Hospitals: a problem of transportation

Governments change. Heads of state change, but what really happens behind the frenzied ADHD of electioneering? The effect on hospitals is very difficult to assess. Paper money and promises abound, but we can never really tell whether decision makers have enough power and status in their hospitals to affect any change during their time on office.  Often funding for projects can be inaccessible – trapped in back room processes such as feasibility studies and prolonged tendering processes. Too often the funding, or what is left of it, only surfaces near the end of its tenure and must be used with some urgency, lest the underspend goes back to the funders’ coffers.

Most incentives and coercions to change are the product of a populist view of hospitals; that they exist to provide long term solutions for patients. Given the overcrowded state of our hospitals, this is an untenable goal. Modern hospitals are not the end of a road to health for patients. They can only be a means to an end.

There is nothing wrong with the label “bed blocker”.

The function of modern healthcare is to transport sick people to a better place. Health care needs to operate like any other means of transportation. Patients who can no longer transport out of an illness by themselves need an efficient transit system. It is no co-incidence that safety in hospitals if often compared to that of another transportation business – airlines. Hospitals need to operate like any other means of transportation.

There is nothing wrong with the labels of health “ tourist” or “bed blocker”.

These supposed insults refer what is happening in hospitals and are not about patients. Hospitals have become transportation hubs; moving sick people to a better place. They are airports, bus terminals and trains stations for the ill. Patients who can no longer transport out of an illness by themselves need an efficient transit system.

Improving health transit requires a range of activities. As clinicians, we need to accept, as pilots do, that we are only the drivers of complex engines and the destinations for our patients are no longer predictable in the long term. Beyond the hospital hub we need health engineers to design short term destinations, rather than long term solutions, so new routes can evolve. For example, placements in care facilities should be viewed as temporary transits rather than long term solutions to complex problems.

Upscaling existing transport modes such as general practice makes good sense. Empowering GPs to be the drivers of comprehensive diagnosis and complex multi morbidity management, rather than security guards at the border of an overwhelmed secondary and tertiary hubs would be a NICE piece of Back to the Future thinking.

We can learn a lot from the transportation industry.

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