AND THEN THERE WAS SWINE FLU: The Diary of a Hospital Manager

By Acklima Akbar

A fictional account of a week in the life of a Hospital manager during the Swine Flu crisis. The author uses her experience as a Clinical Services Manager in the Health Service to provide a compelling insight into the daily drama that surrounds the frontline running of a hospital during a would be epidemic. The manager and her team are asked

• Language: English
• Publisher: TOPLINK PUBLISHING, LLC
• Release date: Jun 14, 2018
• ISBN: 9781949169522

Acklima Akbar

The author has a wealth of experience in managing health services. She is a trained nurse with a background in banking. This gave her a unique perspective for her role as Clinical Service Manager of a University Hospital in the United Kingdom. She started her writing career from an early age when she was growing up in South America. Her work won her awards in various forums, mainly for creative writing and poetry. It was not until she worked in hospitals that she felt compelled to write about her experiences. Her book was penned during a particularly stressful time in her career and although the characters are entirely fictional, the events are captured in a very realistic way that resonates with anyone who works in hospitals.

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And Then There Was Swine Flu

The Diary of a Hospital Manager

Acklima Akbar

Copyright © 2018 by Acklima Akbar.

Paperback: 978-1-949169-51-5

eBook: 978-1-949169-52-2

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any electronic or mechanical means, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

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Printed in the United States of America

Contents

Monday

07.00 hours

08.00 hrs

08.37 hours

10.45 hours

13.30

16.45 hours

17.35 hours

18.00 hours to 21.00 hours

Tuesday

07.00 hours

07.45 hours

08.25 hours

09.30 hours

12.00

13.45 hrs

14.50 hrs

15.10 hrs.

Wednesday 04.00 hrs.

06.50 hrs

07.30 hrs

08.30 Daysurgery Staff Meeting

13.00 hours

23.45 hrs. Wednesday

06.10 hours Thursday

06.20 hours

06.45 hours

07.45 hours

10.20 hrs.

12.00 hrs.

16.00 hours

16.50 hours

17.50 hours

18.25 hours

01.35 hours

06.05 hrs.

07.30 hours

07.45 hours

08.45 hours

I had been a practising Registered Nurse for less than a year when I was promoted to being in charge of an operating theatre. I remember thinking at the time that there must be a mistake as I was hardly an expert in the field. It was only when I was appointed to the post of manager of the entire ten operating theatres that I realised that the higher the post, the less one is required to know. The last five years has seen an increase in government targets and a shift in the management of these targets from non-clinical personnel to clinical directors. These ‘management gurus’ can be sourced from physicians, surgeons, nurses, General Practitioners, Radiologists and almost anyone who is eloquent at voicing his opinion to a non-clinical recruitment panel.

I was appointed to the post of Clinical Service Manager, Planned Care, for a fairly competent acute Trust in July 2007. My remit was to manage 10 main operating theatres, 4 day surgery theatres, 4 endoscopy theatres, the Admissions Department, the Pre-operative Assessment Unit, and the Opthalmology Unit and to provide a 24-hour emergency operating theatre for all areas. Prior to this, I had been the Theatre Manager for 10 years. It did not take me very long to realize that I was one of very few managers in the post with any clinical experience worth noting. Within days of being in the post, I decided to write a diary of a week in my life as an NHS Manager.

Monday

04.10 hours

I cannot imagine anyone with a nine to five job liking Mondays. I invariably fall asleep after midnight on Sundays having got used to late nights on Fridays and Saturdays. I glance at the bedside clock and I’m hugely disappointed to note that it has only just gone four. I try to close my eyes and pretend that I am just having one of those moments when I turn in bed and then fall straight back to sleep. Ten minutes later, I give in. I am wide awake. Bugger. This is not good. I have a very busy week ahead. This is the week in which the monthly meetings occur and although I love the opportunity they afford me to dress to impress, the stress is two-fold—‘what shall I wear?’ and ‘what shall I say?’ Of course, the ‘what shall I wear?’ stress is by far greater than any new intelligence I am able to bring to a meeting, having been doing the job for over ten years. On the other hand, there are few occasions in this job where it is appropriate to wear my hard sourced, foot numbing bargains that I have hunted down over the years. As a manager in an Acute unit in an NHS hospital, I have to hit that ‘not overtly sexy but classy and intelligent’ button. Think Mad Men but not Joan—never Joan.

