Out of the weather

I was later than usual getting away this evening. The sun had set some half an hour or more before I was able to turn off the computer and walk to the bikeshed for my bike to ride home. 

In large part this was due to being one of a group of senior clinicians invited to a meeting (from 1000 to 1500) where we were to consider issues confronting acute inpatient psychiatry in the Northern Region of New Zealand; Northland plus Auckland City (comprising more than a third of the nation's population). After listening to two presentations by analysts of data collected over the last few years, I thought my presence was ill suited to this meeting. There were masses of data, which had been converted into minimal amounts of information, producing no knowledge of significance to inform deliberations of the sort that I was there for.  

The next section was on quality and safety matters. A colleague and friend said with some force that the system is not broken. I could not but recall the "local thought" I blipped some years ago; "The system was never broken; it was built this way" (I confess I remembered it slightly wrong, but the concept was retained!)

After lunch we were invited to present a success or a burning issue from our DHB. In the silence I launched my thoughts on a system that has never been a joined up system, and which has over the years become more siloed than ever, as fiefdoms erect ramparts to protect their patch. I identified our burning issue as the desire of ED to remove psychiatric patients from their space, and my wish to do that as ED is the wrong place to assess their needs. I referred to the Street Triage service in Birmingham with admiration, and their use of a "safe place" for comprehensive assessments. I was joined by my colleagues from neighbouring DHBs endorsing both the issue as important and the proposed approach.

Suddenly, it appears that the sun may rise on a new and connected up system (more than this one aspect is needed of course). By the end, the meeting had (temporarily I hope) retreated to the world of data, and efforts to show the Ministry that we are following guidance on quality and safety issues. However, daring the unknown had energised so many that even in that "safe" world of data and Q&S, the proposals being amde were energetic, innovative, and exciting. (I readily acknowledge the need for data; provided they produce information and knowledge. And I want our service to be high in quality and safe for all; patients, whanau, and staff.)

Going home late was a price worth paying.

My photo is of the Park Road car park at Auckland Hospital as I left for home. Our society can build and maintain multistorey buildings to house cars while leaving people on the street.