When human beings are reduced to throughput, everyone loses
Recently, I had an up-close and personal experience with our long-esteemed Canadian healthcare system, and I am left feeling shaken—and very worried about its future.
I often read headlines about our system being on life support. I now understand that in a much more visceral way.
Earlier this week, I had day surgery at my local regional hospital. A few decades ago, this would likely have been an inpatient procedure. Thanks to advances in technology and technique, it is now standard day surgery. Given the well-known issue of extreme wait times in our system, I felt grateful to have waited only weeks for the procedure, thanks to an opening created by a cancellation.
I arrived at the hospital looking forward to having it behind me. My daughter accompanied me for the day. She is a veteran of hospitals and procedures, and it is usually me who accompanies her. The role of patient is not an especially comfortable one for me.
Things moved smoothly and efficiently at the welcome centre check-in. Before long, we were greeted by an upbeat nurse and a lovely volunteer at day surgery check-in. Everything seemed to be on track. We had arrived before 8 a.m. My surgery was scheduled for 10 a.m.
The tone shifted when I was called in to speak with a nurse. She was clearly frazzled and frustrated as she tried, unsuccessfully, to locate the names of my medications in the online system. She grew even more impatient as I recounted my family history with anesthesia.
For context, I am a healthcare professional myself, with experience working in hospitals. I understand what information is relevant and what is not. I am a clear, concise and accurate reporter.
In that moment, I took a deep breath. This was my patient experience, and I needed to take ownership of it. I needed to change the energy between us.
By the time she was inserting my IV, she had become human. She shared with me the life transition she was about to embark on, and her frustration with how the system has deteriorated since the pandemic. I could feel something around us soften. I could also feel the trauma within the system enveloping the room.
My daughter and I were then directed to wait in an overfilled waiting area with uncomfortable chairs, a number of patients and companions left standing. A television blared endless reports of negative news stories. I found myself becoming agitated—not exactly the state I had envisioned when entering the surgical suite.
I imagined what the experience might have felt like with padded recliner chairs and soothing classical music. Small things, perhaps. But small things are not small when a person is vulnerable.
More than two hours after my scheduled surgery time, I hugged my daughter and was escorted into the surgical suite.
My surgeon was warm and reassuring, as I remembered her from my first visit. I asked to speak with the anesthesiologist before the surgery proceeded. He was pleasant enough, but when I asked him to go low and short-acting with my medications, given my known medication hypersensitivity, he asked no questions. I did not sense that my input would influence his decision-making in any way.
The next thing I knew, I was starting to come to in the recovery room.
The nurse placed my phone in my hand and instructed me to text my friend for pick-up. She was speaking very quickly. It was approaching 4 p.m. I assumed the mandate was to have everyone cleared out before 5 p.m.
Everything was swirling around me. I was drifting in and out of consciousness. I was confused. Somehow, I managed to type a coherent-enough text to my friend—and also, apparently, to some unknown “recipient” named “Tradt.” My friend somehow knew to come for me.
She texted when she arrived at the hospital entrance, expecting me to be waiting. I continued to drift in and out of consciousness. Leaving her car emergency lights flashing, she came in to find me.
An experienced caregiver, she knew exactly what to do. She got me dressed and into a wheelchair. She retrieved my discharge orders from the nurse. She also learned that my surgeon had stopped by to speak with me. To this day, I have no recollection of that conversation.
Her next job was to find my daughter.
My daughter, who is severely hearing impaired, had been left in the waiting area without updates on my condition, and without an invitation to join me in the recovery room along with the companions of other patients. This was despite my having notified the nurse who escorted me into surgery of her hearing impairment, and of the failure that morning of her assistive device.
I was unbelievably dizzy and nauseous on the barely tolerable drive home. My friend and daughter escorted me to my sofa, where I continued to fade in and out of lucidity.
More than 36 hours later, when the effects of the medications had cleared and I was cogent once again, I realized how unsafe that discharge had felt.
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My story is a minor illustration of the current state of affairs within our healthcare system. I was lucky. I had a caring companion in my daughter and a highly experienced caregiver in my friend.
I find myself wondering what happens to people who are not as lucky.
I am not angry at the healthcare professionals involved. In fact, I feel great empathy for them. They are expected to work inside a system that pushes patients through as if they are pieces of equipment on an assembly line.
I imagine the only way many people get through their days is to detach, to tune out, to become almost robotic. They are working within a system that does not support human flourishing. In fact, at times, it seems designed to produce the opposite.
Before my surgery, I had two conversations that inspired me to write about this experience.
The first was with a dynamic young leader within the healthcare system. She is brilliant, talented, and has an indomitable life force that could help change the system for the better—if only the system would let her. She rails against a lack of leadership that thinks too small and feels too threatened by her big ideas and bold vision.
The second was a LinkedIn exchange about resilience. The author was inviting conversation about how often leadership dogma asks us to become more resilient. But is that a fair ask when systems themselves are fractured and unsustainable?
Too often, what is being demanded is that people become more resilient in order to cover up the failings of the system.
My day surgery experience showed me the same leadership failure I have seen across strained systems: when human beings are reduced to throughput, everyone loses.
Patients lose dignity and safety.
Healthcare professionals lose connection with the humanity that likely drew many of them to the work in the first place.
Leaders lose sight of the fact that efficiency without humanity is not excellence. It is failure.
The glory days of more and newer leadership theories and fixes are long past. I believe it is time for a more honest conversation - genuine, authentic, gritty conversation.
Tough, unvarnished conversation that admits how strained our systems are, and the devastating impact this is having on the people operating within them.
It is not the people who are broken and in need of fixing.
We need permission to be human.
Everything else builds from there.
Jane Farnham BSc. Pharmacy, MBA, is a pharmacist, strategic advisor and founder of Whole-Being Leadership working in the Greater Toronto Area.