I also have Friday to look forward to as my errant and elusive love interest returns from his bi-annual jaunt with his family and has promised me an evening at the Savoy with his mates. My thoughts are a jumble of what to wear for my date and what not to wear for my meetings. Pressure, pressure. I have these moments—rare but still there—when I wonder whether I should be spending more time concentrating on the content of my work rather than my wardrobe, but as my favourite author Rumi says,

‘Joseph is most beautiful when he’s completely naked,

But his shirt gives you an idea as the body lets you glimpse the glitter

On the body of his soul’

Now that’s truly inspired.

07.00 hours

I have been at work for 20 minutes. Already a coffee break beckons. The night nurses are poised outside my office waiting for a nod from me to come in to appraise me of the events of last night. I knew as we drove into the car park that a drama was unfolding in true inner London style from the number of police cars that were parked in typical hurried fashion in the Accident and Emergency car park. I thought that could only mean someone was stabbed or had been shot which invariably meant the Emergency Team were working very hard in the emergency theatre.

I raced up the stairs, I never take the lift as I had been told years ago since I was a student nurse that taking the lift cost one pound. In the NHS, every penny counts. So two flights of stairs later, I arrived at the entrance to the main theatres where two very young looking policemen were standing guard. I once asked why they had to stand guard when the patient was anaesthetised on the operating table to which they replied that they were there to guard the entrance to stop the bad guys getting in to finish the job. A pretty sobering thought, especially as my office was located at the entrance. They tell me that the patient on the operating table is a 16-year-old boy who was shot in his house by someone. They were guarding the entrance and exits as usual and the theatre staff was all in the emergency theatre.

I looked in on the emergency theatre and the nurse in charge told me that the operation was almost finished and that they would be out soon. They had successfully repaired the wound which fortunately had missed his vital organs but had caused significant damage to his bowels, and he had lost almost two-thirds of his blood volume. The theatre looks chaotic but yet calm as everyone seems to be engrossed in their individual role. There are numerous empty blood bags laid out on the floor and the Health Care Assistant is busy cross checking the numbers with the junior anaesthetist. I decide to leave them to it as the critical stage seems to be over and they all seem quite tired. It is a sad fact that recently, we have seen a tragic succession of these mindless incidents that somehow seem to be accepted as the norm in this area. Years ago, when I first arrived this area, a shooting would have made the headlines for many days with discussions across the media on how best to avoid it recurring. Now, it is aired on the local news or on the Nationals without any significant impact on our collective consciousness. I walk away, deep in thought, pondering on how blasé we have become.

I usually spend the first hour of each day responding to emails. The jury is still out on whether this mode of communication is a blessing or a curse for me. I receive on average 160 emails per day. I like to attack them as soon as I get in because I often find that people would continue to send emails on the same topic if I do not reply promptly as if by repeating the question, I would reply quicker. Today, however, I have to pause as I can see a crowd of anxious faces gathering outside my door. I do have an open door policy but this begins at 08.00 hours and anyone who knows me is aware of this. I have developed the practice of not looking beyond my screen to a fine art. I look up and beckon them in. The urge for a coffee is becoming stronger. I put this at the back of my mind as I know the report can take a while.

Night nurses are a dying breed. When I started nursing, years ago, night nurses only worked at night. As post registration courses and mandatory updates occur during the day it became evident that their practice was not of the same standard as the day nurses. In recent years, there has been a drive to rotate their duties so that the quality of care could be standardised. However, some of the nurses were so used to working during the day or at night that they either left or produced various reasons why it would be impossible for them to change. Consequently, the quality of service at night is what could only be described as average. One consultant surgeon described their movements as wading through treacle. Changing their behaviour requires time and effort, not to mention the resources required to backfill their posts for mandatory training. Unfortunately, this Trust, along with so many, do not have the luxury of a surplus of nurses that is required to improve practice.

The nurse in charge is of Jamaican origin and has been living in England since the sixties. She is a devout Christian who I am told preaches constantly, with or without the book. One surgeon once complained to me that she refused to help with turning someone in theatre until she had said a prayer. My words to her on that occasion are too colorful to mention. I find myself wishing I had woken up a bit earlier and had my coffee at home as this could take the best part of an hour. Nothing here would be conveyed in one sentence. She also has this annoying habit of interspersing ‘um’ between every other word, a bit like Bruno and ‘yuh know wah ah mean arry?’ I brace myself for a torturous hour.

