The challenges confronting state hospitals, and how do you meet them
World Quality Day is celebrated every year around the world on 12 November. The theme for this year is ‘Sweet Dreams’. Quality, when applied to healthcare institutions, encompasses compliance on recognized national or international healthcare standards of patient care and safety. Ultimately, quality is an outcome – a characteristic of a product or service provided to patients, and the hallmark of an institute which has satisfied all of its stakeholders especially patients.
Our healthcare system always faced serious challenges in the delivery of health care. It’s been in the headlines for all the wrong reasons. There has been least emphasis on reforms. But we are now seeing that the Mufti government has been active,when it comes to announcing reforms, perhaps even hyperactive on healthcare initiatives. If reform is getting extra emphasis, I think that is a positive development because it will put the case of healthcare high on the priority based budgeting. Despite the implementation of National Rural Health Mission over a period of ten years since 2005, the public health system in the country continues to face formidable challenge.
A misguided attempt to improve healthcare in past has led some hospitals to focus on making people happy, rather than making them well. The fact is that public hospitals have become increasingly detached from the larger context in which medicine operates. Whether present Government “model” proves as best solution to improve health care, the planners must also start thinking on healthcare system complexities, impediments, and failures. Why does the quality of health care continue to lag on standards in our system?
1. As a clinical auditor, the main challenges confronting the State hospitals today are deficient infrastructure, deficient human-power, unmanageable patient load, and high public expectations. Inadequate funding from Government along with ineffective execution of futuristic policies in the healthcare institutions are persistent problems. People in positions making their individual mark, often distancing themselves from their predecessor’s initiatives, show a preference for quick fix solutions setting up new mechanisms and initiatives rather than improving on the existing structures. Many of the same recommendations appear time and again, indicating the gap between policy rhetoric and implementation.
2. Selecting a chief executive is critical; is this the right person to lead the organization in this particular business, at this particular time? Is your next Director or Principal going to be a good manager, or an effective leader? Healthcare is a risk prone, high volume team service with sensitivity, not a one–person show. To head an institution and to succeed, both managerial and leadership traits are needed.
3. How do I know if my local hospital is any good? You can’t manage what you don’t measure – an old management adage holds good even today. Unless you measure something you don’t get to know if it is getting better or worse. Most of our institutions need a gap analysis, seeking answer to the questions; "where are we, and where we should have been”.
4. After all, what do patients really want from health care? Every day, thousands of valleyites receive health care that helps to maintain or restore their health and ability to function. However, many are not satisfied, though majority of doctors and paramedics work hard under very difficult circumstances. But the one thing patients want the most from their doctors is empathy. Why are many doctors rude to patients, is a frequently asked question. Can’t doctors’communication behavior be changed – the major factor affecting patient satisfaction and team work. We expect public to understand that it is not always a doctor who is at fault, a system failure, lack of prescribed standards, organizational disarray, trust deficit or attitude problem; there is a long list of problems.
5. What drives patients to seek medical care outside when it is locally available. Not all can afford to go outside state to seek specialized medical attention, which under present socio-economic circumstances is difficult. Mufti sahib has set a practical example in this case.
Hope our next model hospital, and overall health care system, takes into account that good health care is not about how much, but about the right stuff at the right time for the right reasons for every person irrespective of his/her social, political or official status.
Dr Fiaz Fazili is a Surgeon and Clinical auditor; expert on Quality Assurance improving Healthcare Standards and Surgery, Chapter leader for Joint Commission International for Accreditation of Hospitals