#BTEditorial – The QEH – are we rearranging the deckchairs again?

Recently, Minister of Health and Wellness Lieutenant Colonel Jeffrey Bostic spelled out some changes that the Government is making to the managerial structure at the Queen Elizabeth Hospital (QEH) in an attempt to resolve some of the major issues that have hampered its ability to properly deliver on its mandate as the primary acute health care facility on the island.

First, he has appointed an Executive Chairman, who will deal primarily with legal matters, strategy and partnerships, policy implementation, communication, general security and philanthropy among other issues. The Executive Chairman will report directly to the Minister of Health, rather than the Ministry, to “cut out some of the bureaucracy”, Bostic said.

Which does not rule out bureaucracy in other areas. “There will also be a Chief Operations Officer who will be responsible first of all to the Executive Chairman for the overall management of the hospital. In other words, the other executive directors will report to the chief operations officer, and then on to the chairman.” Then, the Executive Director of Clinical and Diagnostic Services will be responsible for the laboratories, pharmacy, radiology, infection control, orderlies, case management, social work and rehabilitation services. Some of these duties will be shared with the Director of Medical Services.

But why is it that we get a feeling of déjà vu with this latest development? After all, over a decade ago, management of the hospital was moved from under the direct responsibility of the Ministry of Health to a statutory corporation, which was aimed at making things run more smoothly as well.

How will the latest ‘administrative upgrades’ make a difference to the everyday problems at the QEH?

For several years now, we have heard of people dying on stretchers in the Accident and Emergency Department after waiting there for hours with no one even looking in their direction; a high turnover of nurses, whether local or sourced from other jurisdictions, for various reasons; malfunctioning, broken down or obsolete equipment essential for performing medical procedures; mould and other environmentally hazardous problems with the air-conditioning systems. There have also been problems with access to hot water, which, according to one source, “has become so bad that nurses have to use the kettle they normally use to make tea to boil water to bathe the patients on the wards”.

There is also the issue of broken toilets for public use in sections of the plant that were out of commission for a while but have now come back into service, such as the Eye Clinic. There was a time patients had to purchase some of the supplies they needed for certain procedures because the hospital did not have them in stock, and generally speaking, despite the fact there are dedicated staff members who do their best to make patients comfortable, many Barbadians now say: “Any time I get sick, I am going to a private doctor or leaving the island. I want nothing to do with the QEH!”

Health care is very costly, especially with an ageing population and an increasing prevalence of non-communicable diseases, and it is a field that is becoming more competitive. In an article entitled Why one-third of hospitals will close by 2020, written by David Houle and Jonathan Fleece in 2012, which looked at health care facilities in the United States, some of the reasons given for their conclusion run parallel to the complaints we have reported on regarding the QEH.

For example, they state: “The Journal of the American Medical Association reports that nearly 100,000 people die in hospitals every year from medical errors, and of this group, 80,000 die from hospital-acquired infections, many of which can be prevented.” Also, to use their words: “Hospital customer care is abysmal. Studies have also revealed that the average wait time in American hospital emergency rooms is four hours.” In Barbados, we all know it can sometimes stretch into 24 hours, and the unpleasant, indifferent attitude patients and their families occasionally get from staff members do not help the situation either.

There is at least one full-fledged private hospital in Barbados, plus emergency response private clinics. Not to mention many of us do have connections – family or otherwise – with other countries, so we should bear in mind the following warning: “Health care reform will make connectivity, electronic medical records and transparency commonplace in health care. That means that anyone considering a hospital stay will simply go online to compare hospitals relative to infection rates, degrees of surgical success, and other factors.”

The physical plant is definitely tired, and given the size and purpose of the facility, a hospital cannot be subjected to the same maintenance schedule (or lack thereof) in terms of cleaning and general repairs as an office building. The look and feel of the wards has been the same since at least the 1980s, and how can patients heal effectively when their surroundings look so – as the current expression goes – ‘pop down?’ It also needs a multi-storey car park so that people do not have to park all over Martindale’s Road and Delamere Land when they come to visit relatives or otherwise do business at the compound.

While there is nothing wrong with changing a managerial structure, were the constituents, namely doctors, consultants, nurses, ancillary staff at all levels (pharmacists, orderlies, cooks, engineers etc.), patients, outpatients and their families consulted regarding their concerns with the hospital’s day-to-day operations and how best they could be addressed? If so, were their considerations taken seriously? Time will tell whether these latest changes will work or if we are merely “rearranging the deckchairs on the Titanic” when the vessel has already hit the iceberg and is sinking fast.