You can measure the pulse of a hospital by its coffee shop


I think you can tell a lot about how things are going in a hospital based on the amount of consumption of coffee by its employees. Visit the Starbucks, Au Bon Pain, Roasterie, Einstein Brothers, or whatever coffee shop inhabits square footage in your hospital, and I’d venture to say that you can take the pulse of the hospital. Lots of large coffees to go? It’s either just about shift change and people are rushing into their jobs for the day (or night), or the hospital is bursting at its seams and everyone is go-go-go. Is someone ordering an Americano? He or she must know that the dregs of the day’s coffee are all that’s left and is instead gambling that a freshly pulled espresso shot is a safer bet. A latte? That lucky person might have a little time to spare and might even sit down to enjoy his or her drink right there instead of hurrying back to the floor/clinic/unit/OR. How about the counter with the milks and sugars — are all the sugar or sweetener packets gone? Must be insanely busy. Milk or — gasp — half-and-half all gone? The shop’s been busy, so much so that they’ve run out of the dairy product within the allowed 2-hour serving time. You see — if you happen to have time to take note of these things — there’s a lot to be observed.

How much coffee does a residency program go through during a conference? Are the residents burning the candle at both ends while on service?  If so, we’ll go through a pot of coffee in 5 minutes as they sit down for afternoon conference.  [My co-chiefs and I have carried on the tradition of providing coffee with conference — there is no excuse for sleeping if you have access to caffeine.]  Things have been a little bit calmer on the floors and they have a few minutes to decompress? We might need to fire up another pot of coffee after conference, just to give everyone a few more minutes to sit together and chat. How fast are we going through the half-and-half or almond creamer? Are all of the caffeine lovers on service at the same time, or has it been an unusually busy time and everyone’s reaching for a cup during conference? Or perhaps there are days when our “proprietary blend” wasn’t that popular, and most of the coffee went down the drain. (I will never again buy French vanilla coffee. Sorry, everyone.)  Even for those who don’t drink coffee, I think just having it there and knowing that someone got there early to set it up and set out the accoutrement for serving shows that we, the nebulous chiefs behind the email account, care.  We want our residents to know that yes, the days are long, and the pages are nonstop, but there’s a hug in a cup waiting for them.

Let’s go back to the coffee shop in the hospital — maybe it’s midafternoon, and a senior resident or fellow or attending has taken an intern there for a quick feedback session.  (Please, everyone, do sit down with your learners to give and receive feedback!)  Maybe it’s 6:30 a.m. and the senior resident is buying five specialty drinks to celebrate the end of a block with her interns and students.  Maybe it’s 9 p.m. and there’s a couple there, both on call, stealing a few minutes of time with each other before heading back to their respective domains.  There is so much to observe in just that little area.  That shop is a measure of the pulse of the hospital, if we just look up from our smartphone long enough to see what is going on.

Ellen Poulose Redger is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

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