It transpires that the surgeon was almost flattened by a relative of the patient who incidentally is suspected by the police of doing the shooting. The consultant surgeon and her registrar went into the ‘Family Room’ across the corridor from the theatres to speak with the relatives. The nurses were getting ready for the operation in a theatre so they were unable to hear the raucous. The policemen, bless their souls, were guarding the patient who was being anaesthetised. Thank goodness the porter was in typical porter mode, walking along the corridor when he heard raised voices and banging. He rushed into the room to see the patient’s relative kicking the filing cabinet. The picture on the wall, a framed print of Monet’s poppy field positioned with the intention of providing a calm, beautiful view to stressed out relatives, had been smashed and was lying on the ground. The consultant surgeon, a very genteel (rare but true) Indian doctor and a young slightly overweight registrar were desperately trying to control the situation by speaking in hushed fear masked tones.

The porter, an over sixty, visibly unfit man took one look at the situation and shouted in his cockney accent, ‘Oi mate, stop that. That’s no way to treat the doctor,’ and order was restored.

I give the nurse in charge my full attention. Clearly, the incident had shaken them. I promise to look into their request for CCTV monitoring along the corridor. I know this request is futile as the trust was trying to save money as usual, but I offer my total support and try my best to restore some equilibrium. Human behaviour is a constant source of amazement for me, as in this case where they seem consumed by the incident in the room and do not even mention the patient. I enquire about the patient, request statements regarding the incident and close the meeting as I have to attend another meeting in seven minutes.

08.00 hrs

Foyer of Main Entrance to Hospital

Waiting List Meeting

This a fairly new meeting that was initiated and is chaired by James, my immediate boss and is attended by John, Mary, Hazel, Kate, Jenny, Brian and myself. I believe the idea to have the meeting in an informal setting was seen as a way of encouraging frank discussions, which seems to be the exception rather than the rule at high-level meetings. I am often told that I have a unique way of communicating because I speak without editing my thoughts.

The meeting begins with coffees for everyone courtesy of John, a very handsome but slightly unkempt consultant surgeon who is also the Clinical Director for my directorate. The role of CD is new to him and although he is clearly very clever in his field of medicine, his knowledge of how to manage the NHS is miniscule. However, he is eager to learn and he is genuinely interested in improving the service which is always admirable. He is also divorced, in his early forties, and is seen to be quite a catch by many. There were rumours of affairs during and after the break-up of his marriage, but when I asked him about this during one of our ‘let’s get to know you better’ chats, he looked at me straight in the eye and emphatically denied he had ever had an affair. Apparently, his wife was an intensely jealous woman with a very vivid imagination. When I repeated this to my best friend, Cathy, she said he was either a very accomplished liar or a poor dear in need of a good woman. I like to think the latter applies but then again, I have a dreadful habit of crediting men with more integrity than they habitually reveal. Only time will tell, I suppose.

James arrives late. This is not an unusual occurrence for him at early morning meetings. Non-clinical managers function according to a different code of conduct, one that was learnt at University and continued unchecked in the Corporate world. A world where one is on flexi time that allows the worker to slowly cruise in after 09.00 hours with latte in hand. In the NHS, clinical staff arrives at 07.00 hours to take over from the night staff, or in my case, at 06.30 to observe the night staff and to prepare for the onslaught of the day. James can be described as personable. Someone who is neither handsome nor ugly, dynamic nor inefficient; in other words, a bland plodder. He has managed to stay in post by being outside the NHS headhunters’ radar. Clearly, there is a lot to be said for being mediocre in the NHS.

We sit coffee in hand and begin 12 minutes late as James is chairing the meeting. Pleasantries over, James presents data showing the activity so far. We are meant to analyse the data and use the session to brainstorm ways of increasing the activity. I find the spreadsheet confusing, so I figure I should allow the others to speak as I might be the only one who is struggling to see the picture.

John looks up with a frown and said, ‘What is this meant to show? I like data I can interpret. Looking at this, we’ve only done 33 operations last week, which is ridiculous.’ He always speaks in a soft tone even when he’s visibly annoyed.

