In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for “Big Barn”) still retained the same aura of celebrity. As a medical student I walked the wards where history had and was being made. Members of the surgical team from that historic event were still to be seen on ward rounds, in the ICU’s, in the operating rooms, and in the communal tearoom. Even Barnard, although no longer operating, maintained a presence – although he missed every lecture scheduled with my class without apology.
The tearoom was in the heart of the hospital, close to all wards, departments and lecture rooms. It was bright and roomy, with faded but comfortable lounge chairs and large wooden tables. And at 10am every day tea and coffee was served without charge in huge pots and white cups to every doctor and medical student who wanted it.
Barnard aside, professors and specialists from all departments would sit in the tea room alongside junior medical students, continue case discussions, answer questions, greet colleagues, accept referrals, or debate completely non-medical issues. For half an hour the medical brain of Groote Schuur Hospital relaxed over a hot refreshment and gathered itself for the hectic day and night that would follow.
And one day the teas were stopped as part of the first cost-cutting exercises that were to dominate provision of medical services for all the years to follow. The tea room was closed and used for something else. Staff were expected to make their own arrangements over tea break, and most could not be bothered to meet together with other departments. There was no cafeteria that doubled as a communal meeting place. As a result, the sense of community within the hospital began to disappear. Friendly, informative and regular companionship amongst future and current professionals of different departments abruptly came to an end.
When I look back, Groote Schuur Hospital changed dramatically at the same time. I qualified, left, and returned ten years later to specialise. By this time a completely new hospital wing had been built, to which all the wards migrated. It had a commercial cafeteria with a more impersonal, sterile, and clinical atmosphere, completely different to the older one. There was no communal meeting place open to students and doctors together, certainly nothing with the warmth, informality and sense of community of the old tearoom. The aura of the old hospital, the sense of celebrity and of history had vanished. Certainly the morale of the doctors had changed. The hierarchy seemed more impenetrable, students and their teachers did not mix as well. In essence, professional relationships and communication within the hospital changed.
Not only in Groote Schuur Hospital. Across South Africa the same happened in hundreds of hospitals as administrators scurried to cut costs. I question just how much money the scrapping of a regular tea provision saved in the long term, particularly when seen against the long term cost in morale.
No hospital I know has managed to recreate the same sense for staff nearly thirty years ago of being part of a wide healthcare community derived in such a simple and inexpensive way. The state hospital tearooms where they exist are still gloomy, cramped, furnished with discarded furniture, and certainly not supplied with inexpensive refreshments. Doctors younger than me have probably never experienced the same camaraderie across a whole hospital as I did, and sadly, their careers are poorer for it.
Other industries across the world have focused on their primary and most critical resource with great success – the people working for them. In hindsight, this cancellation cost Groote Schuur and the system far, far more than it ever saved, with ramifications that went way beyond those familiar and friendly walls. My hospital lost its heart the day the tearoom closed, and doctors and their patients paid the consequences.
The health industry forgets this at its peril.
Martin Young is an otolaryngologist in South Africa and founder and CEO of ConsentCare.
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