Michael Patkin's

  Hospital switchboards

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If a switchboard is not the brain of a hospital, it corresponds closely to the spinal cord. Messages pass to it from both within and outside the hospital, to be relayed so that effective action should take place without delay. If the intermediate cell in this relay does not function well, the results vary from plain bad temper to jeopardy for patients,

Common experience suggests that little formal attention has been paid to the importance and working of hospital switchboards. Someone waiting impatiently for the switchboard to answer might imagine that the operators were lolling back comfortably in their padded swivel chairs, discussing the weather or knitting a couple of rows of wool.

The truth is very far from this. The usual scene at peak hours of mid-morning or late afternoon is one of frantic activity. Coloured panel lights blink on, outside calls are acknowledged, terminals are dialled or plugged in, paging code numbers are actuated, and placatory verbal gestures are made to disembodied voices outraged with impatience. The skill and patience of an experienced switchboard operator must be seen to be appreciated, and suggest the need for much more care than is customary in choosing suitable operators, if one is to eliminate unduly long delays in non-peak periods.

Delay at a hospital switchboard does not have to be accepted like bad weather. This delay can be analysed and put right by a simple analysis for partial improvement and a deep examination with appropriate remedies for best results. Some of the remedies are surprisingly simple, and so obvious! Perhaps it is beneath the dignity of senior doctors or hospital board members to bother about such apparent trivia. Yet the reputation of a hospital, as well as its efficiency, is on trial every time a telephone call is addressed to it.

Just as sensory bombardment can confuse a patient, so too many calls -- or too few operators -- lead to a blockage. A typical hospital with 600 to 700 beds may have over 20 outside lines operating at the one time. Any additional telephone callers -- and there may be a dozen of them at a busy time -- must simply wait their turn as the lines are one by one.

In principle, the remedies are simple -- reduce the number of calls and increase switchboard facilities and operators until the equation is balanced. In practice, the problem can only he skirted in a few hundred words. Many factors enter.

Where can direct outside dialling be introduced without leaving a "free" service open to abuse? Can outside calls be restricted so that personal calls between Sydney and Perth do not add to the hospital's running costs? What departments of a hospital should have their own separately listed numbers?

Some telephones in a hospital often lack a person close by to answer a call, so that it takes many minutes to get an answer, if there is an answer at all. Can such telephones be placed better? Some members of hospital staff have hazy ideas about telephone manners, or immature ideas about the relative importance of dignity (or."pecking order") and promptness. Many callers have exaggerated ideas about what sort of information to expect by telephone, or demand long explanations from a doctor unavoidably busy with other work. (This has led to an interesting ploy, called the "muff-it" ploy, in which the doctor cuts off the caller during his own speech. The caller then blames a technical fault for the abrupt end, never imagining someone would interrupt himself in this way.)

Internal telephone directories can be a problem. It not tattered, hidden or lost, the directory may be printed on a duplicator almost dry of ink, or the numbers may be two or three inches away from the entry, so that it is a gymnastic ocular feat to determine which number corresponds to the phrasing opposite, especially with numbered wards. Even the listings may be confusing. For a hospital veteran the locally used name for each department may be obvious, but the new resident may easily fail to find a number under the more usual headings.

One important step is for hospitals to have more coin-operated telephones, and handy small change of money. Personal calls by hospital staff would be achieved much more quickly, and none should quarrel with the five cents' cost, which has no business coming out of the public purse. Patients who are ambulant could telephone their families from a handy coin box, saving many incoming calls, the need for favours and avoidable dependence on the hospital. Even senior consultants would be glad to part with five cents for the convenience of dialling out directly to their cleared rooms instead of waiting on a complicated series of connections

If facilities are provided on every floor of new hospitals in which people may spend a penny, it is reasonable in this electronic age to have comparable facilities on every floor where they may sit down to spend five cents.



Some details date this piece as 35 years old, for example phone calls costing 5 cents and no mention of mobile phones.

However the general principles still apply - unthinking administration.

Some of the remedies are surprisingly simple, and so obvious!"

Medical Journal of Australia June 12, 1971 p 1253