The cost of failure demand

Warning: this article contains stuff about women and bodies. If you’re not a ‘body person’, look away now!!

I’m not the world’s most prolific Tweeter. I often let others’ tweets pass me by in the absence of a suitably profound response, and I rarely initiate. But when the wonderfully feisty Zara Todd tweeted about women’s health screening a while back, I had just returned from another time-wasting hospital visit of the sort that ends in frustration and undirected anger. Undirected, because there is no one to blame. So I put finger to keyboard:

My last attempt to get a cervical smear involved a time-wasting visit to hospital. I spent one and three-quarter hours suggesting various ways to hospital staff that they might try to transfer me to the couch for the procedure. They were adamant that this should involve no manual handling at all. Fair enough perhaps, but the only hoist they could produce had a sling that had to be placed underneath me. I don’t weight bear, and I have minimal upper body strength, so I couldn’t raise myself up sufficiently for them to get the sling under my bum. They called in the paramedics. They got a different hoist. I suggested ways in which I could be transferred without lifting me (something my PAs did regularly), but that wasn’t acceptable because somebody might damage themselves. And then I gave up. Before I left, the gynaecologist talked to me. He reassured me that a cervical smear was not that important. That sounded unlikely given they are a diagnostic for cancer, but I was polite and put in the required effort to make everybody feel better about failing miserably except me.

Since then, I have tried to ensure my rare hospital visits are successful and easy for both sides. I recently had a CT scan and was amazed and delighted that the process went very smoothly. I had phoned up beforehand and spoke to the member of staff who would be leading the CT scanning team that morning. I explained that I would bring my own personal assistants who are trained in my needs, and I would bring my own hoist slings, which they would not be familiar with but my PAs use every day. And I explained that lying flat is impossible and almost flat is uncomfortable, so I would need to be shored up with pillows which I would bring. I answered a few questions, and everything went well.

The following day (I am clearly a glutton for punishment) I had a mammogram. On previous occasions that’s worked well although I can’t have a full mammogram, because the equipment doesn’t fit me (or I don’t fit it, as the NHS would probably say). This time, the staff did not listen and wouldn’t even let me manoeuvre my own wheelchair. I warned them it was heavy but, apparently, positioning my wheelchair is too complex for me. The staff member put her back out (well, I did say…). The whole experience was so stressful I swore I would never have a mammogram again. As the memory of the experience recedes, I may change my mind. If not, breast screening will be out along with smear tests.

The next step after the CT scan was a cystoscopy. If you don’t know what that is, it’s not a fun day out. Once again, I explained that I would bring my own PAs and equipment and was told it would all be fine. I guess nobody made a note on my file, or the person who decided the location for the procedure didn’t check the file. I ended up in the endoscopy unit which is a ‘green pathway’. That is to say, Covid safe (incidentally, many of them wore their masks under their noses, and I didn’t think that was Covid safe!). There followed a long and painful discussion in which I explained I was not prepared to take the risk of letting NHS staff, skilled in many things but not my body, assist me. Had something gone wrong, I would have had to rely on those who had created the problem to sort it out. I was told that, given it was diagnostic, not life-threatening, I could decide not to have it. I wasn’t exactly ‘deciding’ not to have it, but again I tried to make the staff feel better about it.

There are several more examples, but I won’t elaborate here. My intention is not to whinge about the NHS. NHS staff work incredibly hard to do the right thing for patients and they do not go to work each day to make patients’ lives difficult. The system is desperately trying to catch up the backlog. This would be a whole lot more effective if failure demand were eliminated. Perhaps this is just a problem for disabled people – as Zara pointed out it is certainly a problem for disabled women who miss out on beneficial preventative medicine. As my CT scan shows, it's possible to get it right. Getting it wrong costs administrators’ and medics’ time, my PAs’ time and mine, not to mention frustration all round. I don’t like wasting public money, but I feel as if I am doing a lot of that at the moment and not through any fault of my own.

So what is the lesson for leaders? Identify the pain points for your customers and you will identify pain points for staff and those places where money is draining from the system unnecessarily. Addressing those pain points will pay off in staff engagement, customer satisfaction and your bottom line.