#521
Post
by Amused » Mon Dec 20, 2010 4:25 pm
Alright, I'll tap in again here.
As an existing health care professional, I have been around ward redevelopmets on a number of occasions. The disruption they cause to services and to rehabilition can not go unrecognised. The sound of a single drill in a concrete wall reverberates loudly up and down the floors and along levels to the point that people can not communicate with each each other and can barely hear themselves think. Many patients with long term rehabilitiation need to put up with the noise of redevelopment works for extended periods of time and I refer to my previous discussion about the importance of this. Time of rehabilitation is directly correlated to patient attitude. Now, I was desperately trying to find a study that I read a short while ago but as I can't find it, I'll have to describe it;
There was a study done on two groups of dogs. Both groups were suspended by a harness and electrocuted. Both groups of dogs had a lever in front of them. When the first group flicked the lever, the electrocutions would stop. The second group would have their electrocutions continued regardless of whether the lever was pressed. The first group of dogs learned that they could control the negative stimuli, the second group learned that they couldn't. Both groups of dogs were put in a second test. In this test the dogs were not suspended and electrocutions would cease simply by jumping over a small wall into a second enclosure. Almost all dogs from the first group jumped over the fence to safety. Almost all the dogs from the second group laid down on the ground and waited until the electrocution ceased, effectively giving up. Subsequent tests on the dogs showed the second group was almost always liable to give up under any stress and so the theory goes that continuous negative stimuli uncontrolable by the subject causes the subject to permanently adopt a 'give up' mentality.
What is the importance of this study for the sake of this arguement? Many of the patients in a hospital are there because they are very sick and have no control over their movement. The sound of redevelopments is very loud and a negative stimuli. Therefore, most patients can not control the negative stimuli and hence become just like the dogs in group 2 of the above study. They give up. The thing is though that this classical conditioning causes them to give up on everything, including rehabilitation. In the coldest, administrative view point, this leads to bedblock, ie, patients taking up beds longer. Morally, the results of such stimuli on the patients is grossly negative on their attitude, outlook, motivation, emotions and rehabilitation. It is absolutely wrong to subject patients and staff to this on a large scale.
Secondly, many whom have had direct experience with the reconstruction of hospitals have commented that if they could do it over, they'd never retain original buildings and would have started from scratch. The costs blew out more than expected trying to reinvigorate old buildings and encorporate new buildings into the mix. It was frustrating for all involved, costly, and generally just a pain in the backside.
Many of those in the Save the RAH campaign actually just wanted to retain the name 'RAH' and not have 'MJNH.' With the old name now retained, many in the group have lost their steam to argue against the redevelopment. Those that are still arguing have lost their way a little as they're probably not sure what they're arguing against now. People outside of the hospital really can't possibly make an educated arguement without staying there as a patient or working there. The building is a rabbit warren, different layouts on different floors due to being build on a hill. There's 3 ground floors depending on which side of the hospital you're trying to exit on.
It screams institution. It is run down and the general build does not lend itself to easy rennovation with exceedingly thick concrete walls. Single rooms can not be made out of bays as there will be windowless rooms. Again, patient rehabilitation and the correlation with attitude. The buidlings including lifts were built pre mechanical innovation. Electric bed movers are now used to move large masses around the hospital but the size of corridors, doors, rooms and most impotantly, lifts, do not lend themselves enough room for appropriate use of bed movers so staff are still risking personal injury to their knees and back trying to manouver heavy weights around. Getting into certain lifts at RAH is a time consuming operation, generally removing equipment from the bed or tubes/wires from the patient to allow them to reach when trying to fit everything into the lift.
The 'world class' emergency department is now leagues too small for demand. When Rann opened the new ED he procalimed that no patient would have to wait in the corridors again. It is now common place for the ED to be pushing up to 200% capacity, each bed-length of corridor now has it's own bed number. I challenge you to have a look when you're there next. AC13 means 'unit A, corridor opposite cubicle 13' Just about every cubicle has an ACx opposite it in the corridor.
The fact of the matter is that we are pushing up to critical mass, soon our medical services will collapse. That is the reality. I hate the thought that people think we can keep patching it up and that this will suffice if MAJOR health projects are not undertaken now, we will be in a world of hurt in just a few short years. Take it from someone who calls a day when the emergency department is at 110% full a quiet day. We are at breaking point and a rebuild will not suffice.
P.S I wonder if any of the 'Save The Rah' campaigners work in acute care or whether they're all from stable faculties such as Plastics or Surgical where they get to accept only as many as they're prepared to take and then turn away the rest... oh and where they're paid exceedingly more than us mere mortals unable to turn away our patients as they flood in the front doors.
P.P.S, John Hill was one of the strongest advocates for a RAH rebuilt on ints existing location until he was shown all the evidence, at which point he agreed it had to be built from scratch elsewhere.
