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Saturday, 20 December 2014

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Joanne’s the queen in FGH’s big game of chess

A CLINICAL site manager at Furness General Hospital, it is Joanne Nevinson’s job to organise beds for patients.
In the third of a series of articles documenting her exclusive behind-the-scenes access at FGH, an exhausted EMMA PRESTON reports.

IF you’re going to spend a day following in Joanne Nevinson’s footsteps, you better make sure you invest in some seriously comfy shoes.

A clinical site manager at Furness General Hospital, it is Joanne’s job to work out how many beds are available in the hospital throughout the day, compared to how many are going to be needed.

To do this, she visits 11 different wards around the hospital at various points throughout her 12-hour shift.

As I desperately try to keep up with her, I wonder just how much distance we’re clocking up.

“One of the girls did once put on a pedometer and I think she said it was about 15 miles”, Joanne laughs.

The site manager's day starts out in the hospital’s medical admissions unit to check if anyone is waiting for beds, before carrying on to accident and emergency and intensive care to do the same.

From there, it is on to the medical wards, to find out whether there are any beds available and if there are expected to be any time soon.

The final stop is the surgical wards.

In each, Joanne checks the boards listing their patients, before liasing with staff for more details.

Joanne, who has been doing the job for seven years, describes it as “a lot of walking and a lot of talking”.

“Every ward has its own little systems and ways of doing things”, she tells me, “but you learn all of them after long enough here.

“I can tell straight away from looking at the board who’s going home, who’s a query about going home, and then it’ll be for me to find out what the query is as to whether or not they can be discharged.”

Our lap of the wards, which FGH clinical site managers do between five and seven times a shift, takes around an hour.

Afterwards, we return to the medical admissions unit and Joanne updates them on the situation around hospital.

She then goes to her office and translates what she has found into a computer database.

This shares the information with nearby hospitals and the primary care trust, which can help organise community health services that could help speed up the discharge of patients.

As she works, Joanne is constantly considering the number of patients that will come in today.

She says: “You can actually predict, to the nearest two, three, four patients, how many you’ll need throughout the day.

“People think it’s a total lottery but it’s not.”

Joanne has to do much more than simply match the number of beds to the number of people.

In a musical-chairs-style manner which is starting to make my mind boggle, she has to organise patients into the relevant wards for the type and seriousness of their condition.
Males and females must, as far as possible, be separated while some, for example those with highly infectious illnesses, have to be found side rooms.

Others, who are almost ready to go home or have more easily manageable conditions, can be placed in surgical wards, where the demand for beds is lower.

Joanne explains: “It’s very much juggling throughout the day, using whatever you’ve got and trying to work out where to put people.

“It’s akin to a big chess game.

“You’ve got all the pieces and, hopefully, they slide into place and you get a checkmate at the end of the day.”

As we continue our day together, it is fast becoming clear that the pressure of Joanne’s job is on more than just her feet.

The scope of her role is simply huge.

A clinical site manager controls nearly all admissions and organises dates for patients due in hospital for scheduled procedures.

They are also mindful of anyone waiting to be transferred to FGH from other hospitals, and vice versa.

As she works to organise admissions, it is Joanne’s responsibility to make sure there are places to put new patients.

She is constantly checking patient notes to see who looks like they could be discharged, directing doctors to patients who are ready to leave but need to be seen first.

Joanne also works with community health services to prepare home care packages which allow people to leave.

Every day at noon and 3pm, a “bed meeting” is held with staff from medical and surgical wards, physiotherapy, occupational therapy, X-ray and community health bodies.
Joanne explains: “It’s very much pulling all the services together for a smoother discharge.”

Throughout the day, Joanne constantly monitors the hospital’s “Escalation Level” - one being normal, two being significant pressure and three being the worst demand for beds.

If the clinical site manager chooses to increase the level, every ward has “step up” actions to try and make beds available.

But, Joanne, a former ICU nurse, knows it is important not to get too caught up in the systems.

“It’s all about remembering the patients behind the numbers”, she says.

“It’s very easy to sit in an office and say, ‘get patients out, get patients out’, but when you’re actually involved with the patients, you know things from their side.

“I pride myself on knowing a lot of the patients who are in the hospital, I try and get involved as much as I can.

“It has a big impact on what I do.

“I understand what part of their treatment they’re in and what they’re going to need next.”

Joanne uses a mix of impeccable organisational skills, an excellent relationship with her colleagues and her extensive experience dealing with patients to make sure patients are admitted and discharged safely and smoothly.

But, very occasionally, she tells me, there will be a bad day when there is just no way round a lack of beds.

That is when help has to be called in from other hospitals, and patients are redirected.

But it is a clinical site manager’s job to make sure this really is a rarity.

I tentatively offer up the suggestion that it sounds a little like my worst nightmare, but Joanne just laughs.

“It’s kind of a specialised job’, she says, “you need to be good at problem-solving, you need to be calm in a crisis and you need to be able to deal with high-pressure situations.”

“Everybody says, ‘I wouldn’t have your job’, but I thrive on it.”

* Next week, Emma goes behind the scenes with members of the FGH Heavy Duty Team. Find out how she gets on in next Saturday’s Evening Mail.

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