“What is important is seldom urgent, and what is urgent is seldom important.”
– Dwight Eisenhower
In September 2013, as I took on the medical director role, the outgoing director handed me a symbolic firefighter’s hat. In a hospital that runs minute to minute, shilling to shilling, it was a strikingly appropriate gesture – knowing that every day there would be a sudden crisis – a staff member quitting, a critical machine breaking, national strikes, not enough beds, too many emergencies. Urgent, important issues requiring thought and attention and action to be a part of keeping this institution providing the kind of care that we are all passionate about.
I entered the job with enthusiasm and optimism that a year would be a good period of time to commit to serving the doctors, therapists and hospital. By March, I knew that a year was long enough to do only that – keep up with the emails, put out the fires. But after 6 months in the job, and only just having got my head around the issues, finances, relationships, patterns and history of the hospital, I knew that in order to make any long-term changes and progress, I’d need to stay in this job for 2-3 years.
I also realised that we are all really busy here, all the time. It’s not just me putting out fires – every member of the medical team is dealing with daily struggles of too-many too-sick patients, visiting doctors needing help, trainees needing teaching. Leaving little time for stepping back, looking at the hospital as a whole, and asking – where are we going? Where do we want to be 5 years from now? How do we get there? What needs to change?
In order for us to be able to sit down together and look ahead at the next 5 years, we’d need to sacrifice time away from the hospital, without distractions. So in May, I asked all of the senior long-term medical team (doctors, therapists, nurse anesthetists, dentists, lab managers) to book September 26th as an entire day away from the hospital. Thirty-five of us cancelling elective surgeries, specialty clinics, finding visiting and shorter term doctors to cover us. The difficult decision to put patients who have been waiting to see us, sometimes for months, on a waiting list for another week. Thirty five of us leaving the hospital emergencies to trainees and visitors while we sat down together for 9 hours at a conference centre 45 minutes away to take a step back and look at the big picture.
I honestly didn’t know if it would work. If anyone would actually come to the day, whether other urgent, important things would get in the way.
But on Friday, it happened. I cannot tell you how encouraging it was to sit down with this team – people who have served at the hospital for between 3 days and 15 years, with a balance of fresh perspective and institutional memory and wisdom. To see the 2 orthopaedic doctors step away from the never-decreasing waiting list and have time to talk about – what is our vision for orthopaedics here? To see the dentists aligning on the education they passionately want to provide to other Kenyan trainees. To watch the medicine, pediatric and outpatient teams start to form a concrete plan for better care of patients between 7pm – 8am when tired medics can forget things and important issues become “lost”.
To hear the dental, audiology, physio and speech teams start to develop tentative plans for a multidisciplinary approach to children with cleft palate. To watch surgeons and anesthetists honestly assess issues that keep the operating theatre from better efficiency, and brainstorm ways to get more surgeries done in less time so that desperate patients don’t need to wait so long. To laugh together about outlandish dreams of state-of-the-art staff gym facilities and presidential candidates from our ranks. To pray with each other and encourage each other and realise how blessed we are to have each other as colleagues and how much more effective we are if we work together rather than as individuals.
The goal of the day for was not to come up with a 17-point interdepartmental plan for the next 5 years. But it was to get us all together, talking about those non-urgent but important issues that get crowded out every day by roaring fires. To have each department encouraged by the struggles and successes of the others. To be reminded again of the big picture and of how we all need each other within it. To start conversations that I pray will continue in the coming days, weeks and months as we have smaller scale opportunities to review, analyse, plan and improve. It was a long day for everyone, but it was the first time in living history that we’ve had a day like this as a division, and it won’t be the last.
We are setting the date for another retreat 12 months from now, as if it isn’t planned in advance and committed to, it just won’t happen. Like the easily neglected exercise, sleeping 7-9 hours a night, saving money, prayer – it’s not urgent stuff, but it is so important. I think when I hand over the medical director role to whoever does it next, in addition to a firefighter’s hat, I’m also going to give them a big, stuffed Smokey the Bear and tell them – “Remember – only you can prevent forest fires”.