Matt Morgan and Paul Twose: Efficient, fragmented holistic care

It is a familiar situationsitting on the ward, long after your shift has finished, waiting for the phone to ring so you can clarify a patient treatment plan.

Was that conversation really essential at that very moment? Maybe not. Will the overstretched junior doctor even be able to answer your question? Probably not. Was that efficient use of your time? Definitely not! In hindsight, the last time the authors made such a call was because everyone was being so efficient in “their” aspect of patient care that the holistic plan became fragmented and anything but efficient.

We are certainly not alone in putting extra time to deliver more holistic care. The nurse who helps a patient’s wife find the car park, the physio that holds a patient’s hand whilst blood is taken, the doctor helping to roll a patient. These happen every minute of every day. Yet we seem to get more recognition when we are successful at making “efficiency savings.” We argue that sticking to individualised, fragmented work streams actually result in more work not less. Maybe not for the one being efficient, but for the next healthcare professional involved, or those trying to orchestrate good care.

Modern healthcare is often compared with industry, especially car production, with Toyota’s lean manufacturing system leading the charge in the boardroom. Within this process, each employee knows their precise role and how to achieve their task in the most efficient way. You wouldn’t want the welder to suddenly help out the windscreen installer on the production line just because they needed to go to the toilet.

Of course, service improvement is important including the need for efficiency savings. However, this cannot lose a sense of holistic care which often is not, and must not, be efficient. Sometimes the welder simply needs to hold the glass. So please excuse us if we are not 100% efficient all of the time.

Paul Twose, Lead Physiotherapist, Adult Intensive Care, University Hospital of Wales. @PaulTwose

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan