One interpretation of the trend towards guidelines is that they are not
there for the benefit of staff to ensure that they know the correct
procedure: Management knows that there is no way any one individual could
read, digest, understand and remember all of the policies and guidelines in
place at any one time (millions of pages, given that computers now allow us
to be as verbose as we like, without wasting any real trees); let alone keep
up with changes. Furthermore it would be impossible to check the guideline
every time a procedure is carried out.
The real function of guideleines is to allow an individual transgressor to
be blamed when an error occurs, thus off-setting the institution's blame on
an unwitting scapegoat.
TIM
****************************************************************************
*********
Prof. Tim Reynolds,
Clinical Chemistry Department,
Queens Hospital,
Belvedere Rd.,
Burton-on-Trent,
STAFFORDSHIRE,
DE13 0RB,
UK.
tel: 01283 511511 ext. 4035
fax: 01283 593064
email: [log in to unmask]
alternative email for the all too frequent occasions when the NHS email
connection doesn't work:
[log in to unmask]
****************************************************************************
**********
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> -----Original Message-----
> From: Cudd Peter, Pathology Workload Project Officer, Path Lab
> [mailto:[log in to unmask]]
> Sent: 17 January 2003 11:39
> To: [log in to unmask]
> Subject: Re: Mass production of tests
>
>
> > I have been watching the discussions on Biochemistry
> workload with interest. I have been appointed on a six month
> contract to investigate the use of Pathology services (i.e.
> Biochemistry, Haematology, Immunology and Microbiology,
> Histopathology is excluded from my investigations) at
> Rotherham DGH. I recognise and agree with many of the factors
> that have been raised as issues/influences on increasing
> Biochemistry workload. In Rotherham analysis over the last
> three years clearly shows that increased demand is
> out-stripping the increase in patient throughput. Another
> factor that I don't believe has been mentioned is that on
> average the patients today in hospital are more severly ill
> and may well require more investigations.
> >
> > My experience in Rotherham suggests that a significant
> factor is that there is a mutual communication/education gap
> that exists between Pathology and the 'customer'
> wards/units/departments. It seems the main reasons for this
> are : lack of time/resource; traditional practises; and in
> some cases, an unwillingness to fully co-operate/collaborate
> with changes.
> >
> > I have also found, unfortunately, that much of the critical
> information required to better manage Pathology workload is
> NOT embodied in protocols or guidelines in use in the
> hospital. It probably wont be news to most of you that, it
> would be an error to assume that ALL junior doctors and
> nursing staff have ready access to documented protocols that
> advise them what pathology investigations are appropriate,
> even less so to information that helps them to decide how
> frequently to repeat tests. Furthermore, even if the latter
> have been created and are readily available its also not the
> case that staff take advantage of them. Ownership of
> knowledge and its use in the wards is also a hampering factor
> in obtaining practical and readily available guidelines.
> >
> > Having said all the above, it also true that most nurses
> successfully and accurately follow the guidelines they have.
> >
> > Any attempt to manage (or control) demand for pathology
> investigations must consider how the decisions are currently made.
> >
> > I am currently busy trying to collect information on how
> and what clinical information is used to drive the choice of
> pathology investigations by most consultants and nurse
> practitioners, and a sample of the junior doctors. The level
> of detailed information required to obtain this is likely to
> be too great to get a complete picture in my remaining time.
> However the information gathered should also highlight how
> much variation in practise there is across medical teams, my
> work has already established the variation in practise across
> the hospital directorates, including some excellent and poor
> practise. I am also looking at methods of providing automated
> feedback to consultants on how well their teams are at
> working with pathology (specifically in the first instance
> simply looking at how well the investigation request forms
> are completed).
> >
> > As far as my findings go I am sure that some places will be
> better and others worse.
> >
> > Rotherham DGH is about to embark on internal trading for
> all Pathology services (already present for Blood products
> and some Microbiology investigations). Over spends have
> occurred in the budgeted areas and one of the big issues is
> how the management will handle transgressions over budget.
> >
> > Peter Cudd BSc PhD
> >
> > Pathology Workload Officer
> > Ext. 4251
> >
>
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