Does your hospital have a case of TTWTADH?

hen you’re on the NCHD merry-go-round of changing hospitals every few months, you start to quickly notice the particular culture of a place and what characteristics make a hospital an easy place to settle into and work in and conversely, what characteristics lead to others having, shall we say, less-favourable reputations. Sure, most hospitals are generally the same, however each one tends to have its own particular quirks and way of doing things, much in the same way that each hospital usually has its own distinct smell.

This is only a problem when it leads to the serious clinical condition of ‘That’s The Way Things Are Done Here’, or TTWTADH for short. TTWTADH is widespread throughout the entire health service and common symptoms to look out for are opposition to change, closed-mindedness and the particularly Irish way of saying, ‘sure, where would you be going trying to fix or change things, aren’t we grand as we are?’

TTWTADH can be rampant throughout the smaller hospitals, but the larger hospitals are not immune either. Other important clinical signs to look out for are adherence to out-of-date protocols that serve to only increase workload rather than follow any clinical evidence or guidelines and at its terminal end-stages, it can result in a complete deficit of common sense.

It most commonly affects idealistic interns who have not yet been exposed to the condition and soon succumb to its ill effects. Their idealistic desires to help people and change the world, or even to just improve transfer of tasks, are no match for its virulence and contagion. Another common victim is the newly-qualified nurse who is enthusiastic about engaging in all aspects of their training, before they too are quickly struck down by TTWTADH.

Its long-term sequelae are the jaded SHO and registrar who know that their best way of surviving is to keep their head down and to not ruffle any feathers that could jeopardise the all-important log book sign-off and reference. There is treatment and respite for TTWTADH but to date, cases of long-term survival have only been reported in Australia, Canada and New Zealand.

Without effective control of TTWTADH, the Irish healthcare system will continue to suffer from long delays for patients, wasteful replication of services and delays in innovation. Lack of early recognition of the symptoms of TTWTADH will lead to the continuation of hospitals that should have been reconfigured years ago into more safe and efficient structures still trundling on.

Many have great hopes that the introduction of Sláintecare will finally be the cure for TTWTADH but it has already survived through the health boards and the HSE and the potential re-introduction of the health boards again, and it has only grown more resistant. The clinical course of TTWTADH features suffocation of any attempts at potential innovation, as it can only grow and replicate when there is no change at all in its environment.

The only known cure for TTWTADH is its complete eradication from the Irish healthcare system. Strict infection control needs to be introduced and any clinical suspicion that TTWTADH may be spreading locally must result in strict isolation.

Symptomatic treatment is possible, by allowing both the more transient staff and those who have been there for decades to take ownership of their workplaces and to challenge the culture of TTWTADH. Things that are taken as gospel should be questioned and new, better ways of doing something should be given fair consideration. Hospitals should allow all staff to have their voices heard, not just the doctors and nurses, but the HCAs, AHPs, porters, cleaners, administration — everyone.

Cure of TTWTADH is possible. The introduction of a new culture into the health service, ‘What Way Can Things Be Done Here?’ (WWCTBDH), may be the most effective way of achieving long-term eradication. It may be met with resistance but it’s the only way we can innovate and bring a healthcare system into the 21st Century. We need to run a modern health service for the modern needs of this country, for both its people and its patients.