A Day in a Hospital in Prague

“Hey Jaded Julie, remember when we talked about falls back on February 12?”

“Of course I do. You said your wife was vertically challenged; I figured that meant she falls a lot.”

“Well, she did it again.”

“Was she hurt?”

“This fall was worse than usual. She tripped on a marble step, fell on the hard surface, and dislocated her right shoulder.”

“Oo, sounds bad. Where did it happen?”

“In a hotel in Prague, Czech Republic. We spent the rest of the day in the local hospital getting her shoulder relocated. Being the connoisseur of health care that you are, I thought you’d want to learn what a Czech hospital is like.”

“Are you sure you didn’t push your wife just so we’d have something to talk about?”

“I’m sure. Now I have to wait on her hand and foot. With her right shoulder, arm, and hand immobilized, she can’t even unscrew the top of a tube of toothpaste.”

“So the hotel called an ambulance, and they rushed your wife to the hospital, right?”

“Right. The ambulance ride was unremarkable except that I had to pay the equivalent of $100 in Czech money before they unloaded her. Then they rolled the gurney down the middle of the hallway that served as the ED waiting room. Only a few waiting patients looked up. They put her on an unpadded stainless steel table for a perfunctory triage.”

“Per…what? Well, a dislocated shoulder is pretty obvious.”

“After that, they plopped my wife into an ancient wheelchair, and we joined the line of sick and injured in the hallway. My wife’s requests for pain medication were ignored. After about an hour, a doctor came by and said that we would have to wait a couple more hours (four hours after her last meal) before he could work on her shoulder. They moved her to an inpatient room to wait. Her wheelchair was pushed by a silent, absolutely expressionless male.”

“Was the room what you’d expect in the United States?”

“Not at all. The whole hospital was 1940’s vintage. Perhaps that’s understandable, because only 20 years have passed since the ‘velvet revolution’ when the Czechs threw out their communist rulers.”

“You were telling me about the room.”

“Cast iron beds, four per room. Gas lines were on, not in, the walls. My wife had one roommate, an older woman who had had surgery on her foot. The hospital was not crowded.”

“I think I can understand why.”

“After awhile, they took my wife out for x-rays. They used what appeared to be old-fashioned plates, and the x-ray technician also read the x-rays. I had to pay cash on the barrelhead, the equivalent of about $30, for each x-ray. Finally, they took my wife to reduce (relocate) her shoulder. After some sort of IV anesthesia but before it could take effect, the doc put her shoulder back into place. It required three attempts. Three people held her down; I could hear her screams where I waited in the hallway. After another follow-up x-ray (another $30 worth of Czech currency), she was taken back to her room. We had to wait another four hours before being released. Fortunately, the hospital accepted my credit card.”

“I presume your fluency in Czech made the hospital stay easier.”

“My fluency is limited to ‘hello,’ ‘goodbye,’ ‘please,’ ‘thank you,’ and how to order a beer (pivo). In our rush to the hospital, I left my Czech phrasebook back at the hotel.”

“But don’t most Czechs speak English?”

“Children and doctors do, but the nurses didn’t. Our communication was almost comparable to that of a Czech couple in a U.S. hospital.”

“If you had been able to communicate, you could have taught the Czechs about Personalized Care.”

“I’m sure they never heard of Lean or Quint Studer. A little AIDET or C.A.R.E. would have been nice. I fear that what might be viewed as standard work was a bunch of rigid rules left over from communist days. I’m surely glad my wife didn’t have to have any sort of incision; one would be very fearful of nosocomial infections in that place.”

“How well did the hospital staff do with hand hygiene?”

“The nurse who cared for my wife put on rubber gloves when she emptied the roommate’s urine bag. But I don’t recall her washing her hands or using hand sanitizer. Nevertheless, she was the one cheerful, friendly person that we encountered.”

“So how would you sum up your experience in the hospital?”

“They probably practice acceptable medicine. I’ll know that better if my wife makes a full recovery. However, their reduction of her shoulder without effective anesthesia is not typical practice in the U.S. In my view, the hospital (which we later learned was a state hospital) was drab, dreary, depressing, unfriendly, rigid, and totally devoid of a healing environment.”

“And do you have any final words for the Czech hospital?”

“I sure do. ‘Na shledanou.’ It means ‘goodbye.’”

Affinity’s Kaizen Curmudgeon