Thursday, August 18, 2016

There is Hope for Health Care

It has been just over a week since we have returned from Edmonton.  We are firmly on the very slow road to recovery.  A separated sternum does not heal really quickly and it is a slow and very painful recovery.  I wish I could report amazing progress and that Susan is up and moving around like normal but that just wouldn't be true.  Just about any sudden movement is followed by a deep gasp, squinted eyes, and a few choice words.  This morning at breakfast I heard a snap, crackle, and pop which did not come from the Rice Krispies.  Yes...the sternum and all their attaching components are starting to heal but it is very slow going.  This means that life for Susan right now is a very slow pace.  I'm helping around the house and doing the "heavy lifting."  This leaves lots of time to reflect on the events of the last few weeks.

Many times i'm critical of what goes on in health care.  To be honest, from the time we got on the airplane on August the time we returned home last Tuesday I am hard pressed to come up with anything to be overly critical about.  We had plenty of positive experiences.  What is more impressive is that this is in sharp contrast to the experience we had 7 years ago undergoing the same procedure.  Can Health Systems actually change and improve?  Can the changes become so noticeable that the patient and caregiver can't help but notice the changes.  The short answer is ..."Yes"  So what happened?

The most obvious change over our experience 7 years ago was the physical building.  The Mazankowski building in 2009 was nearing completion, but not yet in use.  We were in less than ideal circumstances, the CVICU was a windowless chamber that was crowded and dismal.  Even staff described it as "that awful place."  The wards were also less than inspiring.  Things were shoved everywhere due to an obvious lack of space.  It is remarkable how just a physical space can make the experience so much better and less dreary.  Fast forward to our experience of early August and we were treated to a spacious CVICU suite with plenty of natural light.  I would also dare say the privacy of these rooms made the ICU almost a serene place.  That took me by surprise.  The rooms on the ward were also spacious...with 2 patients per room we still had plenty of space for visitors.  One of the ladies in the next bed to us had 5 visitors one day and we barely noticed.  There was plenty of space for them.  Everything on the ward was easy to find and relatively intuitive.  I could easily find supplies like blankets, towels, or water.  A very welcoming environment.

The physical space of the hospital was an obvious improvement but after all it is the people who really make things happen.  Staff did a great job at introducing themselves and they were engaged with us enough that we actually got to know their names.  I still recall all of the names of all of the Doctors and nurses we interacted with...and I never wrote the names down.  We had three nurses in CVICU;  all were excellent.  On the ward we had consistency in nursing.  We saw the same nurses on consecutive shifts.   Over a period of  5 days, on the ward, we effectively only had 4 nurses.  That kind of consistency means no repeated introductions.  Not having to repeat yourself is a huge plus and gave us more confidence that the nursing staff had a good handle on what was going on.

Many times you feel like you are abandoned in the hospital.  Someone says they will get something for you and you don't see them for an hour (or more).  This was not the case...we always felt that someone was checking on things and were very accessible.  The consistency and accessibility of the nursing staff was a huge difference in our experience this time as opposed to 7 years ago.  Big change!

One thing that I noticed was the age of the nursing staff, on the ward, as well as the age of some of the patients.   I don't think it is a surprise as education in nursing schools is emphasizing patient and family centred care.  The result is that new nurses are much more in tune with patients needs.  Our ward nurses were likely all under the age of 35.  As an example, one of our nurses graduated from nursing school only a year ago.  However, she had previously been in EMS for 7 years previous.  So, not a rookie by any means.  We also noticed a few of the patients were also under 40.  This is different.  The cardiac crowd tends to be of the 60+ demographic.  Seeing younger patients means patients who have grown up in a different environment and who view health care very differently.  Changes in the demographic of the staff and patients makes change much more likely.  Important to note that a younger demographic does not necessarily mean positive change....change still needs to be managed and directed in a positive direction.  You can't underestimate the value of leadership.  It is also important to recognize the veteran nurses who provide excellent mentors for younger nurses rising through the ranks.  I definitely saw a huge improvement in the quality of nursing.

The one gap that I repeatedly come up against is the issue of discharge.  Having talked to many people who have extensive patient experiences, many feel like being discharged is like falling off a cliff as far as your care and supports are concerned.  The one change, this time around, was that the hospital in Alberta ensured that a home care nurse was coordinated for us here in Manitoba.  As circumstances would have it, we were contacted, by our home care nurse from Selkirk.   The call occurred as we were driving home from the airport.  We hadn't been on the ground in Winnipeg for an hour and we were already getting follow-up.  Our nurse visited us at home and did a brief check up for three consecutive days following our arrival home.  This was a nice support and a good trend to see in post surgical follow up.  We were also asked to make an appointment with our family doctor,  which is another good idea.  It's really important to do this kind of coordinating with everyone involved in your care.

The one reality that cannot be avoided is that going home is a big adjustment.  You go from having all of the staff, equipment, and services (that a hospital offers) to little or no supports in the community.  Caregivers face the brunt of this burden.  It is for this reason that I took time off from work to fill this role.  Although I was busy when I was in Edmonton.  Now that I am home...this is when the work begins for me.  Fortunately, we had booked some help.  My sister hung around for a few days...and my mother in law who helped us a ton 7 years ago is stopping by to help too.

From reading this you would get the impression that we had a very favourable experience in Edmonton and that would be true.  We felt very well cared for.  Was our experience perfect...No...but the amount of changes we have seen have been noticeable and the hospital should be commended for their efforts.  When I raise issues or have complaints about our experience in health care, I have to ensure that the experiences that I am sharing can result in something positive and are not being critical just for the sake of being critical.  When things work well, it is important to identify the positives as and our experience was certainly positive.

Thanks everyone at the "Maz" for our experience.

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