Challenges facing the Hospital-at-Night Team
Organisation, Isolation and Engagement
Written by: Andrew Vincent, Medicology Ltd. Published: 3rd June 2010
Hospital-at-night was heralded as aninnovative solution to ever reducing juniordoctor hours and the knock on effect ofthis on training. Implementation has beenmuch more challenging that originallypredicted, with real gains in service deliveryon fewer staff but questionable benefit froma training perspective. On the grand realitysees many working at terminal velocity withscant opportunity to reflect on their learningduring the frenetic night time environment.We examine just a few of the challengesfacing the team at night.
Leaderless?
This is not a reflection of t¬he committedand extremely hard-working of the hospitalat-night teams, but an observation ofthe remit they are given. The majority areoperational-care delivering staff and whilstso much is expected of them operationally,they have precious little time to devoteto responding to the bigger challenges ofmaking things work – the classic leadershipdilemma of working in, versus working on.Leaders need to be given the opportunity,with their teams, to identify the mostdetrimental challenges and the support toresolve them.
Homeless?
Many hospital-at-night teams operatewithout a dedicated central base, denieda “control centre.” Co-ordination becomesmore difficult and teams can feel disjointedor virtual, reducing team spirit andincreasing individual feelings of isolation.Some teams operate from a base at theperiphery of their hospitals and althoughthey have a base it is difficult to visit becauseof the time constraints and distance.Furthermore, the peripheral bases proveunattractive to daytime teams who needto interact with their hospital-at-nightcounterparts if handover is to be sufficient.
Unsupported?
Night-time teams consist of a mixtureof dedicated staff and more transienttemporarymembers, usually doctorsin-training. Although all team membersoperate in the knowledge that support isusually an on-call Senior Person not residentin the hospital, this can be especiallychallenging for the junior doctor who isalready yet to build clinical confidence.Whereas a Venflon in a Surgical Ward is muchthe same as in a Medical Ward, the unfamiliarenvironment, the prospect of somethinggoing wrong and the lack of directsupervision can be frightening. Appreciatingthis is key to prioritising both appropriatesupport and effective induction to doctorsstarting out at night, itself key to getting thebest out of them.
Frazzled?
Ward Ten needs a Venflon and Ward Twentysixthinks one of its patients is “Going-off.”Night can feel like one big juggling act,fencing a myriad of requests in disparateparts of the hospital. This is not helped bythe greater use of bank staff at night andthe generally less-senior nature of wardstaff. Hospital-at-night teams need to assesswhere their time predominantly goes, andwhether this can be improved through ameasure such as training staff in peripheralwards. Of course this requires time, acommodity not in abundance for youraverage hospital-at-night teams.
Phenomenal
What hospital-at-night teams to achieve isnothing short of phenomenal, although itneeds recognising that this contributioncomes at a great personal cost. They copewith low work-life balance, few breaks,immense pressure and isolation. Despitetheir obvious commitment, it can seem thatnobody else cares, with little recognition(Directors don’t do night!) and a constantbattle to get some departments orspecialties to fully engage. To be maximallysuccessful teams need support, a base andco-ordinated engagement by medical andnursing teams from within the departmentssupported by hospital-at-night. To achievethis requires a unique type of leadership skill,coupled to exceptional organisation abilitiesand a natural appreciation of the biggerpicture.
Author: Andrew Vincent
Managing Director, Medicology Ltd
