Health check for corporate hospitals

Following the horrendous tragedy at the AMRI Hospital, Kolkata, in which 88 patients and three hospital staff members perished, there was, for a few days, a wave of outraged editorials, commentaries and public statements.

The catastrophe has already faded from memory and the people continue to be in the dark about any fool-proof system of inspection of hospitals and enforcement of safety measures instituted by the Central and State governments. In short, it is business as usual for everybody, until, God forbid, another tragedy strikes.

Devastating fires are only one part of the management of private/corporate hospitals. Thanks to the self-promoting glitz and chutzpah surrounding them, they are, in fact, the blind spot of both the governments and the people, as regards accountability and transparency. Occasionally, someone somewhere who has been the victim of their blunders or exactions, bursts out in exasperation as, for instance, in the following blog by a distinguished professor:

“The corporate hospitals scare the life out of a patient as part of the milking process. Most of the drama of treatment that goes on is just to empty your pockets and to fill theirs….We've given them power they don't deserve and respect they haven't earned.”

GLITZY ADS

Well, the language is extreme, but there is no denying the core element of truth.

Indeed, the enlightened members of the medical profession themselves will be the first to admit that most corporate hospitals get away with perfunctory delivery of health care to those who put their trust in them. Here is an extract from an article by Dr Sumanth C.Raman, published in The Hindu of January 15:

“….no one really knows if the quality of care in these hospitals is as good as claimed as there is simply no organisation or body, government or private, that is measuring it. Almost none of these ‘centres of excellence' are willing to publish their outcomes or put up the results they get (with the patient risk stratification) on their websites as is done abroad. Browse through many major hospital websites in the developed world and you can check for yourself what their risk adjusted mortality rates are, their readmission rates, their infection rates, their quality indicators and attainment percentages for specific conditions like a heart attack, stroke and the like, their patient safety indicators, etc. Almost none of our corporate hospitals provide this information. Many do not even have the systems in place to measure these.

“All we have to go by is the assertion by these hospitals themselves through the glitzy ads we see in the media with an emphasis on the certifications they have received….(from) JCI Certified (Joint Commission International) or NABH (National Accreditation Board for Hospitals).….However, what these quality organisations evaluate is predominantly the capability of these hospitals to deliver quality care and not the actual delivery of quality care…”

MILLING CROWDS

I was actually present during the visit of JCI to a much hyped hospital for renewal of its accreditation. Normally, this hospital swarms with milling crowds making for unconscionable delays in attending to patients by doctors and the laboratory staff.

Just to dress it up for the JCI visit, the Chairman himself led his senior aides to drive the patients out and empty the corridors, so that everything looked swanky and picture-perfect.

The hospital might have been in trouble had the JCI interviewed patients, residents and staff and made on-site visit to patient care areas and to departments addressing issues related to physical assessment of infrastructure, maintenance, food quality, infection control, security, and so on, so as to form a correct idea of the clinical competence of hospital to deliver the promised services.

Neither JCI nor the NABH makes sure that the patient receives coordinated medical care with responsibility fixed on a leader of the team.

There are no patient-doctor, patient-specialist, patient-nurse ratios or ratings for surgical complications, infections, medical errors and potentially avoidable deaths, to which the hospital should conform, and based on which patients and their relatives can make a reasoned choice.

The Government should make it mandatory for corporate hospitals to set up independent Patients' Grievance Redress Forums and periodically publish scorecards of their adherence to minimum standards of health care.

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