The problem of poor patient care
Poor service is a major failing in our society, but poor service in the health sector is a particularly important defect, since bad service here threatens people’s lives.
Speaking at the National Public Health Sector Quality Awards last Saturday, Health Minister Fuad Khan raised the issue of citizens’ right to respect and professional care from health sector employees. He revealed that RHAs had gotten 5,000 complaints within a 19-month period, noting that “A large percentage of complaints had to do with the attitude of staff.” This is not surprising since, even in cases where patients have died, relatives often mention the “hoggish” attitude of staff, particularly nurses.
Minister Khan also pointed out that there were 2.4 million visits across the health care system. Since the population of Trinidad and Tobago is just 1.3 million, this means that a significant minority of the population has to go to medical facilities several times. Additionally, those 5,000 complaints surely reflect only a small proportion of poor service incidents, since most people would not take the trouble to file official complaints. And Minister Khan’s speech significantly omitted to list how many of those 5,000 complaints had been dealt with.
Clearly, there is need for customer relations training for RHA employees, who too often fail to realise that their attitude may itself contribute to patients’ illness. In the United States, hospitals which have adopted an “admit and apologise” policy for medical errors have had lawsuits against them drop by as much as 66 per cent. It is possible that this effect is peculiar to American culture but, since that culture is also extremely litigious, this seems unlikely. More pertinently, caring treatment has also been shown to help patients recover faster, particularly in respect of managing pain, which helps clear bed space for new patients.
As a partial solution, Dr Khan recommended that “Quality improvement lies in the principles and understanding the situation...This can be achieved by personal commitment.” In fact, this is part of the problem. Those outstanding nurses and doctors who are praised in letters to the editor are the exception, not the rule. This means that promoting personal commitment cannot be a solution. Instead, the problem is systemic, in the sense that an inefficient system makes staff act inefficiently. That is why the same nurse or doctor who is lackadaisical or terse in a public hospital can be hard-working and polite when working another shift in a private clinic.
Simple manners are an important part of patient care. But that has to start at the top because, when administrators aren’t polite to doctors and doctors aren’t polite to nurses, it is patients who pay the sometimes fatal price for hoggishness.