Is There Any Hope?ailing health care Kashmir

Is There Any Hope? Redefining accountability and quality in healthcare - perceived obstacles and requirements By Dr Fiaz Fazili Published: Mon, 02 July 2012 10:15 PM> ealthcare: Over-promised, Over-burdened, Over-spent, but not “Overhauled”. Is there Any Hope? How Can We Perform better.? Is There Any Hope? --Redefining accountability and quality in health care- ' perceived obstacles and requirements` Published: Mon, 02 July 2012 10:15 PM Greater kashmir- op-ed ------------------------------------------------------------------------------------------------------------  In an  Era of clinical accountability to improve overall  health care; –we  need  to change  our perception from the blame game towards  total system overhaul . Disaster occurring in valley’s only children hospital, ”GB Pant” should not be taken in an isolation . The Whistle-blower is once again unmasking of how  “organization’s” take care of malcontents, and a gripping story of one desperate man's fight for  a   Safe environment  and quality care  in health care .” DR Fiaz Fazili, talking back on suggestions for Improvement in Healthcare for Future Generations. ------------------------------------------------------------------------------------------------------------Our  health-care system  definitely  was never  envy of the world, as it always   faced  serious challenges of, “Shortages, Standards  and  Accountability”.What happened at  GB Pant hospital –the valley’s only  hope for sick children the lasting thought will be,”Every great disaster, every great affliction, rightly interpreted and rightly used, is a lesson and a help to introspection of  our present health care policy.What  you are experiencing now is the sweet or bitter fruit  of  previous health care policies  acquired or inherited as an hierarchy from the legacy  of  improper health care policy of previous administrators or lack of  revision  of those decisions by present authorities .resulting in laxity in supervision and accaountability.The most important question that is pivotal now, How safe is our current health care, and–How to improvise it”? Are we ready to fundamentally rethink how patient safety and accountability policy is actually designed into our health care systems? Are our  provincial politicians and their designated Health care administrator’s  prepared to give up the illusion of control, and show willingness to re- evaluate  system  of health care  standards to be maintained  for achieving high-level outcomes in patient care ?..Hospitals and professionals  are supposed to follow and maintain certain  standard’s ,policy procedures, protocols, professional conduct, etiquette and ethics as  laid by MCI Regulations -2002.For the accurate delivery of health services in  any Governmental  or non- governmental organization   periodic accreditation, validation and certification of standards creates a check and balance system by the department  of,  “Quality assurance,” and a designated  Patient safety Officer (can be any senior doctor with high moral integrity) is mandatory. Besides supervising the maintenance of standards and safety with the introduction of  OVR- observance variation/incidental reporting system they  perform RCA(root cause analysis) of  identify the origin of a problem,mistakes,irregularities.deviation from the standard norms using  a specific set of steps  to find the primary cause of the problem, so that you can:Determine what happened.;Determine why it happened;Figure out  recommendations what to do to reduce the likelihood that it will happen again. Unfortunately —we lack this concept and expertise in our health- care system, hence disasters like GB pant shall continue to happen until such a system of accountability and quality is developed in our Health care.Our health care system is much sicker than you and me understand .How essential is morality and accountability in medical practice.Bollywood  celebrities are  reminding   the  medical fraternity about , Hippocrates oath  and   Professional code of Ethics. Barring few un- ethical professionals who need exemplary punishmentfor misconduct generally speaking we have excellent Specialists of International repute, hardworking staff  working  at times trying no deliver even in unfavourable circumstances but Alas!when it comes to actual patient satisfaction a trust deficit exists.We all know machines don’t give satisfaction and “standard output” as it is the man behind machine who matters..Lack of  policy of appreciation or reward  of those employees who are meeting these standards  can also have far reaching effects on each member of health care  team. If one employee fails to produce as expected or breaks established work rules, it's not fair to others who must pick up the slack or who rightfully expect everyone to follow the rules. Public perception of medical profession is nobility and selfless service  not money, name or fame, prestige or position. In the recent past, which can be termed as a period of 'technicalization', specialization and commercialization” definitely, there has been a sharp decline in the ethical conduct of the medical practitioners. The people should understand the circumstances and limited resources within which health workers provide care ,so patients and their attendants should co-operate  in  providing  a safe Environment for Staff..In cases of  grievances/resentments/ instead of resorting to verbal or physical abuse the complaints can be routed through official channels.These developments   have seriously affected the doctor-patient relationship, and safety environment required  to deliver quality care.We all agree that there are always genuine pitfalls in any existing policy and, as no system is ever perfect. When there is a problem, we are angry (which is often),by human nature  we need to act and  release our tension. Typically, we do so by blaming someone so we identify (or name/s) the culprit/s, generally picking on the most obvious person/s, and shame him or her/them by assigning the blame. Structural "quick fixes" of re-actions like the present model of quick enquiry with report awaited officer attached may be under rules a corrective administrative re- action but in reality the basic flaws/deficiencies in the prevailing system are to be understood and fixed effectively with the consultation of experts. It may be not too late for the concerned authority to shift from their traditional political strategy of blaming the health care provider/ worker to a  “Continuous Quality Improvement” policy in the health  care delivery. If there is a small kernel of truth in every statement above, as all gross exaggerations or over-simplifications, on priority basis, are we really prepared to improvise on health care? –Then the existing concept and the process of Accountability in health care needs to be fundamentally redefined or restructured. Though accountability and stewardship for the organization belongs to every heath care employee ,but heath workers can't keep their promises if circumstances beyond their control change. That makes sense, doesn't it? If any  officer  is being held accountable for an outcome that can only be achieved if a certain barrier is removed - such as the lack of a skills  development program, or the lack of manpower, equipment or technology, lack of discipline and nobody removes the barrier? How can an administrator possibly deliver on that promise if he or she is not given the support required to succeed? If any administrator or HOD  is being held accountable for improving staff/physician moral, discipline and the provincial authority  is engaged in highly emotional disputes with unions and physician organizations, how can  the  administrative  officers   be held accountable for the results that such an atmosphere will produce? However, these administrative constraints don’t absolve the officers in  demonstrating improved outcomes with the mutual cooperation of  his  own organizations' staff.. Criticism is easiest source of expression, suggesting viable measures to take practical shape on the ground needs outlook- All healthcare providers must understand what is expected of them, they must also have the necessary resources, conditions and skills to achieve the outcomes for which they are being held accountable. Local needs vary and diverse cultures present unique challenges. These outcomes must be understood and adjusted periodically to reflect new realities in our set ups. A Call to Action' is thought-provoking policy and ultimately hopeful challenge to establish standardized   safe and sustainable health care system. I strongly recommend this to anyone interested in one of the biggest issues facing the state today. So let's start now honestly, contribute selflessly,  mutual trust holds great promise..Say,Insha Allah(God willing)..., "Coming together is a beginning. Keeping together is progress. Working together is success." ---------------------------------------- ` Dr. Fiaz  Fazili- is Quality Assurance expert on Health care and Surgery Chapter leader for Joint commission for Accreditation of international hospitals.