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Customer is king: Visiting a private sector intensive care unit

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When it comes to hospitals in Marylebone, one normally thinks first of UCLH. But I learnt recently that behind the Georgian facades nearer Great Portland Street lies one of the country’s largest independent hospitals.

As a registered charity, the London Clinic does more than your average “private hospital”, having an intensive care unit, cancer treatment rooms and a stem cell donation centre – all of which I have the pleasure of visiting one morning at the beginning of December.

“Passion for good care runs across the profession, regardless of sector”

Walking in the front door, I am immediately struck by the fact that it felt more like entering an office than a hospital. The reception desk felt more corporate somehow.

This prompts me to make a stupid comment about whether there is a larger entrance out the back, though it gradually dawns on me that it’s not the sort of place that expects ambulances. My weak excuse is that I’m not properly awake yet after a night disturbed by my two-year-old daughter.

However, once taken through to the clinical settings things seem like any other hospital, though I have to admit the art on the walls is strikingly good and I notice that some of the ceiling panels are covered with images of the sky, which it occurs to me must be a nice touch for someone on a trolley.

Needless to say, the staff I meet all came across as passionate and proud about their roles and the care they provide – impressively so, in fact.

So what is behind my visit? I am principally here to look at the new intensive care unit – something of a rarity in the private sector, I am told – while also taking a welcome opportunity to get out of the office and meet some health professionals.

“Out of the blue, I am asked what my favourite football team is”

My guides are intensive care unit manager Afonso Varela, and Nuala Close, the hospital’s matron/ director of nursing.

They showed me up to the third floor, where they are clearly proud of their brand new, state-the-art intensive care unit. They moved in two weeks ago – probably about a month as I write this.

When it’s fully operational, it will boast 13 rooms, of which five have en suite facilities. Four are full isolation rooms, offering both negative and positive pressure for advanced infection control.

There are nursing stations outside every room, with simple sight lines so patients can be monitored without being disturbed and records can be updated easily. They also have mobile hoists and equipment so patients can wash or be washed easily, and there are computers inside and outside the rooms and, unusually, lockable cupboards for patients to store their belongings.

So far so good. But then it gets really flash and I must admit I’m rather impressed. I am given a demonstration of “smart glass” technology that can be switched from transparent to opaque with the press of a button – giving privacy to patients and relatives.

The London Clinic

Customer is king: Visiting a private sector intensive care unit

ICU nursing station

And then it gets better still. There are multi-functional television screens that can display live images from patients’ homes and interactive tours around their favourite museums – clear evidence of what I’m told is the hospital’s “customer focus”.

To reinforce this point, I am told about the “call bell system”, which basically means the nurses all have a tag on their uniforms that notifies them when a patient wants them.

Meanwhile, a green light comes on in the room when a nurse is in attendance and, in an emergency, lights flash alerting staff outside – I am given an effective demonstration!

Then, out of the blue – or in my case, claret and blue – I am asked what my favourite football team is. I cautiously reply West Ham – you never know how these things are going to go down with people – at which point some of the lights in the room take on a purple hew.

I am thus informed that there is a choice of different coloured lighting in the patient rooms. And if mood lighting isn’t your thing, the room I am in has a view of the outside world through triple-glazed windows – and all have blackout blinds, are ventilated with natural air to reduce infection risk and have heated panels in the ceiling that act like radiators.

It’s “all about patient experience”, highlights Ms Close, with the temperature, noise levels and light all carefully blended.

However, despite all the impressive technology, Ms Close notes that it is all a relatively new development for the hospital.

Nuala Close

Nuala Close

Nuala Close

The new unit – five years in the planning – has replaced an old one that was “not state of the art”, she admits. It was “dated” and had 11 beds and five isolation rooms, as opposed to the 13 rooms in the new one, she says, adding that the move was “customer driven”.

However, my guides admit that some things are not quite there yet – the CCTV in the rooms is not live, some of the rooms are still being used for storage and, perhaps surprisingly given the technology on show, the unit still uses paper.

Mr Varela highlights though that the unit is “almost paperless” and it should be completely so by mid-2017 – with echoes of most NHS IT programmes, they are running late on a target of January.

After a look round the impressive critical care facilities, I have a chance to sit down in the staff room and chat to Ms Close, who has been at the hospital for four and a half years and was interviewed recently by Nursing Times, and Mr Varela, the highly articulate head of department.

In answer to my questions, they note some similarities to nurses working in much of the country. For example, they work 12-hour shifts – increasingly popular elsewhere – and they have a multi-national team with at least a dozen countries represented.

The unit has nurses from Portugal, Ireland, South Africa, Italy, Spain, France, India, the West Indies, India, Philippines, a “couple from England” and, possibly less likely in the NHS, one from Iran.

