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SUBJECT: Observations of Mr. Cohen

INTRODUCTION

The purpose of this paper is to address the problems brought to light by a memo prepared by Mr. Elias Cohen after a stay in our hospital. In his memo he pointed out many discrepancies in our procedures, staff, and facilities. I will address three of these issues and offer solutions to the problems.

IDENTIFICATION OF PROBLEMS

This report is in response to a memorandum forwarded to the hospital by a former patient Mr. Cohen. Mr. Cohen expressed his concerns and observations involving several aspects of the hospital’s operations. I will address three of his concerns and offer potential solutions for the problems presented. The problems I will address are:

• Admissions

• Room Design

• Medical Surveillance

ADMISSIONS PROBLEMS

Mr. Cohen addressed three concerns relating to the admission process. These concerns were: (1) the stated and actual admission time, (2) inadequate preparation by hospital staff, and (3) the lack of information concerning hospital procedures.

(1) The stated and actual admission time - Mr. Cohen was instructed to be at the hospital for admission at 10:30 am. Upon his arrival he was surprised to find out that admissions were scheduled for 11:00 am. Mr. Cohen waited in the lounge for an hour before being called by the admitting clerk. After getting his pertinent information, the clerk then informed him that it would be quite a while before his room was ready and he should go to the snack bar and have a cup of coffee. Forty five minutes to an hour the patient was escorted to his room.

(2) Inadequate preparation by hospital staff - After waiting for hours Mr. Cohen was shown to his room only to find the bed not made, floor not swept, and the room in a generally untidy state. He was then informed that he should return to the lounge and wait some more. Upon his return to the room he found that the bed had been made but the room was still dirty.

(3) The lack of information concerning hospital procedures - After changing into his pajamas and settling into his dirty room Mr. Cohen wondered what would happen next. No member of the hospital staff had informed him of any upcoming procedures, the normal routine, or was available to ease any of his anxieties. Although there was no personal contact by the staff concerning these matters there was the “very nice brochure” provided by the hospital.

ADDMISSION SOLUTIONS

(1) The stated and actual admission time - The hospital should implement the following recommendations to improve their admitting procedures. First, the staff must provide a patient with a time to report for admission that allows all hospital staff time to properly prepare for that patient. The patient should only have a minimal wait. Second, the hospital should install a computerized bed management system to coordinate the activities necessary to admit the patient.

(2) Inadequate preparation by hospital staff – The bed management system mentioned above should track the status of the room in question and avoid problems like unmade beds, dirty floors, etc. A member of the nursing staff should physically check the room before notifying admissions to send the patient to his or her room.

(3) The lack of information concerning hospital procedures – Upon arrival of the patient in their room a member of the nursing staff should be on hand to explain the daily routine, scheduled procedures, and answer any questions the patient may have.

ROOM DESIGN PROBLEMS

Mr. Cohen addressed three concerns relating to the design of the hospital and his room in particular. These concerns were: (1) The room was too small. (2) The lack of handicap amenities. (3) The socialization environment in the hospital.

(1) The room was too small – Mr. Cohen points out that the room he occupied was designed for two people. But he also highlights several problems associated with the room. The beds were only one and a half feet apart. Almost all of the furniture in the room had to be moved to accommodate a surgical litter. The placement of the furniture did not allow for easy movement within the room. Also, there was little room for visitors.

(2) The lack of handicap amenities – Mr. Cohen expressed his concern about the lack of handicap rails in the bathroom and hallways.

(3) The socialization environment in the hospital –