An important part of my work concerns the “settings” in which we lead our lives. Settings are both physical and social spaces; they are the main “nodes” in our lives: home, school, workplace, park, marketplace, neighbourhood, city, and special places such as hospitals and even prisons.
The importance of these settings is, as Sir Winston Churchill once remarked of the British Parliament buildings: “First we shape our buildings, then they shape us.” So we try to create healthy settings, in the hope and expectation that we will thus make the healthy choice the easy choice for those who inhabit them.
In the 1990s, I was a partner in Planetree Canada, an attempt to bring the Planetree concept to Canada from the U.S. Planetree is a non-profit alliance of hospitals in the U.S. and some other countries dedicated to creating healthy hospitals for patients and staff. It started in 1978 due to the experience of Angelica Theriot, an Argentine living in San Francisco.
She had some serious medical problems and received excellent clinical care, but was appalled by the poor human quality of her experience. She resolved to make hospitals more humane and patient-centred, and founded Planetree.
I had the good fortune to visit the first Planetree unit at Pacific Presbyterian Hospital in San Francisco in 1986, in company with the architect who had designed it. I was impressed, and the concept stayed in my mind, although it was a decade or so before I started to work on Planetree Canada.
When I did, I would begin all my workshops with four simple questions: First, can I get a good night’s sleep in your hospital? Second, do you have the healthiest food in your community? Third, are you the healthiest workplace in your community? Fourth, are you the most environmentally responsible corporate citizen in your community?
Obviously, the answer to all four should be yes; as the “temple of healing” in the community, the hospital should be a model healthy setting. But in fact, it was rare that even a small number of the participants — whether hospital staff, managers or the public — said yes. The usual response was discomfort, some giggling, even outright laughter.
So what is wrong with this picture? Why can’t a patient get a good night’s sleep in hospital? After all, what is more healing than sleep when you are sick? Why does hospital food have such a poor reputation? What is more important than delicious, healthy food? And surely a hospital should not be harming the environment, when we know that in doing so it is indirectly and sometimes directly harming well-being in the surrounding community.
But what is particularly disturbing is how unhealthy the hospital is as a workplace. Graham Lowe, a workplace health expert and professor emeritus at the University of Alberta, reported in 2002 that in Canada, nursing, technical and support staff in health care had the highest number of days lost due to personal illness or injury of any occupation, double or more the national average.
The now-discontinued Occupational Health and Safety Agency for Health Care in British Columbia noted in 2004 that the risks they faced were from infectious diseases, violence from patients or residents with dementia, allergic reactions from chemical agents, and strains and injuries associated with patient-handling. The agency later cited a 2005 Statistics Canada study of the work and health of nurses, noting:
“Health-care professionals gave the lowest rating on questions related to a healthy and supportive work environment, [and] health-care professionals ranked the lowest of all on trust in their employer, commitment to their employer, workplace communication and decision-making influence.”
This is not just an issue for nurses; this is an important safety concern for patients and their families. How can nurses and other hospital staff be expected to provide high-quality patient care under such circumstances? Add to that the trend in some places to 12-hour shifts for nurses — a recent U.K. report notes that nurses working such shifts are “more likely to report poor-quality care, poor patient safety and more care left undone” — and we have a major problem on our hands.
Next week, I will delve further into these issues and suggest some remedies.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.