The simile of the operating room
One upon a day, an hypothetical government in Spain unilaterally decided that the National Health System (NHS) was not efficient anymore, financially speaking, because they had built hospitals in remote areas that did not have patients to attend. These hospitals had cost millions of , because some construction companies and regional governments had been pushing for multimillion-euro contracts, apart from the real need for a hospital in the area. This had caused a huge deficit in the accounts of the NHS.
In parallel, a network of foreign companies had shown interest in participating in the privatization of these hospitals, after the payment of the appropriate bribes and/or illegal gratuities. Coinciding in time with an international financial crisis and under pressure from Europe to reduce the huge deficit, this hypothetical adrift government improvised ...
Instead of rationalizing the network of hospitals, the government decided to undertake a media campaign of harassment and demolition against operating room staff, who were "just" well-qualified workers. They began to be publicly accused of ruining the Spanish NHS. These scapegoats were going to pay the bill for an inefficient management, and a tangled web of political and economical interests. I. e. the director of the NHS was simultaneously during 6 months in his public office and in the board of directors of a very important construction company that was awarded with several multi-million contracts. Of course, this was a mere coincidence ...
People buy the idea that these measures are necessary because they will enjoy a cheaper and more efficient medical service. And public opinion and political forces welcome the measure because they do not understand technical details and a campaign of demagogy and political propaganda has been carried out with success.
Consequently, this hypothetical government, in collusion with certain directors of the hospitals, their friends in the construction companies, and certain allied political forces, decided to "excrete" a decree-law imposing new and abusive working conditions for operating room staff, to override their 1st Collective Agreement (T&Cīs), the Statute of Workers and the Spanish Constitution. The decree-law was written months before it was published, while they pretended they were still negotiating a new Collective Agreement with the legal trade union representing 96% of the staff of the operating rooms, and in fact certain clauses were introduced to benefit a network of companies and chosen individuals.
Months later, the media publish that waiting lists for surgery and other medical tests have increased in number and length of time, and medical errors have skyrocketed. People do not understand anything. Let us explain the causes.
Reduction of medical staff:
If before the decree-law an operation was carried out by 10 people, now only five are required to save up five salaries. The remaining five workers are overloaded and make mistakes. The quality of the service sinks and patients are treated like cattle. If families of the patients protests, the hospital directors blame the surgeons without remorse.
Reduction of time for rest:
Surgeons, anesthesiologists and nurses have their breaks reduced, both within and between shifts. If they enter service during the day, for every 7 hours they rest 1 hour 45 minutes (25%). But rest during the night is only one third of the time (33%), which means that sometimes they get only 3 hours of sleep. They perform their surgery quite sleepy and make more mistakes. If they protest, they get a disciplinary notice.
Between shifts there is no 12 hours of rest, as the law commands.
Increased workload:
Previously 3 surgical operations were performed a day. Now they are required to perform 6 with fewer staff. They also have to bring past paperwork to the operating room to complete it during surgery, and are required, under threat of a disciplinary notice, to complete also 56000 pages per month detailing everything they do. They are required upon arrival to the operating room to press a button on an stupid machine that emits a "ping" and that was previously forgotten in a corner of the room, but that was bought at an exorbitant price to a company that works with the owner of the hospital.
Surgeons are saturated. They demand a staff increase, but are told that actual staff is more than enough. In the meanwhile, a subsidiary company of the public hospitals offer an advanced master in surgery with a price of "only" 45000 .
Increasing the monthly working days, express recalls and random roster:
Staff in operating rooms are forced to work a number of days per month that is arbitrarily assigned by the hospitalīs director, the Health Minister and the text of the decree-law, without seeing their families in days, regardless of their Collective Agreement, the provisions of the Workers' Statute, and without the participation of the trade unionīs legal representants in these decisions, as it should be acording to the Spanish Constitution.
Some have only two days off per month, and even on those two days mandatory recalls ("express services") can be imposed.
Disappearance of the "sleeping day":
Before all this madness, after a night shift, an operating room worker had a full day of rest for a full recovery of his capacity. Not anymore. Traffic accidents have increased, because physicians are stressed and spend their life on the road, driving to and from work. When they arrive at home, get into bed without even saluting their children. When they wake up they are in a bad mood. They eat poorly, sleep poorly, have circadian disarray, personal issues are neglected, and they never know on what day of the week or month they are.
