It was revealed that India has only 938,861 registered allopathy doctors or just seven doctors per 1,000 people, per a report released by health minister J.P. Nadda. So not surprisingly most discussions in healthcare today are around ways and means to build more infrastructure and increase access to care. Indian healthcare was ranked 112th in the world in a survey by the WHO. So there is a sense of urgency to improve our care standards. Many startups have sprung up in the healthcare space promoting better health and preventive care. Investments are pouring into the country; new state of the art hospitals are being set up. Digital is the new mantra and we are soon going to live happier and healthier lives.
But one must wonder are we doing the best we can with the existing doctors, hospitals, clinics and processes? What I mean is how efficient is our system of care and what are the outcomes? Does a patient comes out healthier and better than he went in or is it just a case of good fortune that nothing untoward happens to him or her? What exactly are our priorities for safer care?
As per Indian Confederation for Healthcare Accreditation(ICHA) it takes almost 133 people to take care of 1 patient in a tertiary care hospital. This is right from the time the patient decides to access healthcare in the hospital and till the time (s) he is discharged. Though the numbers seem interesting but it also gives us an idea about the complexity of the current healthcare system. Digital transformation, Modern technology and techniques might have made healthcare more effective but it has also made care more complex and unsafe. That means there are 133 touch points where the patient safety can be compromised.
Technology today is a double-edged sword. While it can help improve standards of care but at the same time it can also be misused. There was a report recently which stated that almost 30% of tests during the planned procedures are unnecessary. So why were the tests prescribed then? Somehow, I feel the numbers are understated. The global numbers for avoidable tests, is as high as 60%. Could the numbers in India be higher? Maybe as high as 80% in some cases.
Let me give you an example. A blood analyzer can be used to run multiple tests on a given sample. Sometimes some peripheral findings may seem borderline and often the hospital in their over zealousness to use technology, order another series of tests. This process is the same for medical devices and once a hospital buys a CT Scan or a MRI, there is a tendency to order more tests. Clearly technology can have its side effects and this is one area which we need to work on.
The fees for post graduate and super specialty is very high today. As the doctor’s graduate, the first thing on his or her mind is to repay the education loans and hence the tendency to focus more on tests and more diagnosis rather than focusing on patient safety. I have heard from many sources that doctors have quota for revenues and number of tests. A good doctor is one who meets his revenue quota and prescribes the right number of tests. No one judges a doctor by the care outcomes.
“Our current medical education system has spawned a new category of doctors which I call EMI Doctors, as they are more worries about paying the EMI’s that focus on care.” says Dr Akhil Sangal CEO of Indian Confederation of Healthcare Accreditation
So, in a sense we see how Complexity in the healthcare system has created a total breakdown in the doctor patient relationship, where the doctor cannot afford to care for the patient and this is in a way aided by technology.
While the real answer to this equation is better communication, collaboration and coordination between care provider and care receivers. While most healthcare systems talk about the system of safety and care but there are many instances of these institutions are not walking the talk.
“There is a big gap between what we know and what we do in case of healthcare” says Dr Sangal “So there are cases where the quality of care is compromised leading to sub optimal outcomes to the patients”
The most fascinating story I have heard is this regard is one Dr Sangal told me about a certification inspection at a new born care unit. The institution had adopted quality processes and was required to have an incubator to comply with quality standards set by the quality regulations. On inspection, it was found that the incubator was present but not working. When this instance was flagged and the protocol rewritten to say that the incubator should be present and working, on subsequent inspection there was a service slip in place of the incubator indicating it had gone for repair. Finally, the quality protocols were amended to state that the incubator should be present physically and in working condition always for the facility to pass the quality audit. The instance differentiates between conformance and wanting to conform – any pediatrician would agree the need for a working incubator always!!!
I don’t even want to think about the safety of the babies delivered in the nursing home that might have suffered due to the lack of a working incubator. This is a good example of not walking the talk and break down in coordination between the 133 individuals responsible for the health and safety of the patient.
What ails our healthcare system today is the trust deficit? On one hand, we have communication gaps between various departments, hospital management, senior doctors, nurses and para clinical staff, while on the other hand we have total lack of transparency to what really happens when a patient gets admitted.
What we have today is a situation where healthcare facility wants to conform to standards to achieve certification, without necessarily a focus on excellence. To focus on excellence, all parts of the healthcare system should by themselves want to conform to the intent of standards and should do so by the patient safety guidelines or by quality protocols.
It is believed that there are three key safety risks when it comes to the healthcare systems and are on both sides viz. Receivers (patients and families) and Providers (Healthcare teams and hospitals).
- Physical Safety Risks- Today the risks are on both sides i.e. patients as well as providers with increasing instances of violence against hospitals.
- Mental Safety Risks – This is for the patient and the patient party as well. After all it is the patient party that suffers more mentally while the patient is being treated. The conscientious physician is equal sufferer and thus called the second victim. There are known instances of even suicides.
- Financial Safety Risk- Patients and families are known to have gone bankrupt while undergoing treatment. With increasing litigation, the healthcare system which is liable in case the patient is harmed during the treatment
In the subsequent posts on this topic we would talk about areas like Insurance and how they are complicating and putting stress on a fragile ecosystem. We will also discuss some common controversies and common myths in the healthcare in India. If you want to share examples where the patient safety was compromised due to poor quality, unnecessary tests or lack of adherence to quality standards, please send us those examples and we will feature them in the following posts on the topic.