The places of healing or suffering?

Karanvir Gupta
From getting our baby delivered to dad getting operated on; from visiting for specific lab tests for my mother to getting admitted under emergency myself – I think visiting a hospital is an unavoidable event in our day to day lives. How much so ever we would love to stay away from the hospitals and medicines – there is no escaping the fact that there are going to be some bad health days and you would land up in a hospital. I have just been blessed to have witnessed and interacted with some of the most kind and attentive doctors. This has always made a certain part of the treatment and stay at the hospital a bearable experience. But not everything is hunky dory when it comes to the state of affairs in these much talked about hospitals.
I will never forget the night when a junior doctor kept rushing in her patients – out of the queue – in an emergency ward pushing the cases back in a long queue when finally one senior ward staff pushed back by telling her that we could not be breaking queues for her. But I was appalled by the stubbornness and arrogance of that junior doctor who almost had created a ruckus at the emergency ward. In another incident in another hospital, while I was accompanying my patient to a washroom, I almost puked by looking at the state of the washroom in that hospital. There were no bins around, litter was lying around on the floor being dragged by foot here and there. The urinals were broken and waste was leaking from the flush. There were dogs sitting in the cafeteria and the cafeteria looked like a spooky canteen under the hood selling some illegal stuff. Two of these hospitals looked like a direct scene from a halloween night. It seemed as if the whole building would just crumble at the touch of a finger. Dust engulfed every piece of furniture, cranky and squeaky beds, locked rooms and noisy machines grip these hospitals. The overall hygiene was up for a toss.
While I went to another hospital, their entire queuing system was an open ground for red tape and utter chaos. Parents toil with their sick and cranky kids without getting their turn to see a doctor at the designated time. I was glad when I finally landed up at a much better hospital but after 3 days of stay, I got to know that the staff has been asking for a pay hike for quite a number of months which was being denied to them. Half of the floors had trained staff and the other half had under-training staff thus resulting in an inconsistent customer experience. After seeing all of this, there are inadvertent questions that pop up, “What gets these hospitals moving? Are these hospitals – places of healing or places of suffering?”
It is interesting to note that most of the problems that you and I will witness are around poorly managed operations and unthoughtful customer-centric approach. Lack of professionalism makes it much worse. While hospitals are equipped to make enough money (and lots of it), the hospital owners and management is not willing enough to put back a portion of that revenue into uplifting the face of the hospital and conditions either for betterment of its patients or its own staff because of which hospitals actually survive!
Let’s break this into 5 key headers viz: Infrastructure, Capacity Planning, Queuing, Staff Training and Facilities, Hygiene.
The entire experience from the time a customer visits or gets admitted to a hospital to the time they carry the discharge summary has to be such that a customer and an accompanying attendee do not feel harassed but rather welcomed. They do not have to call Mr. X or Y to ensure that they are treated well but that “being taken well care of” is a part of the organic DNA of each hospital itself.
Talking about the infrastructure, we do not only mean adding more operating units, or more advanced machinery, but also well equipped rooms, fully-operational machines (and not the ones which exist on paper alone), silent (noise-free) machinery, wheelchair access across the hospital compound for specially abled people. It becomes easier for attendees in today’s single family social milieu to accompany their patients hassle-free. This infrastructure needs to expand beyond just a VIP room and a floor to other categories of rooms as well to the common area, restrooms, and lobbies as well. This should be accompanied with leisure rooms, library and proper resting areas for attendees as well. The hospital compound should have less concrete but more soothing interior decor, pacifying art on the compound walls, greenery outside the campus, seasonal flowers and a well manoeuvred garden if available. Hospitals are supposed to be the places where patients come to feel better and healthy and not disgruntled.
It then becomes imperative that the hospital staff is not over burdened. The staff to patient ratio is as per the best practices of international medical standards. There is an adequate bed/patient ratio each year as per the heuristic analysis. Hospitals should be considerate for not admitting patients at a rate faster than the discharge rate. It has been found that hospitals discharge patients faster than their due discharge time in order to accommodate more patients in a given window. The sad part is despite the fact we know this, none of this is reported or taken care of. Hospitals need to ensure that there is ample staff to cater to the in-house patients and the visiting patients. This capacity planning will then trickle from the doctors-on-duty to the nursing staff, on ground staff to admin/operations folks in the hospital. The objective is to “prevent” the state of ruckus which is currently prevailing in almost each hospital at various customer touch points. This also prevents the staff members from delivering their best.
