Whose hospital?

The Normans brought the function we now know as The Hospital to England. Initially charitable houses, they were quickly absorbed into the pre-Conquest frameworks of custom and alms and were a distinct development from the monasteries dispensing treatment. The status of the hospitals, as private ventures, was reflected by the generosity and intent of the founder.

Who is the patient?
The word ‘patient’ is derived from the Latin word patiens, meaning ‘one who endures’ or ‘one who suffers. Patient is also an adjective with both senses of the word sharing a common origin.
    
Although the definition does not imply suffering or passivity and can be described as ‘enduring trying circumstances with an even temper’, for instance suffering in silence, some clinicians have suggested that the word ‘patient’ should be dropped, because it underlines the inferior status of health care recipients.
    
An active patient is a contradiction and the assumption of passivity is dangerous. In medical terms, a patient is a person waiting for medical or dental care, or is receiving it, or may have received it.
    
Everyone wants a healthy life. But while many are healthy, virtually all of us will require treatment for an ailment at some stage of lives. Some rely upon treatment for lengthy periods, if not lifetimes.

Unfamililar environment
Admission into a strange and unfamiliar environment is a daunting prospect because of the fear of the unknown. With patients arriving in all sorts of shapes and sizes from all kinds of backgrounds and with thousands of reasons, in many respects public and private hospitals are levellers of the strands of society because they have just one purpose – to treat patients irrespective of their status, wealth and opinions.
    
Outpatients fare better because their stay in hospital is temporary, maybe for a few hours. The majority of inpatients have the time and opportunity to prepare for their stay, perhaps packing a bag and mentally trawling through the treatment.
    
A visit to a GP or admittance to an Emergency Department or those admitted under Mental Health Act sections, however, can result in the impact of a patient suddenly being denied their comfortable zone and then thrust into an alien public place with immediate restrictions on their liberty, privacy and dignity and an expectation of adapting to different routines, sometimes literally within seconds. Relaxation with a cigarette is denied.

Accommodation is likely to be in a dormitory, perhaps mixed, of complete strangers, whose personal lifestyles differ. There might be prison officers sitting alongside a patient. The patient may arrive without nightclothes and a toothbrush and may be confined to bed with visitors restricted to a few hours a day. Boredom is an enemy. Choice and amount of food is restricted and refreshments depend on the ability of nurses to organise a cup of tea.
    
Oppression may be a factor because some patients may have no idea what is expected of them and they are being governed by a group of strangers - who appear to have their best interests in mind. They have become cogs in the hospital routine - visiting X-Ray and scanners, and talked about in indecipherable jargon during doctor’s rounds.

HAIC
Hospital acquired infections have been around for centuries, however, the publicity and ‘cleaner hospitals’ adds to the psychological pressure. Picking one up means a longer, unexpected stay or worse. Little happens at the weekend in this 24 hour operation, which means that those who do not pass the doctor’s muster on Friday usually must wait until Monday to be discharged, whereas Tuesday discharges are not uncommon.
    
Patients may be unconscious for periods and reliant upon staff for their welfare and property, in particular jewellery, money and clothes, and are rightly upset when it cannot be produced on discharge. Missing property affects reputations of organisations and individuals and while it may have little intrinsic value, it can have huge sentimental value. An apologetic letter is valueless.
    
A full night’s sleep cannot be guaranteed because of lights at the nurses station, whirring medical machinery and noise as nurses treat other patients, particularly in admissions wards where most patients are transient. There are few comfort zones in hospitals, in spite of the best efforts of nurses, in particular, to make the stay as comfortable and seamless as possible.
    
Those in the mental health and learning disability sector face significant problems, although much will depend on the purpose of the relevant ward. Some may be admitted to a secure unit against their will with no idea when they will be released and are accommodated with patients displaying challenging behaviour.

Dealing with change
A key factor is that when patients arrive in hospital, very few have control over the future. Change is something that we deal with every day, a key factor being the circumstances and manner in which it is managed. The past has gone and the immediate and long-term future might be uncertain. Some resist because of the fear of the unknown. A patient orders a salad and when it arrives on the plate there is some meat. “What is that?” asks the patient. “Tongue,” replies the nurse. “Oh dear,” replies the patient. “I’ve never had anything from inside a cow’s mouth. I’ll have an egg instead.”
    
In recognising the management of change, we need to understand how people react to change? Although millions of words have been written about it, we are going to reduce it to six phases:

• Immobility in which the individual freezes and is unable to plan. The future is bleak and beyond comprehension.
• Depression from a sense of powerlessness. Oppression sets in. Life is out of control.
• Recognition of the reality sets in but there is frustration on how best to cope with the new circumstances. This is often by transferring previous routines and habits.
• Gradual acceptance of ‘Here I am. I have no choice. I am not sure what they want but I shall survive’. This is fight, as opposed to flight. Morale rises.
• Failed experimenting with the new circumstances can lead to irritability and may result in demoralisation. Nevertheless individuals begin to accept the differences.
• The need for change is recognised. The individual passes into accepting change and incorporating new systems into their behaviour.  

It must be recognised that life’s experiences often dictates changed is managed. In the hospital setting, it applies equally to relatives and friends. Since brainstorming is a recognised change management tool usually group sessions, every admission should be accompanied, as soon as possible, by a frank verbal and also written brief to resolve queries and anxieties. So how can Security as a factor in hospital life contribute to that change in a healthcare setting?

Security and safety
Included in the session should be discussions around the safety and security of the patient to include:

• Dealing only with staff wearing ID badges. Bogus healthcare staff is a fact.
• An explanation of measures to protect the safety and security of the patient. Patients need to be protected from unauthorised access with decent locks.
• Arrangements for the protection of property, in particular during those periods when the patient may be unconscious and/or asleep.
• An explanation that staff will be robust with intentional and reckless violence and aggression and that the unintentional will be considered sympathetically.   

Generally, hospitals still need to change and accept that security is a facet of modern life and its introduction does not necessarily mean imply turning it into a prison. The public now expect and deserve safety and security, particularly when they are their most vulnerable. But first, hospitals might like to ask whose hospital is it?