Mr Varela is clearly proud of the facilities and dedicated to his team, but he is also open about the challenges he faces.

I am perhaps surprised to learn that it can be a real challenge when the unit is at full or near full capacity, with resources “stretched”. It “can be a really dynamic environment in terms of patient needs”, notes Mr Varela.

“I am told they have royal guests, sometimes, and celebrities who bring their own security teams”

What again surprises me is that, in spite of the state of the art setting and better pay on offer, both my guides highlight the unit is suffering from problems recruiting and retaining nursing staff, which they suggest is reflected across the private sector and is not just an issue for the health service.

Likewise, my guides freely acknowledge that the hospital and ICU have to fill gaps with either bank or agency nursing staff. In fact, they describe their levels of agency use as “higher than usual” and “more than the NHS” – though they highlight they use the same agency and staff do a full induction.

At the moment, the unit employs 45 full-time staff, including two healthcare assistants and around 40 registered nurses. But the hospital’s business plan is to double the number of ICU nurses.

Ms Close notes that one of the recruitment problems is that recently qualified nurses do not think the private ICU environment is “dynamic enough”, as they are looking for “excitement and action”.

As a result, she notes that the unit tends to look for nurses who are more experienced and “not so eager” for the action roles and more focused on the patient care element.

The London Clinic

Customer is king: Visiting a private sector intensive care unit

ICU equipment and skyline

At the end of the day, perhaps some of the pressure comes from the expectations of the hospital’s wealthy cliental. The word “customer” is used several times during my visit, which hints at a whole new level of expectation on top of safe, compassionate nursing care – a seventh “C” perhaps?

Reinforcing this point, I am told they have royal guests, sometimes, and celebrities who bring their own security teams. In addition, catering is available at most times and the hospital employs a patient experience manager who deals with “all things quality”.

The “mind set is we are in the private sector”, says Ms Close, with a “different expectation to the NHS”.

Likewise, Mr Varela adds: “I expect my nurses to go the extra length to be delicate when dealing with patient experience.”

Acknowledging the extra challenge that accompanies this, Ms Close notes there are some patients and relatives “who think throwing money at something” will always get them what they want.

But she tells me there are moves underway on “building resilience in the team” and on “how to look after each other” during periods of “high stress” for the unit’s staff.

Mr Varela explains that one of the innovations being tried is a monthly team day, where a 50-page agenda on concerns raised by staff and updates on ways of working are discussed as a group. The ICU team is broken into two, with each half spending an entire day together.

There are also opportunities for nurses to shadow staff in other departments, for example theatres, to see if they would like a change of setting, but without losing them from the hospital altogether.

In addition, by introducing more integrated work process, they are “trying to break down” the idea of ICU nurses being “elite” and in a “bubble”.

“We also inspect the different heads that can be attached to the device – like a set of drill bits”

After my tour of ICU, it was across the road – though I’m told there is also a tunnel under it – and down to radiotherapy. There I was greeted by more really engaging and enthusiastic staff, keen to explain how their cancer treatment worked.

I had heard of a CyberKnife – a robotic radiosurgery system used as a non-invasive alternative to surgery – but never come face to face with one. To me, it looks like a cross between something you’d find in a car factory and a laser from a James Bond film.

My guide explains that the robot can adjust to the slightest movement by the patient who is required to remain still but awake during the procedure. Something I imagine to be quite difficult.

We also inspect the different heads that can be attached to the device, depending on the required size and focus of the radiotherapy dose – like a set of drill bits, I think.

Also impressive is the foot-wide door in and out of the treatment room, indicating the serious levels of radiation involved.

The London Clinic

Customer is king: Visiting a private sector intensive care unit

The CyberKnife

My last stop is upstairs in the stem cell transplant area where I meet nurse Omar Domingo, who is in the middle of overseeing a volunteer donate his stem cells for a matched cancer patient.

They are about halfway through the four-hour process that involves a rather large needle and a machine that look a bit like something out of the film Return to Oz, with lots of turning dials and blood bags – actually an amazing piece of kit called a cell-separator machine that separates blood into its various components using a centrifuge.

Mr Domingo is one of two clinicians recently shortlisted for the Clinical Supporter of the Year award from the charity Anthony Nolan, coming away with a “highly commended”.

My visit leads me to recall that around a fifth of England’s roughly 500,000 nurses work in the private or independent sector.

I, like many others, am probably guilty of focusing too much on the NHS when writing about nursing. But what I’ve learnt on my visit to the London Clinic is that passion for good care runs across the profession, regardless of sector.

The London Clinic

Customer is king: Visiting a private sector intensive care unit

ICU nursing station at the London Clinic

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