There’s an entirely different feel to the afternoon and midnight shifts in a hospital.
During the “normal” working hours of the day shift, much of the activity in a hospital centers on patient diagnosis and therapy (the processes of care).
And doctors are in abundance in the halls and the procedure rooms.
For the most part, there’s a shift after hours to the on-going maintenance and care of the patients through the hospitalization process: fewer doctors and people, but still a lot of ongoing processes of care.
There is an “aloneness” that one feels in the halls of a hospital, especially after normal visiting hours are over.
Being removed from the usual day-to-day communication and involvement of management, off-hours staff are curiously more interactive, more social, and much more eager to talk with the management about quality, safety, pay and even rumors.
Some areas of the hospital actually are more bustling in the off hours.
The emergency department peaks activities in these hours, carrying patients over from the day and having the influx of patients with new illnesses or injuries.
In addition, the lack of access to primary care services in urban settings such as Detroit, patients come in after working their day job to have themselves or family members seen for routine care (CAT 3) in the ER.
The general laboratory services operation works round the clock, often with a larger team of technicians than during the day.
As CEO, I see an entirely different hospital and staff on these rounds.
Different issues (i.e. rules for visiting hours) have greater priority for them.
They take for granted that a smaller contingent of physicians are in the house, and act with greater independence.
Interestingly, they don’t take a visit by the CEO for granted.
By and large, they take the opportunity to ask the tough questions but are appreciative and welcoming – trying to bridge the “aloneness.”