There is now a cacophony of ‘I thought it was just me who found it confusing’ from the rest of us.

James picks up the paper with shaking hands, (I often wonder whether this is due to nerves or an early onset of Parkinsons; hopefully, it’s nerves). ‘Well, obviously there’s an error.’ He turns to me, ‘Acky, you would be able to tell us the real figure.’

Incredible. He really thinks I am walking around with this data in my head.

‘I do not carry that information in my head, James, but if you want me to bring the data in future, I am happy to do so,’ I said looking at him with raised brows, unsmiling. This is not the first time that he has tried to evade attention by transferring the attention to some unsuspecting person. In fact, it has become his modus operandi.

Mary, who is the Director of Operations and James’ immediate boss is unimpressed. She is a very pale, thin, neatly dressed woman with a husky, encouraging voice. The sort of voice nurses have in TV dramas, all comforting and reasonable. She joined the Trust less than six months ago at the bequest of the CEO who worked with her in another Trust. It is widely acknowledged that CEOs bring their team with them within six months of taking up their posts. I once mentioned to a CEO that this was quite an alarming trend as it results in Trusts being managed by inexperienced executive teams which could be a recipe for disaster, to which he replied that they are above average learners.

‘What is going on here? We have to take this meeting seriously. We need to know where we are and this is not helping. Whose job is it to provide the data for this meeting?’ she said, looking at both of us.

Before James could answer, having just taken a swig of his coffee, John said, ‘Data cannot be wrong. This information is available on our website. We cannot afford mistakes like this.’ He fixes his gaze on Brian, the IT data manager, which is not an easy feat as he has been blessed with a squint. I really cannot fathom why anyone in England should have a squint as they are so easily corrected. However, apart from the squint, he is quite good looking, early twenties and brilliant at IT. As I was brought up in South America in the seventies, computers were a mystery to me until a few years ago. I find Brian a constant source of enlightenment.

In this instance, under attack, he begins to fumble for words. We can barely hear what he’s saying. We try not to look at him. I glare at John. I have years of experience at calming irate surgeons. I am now at the stage where one look is enough to silence them.

He takes the hint and says, ‘Right. Let’s begin again. We cannot afford to get this wrong. Are we all clear on the purpose of this meeting?’ We nod. ‘Brian, I suggest you get together with James before we get here and verify the data. We need correct data that is easy to read. We have 30 minutes every Monday to spend on this and we cannot afford to waste time. As it’s now 08.25, I suggest we close and meet again next week. Agreed?’ We nod.

The fact that these meetings were initiated because we are underperforming seems to be lost in the discussion regarding a typing error. I am reminded of the time when on arriving at the check-in desk at JFK airport in New York, the beautifully painted clerk said to me, ‘You cannot be here, madam. We do not have you on the system.’

On the way back to the theatre, I am greeted by the Intensive Care Nurse Manager who reminds me that we are late for the Bed Meeting. This is a daily meeting which is held in the Operations Centre in the old wing of the hospital. The meeting is usually chaired by Mary, the Director of Operations and is attended by the Service, Business and Nurse Managers. The purpose of the meeting is to discuss the bed status and each manager is expected to bring up to date data regarding admissions and discharges in order to facilitate the organisation of the day’s activities.

08.37 hours

Operations Centre

Bed Meeting

We arrive at the meeting ahead of Mary, Hazel and Kate, my two senior nurses who were with me at the previous meeting. Whilst waiting, we perch on whatever is available in the small room, high backed old chairs lining the walls, desks and on the windowpane. Unfortunately, the nurse who is perched on the windowpane is so obese she almost blocks out the view. From my seat opposite the window, I can see the windowpane almost disappearing into her derriere. She supports the rest of her body by placing one hand on the side of the window frame as she uses the other hand to gulp something from a plastic

Burger King cup. I find myself silently sympathising with the windowpane for the pressure it must be feeling.

Mary arrives with Hazel and Kate. Kate, who dresses and acts like she is several sizes smaller than she really is, shares a seat with another manager. A bubbly, curvy blonde with questionable skills for her role, she earned the nickname ‘trolley dolly’ form her junior nurses, who from all accounts grew tired of her penchant for leading them down non-caring alleys in an effort to achieve her targets. Thankfully, she has not yet tried to lead me.

