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I don’t think the problem is cost cutting. I think the problem is just the same problem that every human enterprise has. Most people just don’t give a shit out

I don’t think the problem is cost cutting. I think the problem is just the same problem that every human enterprise has. Most people just don’t give a shit outside thier immediate responsibility. Looking at the global view and actually making changes that require persuading other people is a hard and often thankless task. Many people who do give a shit get this crushed out of them early in their career by the negativity you will face if you try. Much easier to just accept the status quo. Occasionally you get a group of people who really care and come together determined not to let things be crappy and they can form an organisation that is significantly more effective for a time. But once the rot of “We can’t fix things” sets in, it’s really really hard to turn things around.

halpmeh 4y ago
Everything you said is spot-on, but, brining things full circle, the lack of “shit giving” could be due to cost cutting. People don’t have an incentive to care. The end result, vis-a-vis their personal situation, is unchanged whether or not they go the extra mile. Part of this is because they exist in a rigid corporate structure hyper-focused on value extraction and not at all focused on the development of human capital.
rscho 4y ago
I work in a hospital, and occasionally in ICUs. You're wrong. Most workers are very much jaded, but they do care. Problem is, the system crushes you to death if you don't set pretty harsh limits to protect yourself. In a lot of cases, that means de-humanizing your work, put your feelings aside and work like a machine. Good little machines are just what management wants, right? Now higher management... wow, those people really don't give a hoot about anything that's not themselves! A second major contributor to inertia, is that the initiatives from lower echelons are usually set for failure by the intricacies of bureaucracy. And said bureaucrats are completely unimaginative about what they could do to fix things, because they never leave their office to see what's really happening in the trenches. So yes, in fine the problem is the extreme stupidity stemming from human collective behaviour. Complain, and suddenly _you_ are the problem!
- gowings97 4y ago
  What percent of patients have a medical need to be woken up every few hours then?
  - rscho 4y ago
    You'd be surprised to see what happens to staff going against waking up patients all night. You get the "dangerous sloth" sticker on your forehead real quick on the morning grand rounds.
    - gowings97 4y ago
      With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station? This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.
      - rscho 4y ago
        Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.
        gowings97 4y ago
        Not saying monitors should be silenced. You can monitor someone without waking them up. Fiefdoms of power - nursing union not wanting to give up the night shift premium pay when the job description changes to monitoring a screen and half the physical workload vs. day shift.
        haldujai 4y ago
        I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm). Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%+ are false alarms (aka IV or SpO2 sensors). The real issue is that hospital technology is outdated and most places don’t have the option for this level of telemetry. I’ve never been told / instructed my staff to “be near the patient at all times”. In fact, most places have 1:8 nursing coverage on the ward…
msrenee 4y ago
Cost cutting is definitely to blame for how understaffed hospitals are. Then Covid happened and it got even worse. It's definitely not all due to Covid though. Even the "not-for-profit" medical group in my area has been pushing doctors and PAs to take more and more patients, well past what they're comfortable with. Nursing staff has been cut down to nothing compared to 10 years ago. Wages haven't gone up to match the increase in workload. Again, this started before Covid, the pandemic just highlighted how much these cuts screwed over both healthcare professionals and patients.

halpmeh 4y ago

Everything you said is spot-on, but, brining things full circle, the lack of “shit giving” could be due to cost cutting. People don’t have an incentive to care. The end result, vis-a-vis their personal situation, is unchanged whether or not they go the extra mile. Part of this is because they exist in a rigid corporate structure hyper-focused on value extraction and not at all focused on the development of human capital.

rscho 4y ago

I work in a hospital, and occasionally in ICUs. You're wrong. Most workers are very much jaded, but they do care. Problem is, the system crushes you to death if you don't set pretty harsh limits to protect yourself. In a lot of cases, that means de-humanizing your work, put your feelings aside and work like a machine. Good little machines are just what management wants, right? Now higher management... wow, those people really don't give a hoot about anything that's not themselves! A second major contributor to inertia, is that the initiatives from lower echelons are usually set for failure by the intricacies of bureaucracy. And said bureaucrats are completely unimaginative about what they could do to fix things, because they never leave their office to see what's really happening in the trenches. So yes, in fine the problem is the extreme stupidity stemming from human collective behaviour. Complain, and suddenly _you_ are the problem!

gowings97 4y ago
What percent of patients have a medical need to be woken up every few hours then?
- rscho 4y ago
  You'd be surprised to see what happens to staff going against waking up patients all night. You get the "dangerous sloth" sticker on your forehead real quick on the morning grand rounds.
  - gowings97 4y ago
    With all the focus on EHR and billing, they can't have all the machines taking vitals hooked up and in a ready only state thats sent to the nursing station? This is the type of stuff I have a gripe with. Sinecure and fiefdoms of power.
    - rscho 4y ago
      Silencing monitors is actually forbidden by law in many places. Staff is supposed to be near the patient at all times => monitors beeping. That's certainly a bad state of things, but not a "fiefdom of power". It's so ingrained in our education that most staff don't even think about it but would certainly agree if asked whether the patient would sleep better without it.
      - gowings97 4y ago
        Not saying monitors should be silenced. You can monitor someone without waking them up. Fiefdoms of power - nursing union not wanting to give up the night shift premium pay when the job description changes to monitoring a screen and half the physical workload vs. day shift.
      - haldujai 4y ago
        I’m not sure where you’re getting this from. I / my nurses silence alarms at literally every hospital I’ve ever worked at (granted they’re temporary silences by design so you have to hit silence q1h/q30mins depending on the alarm). Stanford Healthcare recently installed a system where all alarms/notifications get sent to a hospital assigned device the nurse carries rather blasting in the sleeping patients room as 90%+ are false alarms (aka IV or SpO2 sensors). The real issue is that hospital technology is outdated and most places don’t have the option for this level of telemetry. I’ve never been told / instructed my staff to “be near the patient at all times”. In fact, most places have 1:8 nursing coverage on the ward…

msrenee 4y ago

Cost cutting is definitely to blame for how understaffed hospitals are. Then Covid happened and it got even worse. It's definitely not all due to Covid though. Even the "not-for-profit" medical group in my area has been pushing doctors and PAs to take more and more patients, well past what they're comfortable with. Nursing staff has been cut down to nothing compared to 10 years ago. Wages haven't gone up to match the increase in workload. Again, this started before Covid, the pandemic just highlighted how much these cuts screwed over both healthcare professionals and patients.