Fixing health: Why the long wait?
Patients seeking attention at public health facilities have one pervasive complaint: The wait is too long.
Patients are waiting far too long in clinics and emergency rooms. They wait for elective surgeries, and they wait for the results of tests.
Whereas the waiting time for surgery is a complex and vexing issue not yet resolved by even the most advanced and well-funded health systems, the waiting times in clinics and emergency rooms can be addressed by simple changes.
Patients' waiting time has been defined as the length of time from when the patient enters the outpatient department (OPD) to the time the patient actually leaves the OPD. The time used for registration of the patient, finding the medical record, collecting results of prior investigations, seeing the doctor and, in the case of the emergency department, undergoing new tests, treatment and procedures.
There is no way around waiting in a health care system. Picking any two out of the following descriptions of health services best sums it up: good, cheap and quick. In our free health care system where the treatment is fairly good, you can certainly expect that the variable that is unobtainable is quick.
Let us look at what happens when a patient enters an emergency department, for example.
The sick patient first has to get past a security guard. Then a nurse or doctor decides how sick they are and the priority in which they will be seen. After registering, the non-emergency patients sit in the waiting room. After being seen by a doctor, they may undergo various tests such as blood tests, X-rays, ultrasound, ECG and CT scans. The patient then commences treatment or is sent to wait again until the results of the tests are back. Only then can the decision made with certainty that they can leave the department, thus ending their long ordeal.
For the patient, holdups occur at every step of the way.
The security guard has to screen for weapons and keep persons from flooding the departments. This is worsened by persons being disruptive and unruly, at times leading to lockdowns and enhanced screening.
The triage system that determines how soon you will be seen is not perfect. It is difficult to determine from a short contact with the patient with 100 per cent accuracy as to who should see the doctor immediately.
A major problem arises because a large number of the patients seeking medical attention in emergency departments are not true emergencies. They then get placed in the group with those who need non-urgent care, as there is a reluctance to turn away patients from the hospital. This large non-urgent group has the longest waiting period, as the emergencies and urgent cases are given priority over them, and even if they are next in line, the arrival of an emergency pushes them back into the waiting room.
Unfortunately, social issues are the primary cause of the long waiting period for non-urgent cases. Patients believe that a hospital, and not a health centre, is the best place to seek treatment and they understandably tend to overestimate the seriousness of their illnesses.
Road traffic accidents and violence result in an overwhelming of the facilities, forcing non-urgent patients to wait longer. Or patients or relatives may not get time off from work to attend health centres and so end up at hospitals after working hours.
The most the Ministry of Health can hope to do is to extend the opening hours of the health centres and hope that a public education campaign can convince patients to access health care at these centres, thus freeing up emergency rooms for urgent and emergency cases.
Emergency rooms are most times understaffed. The stretched staff is often chronically fatigued and this may affect their efficiency, contributing to longer waits.
Simply finding space in the emergency room to examine or treat a patient is a task when the department is overcrowded with patients already admitted but awaiting transfer because there are no beds available on the wards. The staff of this emergency room/overflow ward now have to care for these patients in addition to those being seen. This ties up the staff even more, increasing waiting times.
Far too often the staff do not have the supplies to treat the patients. With limited or no supply of gloves, cotton, needles, tape, masks, blood tubes, oxygen and basic medication in the emergency room, the patient is forced to wait for supplies to arrive from well-stocked storage rooms. These artificial shortages are somebody's fault. However, nobody is ever held accountable.
When radiological and blood studies are ordered, there are again delays because poorly maintained machines often break down - or there is simply no machine. Patients have to travel to private facilities to get their studies done and take back the results to the hospital.
Maintenance and upgrading of the existing radiology departments and laboratories would have an immediate impact on waiting times. Again, nobody is held accountable for the purchase of inferior machines without maintenance contracts.
There is, however, light at the end of the tunnel. The increase in the health budget for 2015-2016 saw significant increases in the allotment for supplies and maintenance. There is talk of extended opening hours for health centres, and doctors and nurses are being trained at a previously unimaginable rate.
If only there was a desire to demand greater accountability, we would begin to see some measurable improvement in the waiting times.
- Upgrade existing infrastructure, including bed capacity, laboratories and radiology departments
- Establish wait time benchmarks for consultations, diagnostics and definitive treatment.
- Reform supply chain management.
- Roving, on-call maintenance crews.
- Greater accountability.
- Extend opening hours of health centres.