The meeting begins with the bed manager’s update on the current situation. The hospital is on Code Red, which is the code for full bed occupancy. Essentially, this translates into the need for me to cancel all elective operations for every patient who may require a bed. This is not met with enthusiasm by me nor the manager of Admissions. I find this unsatisfactory and frustrating as it is August and bed pressures are usually associated with winter.

‘I find this totally bewildering,’ I said. ‘How many patients are being discharged today? According to my list, fifteen of the patients who received their operations on Friday should be going home today. Are you saying all of those beds are occupied?’

Mary looks at Kate. ‘Have you done a round of the surgical beds?’

Kate says, ‘No. I was at that meeting with you, but the sisters have sent the information to Josie.’

I restrain myself from responding. I have had to insert a pause button in my method of communicating just for these meetings, where I am often accused of being unsympathetic to the pressures faced by the others. To compensate for this, I have developed the ‘raised eyebrow in amazement’ technique to perfection. The only drawback with this is that the recipient has to be looking at me. In this case, it’s Mary and she is.

Mary says, ‘We’ve discussed this before. Hazel, perhaps you could have done the round. How about the medical beds? Are we expecting any discharges from there?’

The nurse manager in charge of the medical beds is not present but she is being represented by her ward sister and her business manager both of whom are unable to answer the question because one of the four Consultant Physicians is in the process of doing a round. The other three have yet to appear. This state of affairs is nothing new. The NHS continues to dedicate infinite resources, both human and financial, into the quest for acquiring a degree of control over the schedules for Consultant Physicians and Consultant Surgeons. Incredibly, even now, with the Trust unable to achieve its savings’ targets and with a global recession looming, their behaviour remains driven very much according to their needs. I used to think, quite naively as it transpires, that the consultants were answerable to the executive team and would be challenged and managed by them. Unfortunately, there seemed to be a gap in the leadership skills of our last three CEOs and their executive teams, which has resulted in the current out of control status.

Mary instructs the business managers to contact the consultants and ask them to perform their ward rounds in an effort to speed up the discharging of patients. One of the ward sisters enters the room and walks quite quickly to where Mary is sitting, clearly worried, then again maybe that is her usual expression. I find it difficult to tell at these meetings as they all seem harassed. She is a rotund woman with a small waistline into which her belt seems to disappear. The nursing buckle that carries the emblem of the nursing college from which she has graduated is invariably hidden beneath the waves of flesh above and below her waist, making her professional origin a mystery. She normally appears unflappable; however, today is another story. As she leans down to whisper something in Mary’s ear and raises a hand to shield her mouth from the rest of us, I cannot help but notice that her armpit is damp and there are beads of perspiration on her brow. ‘Stress or menopause?’ I ponder. I would lay a bet on ‘stress.’ As I look around at the other faces in the room, I can see that they are intrigued as well. There is hardly a whisper as we wait as what we know will soon be revealed to us.

The ward sister straightens and takes a step backward, arms clasped in front of her as Mary looks up and begins to speak, ‘There is a pile up at the rounda-bout four blocks away and the news from the London Ambulance is that we could be getting seven casualties. We are not sure of the nature of the injuries but I suspect they will be serious as the accident involved a tram and two cars. This is, of course, our first priority. I would ask you all to do whatever you can to clear beds as soon as possible. Thank you for coming. I shall be in touch once I have more information.’

Note to self: Find an excuse not to attend these meetings every day. The scenarios are totally predictable—increase in emergency admissions, delay in discharges, and cancellation of elective surgery. It would be encouraging if lessons are learnt as the issues are not new. My bleep interrupts my thoughts. Thankfully, I have to leave the room to answer it. I am being bleeped by my secretary. One of the gynaecologists is demanding my presence in the theatre because a machine is malfunctioning. I make my way up two flights of stairs to main theatres. It is highly probable that the RTA (road traffic accident) casualties would need to be operated on which, of course, would take organising and possibly reallocating of staff. I have learnt from past experience that RTA casualties take a few hours to arrive in theatre. The ones that suffer major injuries are seldom accepted at our A/E department as we are not classified as a major Trauma centre.

I arrive in theatres slightly out of