Same sex facilities call for changed attitudes more than new buildings

Delivering single sex accommodation involves shifting acceptance of mixed accommodation to intolerance and redesigning systems and processes rather than the building itself.

When did we begin to think it was justifiable to put men and women in the same bay sharing sleeping accommodation and toilets?

A year ago, then health secretary Alan Johnson announced a drive to virtually eliminate mixed sex accommodation, providing a £100m privacy and dignity fund to help.

This goal will be achieved and sustained if positioned in the broader framework of improving privacy and dignity through the overall patient experience, as well as understanding how it supports QIPP (quality, innovation, productivity and prevention).

The link with the “quality” component is obvious but, unexpectedly, early findings from our improvement reviews highlight a highly relevant implication for productivity too.

Starting with quality, when did we begin to think it was justifiable to put men and women in the same bay sharing sleeping accommodation and toilets? How did we become immune to this infringement of the most basic aspect of privacy and dignity? Thinking on a personal level about how sharing these facilities affects patients makes the case to change a compelling one.

Tackling it should be an integral part of delivering high quality patient care and a positive patient experience, rather than simply thinking of it as “another pseudo-target” or “must-do”.

Last year I suggested the principles used to make significant reductions in MRSA and C difficile were transferable to other improvement efforts. Working with strategic health authority leads, we have put this to the test in developing a programme plan that includes diagnostic reviews and tools trusts can use to deliver same-sex accommodation.

Our early trust visits and reviews engendered a sense of déjà vu as teams were told it is impossible to deliver same sex accommodation due to targets, high bed occupancy and building design. It confirmed our hypothesis that addressing belief and behaviour is as great a challenge as redesigning systems and processes. So the programme includes strategies aimed at achieving a shift from acceptance to intolerance, mirroring the cultural change that has emerged with reducing infections.

Demand and flow

We have also determined that, overall, delivering same sex accommodation is less about buildings and more about how organisations manage capacity, demand and patient flow.

Very few organisations have examined in much detail the gender split by specialty or elective/non-elective demand or understand whether there is any level of predictability. They cannot therefore say whether the existing configuration of beds supports or hinders delivery of same sex accommodation.

Equally, good practice in managing demand and patient flow appears varied within organisations, with trusts doing elements of the proven recommended practice but rarely all of it. It seems lots of work has been done on front end improvement to enable patients to move from accident and emergency in four hours, but far less work has been done on other organisational systems and processes that can affect the patient journey.

There has been a concerted effort to achieve same sex accommodation over the last few months. Where trusts still appear to face challenges is with emergency admissions and assessment units. We have urged trusts not to start from “how do I provide same sex accommodation” but with reviewing the purpose and function of their unit.

The principles on which assessment units were created appear to have been lost in many organisations. It means they often function more as short stay wards that are often not conducive to extended stays.

It is important actions taken do not have unintended consequences for other aspects of service delivery. Achieving same sex accommodation may require a more radical and fundamental rethink, one that involves organisations and health economies revisiting how they are managing demand, capacity and flow, and using resources, such as the tools developed by the NHS Institute and the Institute for Healthcare Improvement, to make the necessary changes.

Delivering single sex wards offers an opportunity to understand where productivity improvements can occur, while improving patient experience and safety. There are without doubt significant gains to be made in reducing unnecessary bed days, which will both help in placing patients appropriately and improve overall productivity.

How will success be measured? There is no single metric although many trusts and PCT commissioners have developed bespoke systems to provide assurance. Ultimately, success will be judged through patients’ eyes. Many trusts are already seeking patients’ views through their own surveys and those results will be an important indicator of local progress. Active patient engagement will be important.

A few weeks ago I personally had day surgery in a mixed sex facility, and it was not pleasant. Although a number of clinicians have challenged the need for same sex accommodation in short stay surgery, I can attest that there is no dignity and very limited privacy in having to wear a patient gown and sit next to two male patients, even for three hours.