Small is beautiful. Under the covers part 2.

A few months ago, completely out of the blue, I learnt that I had a problem with the flow of cerebral spinal fluid (CSF) in my head. It was caused by a thing called a Chiari Malformation – which I’d probably had since birth.

I had an operation to reduce the risk of potentially serious problems developing in the future. Actually there were five separate stages to the operation…this image I found on instagram sums it up quite succinctly


I’m not surprised the whole thing took around 7 hours to complete. It’s impossible not to be in awe of the skill of the surgeons who can do this sort of thing inside your head…and leave you up and about a few days later [A quick glance at the diagrams in this information sheet will be more than enough details for most].

I’ve no idea how much this sophisticated kind of treatment might have cost. I tried searching the NHS England National Tarriff but couldn’t find anything. A search of US healthcare sites on Google would suggest tens of thousands of dollars.

The NHS does the big stuff really well and I am very grateful.

But the small stuff? Not so good.

Finding out whether I was actually going to have an operation was hard work. I’d had a provisional date for months but had been told my Consultant needed to take my case to his team meeting. I had to chase and chase to finally get confirmation of the date just over a week before it happened.

We arrived at 7am on the designated day with a bag containing the items listed in a fact sheet I was given at my pre-op. We were shown to the day room where other couples sat looking apprehensive and unsure about what would happen next. Grim doesn’t come close. This space was where people in pain and about to undergo brain surgery waited for three hours or more. I get tyres changed at Kwik-Fit and I’m pretty sure they would be ashamed of this if it were their customer waiting area. (The sign on the wall, by the way, asked people not to move the bin. The thought never crossed my mind.)


No one explained what exactly was going to happen or how long it would take before anything happened. Eventually I was invited to another room to talk to a very friendly anesthetist. Then after another hour or so a doctor invited me and my wife Jo to join him in another room where he went through all the things that might go wrong with the operation and asked me to sign a consent form. It all really sunk in for Jo at this point.

Another long wait and then a nurse asked us to join her…this time in a sort of store room come office with just a curtain to screen it off. All the information and blood samples I had given at my pre-op had got mislaid so the nurse took more bloods and asked me lots of questions I’d already answered once. The curtain opened and someone in a gown burst in. They were ready to take me down for my anesthetic. “Ooh! quick, put these on!” said the nurse thrusting a gown and support stockings into my hands. So in a tiny space I stripped off and tried to work out how to do the gown up while an impatient trolley man stood waiting and the nurse double checked my post code.

If it wasn’t Alan Ayckbourn enough already, at this point my Consultant showed up. It seemed that the junior doctor who did my consent form had forgotten to mention something horrible that might happen so he had to quickly run through the whole grisly process again. This is when it got a bit too much for poor old Jo.

Finally I was ready to be wheeled away.

“What about my bag?” we asked.

The nurse looked around.

“Well you could leave it here I suppose but it might get nicked!”.

So my bag, carefully packed with all the things the hospital had advised me to bring with me that morning, was left with Jo to take home; and I waved goodbye as I disappeared down the corridor on the trolley.

The operation went well. I was discharged from hospital. After a few weeks recovery at home I went back to work and life has soon picked up its old rhythm. I have a rather nice scar on the back of my neck but I can’t see it so I often forget it’s even there.

But I don’t think I’ll ever forget those first three hours in the hospital and how they made us feel.

There has to be a lesson here for any of us involved in designing services or making investment decisions. It’s really important to get the big things right but the small things; the things that might not cost much (or which might even be free) can leave an even more lasting impression on those using our service; and not always the one we’d like them to have.




6 responses to “Small is beautiful. Under the covers part 2.

  1. Wow, what a harrowing experience for you and Jo to have gone through. It’s been good seeing you around the office again John but I really had no idea just how much you’d been through during your time away. It’s amazing what these surgeons, and their team, can do for people. All of those years in education, on the job-training and seemingly endless shifts to enable them to fine tune their profession is nothing to be sniffed at. Yet, all that invested time, effort and money so quickly becomes undone by the simplest of flaws in what feels to me like basic customer service. Things like; give others the same respect you’d to expect be given to you and look after others’ belongings as if they were your own. I hope this blog finds its way to the people with the power and influence to enforce change…and quickly.


    • Thanks Andy. I guess I rather laughed off what I was going to have done before I went into hospital….and it was all a bit sudden. Agree with you though. The NHS has invested so much time and money in things that are incredibly hard to do but seems oblivious to how bad it can be at the things that many sectors get right every day.

      Liked by 1 person

  2. I’ve heard and witnessed similar experiences where you cannot fault the skill, dedication and amazing work of surgeons and the majority of hospital staff mean well and work hard. Often it’s the systems and mixed communications, not the people. that are at fault although a few probably do get de-sensitised about the profound trauma the waiting, endless duplicated questions, incorrect information along with several warnings of what can go wrong can have on patients. Glad the op was so successful and you’ve made a really speedy recovery.

    Liked by 2 people

    • Thanks for that Sue. I did meet lots of fantastic people…all in all I had a thoroughly enjoyable and fascinating time in hospital. The frustrating thing was how easily the things that don’t work could be addressed if only there was a will.


  3. Hi Peter. I’m more or less fine now thanks (actually I still wake with a headache and it returns mid evening – so just had two paracetamol. I was told on 25th October that I’d get a follow up meeting with my Consultant after 6-8 weeks. I rang after 8 weeks to be told “Oh the hospital always says that….it”l be 8-12 weeks”….well it’s now been 16 weeks and counting!).

    I just read your LinkedIn piece. Dreadful. Last time I went to A&E (it was a return visit after the woman who took an x-ray said I’d broken a bone but 3 hours later a junior doctor said I hadn’t) I arrived before it re-opened in the morning. I sat in an empty waiting room, saw the person in charge arrive, hang up her coat, make a coffee and then switch on the ‘info-screen’. It proudly announce that the waiting time was 90 minutes!

    You summed it up perfectly, “this is not about cost but a failure to see the implications of a poor customer experience”.


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