Once we have looked into the infrastructure and capacity planning – the next important area of concern is to not let the visiting patients hamper the functioning of the hospital and its staff in their regular affairs. But unfortunately, there is so much energy spent in managing the visiting patients that it is unfathomable. The best solution is to digitise the token system which should be easily doable from a hospital app or website. (or be fetchable on arrival in hospital/clinic). This is not something new. It just needs to be replicated well in hospitals across Jammu. A well defined queuing algorithm will free more medical staff for other meaningful work. This is important because this also is the epicentre of most of the hospital fights and complaints. A streamlined queuing methodology will automatically streamline other subsequent operations such as unprecedented rush at the medical shop, at the billing counter, etc.
Now that we have taken a look at these customer touch-points, it is important to take a look at what we do as hospitals to ensure safety, security, and upskilling of our current staff. From getting them due salary hikes year on year to organising training programs so that the staff is equipped with best practices and techniques at par with other best hospitals in India would boost their confidence and only going to increase employee retention and loyalty. This might sound plainly expensive but this is going to reduce multi-year multi-staff onboarding and training costs. As hospitals’ goodwill and fair treatment of staff becomes a word of mouth, hospitals can see more able staff coming to apply for open roles and positions thus reducing hiring costs as well. It might sound tedious to begin with but will have fruitful long term results.
Last but not the least, it is important that hygiene is well taken care of at each nook and cranny of the hospital. Sometimes I wonder, if hospital administrations, owners and management ever take rounds for sudden inspection in the places they have built? Trust me, if they would, they would not stand the muck a second. Hygiene conditions in some of these hospitals need immediate attention. The staff needs to be educated and trained to not pollute the premises themselves, first of all. Tea and coffee cups, sandwich plates, and other disposable material cannot be thrown in the hospital corridors. It becomes a perfect breeding place for insects, flies and infections. Manual scavenging has to completely stop. The janitors need to be equipped with advanced manchines and need to be educated with the purpose/importance of keeping hospital premises spick and span. A culture of hygiene and cleanliness needs to be instilled in every working personnel in any hospital.
From clean outdoor ambience at arrival and car parking, smell-free and litter free corridors; from fully equipped and clean canteens (without stray dogs and mice), well planted gardens and beautifully painted walls, greenery in and around the hospital premises is a must have to ensure that patients, attendees and the hospital staff has a soothing effect under distressed situations. The hospitals cannot be a place of unrest, repulsion and detest. They are rather places where humans come with hope to survive and live once again.
Over and above the treatment by able doctors, hygiene and happiness are inextricable parts of providing the best treatment to the patients. Doctors and medical staff can play a huge role in fixing what is broken in their hospitals but only if they have the will to make a change and dent in the little world they operate in.
It is sad to see hospital management complain about paucity of funds whenever it comes to improvising the working conditions and overall upliftment of the hospital environment. In such cases the concerned authorities should take drastic steps and make P&L statements of these hospitals public – available for scrutiny. Because if they are genuinely loss making then it is in best interest for everyone for these hospitals to shut shop. Humans and human ailments are to be treated with empathy, compassion and humanity and certainly not with money alone.
Today, with quite a few hospitals already in Jammu and AIIMs coming up soon, it is an opportune moment to create Jammu a perfect hub for Medical Tourism. It’s time that all hospitals come together for competitive collaboration with each hospital being able to identify its niche and create centres of excellence in those specific departments. This is only going to add leverage to the existing active medical landscape in the Jammu city. If hospital administration and management take onus of making their hospitals world class – operating fair and square – it is not an unachievable feat to let Jammu create a niche as a medical hub.
It remains to be seen how far we can go when it comes to treating humans with humanity. Will hospitals in Jammu be able to improvise their working conditions for their staff? Will hospital management take hygiene at their hospitals as a serious affair? Or will they remain focused on making more money via doling out more medical seats? Will they come together in a collaborative space to make jammu the best place to come for medical treatment of any kind? Will be able to call Jammu – a City with a heart – where anyone who goes ill but comes out hale and hearty? Only time will tell.