20 YEARS IN OP E RAT ING THEAT R E S
Healthcare: twenty years of progress?
As part of CSJ’s anniversary celebrations, Kate Woodhead RGN DMS reflects on the changes she has witnessed over the past 20 years. She interviewed some of the Association for Perioperative Practice’s previous presidents for their reflections and expert insights too.
Healthcare has changed immeasurably over the last twenty years, as my colleagues interviewed for this anniversary edition will testify. While many healthcare professionals were once seen as subservient to the medical profession and did their bidding, now nurses and professions allied to medicine (such as physiotherapists and radiographers) conduct detailed patient assessments, prescribe drugs and work to a large extent autonomously. There has been a large movement towards specialist practice within the professions and there are now few generalists in acute care. In parallel, there has been a great change in the level of education. Nurses, in particular, are largely degree holders and many individuals go on to undertake PhDs. Technology has perhaps made the greatest change in healthcare, enabling far better diagnostics using magnetic resonance imaging, for example. Minimally invasive
surgery has reduced the length of time a patient has to spend in hospital and developments in endoscopy have enabled treatments to be delivered directly, avoiding invasive surgery. Transplants have evolved due to drug therapies, which could not have been dreamed of twenty years ago. Interventional radiography has saved many lives. Patient safety science has brought much to the table and, as Professor Jane Reid reminds us, human factors learning has given us a far greater understanding of the way we behave as healthcare professionals when managing patient care and teamwork. Focus on patient safety, since the publication of To Err is Human,1
has
been immense in all developed healthcare systems around the world. In surgery, the development and implementation of the World Health Organization Surgical Checklist has no doubt reduced the
number of surgical incidents and mistakes and increased efficiency and teamwork. Awareness of patient safety science has reduced the number of patient safety incidents and healthcare infections have also fallen – although data to support this is difficult to find, as data gathering is so much better now than it was. To do justice to the longevity of The Clinical
Services Journal, it does no harm to review the last twenty years of healthcare on which the journal has reported continually. This author chose to interview some of the past presidents of the Association for Perioperative Practice (AfPP) to take a look backwards over our shoulders at where we have come from. The individuals have all worked at a high level in healthcare with over thirty to forty years of experience. Most are still active both voluntarily and in fulltime healthcare. Melanie van Limborgh was chair of the National Association of Theatre Nurses 2002-2005 (now the AfPP) but is currently director of nursing at a London Trust. She focuses largely on progress for nursing over the last twenty years. She said that there is greater structure to work now, mostly brought about by digitisation of care plans and the effect of ward and department accreditation via Care Quality Commission processes. Melanie suggested that we have improved in our clinical decision making and the accountability for it, now that we have more recognised frameworks. She added that clinical equipment has greatly improved – especially where there is monitoring that captures the data, allowing for clinical risk identification.
Single patient use equipment and the national decontamination changes with track and trace for instruments has reduced risk in surgery and made progress for the good. Revalidation in nursing and midwifery has made great strides forward, with its focus
NOVEMBER 2022
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