This morning on the news I was following the story about the report into the treatment of old people in hospitals.
Some of the findings are truely shocking.
This led to me and my partner discussing the issues and of our own recent experiences with hospitals.
From earlier posts you may know that I broke my ankle last year, I lived to tell the tale, and have nothing but praise for the hospital, from my first vsit to A&E to my final discharge from the physiotherapy department, with the words, “we can do no more for you, you are too good for us” from my very proofessional physiotherapist making me smile as I walked out of the building.
My partner has experiences from a couple of different hospitals delivering treatment to her parents. There the feedback isn’t so universally positive. Some of the treatment has been excellent from NHS and private facilities, some not so good. Once we thought about some of the stories that our friends have told us particularly with regards to elderly parents, the stories were mush worse.
This got me to wondering, is this one of the side effects of tame and wicked problems not being clearly differentiated, and treated in different ways, as they need to be.
A tame problem, such as my broken ankle is pretty clear. The correct resolution is that I am put back into a state that resembles as close as possible the state that I was in immediately prior to my accident.
A knee replacement, again tame, the objective is improved mobility and reduced pain.
I’m in no way minimising the challenges and skill and dedication involved in solving these tame problems. The first moon landing and safe return of the astronauts was a tame problem, and that really was rocket science!
But tame problems, can be bounded, they can be described clearly and they have a “right aswer”.
Wicked problems however don’t operate by the same rules. There is no right answer or solution. They are much more about judgement and best options.
Is the care of old people in hospitals a wicked rather than a tame problem? For sure, for 100% sure, the care contains within it bounded and clear and specific tame problems, making sure people are not dehydrated (does it really need a doctor to write a prescription to ensure people are given water?). Making sure that people can actually reach the food that is being given to them is a tame problem.
But maybe the wider challenge of care, not solving a broken bone, and ensuring no infection and a return to mobility type of care, which has a definate end point, but ongoing, human interaction, humane treatement and consideration, in a general more industrialised environment is a complex and wicked problem.
I’m reminded of the treatment that my dying father recieved in his last two weeks in a hospice. It was amazing, the staff were fantastic, but I frankly couldn’t understand how people could do this, and be around death every day.
I spoke to the head nurse and she explained that this was exactly why she and other nurses went into the profession, to care for people, patients and relatives, and that she had moved to the hospice because it was a level of care that she was no longer able to give in the general hospital.
Maybe the separation of services allows people to differentiate the right approach, and without ever calling them “problems” or “tame” or “wicked” there is a focus on what is needed to bring the right result, or the best outcome that we are capable of producing.
Being able to differetiate and understand is important. In the challenge of hospitals facing both tame and wicked problems, maybe there is no opportunity to differentiate, and a one type of solution fits all problems is sometimes being applied.
Sadly in some instances it appears to be failing in dramatic and and inhumane ways. It’s no doubt a difficult issue to tackle, but as a start, even in a wicked problem, getting the tame bits right would go a long way to making peoples lives, patients, relatives, and nurses better.
