Value chain of healthcare delivery is intertwined among multiple stakeholders at every stage. Everyone has a role and responsibility too. The patient cannot be absolved of the responsibility under the pretext of wilful ignorance even if it is due to the subject matter being too technical or too clinical to comprehend. Moreover, there is a flurry of systemic gaps like missing or misaligned rules; compromised quality of care; sub-standard devices/drugs; or conflicted/improper choices to drive profiteering or other agendas. Far from being failproof, currently we are not even foolproof!
2014 averages over 100,000 flights per day. For every flight that takes-off, it undergoes a series of procedures and checks for readiness and safety. Maintenance clearance; fuelling and refuelling levels; preflight inspections; starting procedures; wind and weather information; routing maps; current enroute traffic; passenger security checks; boarding procedures; in-flight-briefing and safety demonstration; taxiing at walking speed; take-off and altitude levels; descend and landing steps; off-boarding and more. For everything across the value chain there are detailed aviation norms and a checklist approach to ensure conformance without compromise. The regulator is an active watchdog who keeps a sharp eye on monitoring and enforcing at one end; and reviewing and refining norms on the other.
How assured/anxious are you while boarding a flight as compared to undergoing a medical/surgical treatment? Most people will not even blink an eyelid about taking a flight. It is taken for granted that everything is well taken care of. Then, why is it that we have so many doubts about medical treatment? Why do we need second/third/fourth opinion to gain assurance on the line of treatment; or for that matter about the credibility of the caregiver?
Every day millions of patients undertake journeys of care. Momentarily at the cost of sounding cynical, how many reach the desired destination — with a good patient experience? How many among these know the real destination? Why do so many accept a compromised lifestyle? Clearly healthcare delivery is more complex than managing the 100,000 flights per day. Foremost because a single universal template of rules works for the latter; whereas uniqueness across a wide-spectrum of treatments needs multiple sets of standards. However, the complexities cannot deter us from making/monitoring the service and safety levels. That’s like shying away from a responsibility just because it is not convenient to do what it demands. This case is just highlighting the systemic gaps in the frameworks (or, the lack of a holistic framework for care). While it is a much deeper hole to fill than what can be described in this brief analysis, let me make a few pertinent observations.
Disconnected Fixes Don’t Work: Sustained safety and service levels cannot be assured without a robust holistic framework. Many laws have been enacted as a knee-jerk reaction to some ruling by the court. Instead a more holistic approach is needed with due consideration to ground realities. For instance, the conflict of interest in this field cannot be looked at in isolation. Ongoing interaction between device suppliers and doctors is needed to ensure education (knowledge/skill transfer) and also to feed back for further innovation. On the other hand, the influence of such interactions on prescribing and purchasing behaviours needs to be checked. Extreme views on either side do not work. There are many more areas where if we flip the coin, then the potential conflict of interest turns into a healthy symbiosis for improving patient care.
Address the Skill Gaps: Healthcare is an information and manpower intensive industry. Advances in medical technology cannot improve the quality of service delivery until the skill of the doctors and other healthcare workers is continuously enhanced. There is a collective imperative for the medical colleges, professional associations, industry bodies, government agencies and technology suppliers. Professional associations in every field need to take a more proactive role along with industry bodies in regulating the continuing medical education in line with the desired surgical outcomes.
Before trusting with lives of passengers in a commercial flight, pilot training is a must. Not allowed to fly, until the pilot has accumulated the needed flying hours, instrument time and gained certified proficiency; duly checked by an authorised instructor. Likewise, how else will we achieve the same level of assurance for a surgeon implanting a device into the body of a patient! Surgeons need to be upskilled in workshops on anatomical models or cadavers before they undertake new surgical procedures on real patient cases.
Rigour is Missing: Improper healthcare delivery claims more lives than terrorism and large-scale catastrophes put together. Medical negligence and related issues cannot be left solely at the quality discretion of a caregiver. The job is not complete after some law has been defined or enacted until it is enforced in the same essence as it was passed. This needs administrative machinery which is not just incorruptible but more importantly resourced with domain depth and expertise. USFDA deploys hundreds of resources to detail every area of treatment. Infiltration of sub-standard implants in this case is a shared responsibility between both the regulator and the provider.
Consumer is Passive and Disengaged: It may work for a flight passenger to be indifferent and disengaged with technical details of flight management. While flight management can be left in the hands of the airline staff, one’s own healthcare cannot be delegated or left to fate. I am not suggesting distrusting the doctor. What is imperative is to be informed, trust with knowledge, not blind illogic. Ask questions without inhibitions. Questioning does not challenge the position or respect of any doctor.
Vagueness in Accountability: Healthcare providers constantly strive to improve quality and efficiency of care. If we simply ask, ‘Are they accountable?’, then the answer remains a resounding yes until this remains a subjective discussion. But the cracks start showing, the moment you bring in measurable yardsticks and propose to introduce auditable trails, which can justify all actions, inactions or omissions. The need is to create and maintain a culture of accountability at an ecosystem level. Independent peer reviews, case registries, disease classification, treatment indexing, monthly reporting, interoperability, patient experience, patient privacy and many more buzzwords will need to be addressed — again in the robust holistic framework.
Inhuman Indifference: May be there are too many. Probably the unending queues are overwhelming. While the government cannot afford quality healthcare for all, the industry philosophy oscillates between socialistic and capitalistic agendas. No one has clear answers. Scarcity of resources challenges quality; and affordability constraints fuel demand. Under-informed and faith driven patients drive this market demand into a business opportunity for the jugaad providers. It is just a vicious cycle of an emerging economy with patients struggling to make ends meet. In such a situation, the choice between half-glass-full or half-glass-empty is all that you get. Failproof needs a full-glass-full.
To reiterate, everyone shares responsibility for assured healthcare outcomes.
The author is MD, INHX (Indian Healthcare Exchange). He is a keen analyst of the healthcare industry with primary focus on supply chain, medical devices and patient experience
(This story was published in BW | Businessworld Issue Dated 12-01-2015)
