FROM THE BLAME GAME TO Clinical Accountability . Redefining Accountability and Quality in Health care- ' perceived obstacles and requirements`

FROM THE BLAME GAME TO Clinical Accountability . Redefining Accountability and Quality in Health care- ' perceived obstacles and requirements`. Health Care Mess: How We Got into It and How We Can we Fix It(get out of it)? Is There any Hope…..? In an Era of clinical accountability to improve overall health care; –we need to change our perception from the blame game towards greater accountability .Amidst accusations of unholy nexus between pharmaceuticals ,diagnostic centres ,private hospitals and Medical practitioners. A Call to Action :by Health care quality management expert –“We NEED A “charter” to encompass a set of principles to which all medical professionals can and should aspire. The charter supports physicians' efforts to ensure that the standards of health care systems and the physicians working within them remain committed both to patient welfare and to the basic tenets of social justice.”,DR Fiaz Fazili, talking back on suggestions for Improvement in Healthcare for Future Generations - ------------------------------------------------------------------------------------------------------------ The safety and the progress of the world are built upon the afflictions and the sufferings of those that have gone before us. 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 standard s of “ Quality culture” and System of Safe environment in health care .” Quality is -Doing the right thing right the first time, doing it better the next time---in all time. Our health-care system definitely is not the envy of the world, as it continually faces serious challenges of, “Quality care and Accountability”. The figure of Morbidity and Mortality published in media has raised fingers regarding the policy of safety environment and quality of care prevailing in our health care services. Further, with the influx of frequently visiting Non –state subject practioners and opening of branded health care retail outlets by non- state private operators in the valley there are serious concerns about ,.”Who is doing what ? Is there any , “State Health Accreditation and Validation policy .How can such a system be made safer? How can we preserve the strengths of our current system while correcting its weaknesses”? World's leading health-care scholars answer these questions in three words,” Healthy, Wealthy, and Wise.”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. The universal law of sowing and reaping is the same as the law of cause and effect. Whether you are experiencing now is the sweet or bitter fruit of policies and hierarchy of the decisions of the past masters –lack of accountability and Quality management units in organisations.The most important question that is pivotal now, How safe is our current health care and–how to improvise”? Are we ready to fundamentally rethink how patient safety and accountability policy is actually designed into our health care systems? Are provincial politicians and their Health care administrator’s prepared to give up the illusion of control, and show willingness to re- evaluate health care regulations and policy of Quality care for achieving high-level outcomes in patient care ? We have excellent Specialists of International repute, hardworking staff working at times even in unfavourable circumstances ,and genuinely at some places we may be having shortage in manpower or machines or diagnostic aids of international standard and the dissatisfaction arising out of such situations ,But unfortunately when it comes to the ultimate goal of health care, “patient satisfaction”, and “quality" ~~ the shadow of accusations of "Arrogance, Abuse, Fraud, and Medical Malpractice( maltreatment ) is there. How essential is morality in medical practice.?-Do we need bollywood celebrities to remind the medical fraternity of ”the Hippocrates oath” or Code Of Medical Professional Ethics which every Doctor is duty bound to adhere. We all know machines don’t give satisfaction and “standard output” as it is the man behind machine who matters. Public perception of medical profession is nobility and selfless service not money, name or fame, prestige or position. While engaged in professional activities, being busy with the technical and academic pursuits, the doctors and para-medical staff should not lose sight of the ethical, human, psychological and spiritual aspects of their profession. In the recent past, which can be termed as a period of 'technicalization', specialization and commercialization” however, there has been a sharp decline in the ethical conduct of the medical practitioners. The public at large also should understand the circumstances health workers provide care and display restraint while registering their genuine complaints against mal-treatment through official channels. These developments have seriously affected the doctor-patient relationship. Why are we in this mess and what we lack is policy on standards ?Hospitals are supposed to follow and maintain certain standard’s ,policy procedures, protocols; policy of job descriptions and do root cause analysis of mishaps and suggest recommendations on the basis of OVR- observance variation reports of incident reports (as laid down in Hospital manual of joint commission 2011-2012)with periodic inspection by any non -governmental body like JCI(Joint Commission international) for Accreditation of hospitals. For any organization accreditation certification has created a check and balance system for the accurate delivery of health services. Unfortunately ,—we lack this concept in our health care ,hence disasters waking us as,” breaking news”.(some papers related to this issue I handed over to Director SKIMS;for hopeful necessary action). Pending answers & solutions on this issue, a delicate mutual trust which existed in this noble profession has been lost. How early can it be reclaimed depends on, how sooner we all realize our collective and individual responsibility in this hierarchy from “top to bottom”.The fact that patients are not feeling entirely satisfied with the care is not breaking news as there are lot of issues and misperceptions involved on both sides. Whether these are genuine doubts or unfounded fears created out of vested personal or professional vendetta, or rivalry, with merciless highlighting of some stray ugly incidents in the media, unfortunately our focus has been mostly on managing the crisis "du jour.", rather than redrafting long term health care planning policy. 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 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 may be a correct administrative action but in reality to change much on the front lines of health care delivery the basic flaws/deficiencies in the prevailing system are to be understood and fixed effectively with the help 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 planning of construction of new hospitals but it is not too late to shift course when it comes to implementing or defining the word "accountability" as “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 for mind-set shift? . Though accountability and stewardship for the organization belongs to every heath care employee. A committee of health care planners or experts to be formulated in this direction is mandatory to put forth their recommendations .Accountability requires clarity about who is accountable to whom for what for their decisions and performance and must be a fair business bargain. Not only must everyone understand what is expected of them and why; they must also have the necessary resources, conditions and skills to achieve the outcomes for which they are being held accountable. A best practice is induction of Quality management unit in each organisation who will define and monitor the job descriptions ,activities and accountability with written policy procedures and protocols, be placed in every hospital or health care unit.Every heath care provider has to be well versed with it and signs his/her job descriptions on entering any organisation as is the practice in the west. But heath workers can't keep their promises if circumstances beyond their control change. If any Health administrator/care provider 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 any administrator possibly deliver on that promise if he or she is not given the support required to succeed? These outcomes must be understood and adjusted regularly to reflect new realities as they emerge in a constantly changing and chaotic environment. Improving the quality, safety, and efficiency of health care is a goal shared by health care Organizations.Local needs vary and diverse cultures present unique challenges.To improvise on health care the existing concept and the process of Accountability in health care needs to be fundamentally redefined or restructured towards Continuous Quality Improvement. 'A Call to Action' is thought-provoking policy and ultimately hopeful challenge to establish a true and sustainable health care system. I strongly recommend this to anyone interested in one of the biggest issues facing the state both today and in the future. We need to ensure that we all are working synergistically within our organizations and with all parts of the system/society, so that ultimate and real beneficiary of all this exercise is the patient himself.So let's start now honestly, 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 Health care expert and Chapter leader for Committee for Accreditation of hospitals. ( excerpts from lecture delivered by author in SKIMS, during Hepatobiliary pancreas –indian chapter meeting on 25May2012.