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Now wash your hands

BMJ 2007; 335 doi: (Published 23 August 2007) Cite this as: BMJ 2007;335:402

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Bed occupancy has become an excuse

Peter Mahaffey makes some good points, but he is wrong to blame the
drive for 100% bed occupancy as an external factor outside the control of
the hospital (and its not clear there is any government pressure on

The factors that most prevent beds being available when required
(including adequate time to clean them) are entirely within the control of
doctors and hospital managers, if they choose to control them. Planning
and coordinating arrivals and departures can free up large numbers of beds
at the times of day they are required; failure to coordinate or plan leads
to severe pressure on the few free beds and all the problems that flow
from that.

The underlying problem comes from the following factors (all of which
are fixable given the will to improve): doctors don't think managing beds
is important; doctors don't like to waste time on planning and probably
often lack the relevant planning skills; doctors don't like other people
telling them what to do (so when some manager who has some ability to plan
declares that we could free up 15% of the bed stock by doing discharge
rounds in the morning, nobody pays attention).

If hospitals want better availability of clean beds then they should
fix the problems within their control before blaming some evil government

Competing interests:
None declared

Competing interests: No competing interests

29 August 2007
stephen black
management consultant
london sw1w 9sr