our health system.

But on the A & E thing, they need to be harder on some people who turn up simply because they don’t want to pay to go to their normal doc, or the after hours medical centre. Though I know at Dunedin hospital, they analysed the patient data, and only a very low percentage of people presenting at A & E weren’t urgent, it is just lack of space & medical staff that make the waits long there.

The problem is systemic – wards don’t have enough beds so ED have to hold patients for longer, patients back up in ED = extensive waiting times.

http://www.youtube.com/watch?v=Eyf97LAjjcY

it seems management and HR don’t seem to see the staff goodwill eroding as they should, otherwise there might be more urgency to solving problems.

so just glued it together myself
So you didn’t really need to go to ED afterall did ya love?

It would also help if A&E departments started to turn away people who turn up with the flu
You’d be surprised at the ailments that people turn up to ED with – man flu is a regular!!

The brutal reality is that ED’s are seriously under staffed, are becoming increasingly unsafe to work in and have an incredibly high staff turn over – it’s a vicious cycle! Wgtn is suposed to have approx 35-40 FTE nursing staff and currently operate with around 25. People are leaving in droves due to poor management and unsafe working conditions. While its not the sole reason for extensive waiting times it is certainly one of the many contributing factors to our crappy health system.

Advice: unless your completely convinced that your dying, don’t go.

ps – no i don’t work in ED

The medical council isn’t as efficient as they make out, in fact in 10 years I’ve heard/seen some stupid stupid behaviour and non professionalism.
I know 4 overseas GP’s in different parts of NZ as well as a coupla specialists, all have had problems with the medical council at soemtime.

All very experienced, one ran an a&E that is busier than Auckland, who’s surgical experience surpasses some of our surgeons in the area they are based.
but no the gnomes pull the strings.
all are contributors.
considering the barriers to entry in medicine you’d think they’d be more efficient and on the ball.
Is it the same with the engineers and others?

Last week(Thursday) one of my male employee’s complained of a headache or in his words a very severe migraine. By evening he was vomiting and had severe pain in his head. Sent to A&E where he waited for 3 hours, vomiting etc. By the time he was seen his brain had swelled and he was in serious trouble. Blood tests revealed meningitis, so he has spent five days in the hospital.
Good action once the right people get to work but bloody woeful at entry. Contrast that with going in to the entry desk with someone suffering chest pains and the reaction is instant and service really good.
All this in a hospital that has just had an injection of 125 million for a new building. And nice too but pointless if the customers are not looked after when in urgent need.

Earlier this year some hospital A&E dept’s in Aussie set to wor to tackle just these problems with some amazing results.
Perhaps someone with some time can look back for the news items.

PS: Turpin – in most cases there probably IS a shortage in their area! Been trying to get registered with a GP for 2 years now… “Oh sorry, we can’t take any new patients just now…” “Oh sorry, you’re not in our area…” etc etc

They need to learn consequences apart from being bumped from a list as to them it just means more delay.

If they are going to waste OPM why not charge them for doing so?

As for suggesting then a doctor/manager needs to send them off to their local GP with a flea in their ear if it is simple and tell them off if they haven’t registered for a pMO /GP.

Assuming there isn’t a shortage in their area.

While the health system remains a “free” service with no reform, waiting lists remain the only rationing agent. Any targets will only cause unintended consequences elsewhere. I predict tears in the future.

the health system like many things governemnt get involved with is inward focused It is process and procedure driven

the customer is viewed as the problem. the process and the procedure is all important.

if the customers gets a good outcome it is ancillary to the real job

As one who has been involved in customer service in the private sector and worked for several of the worlds best customer service organisations its is frustrating to watch the shambles play out.

You see those at the top have no idea or understanding of what constitutes good customer service.

they are blinded to the simple and obbessed with the complicated. the Sir Humphries delight in building road blocks to good customer service because they have a command and control mindset.

they set up failure systems they will never succeed and then blame the customers.

Take the roads its all the customers fault that we have traffic jams. Nothing to do with idiot planning.

Until we change the people or change the people nothing will improve.

we need to forceable remove the old CD and insert the new CD in the top 2 inches.

democracymum – yes it is tough hanging our in A&E (especially when you are a genuine case) with a starving and thirsty kid (been there and done that). But remember, depending on what sort of break in the limb is can mean a simple plaster cast or surgery. People forget in the heat of the moment that the most conservative treatment route has to be initially taken. The ill-timed consumption of food can mean the difference of being operated on quickly or being forced to wait overnight till full digestion has taken place. My husband is a hospital surgeon and hardly a week goes by when one of his elective f***wit patients, despite a face-to-face consultation, follow-up letter and a phone call from a nurse restating not to eat before booked surgery, does so. The resulting loss in operating time, when someone elese could have been seen, misuse of staff time etc is a huge burden on the system and the taxpayer. These same idiots rarely seem contrite or embarrassed at their self-induced stupidity and naturally demand they get operated on the next day.

Fuck me – a decent proposal to set targets and move service levels in the health service upwards and we get a bunch of fucktard rightwing angry folk going mental.

If YOU want to improve YOUR society get out there and GET INVOLVED at the grass roots.

Otherwise STFU.

you sound like an angry idealistic optimist.

It isn’t a proposal, it’s vague idea of targets. There are no details as to how targets will improve flow of patients, what new method is required, how much it will cost, where the money will come from, and whether it will actually be funded. There is no mention of what will happen if the targets are not met outside of blaming the management. There is no mention of how they will track implementation of method that hasn’t even been invented yet.

Let me know how many years it takes you to first get involved at “grassroots” level before you actually make a difference. If you start now, you may, if you’re lucky, not make a difference over the rest of your professional life. Keep the cliche slogans for naieve fools and children who don’t know better and do have fun mopping those hospital floors won’t you.

Democracymum: the lack of food in the waiting room is deliberate. Otherwise people who need surgery would eat and delay their operation still further (and, believe me, it does not matter if you tell them not to!)

Kaydid: I’m skeptical too. Unless Ryall actually deploys some real resources, the same thing will happen here as did in the UK.