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Index - Major Sections
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Quality Health Care
Clients cannot get quality health care.
“…people will not accept poor-quality services uncritically just because they are there, and services in many countries are therefore grossly underutilized (Cassels, 1995).
Health Care of the Social UnitThe client and his household are not treated as a social unit. WHO (1978) describes five basic functional levels of the family unit: biologic, economic, educational, psychological, and socio-cultural. In order to provide good health care and maximize the effectiveness of health care treatments, all five functional levels must be treated. It is the belief of InHCc that disadvantaged people and people in areas where there is a great deal of social change become “ill” for reasons that are still unclear. Many health care organizations serve communities with a diverse population. Clients may speak multiple languages, be culturally diverse, or present other barriers that make the process of entering and accessing the health care system very difficult. In order for the organization to eliminate or reduce these barriers it must first understand their target population. This can only be accomplished through the collection of detail data of the individual and of his or her environment. If the individual is not treated according to their individual needs, then there will be no equity in health care. Unless all information concerning a client’s environment is evaluated, the client will continue to be treated only for the symptoms and not the “cause of the problem”. While a child may have a broken arm, it is more important to know that it was broken by his father who was drunk because he was depression because he had no work. Health care professionals can not just focus on the individual’s present physical problem but rather must focus on the care of the individual as a whole. The individual’s beliefs and the value system that serves as his criterion in the choice of health care solutions are just as important to his health status as a prescribed drug. The individual’s value system and beliefs are mostly influenced by the family unit and it is at this level that the greatest health care cost-health status benefit can be obtained. However, very few systems address the individual within the context of the family unit. Too many health care systems, “patch up the individuals” when they presents to the clinic and send them out again into the same unhealthy environment only to see them again within the month. Any sick member of a household creates a drain of resources away from that household. While the organization may have been treating the individual it is probably more important to look at how any bad health experiences affects all members of that household. Does the improvement in the overall health of a household make the individuals in that household more productive? This is one of the most important questions to ask in developing countries. Can increase expenditures on medical care be used to improve the productivity of the nation? Although researchers have studied this question, it is impossible to answer without long term analysis.
Education of the Healthcare Professional
There is a sever shortage of skilled healthcare workers. The Joint Commission (JCAHO) has stated that the root cause of as much as 90% of patient-related incidents is inadequate orientation and training of staff (Koerner, 2003)...and that is in the US! Health Care Workers do not have sufficient up-to-date training and lack reference materials to do their work. Since many of the young graduates are sent directly to rural area to do their residence, there is little opportunity for them to advance their education or to have anyone correct them if they make mistakes. In many cases, these physicians pick up very bad habits. Increasing the ability of the Healthcare professional to deliver the correct care is a major goal of any HMIS. Healthcare is a broad complex subject and no-one (no matter what most physicians tell you) can know everything. Healthcare professionals require immediate access to extensive reference materials. In many countries, Healthcare professionals are educated by the government. When the HCP are finished with their training, they are required to "pay back" the cost by working in healthcare facilities designed by the government for a certain period of time. The problem with this is that many of these new healthcare workers are sent out to areas where no one else wants to work The HCP usually has no one else in these locations to help him. The HCP, in turn, forms bad habits. Medical Schools The desire for some developing countries to "increase the ratio of Healthcare Professionals to population" has caused many "Medical Schools" to open that provide inferior education. However, as some say, it may be better to have someone with a little education than to have no one! Client Education In addition to teaching clients about the services offered, clients should be taught when it is important to come into the health care organizations for services and when is not necessary to come into the clinic. Clients should be taught how they can care for themselves and recognize important personal health indicators. However, this also requires teaching the Healthcare Professional how to do this. Retention of Skilled Healthcare ProfessionalsEven when there are property trained Healthcare Professionals, these professionals leave (or fail to return) to their native countries and rather choose to work in locations more desirable or wealthier. This not only happens across countries but also within individual countries where the newly trained trained doctor would rather work in the urban cities instead of the rural village.
Problem:The "give me a pill and made me better" syndrome...which I heard often at the Triage desk! In general, quality of health care issues has been defined as the absence of shortages of financial, material, and human inputs (De Geyndt 1995). However, not only is there a need to know the inputs that go into the care, there is a need for the evaluation of the actual process of care. This has not previously been done because it was thought too difficult and costly. De Geyndt in his paper made the statement:
“Outcome measures were not used in the developing country studies. Improving outcomes is a presumptive result of improving the process and is not documented mainly for lack of valid and reliable measuring tools and indicators, the expense involved and the tenuous cause-effect relationship between process and outcome.
Solutions:
Medical Audit Committees can be established to audit retrospectively the clinical application of medical knowledge and compare the care rendered to the pre-set standards (De Geyndt 1995)…if the data is available to analyze. If the data is available, the strategy developed by Williamson (1971) of diagnostic categories and specific clinical procedures can be used. Standards are set by using evidence based medicine.
InHCc’s research (Mexico 2003) shows that even in very poor areas, a majority of clients are willing to pay for the services of a specialist even when the charges for these services are twice as much as the general practitioner. What is even more interesting is that these clients will visit a clinic that offers the services of specialists and by-pass clinics that do not have these services even though the other clinics may be closer.
“Perceived” quality of care may be the most import factor influencing clients’ choice of health care organizations. This observation may be extremely important when governmental organizations attempt to build health care facilities in very small rural towns and villages. If the quality of care in these facilities is not perceived to be good, then these facilities will fail economically and more importantly will fail to serve the needs of the local population. It may make little difference if these facilities are closer to the client or even offer the lowest price service; they will not be used. InHCc’s research has also shown that clients, in general, equate “larger” with “better.”
Many numbers that are calculated today to indicate “good quality of care” actually indicates poor management. As an example, the “proportion of health facilities that did not experience drug stock-outs” is a sign of very poor management. It is impossible for every facility to carry every drug and they should not be expected to do so. This is a waste of resources (overstocking of inventory requires additional money).
Patient SafetyEver since the US organization, Institute of Medicine (IOM) issued its report "To Err is Human: Building a Safer Health System" in December 1999, patient safety has been a major concern for a healthcare system. While many different types of "Errors" were being reported, what is never ever reported is how many people are being injured because the healthcare professionals are over treating their patients or giving them the wrong treatment for their "problem". Instead of an adverse reaction caused by a drug-drug interaction, we should say it is because the patient was given to many drugs! One CEO of the largest healthcare system in the US as the keynote speaker of a group of healthcare professionals said that their research showed that at lease 67% of all diagnosis are wrong!...Now if the Healthcare Professional cannot make the correct diagnosis...how is he going to give the correct drug??
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