Some begin to get sick leaves because they can not stand it any more. They are afraid of making a mistake that could cost a patient his life. When they are under legal sick leaves, certified by doctors from the NHS, hospital managers accuse them of labour absenteeism and put them under surveillance of detectives and inspectors. Not a single case of absenteeism is ever detected, but it doesnīt matter: people already got the "official" message, and consider these workers as scum.
Publication of procedure without previous studies:
In the middle of a surgery, the operating room staff receive a letter from the hospital director and his deputy of accountability requiring them to reduce the number of vials of plasma for transfusion, and are asked to recycle the medical cotton gauzes. The hospital director, who is an engineer, forces the surgeon to use certain scalpel and not any other, because he is the boss of the movie.
Permanently available:
The operating room staff know their work roster with only 10 days notice, and they can not plan ahead their personal life. They can be imposed a mandatory recall ("express service") "to ensure the continuity of the Health Service and the financial viability of the NHS". Negation to accept is "rewarded" with a disciplinary notice.
Low-cost medical service:
The "beancounters" begin to hire unemployed "professionals" from Southeast Asia. They do not speak Spanish, and their medical license is accepted by the "beancounters" because they are in a hurry. They rapidly integrate them in the operating room teams, but because of their limited Spanish skills, they make constant mistakes. The surgeon has real problems to communicate with the anesthesiologist or with the nurse in the middle of the operation.
Staff from certain hospitals with few patients are transferred to other hospitals with more work. In the former hospitals, a low-cost medical service is implemented, provided by itinerant butchers and tooth-pullers. Some automatic machines are also installed: now anyone can get a "sanitary" treatment (they canīt call it "medical" treatment, because not doctor intervenes). They mislead the people, as they are told that this new system will offer the same level of safety and quality in the medical service.
Bullying and mobbing environment:
Each day, upon arriving their workplace, medical professionals receive plenty of written guidance on various operational matters and are threatened with a disciplinary notice and punishment if they refuse to comply the guidelines, no matter they may be safe or not. When written requests for clarification or information are filed, they get administrative silence as an answer, and referred to the text of the decree-law.
Middle managers are coerced by the threat of a disciplinary notice if they donīt press the staff to work in these conditions. Hospitals look and feel like a concentration camp.
If doctors decide to publicly denounce their working conditions and warn of the risks to the patient's health, then they are accused of irresponsible behavior and causing false public alarm.
Public scorn:
The health minister, a man with only high school formation, but very loyal to his political party, is out constantly in the media beating the health professionals black and blue. Their children no longer dare to admit that their parents are doctors, or anesthesiologists, or nurses.
The hospital directors publicy state in the media that Spanish surgeons are working to the rule, and that they are bad professionals, thus contributing to the moral degradation of the health collective. It's like if the NASA proclaimed their astronauts were just a bucket-full of ****.
Lack of transparency:
The directors of the hospitals prohibit the entry of journalists. Visit permits have to be requested with at least 5 days notice (half the time monthly rosters are released for workers), and are scrutinized by the managers. The purpose is to hide the actual conditions of the operating rooms because if they were disclosed, they would be unmasked in front of everybody, and resignations and dismissals would have to be executed, and a political price would have to be paid.
Lack of independence of the regulator and the provider:
An executive from Bayer is appointed as director of the National Agency of Medicines .
Economic pressures, politicization, privatization and fraud to consumers and users:
Certain companies that manufacture Surgical material pressure on hospitals to buy their material at the best price. Hospitals and the government calm them and tell them that yes, do not worry, when we finish with the high salaries of surgeons and their privileged T&Cīs, there will be money for everyone. The citizens paid the construction and equipment of the hospitals with their taxes, but now they will have to pay for each medical procedure because hospitals have been sold to private companies. Citizens pay twice for their NHS, and get an infamous service.
Would you undergo surgery in this hospital? Demand the truth: your health is at stake.
Last edited by p_perez; 16th Jul 2010 at 22:48.
Reason: Corrections ...