I have quite a few projects up in the air at the moment but thankfully they are all with different people and moving at different paces so there's always been something to do. Failing that I have developed a good knack of wandering around the hospital smiling at babies - generally they stare wide eyed and I am yet to manage to make one cry!
Hospital Newsletter
I was asked by the English couple that used to run the hospital if I could update the newsletter. It used to be sent out frequently but has somewhat fallen by the wayside in the past year. I have therefore been scouring the hospital for stories - I have found plenty but these must then be filtered into the much smaller and, imho, less interesting bucket of 'acceptable' stories. No mention must be made of the rat in theatre, for example!!A safe bet was just to update the annual figures for the hospital in terms of outpatients, inpatients, people on HIV treatment etc. I am sent to Medical Records to get the information. I'd been once before to this large room filled with notes - they even have them all the way back to 1947! - stuck in the corner are a couple of people at computers - seemingly typing things in. Still, I'm not hopeful, all the statistics stuck up around the hospital are from 2010 or earlier...
I sit down with the chap in charge and he begins to write down the list of things I need. I don't really know why I'm asking how many people go to OPD - as far as I can see there's no way of monitoring that in the mayhem. I imagine that he's sucking his teeth 'you want this for the whole of 2011?' Yes, please. He says he's printing it, I don't get my hopes up just yet.
And then, magically, I am presented with 4 printed sides of A4 of what can only be described as a management report! They have KPIs on here - blood tests, malaria cases, births with and without assistance. It covers all key areas of the hospital, admittedly at a high level but it's there - annually back to 2009.
Something in my head clicks into work mode specifically 'due diligence'. I find myself scanning the trends and asking questions. Not that he really knows the answers and looks a little scared! Then I remember another piece of data I might need. Does he have Average Length of Stay? [I almost say AVLOS in my hurry before remembering that he isn't a Care Home owner and probably won't have a clue what I'm on about]. He does but they look at 'Bed Days', which appears by month - perfect.
Now the brain is in gear. How do you know your OPD attendance figure is correct? I've seen people just sneaking in! 'Well, they are supposed to register but if they don't and they get a prescription then Pharmacy sends them back to OPD. But if they come and don't get a prescription then maybe they won't be counted.' I tell the guy that I'm going to spend an entire day in OPD counting people, then I'll ask him for his number and then I will show him that he's wrong. He laughs, 'no, then I will show you why you are wrong! Say I am ill, and I take you and you [there's another guy in the room] with me to look after me - now you count 3 people.' I say I will count green forms not people - it's a deal!
But now I'm remembering something else - some health centres seem to hold on to their very sick patients for too long before referring them here. This means that lives are lost unnecessarily, people might be saved if they came earlier. Can they work out whether any of the rural hospitals are outliers? And then target training there to improve referral speeds? 'I see where you are going with this idea'.
Now that I've found all this amazing data, I have one really burning question. Do you look at it? Do you analyse it at all? 'No, not really, only sometimes if one district is sending us more malaria patients than we'd expect...' Oh! So someone has gone to the effort of setting all of this up but hasn't shown them how to use the Management Information (MI) to help the hospital run more efficiently! Such a shame.
Pharmacy stock tracking software
It's a similar story in the Pharmacy. They have had for a year an amazing piece of software that should be able to track the location of all drugs in the hospital down to which patient was prescribed them and on which ward. But they haven't been able to get it working and they are so busy doing the day job that they don't have time to work it out. Can I have a look?
Initially I had been hopeful but then a team from Scotland came and looked and said the manuals were missing. I go anyway and am sat at a terminal and given two 20 page training guides. From this I discern that the software should be all singing and all dancing but is too complex to learn by doing. Plus I'm pretty sure I'm on the live terminal so scared to do anything bad!
I spend a bit of time chatting to the 'IT guru' Abraham. He's a great chap - in a wheelchair [this is only relevant to help you picture him], quite skinny, very broad smile, really bright white teeth and an amazing giggle. Obviously we talk about the weather - he can't believe it can rain for days in England, I tell him that my ideal operating temperature range is 8 degrees to 25 degrees - this has him in creases (probably because it's been about 25 at night as far as I can tell!), I tell him how long our summer days are. Then I start explaining about the things I'm adjusting to here and say idly 'Obviously I'm used to hot and cold running water and electricity all day every day' - what?!? He's astonished, as if I just said that pigs fly! I hope that one day he will have that luxury too.
After a few hours of reading (the full manuals have reappeared overnight) I can tell the head Pharmacist how to enter new drugs and how to get the proper costs into the system (I promise to show the stores boy next week). I'm afraid I can't unlock the patient data entry part of the system without assistance. But I have 5 months! My suspicion is that a lot of the stock level data in there at the moment is wrong but perhaps if I sit with the stores boy next week then I'll get some evidence that that is the case...
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