The quality of care

There is a shift in attitude in public hospitals. Quality is the major change that is evident in our public hospitals. This is a welcome change. Most people rely on public hospitals for their healthcare needs as private hospitals are often not within reach for many. A friend recently delivered a baby at a private hospital and faced some complications. She ended up spending about INR 40 lakh (INR 4 million) for a two-month treatment. It is for this reason that we need to improve public facilities and their quality of care.

Ensuring quality care in public hospitals often requires healthcare workers to go beyond their mandated duties. In public hospitals, resources are often limited but patient volume is high. Thus, each healthcare service provider must wear multiple hats and multitask to deliver care efficiently without compromising on quality. Nurses may not only have to administer medications but also provide emotional support to patients and their families. Doctors may need to juggle complex cases with administrative tasks and hand-holding while teaching and imparting knowledge to other healthcare workers. Allied health professionals could find themselves taking on additional responsibilities to ensure smooth patient flow and continuity of care. Despite challenges such as understaffing and budget constraints, dedication to patient welfare must always remain paramount. Thus, healthcare workers have to use innovation and resourcefulness to provide comprehensive care using every available tool and technique to meet the diverse needs of each patient.

There is a common phenomenon at public hospitals wherein a minority of the workforce shoulders a significant share of the responsibilities, while the remaining members adhere strictly to their designated tasks. I observed this too when our hospital was preparing for National Quality Assurance Standards (NQAS) certification. In fact, one of the assessors commented on it while they were examining our facility.

Thus, provision of quality care in public hospitals requires some added responsibilities and innovative thinking from healthcare workers. It’s about doing the same job differently. It’s about shouldering responsibilities. It is fundamental that workers cultivate a profound sense of ownership about their workplace akin to nurturing a personal venture. When employees feel that they have a genuine stake in their workplace, they become more than just workers. This sense of ownership instils a profound sense of responsibility creating an environment where individuals are not just carrying out duties but actively contributing to everyone’s collective benefit. They take pride in their work. Each worker recognises their role in the organisation’s success and failure.

There is a need to identify such workers along with mechanisms to encourage greater involvement from all staff members. By fostering a culture of appreciation and accountability, public hospitals can cultivate a more equitable and productive work environment. This will ultimately benefit healthcare workers as well as the patients they serve. Some workers become invaluable assets to specific workplaces due to their unique skills, experiences, and relationships built over time. Treating them alike and rotating them could disrupt workflow and diminish institutional knowledge. It’s important to recognise and retain such valuable contributors to maintain stability and excellence at the workplace.

A friend once mentioned that in countries like the USA, initial postings for doctors are often determined by the need of the healthcare system or the government, while subsequent postings may be more flexible and based on the preference of the worker while their performance will also influence these decisions.

Private facilities generally have a system to identify and recognise such workers. Such systems generally do not exist in public facilities. Without acknowledgment of their hard work, morale among such individuals may decline and impact team cohesion along with quality of care provided to patients. Furthermore, the absence of consequences for those who do not actively engage beyond their prescribed duties perpetuates a culture of complacency. Without accountability measures in place, there is little motivation for individuals to exceed expectations or contribute beyond the bare minimum. The minority who fulfil only their basic duties often go unchallenged, as there is a systemic acceptance of their limited involvement.

This reminds me of a Ladakhi proverb, “Chu skakan la shabash met chukar chakkan la kabkyon met!” The proverb translates as, “There is no one to praise for fetching water and no one to blame for breaking the pitcher.” This famous Ladakhi proverb reflects the views of the dedicated workers who are assets of an institution but often remain unrecognised. This statement encapsulates the frustration of unrecognised efforts and consequences in a system where neither diligent work nor negligence is acknowledged or held to account. It illustrates a lack of appreciation for those who fulfil essential tasks and a failure to address or discipline those who underperform.

By Dr Spalchen Gonbo

Dr Spalchen Gonbo is a Paediatrician based in Ladakh