I read recently with delight that the Bahamas’ Public Hospitals Board (PHB) had invited the renowned Johns Hopkins Medicine (JHM), a formidable name in health care, to explore the possibility of partnership, which would bring to bear JHM’s “wherewithal, experience, talent and resources to elevate the operations, infrastructure and environment of the public hospital institutions of the PHA (Public Hospitals Authority).”
It’s about time. Time to realize that when one does not have the necessary resources in house to effect the desired ‘elevation’ of assets and resources, the smart bet is to look for best wherever it may be found and draw upon it—whether it be know-how, personnel, technology or experience. Somehow, in the early, heady days of our independence from Britain, we acquired a fierce, but sometimes erroneous notion of self-sufficiency, added to unceasingly by politicians on the make for permanency in Parliament. It has been a theme further embellished by opportunists who tell their followers that all they have to do is pray or join a union to access the super lotteries of toil-free life.
‘Bahamianization’ was obligatory and the answer to righting all that was deformed by colonialist praxis. Young Bahamians returning home from overseas study were often shoved into sensitive jobs, innocent of the years of experience that would have allowed them to triage the systems they found in place to build anew. Armed with practice, they would have been better equipped to ditch the bad, hold on to the good and fashion new systems to match the unique needs of the new nation. This was all too often not the case in public service. Then there were those whom politics elevated, whether suited to a position or not. In these circumstances a few brilliant ones swam, but more sank and we ended up with systems that were patchwork frankensteins of infrastructure, knowledge, personnel and practice.
One such system has been health care. Add malfeasance all along the spectrum of activity and you get cancerous, rather than healthy national development. After almost a half-century of national sovereignty, the healing arm of nationhood is itself in urgent need of care. I say it’s high time for the PHB to send out a call for help.
Let me say, first of all, that the lack is not in the quality of trained healthcare professionals. I should know. The perceptiveness of some very fine local physicians has saved my life and those of family members more than once. I have known some of the world’s most compassionate nurses. In the course of their interventions over time, however, I have experienced enough to know that all is not well in the system itself. I have been an inpatient at the state-run Princess Margaret Hospital (PMH), at the private Doctors Hospital and at a couple of public clinics, but I focus here mainly on public outpatient care.
Years ago, I watched my infant baby brother, in the arms of my aunt, gasping for what could have been his last breath, as we sat on benches that once passed for outpatient accommodation at Accident & Emergency at the PMH. He probably would have expired if my father, an imposing figure of a man, had not turned up in time to get the child seen by a doctor. In more recent times, I have twice had to spend long hours at the A & E with my mother-in-law. In the first instance, when she was seeking treatment for a broken wrist, I was with her from 9:00am until after 5:00pm—through triage, file acquisition, various signoffs, waiting for x-rays, more waiting for results, more waiting for a physician to sign off on the x-rays to allow her to proceed to Orthopedics for treatment. She saw the doctor at about 5:00pm when my brother-in-law took over the support duties. The patient got back home way after dark.
In the course of that day, I saw the business of A & E impeded by the department’s use as an overflow ward for inpatients, some of whom seemed moribund. I saw mountains of dog-eared paper files spilling over. I saw the X-ray Department come to a halt because of lunch. I saw harried nurses and infrequent physicians. I saw insufficient seating, toilets and other amenities for those waiting to be attended. What I did not see was the kind of sequencing and technology that would have saved time, money and, possibly, hours of suffering and possibly lives.
I will use as my point of comparison Allegheny General Hospital (AGH) in Pittsburgh, PA, where necessity has driven me to experiences as an inpatient, as well as an outpatient for the past ten years. I have had a wonderful viewpoint from which to judge the evolution of the reception of outpatients for the clinics at AGH.
On my very first time there, I walked into a reception area surrounded by a gift shop, a coffee counter, a chapel, lots of seating and nearby restrooms. The procedure required me to go to a desk where my name was added to a list and I was given a buzzer and asked to take a seat in the general area. When the buzzer came alive, I was sent to one of several cubbyholes, where a staff member entered my information into a computer and provided me with an ID bracelet. From there, I was moved to various labs for tests and finally on to prep area for examinations and anaesthesia for undergoing invasive procedures.
Ten years later, I do the walk to the reception desk to give my name—This time no buzzer, no interview, no wait—just direction to an elevator to the prep area. By the time I got there, computers had talked to each other and I was given the ID tag. That wristband, the scanners used by the many people who came in and out of the prep area to deal with me and several other patients, the seamless logistics in evidence–therein lies the heart of this essay.
Here was 21stcentury technology at work in the hands of well-trained professionals. No dogged-eared paper files spilling out of boxes being frantically explored. A scan of my wristband activated computers on moving stands. They told the professionals of my ten-year relationship with AGH, which is no cushy facility, although it is accounted a Level I A & E facility. All I had to do was tell them if anything had changed since someone last talked to their computers about me. What impressed me was that everyone who dealt with me knew what I was there for and made their contribution with a minimum of fuss. When I woke up from induced oblivion, the specialist had the follow-up talk with me, and when I was released, I left with image and text printouts of findings, prescriptions, etc.
What practical analysis, to date, has been done to inform forward movement in the health care facilities of The Bahamas? Have there been simple time trials of movement through Accident & Emergency at the Princess Margaret Hospital? For example, from the time someone seeking assistance enters the door, how long does it take that person to move from one stage to another? How long does it take to locate a file? How long before a physician enters the picture? How long before someone hangs an IV? To what extent have we mined data to examine the nature and frequency of outcomes, good, bad or indifferent?
What of supply chain logistics? What about maintenance time lines? What methodologies examine and feed quality improvements,service enhancements,cost reductionsandproductivity increases, if any? What examinations have there been of time-value ratios?
If we really mean to make a quantum leap forward this time, shouldn’t our decisions be driven by the more scientific analytic environment employed by modern, highly competitive businesses in the 21stcentury? Such an environment is usually built on the following platform:
- Descriptiveanalytics asking the question ‘What has happened?’, conducting research, data aggregation and data mining to provide insight into the past
- Predictive analytics, which, by asking ‘What could happen?’, provides insight into the future
- Prescriptiveanalytics, using the data aggregated from the two earlier phases, helping to answer the question: ‘What should we do next?’
Money for modernization is nearly always a challenge in providing quality health care, even in highly developed nations and many times more so in countries still developing. In The Bahamas, we can do far better than we have done so far, however. If we really mean business this time, other necessary adjuncts to healthy healthcare will require unequivocally dispensing with political appointments unblessed by competence in the field of appointment and dispatching to Hades labour union practices that seem to forswear any obligation to productivity, compassion and community.
On the other hand, the new, brighter future of Bahamian health care will demand a populace that accepts and acquits their individual obligations to the health care equation—understanding the need to contribute to personal and national health plans and making a personal commitment to the eradication of non-communicable chronic diseases, starting with one’s own lifestyle practices. An article dating from 2011, based on data from the World Economic Forum, noted that the global cost of five non-communicable diseases—CVD (cardiovascular disease), diabetes, mental illness, chronic respiratory disease, and cancer would reach over $47 trillion over the following twenty years—a cost, in my opinion, that is as unnecessary as our vestigial tails. (https://www.medicalnewstoday.com/articles/234590.php)
And we need more compassion and less arrogance in newly minted physicians and a fairer apportionment of patient time from the lordly consultants.
My sincere hope is that a partnership between Johns Hopkins Medicine and the Public Hospitals Authority will materialize and will continue on a basis of honest self-examination and accountability at each step of the way.