Shift happens

There's a phrase that's been posted on the wall of my office for many years now. It reads, "Shift Happens."

As a change management consultant, I placed it there as a reminder that the work I do within organizations and with executives often occurs at a snail's pace. But never in a million years would I have believed that I would play a role in "shift happening" within the health care system. But then, "paradigm pioneers," as business guru Joel Barker would call us, rarely set out to change the world. We simply see things happening and try to understand what we can do to address them.

That's what I set out to do when my husband, Bill, got sick, spending 6 1/2 months in four hospitals. For five of those months, he was on life support. My story is not about what happened to Bill, but rather about the shift that happened to me while caring for him inside today's health care system.

Early in his disease, I decided to stay at the hospital around the clock. He was so catastrophically ill that we faced daily, sometimes hourly, crises as every organ in his body failed, some more than once. To understand what was happening, I watched everything, asked lots of questions, did research, and took lots of notes. All of this helped, but nothing helped more than my 24/7 presence.

I began to understand the types of things that occurred during days vs. nights, weekdays vs. weekends, non-holidays vs. holidays, and routine shifts vs. shift changes. I noted what happened when family members of other patients were present and when they went home. I watched patients die in the family's absence. My experience bore out the following:

• The most seasoned nurses typically worked 8:00 a.m.-5:00 p.m. These in-demand nurses are usually the ones with the most tenure, and they get to choose their schedules. Seasoned, however, doesn't necessarily mean best.
  
• Less seasoned nurses worked nights, weekends, and holidays.
  
• Staffing shortages frequently occurred on nights, weekends, and holidays, and errors were more frequent when "temps" were in the nurse positions. They didn't always know the hospital protocols or where to get help.
  
• Fewer nurses, care partners (nurse aides), and doctors were available on nights, weekends, and holidays.
  
• In private hospitals, the doctors who were present on nights, weekends, and holidays were frequently the partners of the treating physicians, acting in a substitute capacity. In public hospitals, the doctors who were present on nights, weekends, and holidays were residents—physicians who have received a medical degree or diploma and are under direct supervision of more senior physicians. Neither set of doctors knew Bill's case or were willing to make treatment interventions, so they were likely to stabilize him or postpone action.
  
• Medication problems happened and went unresolved more often on nights, weekends, and holidays.
  

During nights, weekends, and holidays, I observed and involved myself actively in countless harrowing events. Here are just a few:

• Bill's primary IV line was pulled out by a rotating bed and he was without three medications that were keeping him alive for four hours while I fought with the head nurse to bring in the specialist needed to reinsert the line.
  
• Bill was denied kidney dialysis due to an "equipment shortage."
  
• The pharmacy did not have his prescribed medication and had to wait until morning to order it.
  
• Nurses who were not accustomed to caring for Bill and his complex medical situation tried to give him his medications by mouth three times while he was "NPO" (nothing by mouth). Had they succeeded, he would have died.
  
• Bill was denied the rotating bed that helped him avoid bedsores.
  
• The partner of the treating cardiologist told me that Bill had been misdiagnosed and proceeded to offer a new and terrifyingly dire diagnosis that was wrong and unsupported by the facts.
  
• A monitor alarm was mis-set, allowing Bill to slip into sinus ventricular tachycardia without the nurse being alerted. I had to notify her.
  
• A 10-minute delay in response to an ICU alarm during a shift change required me to stand outside Bill's room, gowned, gloved, and masked, and holler at the top of my lungs for assistance.

As family members and advocates, we represent a huge force with whom the health care system must eventually reckon. Will that happen soon enough for you and your loved ones?

The choice I made was simple: Care for my husband. When the surgeon to whom we attribute Bill's survival visited him, Bill thanked him for saving his life. The doctor responded, "I didn't save your life. Your wife did."

Bill survived, against staggering odds. Without the skilled and dedicated health care workers' expertise and caring, he would never have made it. But if I had to name what caused Bill to survive at an emotional level, I would have to say the 24/7 presence of his family. And that presence during nights, weekends, holidays, and shift changes can and did cause the health care system to function differently. Why? Because I required that they treat me as part of the health care team.

Creating change in the health care system is too overwhelming for most of us even to consider. But if one-by-one we make our presence known and do not capitulate to the apparently well-meaning requests to "go home and care for ourselves," we are a formidable force on behalf of our loved ones.

I only want what is best for my family. I ensure that my input is included and that my hospitalized family member receives the best possible treatment with the 24/7 presence of someone who cares, even in the face of resistance by the health care community. Nights, weekends, holidays and shift changes are risky times for hospital patients. Doesn't it make sense that we stand guard?

Our journey and the journey of health care in the United States run parallel, and we are the agents of change—but not unless we step into our power. That is always how Shift Happens!