Wednesday, December 22, 2010

how hospitals or any service organization can improve its services

As mentioned in my last post, my dad died due to motor neuron degeneration (MND), and we had to visit many hospitals in hope to get some cure or at least to make his life easy. We visited many neurologists, but some of them do need to improve how they communicate with patients. I will not mention the names of hospitals where we visited those neurologists, but I will describe how those neurologists behaved with us.


Before I explain what happened, I would state that the hospitals are not at fault, the problem is that there is no effective way to gather feedback about patients experience. IF hospitals or other service organizations start conducting exit interviews with their clients, they would be able to improve their services.


So coming back to what happened. We visited a neurologist in a hospital 10 days before my dad’s death. His nerves had already damaged very much, and 4 months before the same neurologist had suggested a test to understand the extend of nerve damage. The test is called Nerve Conduction Velocity (NCV) test. I agree, It was our mistake that we didn’t go for the test 4 months back, (my parents are usually against the tests). But I was shocked to see the rudeness of the doctor. He was curt about the test being not done and he rudely informed us that we have to get a feeding tube and an invasive ventilation tube in his lungs. Can you imagine that the doctor is rude to someone who is terminally ill instead of being supportive? I understand that for doctors the above treatment is a routine treatment for MND patients, but the doctors must also realize that a patient is a person with feelings. So the doctors must inform in such a way that the patient is not put off by the treatment.

In another hospital, the neurologist was straightforward  and well behaved, but there was an interesting problem. This visit was only 3 days before my dad died, and his condition was such that he could not breathe properly and could not speak. Our visit to this neurologist was the first one. The neurologist asked us to get the same nCV test done, and We had to spend 3 hours in the hospital,. Till this point, things were as they might be with anyone. But after the test when we showed the report to the doctor, he suggested some medications and also informed us that we might have to go for non- invasive ventilation. In order to start non- invasive ventilation, we need to get a  test done to figure out the intensity for the ventilators. We left doctor’s office, and got the medication for my dad. And then We realized that we don’t know when to get the test done. We asked the hospital staff about when to get the test done, and they asked the doctor over the phone. The doctor suggested that we should continue with the medication for a month and then come for the test. We were shocked to hear that, as my dad’s condition was critical and he asked us to come after a month? I think there could be a mistake in communication, because my dad’s condition was not such that we could wait for a month for a test and start the ventilation after a month. We left the hospital unsatisfied. Next day we contacted another doctor in the same hospital who is a respiration specialist. And she asked us to admit my dad in emergency so that the tests could be done. It is a totally another issue that my dad refused to get admitted for an overnight test, and that was the reason that he died so soon.


The conclusion of what happened is that if hospitals add an exit interview for each patient, they would get to know the areas of improvement in the patient care. In fact all the service organizations may be abel to improve their services by adding an effective exit interview with their clients.


An effective exit interview should not be about filling forms, but rather it should be a face to face interview by an interviewer who is trained to probe the clients about good and bad experiences. Such an interview should not be to gather plus points for annual reports, but it should be to figure out how the service can be improved.

Monday, December 20, 2010

remembering my dad

For last few days, I could not write anything on twitter or blog. Working in front of computer became a pain. because after the death of my dad Mr. N.K. Kaushal, working alone in front of computer seems a waste of time. There are lots of questions about life, relationships, and death.


But after 18 days, I am now in a state to write something about him. He died due to Motor neuron degeneration. even though his death was expected, we could not come to terms with it. Doctors had told us that there is no treatment for MND, but it seems that we were in denial so we tried any alternative treatment that we found. So we tried multi vitamins, homeopathy, ayurveda, and any other treatment. But nothing worked, and he died on the morning of 2nd December 2010.


To an extend he chose the time of his death, because he refused any intervention that could prolong his life and suffering. Doctors had suggested a feeding tube because he could not swallow, and ventilator because breathing became difficult. But he chose no medical intervention and died in his sleep.


If we think rationally, it seems that his death was a good thing for him, as any intervention could only prolong his troubles, and as there is no treatment for MND, prolonging his life could only prolong his troubles. In spite of all the facts, we are not able to accept his departure. We want to get in touch with him, talk to him, and we know that it is not going to happen.


So the only thing that I can do now, is to remember his life as he lived. He basically lived a life in which he tried not to hurt anyone. And I think he succeeded in that mission. He was not a person who would go to temples, because he always believed that going to temple is only a first step in spirituality. according to him, temple is a tool to realize god, and people who realize god respect others life. Often he pointed out paradox in people who would go to temples and do lots of puja but would deceive or trouble others. He always tried to live as he believed, and followed the principle of preaching by actions rather than words.


Another important thing about him is that he never tried to force us in to any profession. He discussed with us various pros and cons about various professions, but always said that don’t fret too much. He pointed out various examples for people who didn’t do very well in the beginning of their careers, but attained success later. Then he pointed out reverse examples as well, in which people were very successful in the start but lost their way later. So he suggested that try your best and leave it on god.


An interesting thing is that he was not afraid of dying. But he never supported suicide. He wanted to be in army because he was not afraid of death, but he never wanted to hurt anyone. He also believed in taking care of once responsibilities, so after he got married, he avoided risky activities.


It seems impossible to live the way he did, but for us most important lesson is to respect others and try not to hurt anyone.