My time at Ren Ci Community Hospital has nothing been short of eye opening. I did not bring with me any relevant medical knowledge due to my academic background and working in the healthcare sector allowed me to engage with on the ground issues which go beyond medical knowledge or procedures. Ren Ci’s tagline of “Service with Heart and Hope” became very apparent to me as I went on my rounds in the wards and engaged in meaningful discussions with my supervisor. In this reflection, I dare not criticise the workings of current medical professionals but like my supervisor, I wish to offer a view from another perspective regarding admissions, hopefully to break boundaries and improve patients and family engagement above the healthcare services that everyone is receiving.
My project involves investigating the current state of admissions in Ren Ci Community Hospital and hoping to streamline and improve problems sieved out from the earlier observations conducted in earlier weeks of the internship. I would categorize the learning points from this internship into two main points. First was the realisation that implementation of change need to come in many stages and go through many layers of the organisation. Following that, it is important to adapt according to various stakeholders involved. Second, I try to introduce and discuss a possible conflict that is present in healthcare which is striking the balance between medical professionalism and personal patient engagement.
To start off, I quote Ren Ci’s CEO. During our first sharing session, I asked her about one main difficulty she faced while working in the healthcare industry. CEO said, “One thing would be that in healthcare, changes take place very slowly”. This did not hit me until I reached implementation stage in my project. It is no wonder why we read about slow health care reforms. Yet I learnt that it may not necessarily be a bad thing as it goes to show how as change makers, we must take time to consider all possible stakeholders and engage them. Bypassing stakeholders would mean that their needs are not possibly taken care off. Moreover, it is understood that to improve efficiency and save cost, employee engagement was needful (Marini, 2014). This was apparent in the implementation of the change in job scope of the CSOs, which showed initial non-compliance. If there was one thing I would change about the way I approached my project was to plan more time for stakeholders’ engagement. Other than approaching patients and families for their views towards a possible admission guide, various departments such as Clinical Operations, Finance, Nursing, Therapy, Business Office, Corporate Communications and the CEO represent the stages that the implementation has to go through before it is good to go.
Secondly, I saw the conflict of trying to balance medical professionalism and the need for patient or family engagement. Medical professionalism does not entail that compassion and empathy are lost, but in fact it imposes that compassion is a duty of medical professionals (Dougherty, 1995). Yet, it is not stated how medical professionals should go about engaging their patients or rather, the extent to which they should engage. It is one thing to be compassionate to your patients but it is another issue all together when patients feel that you are being compassionate but still ill-informed of their treatment. Little literature has expounded on this and hence, I suppose in my observations, I find more often than not, information not being communicated to patients and their families. I would like to clarify here that no information was being withheld but to retrieve any information, the patients and their families must first ask. In my observations, the families prefer to “go with the flow” and not ask, but at the end of the interview,they raised questions regarding availability of information such as rehabilitation progress. Meetings are held weekly to discuss the patient’s progress but this information is not being communicated to the families, for example rehabilitation goals that the therapists, doctors and nurses come to agreement with. What if these information were being related to families now? It was later found out that therapists were concerned with “more questions” being directed to them. However, if “more questions” would mean more engagement, why not? Then there was another concern of misinterpretation, which ultimately leads to more questions and “unnecessary stress” for both parties. So, the question ultimately to be decided by medical professionals is whether how much information they are willing to give. This definitely goes beyond their job scope, and normal routine daily duties such as therapy exercises, recording notes and taking the patient’s blood pressure. This demands more than medical professionalism (yes, patient confidentiality is key still) but rather an opportunity to take up challenges in a route to longer term engagement with families.
Moreover, it seems that patients I spoke to recognised the professionalism of the staff, for example how they were efficient in responding to their medical needs and they were clear in their procedures. Yet, I would like to quote a family member in saying that “ staff needs to be trained such that they do not just follow administrative details, but go one step further to be sensitive about patients and families’ individual needs and be flexible about them”. This highlights the need for professionals to go beyond their daily procedures and start practicing seeing patients as humans who have their desires, questions, insecurities, strengths and weaknesses. To be flexible, adaptable and quick to pick up and meet the doubts of families would be crucial for family engagement.
In conclusion, more than the possible success of the implementations proposed in my report (which would probably need a long time of a few months to implement and track), I have taken away interesting yet real conflicts that are present in the healthcare sector today. It is more common to see medical services all proclaiming the need to serve and engage, but above the daily grind of work in wards, there remains to be seen more people who could break these procedural boundaries and reach out to engage beyond the needles, wheelchair and the blood pressure machine.