Saturday, October 06, 2007

Managing expectations

The recent catalogue of mismanaged expectations around my husband's eye surgery have reminded me how important it is that people know what they're in for before they embark on something.

Even when a learning event is mandatory and people don't have the option to back out, we can't be cavalier with their time. They need to know how much time they're going to have to invest and what the impact is going to be on their lives.

We knew that this op was necessary. We also knew that it was delicate. What we didn't know was the level of post-operative care that was necessary.

We didn't know that knew he wouldn't be to go to work for two weeks.

We didn't know that he would be expected to hold certain positions for days on end (called posturing), or that there are aids that can be hired to assist with this.

We didn't know that I would have to be on hand four times a day for two weeks, to apply ointment and drops. (Even under normal circumstances, like many people, he is unable to keep his eye open to apply drops. These circumstances are not normal. For a start, the eye is swollen shut.) The fact that I have a full time job seems not to have been factored into the equation.

Of course I don't resent having to take care of him, I don't even resent having to do stuff that makes me feel really queasy. What I resent is that no-one saw fit to LET ME KNOW!

I feel unprepared and... I guess... used, taken for granted.

Learning isn't surgery. I know that. But people's time matters to them just the same. They have commitments, they have lives, they have families. They need to know exactly what is expected of them so that that they can plan and make informed decisions. It is not up to us as the providers of the learning to make assumptions on their behalf.

When I started my MA programme a year ago, our course leader asked a guy at the other end of the programme - just about to submit his dissertation - to come in and talk to us. To tell us what he wished he had known when he embarked on the course, and to share his experience and hard earned wisdom. This was the single most useful session of the first semester and it had the effect of making me feel respected and valued.


Harold Jarche said...

The medical profession is still predicated on a delivery and acute care model, kind of like the education & training field.

Several years ago I worked with a healthcare region in Quebec that was moving to the McGill Nursing Model. The previous models had been disease-centric and later patient-centric, but the McGill model is learning-centric, and it is focused on using the patient's entire network to learn about one's health and take control.

There isn't much info available on the Web, but here is an abstract:

"According to the model, the central goal of nursing is to maintain, strengthen, and develop the patient's health by actively engaging him or her in a learning process. Because health is a learned phenomenon and the family is considered the primary socializer in this learning, the family is the focus of nursing. The nurse strives to structure a learning environment that enables the patient to participate as fully as possible. The nurse and patient together set goals and, building on the patient's strengths and resources, devise means of achieving them."

As Churchill said, "First we shape our structures ... Then, our structures shape us"

Anonymous said...

Sounds like a great model, Harold. However, I would like to see it extended to include the surgeons.

Our (admittedly limited) experience is that the surgeon is often treated like some sort of deity, and everything is geared to suit him/her, with the patient seen as the life support system for the pathology. I would like to see a model which places the patient in the position of customer, and the surgeon as service provider, with everything (as far as is practical) being geared to suit the customer.

Perhaps it's like that in private clinics - on this occasion (long story), we were forced to go the National Health route.

Harold Jarche said...

You hit the nail on the head, Karyn. The cultures & tribes in the medical field all do their own thing, and the surgeons are the ruling caste.

I was previously employed as a Hospital Administrator and one of the reasons I left was because I could see no way to make any real changes unless I was a doctor. A great book that shows why the aviation industry is so accident free while the medical field is filled with accidents and problems is Kim Vicente's "The Human Factor".

It's all about culture.

Anonymous said...

Sounds like Mark Oehlert's natural element!