Category: Quality healthcare in Ghana

Concierge medical practice. Medical equipment supplier

THE CRY FOR GOOD CUSTOMER CARE IN THE HEALTH SECTOR IN GHANA

 

Someone jokingly said customer care meant that the customer rendered the service. As funny as that sounds, that tends to reflect the quality of customer service with is offered to many clients and customers in various industries in Ghana. The health sector is not immune to this problem.

Whoever coined the phrase “Ghanaians are very hospital people” must have been joking at the time, but it has been widely circulated and believed. Ghanaians are not any more hospital than the people at the North Pole.

Because the health sector has been largely socialized by various governments for political expediency, it has been difficult to inject sound business practices into the sector. The result of this is an entitled patient and a disgruntled service provider.

I have met with patients in both public and private hospitals who are just downright rude to health workers. Those same patients will quietly sit and wait for hours to see some politician in their office. I have also known rude healthcare service providers. There are rude people in every industry.

No one is born with good customer service skills, anymore than anyone is born with the inherent ability to fly a plane. Customer service is a skill. It must be taught.

Major corporations spend significant portions of their revenue on customer care training for their staff. Unfortunately the Health Sector has largely left customer care to the discretion of the staff. Both public and private hospitals are culprits.

People will generally buy goods from people who treat them well, and the same thing extends to the service industry. Banks that have excellent customer service generally do better than those that mistreat their customers. People will keep seeing a doctor they like and trust, and who treats them well. They will keep their distance from one who does not treat them well.

At the bedrock of customer service is quality medical care delivered by highly competent professionals. This is however not enough to make the patient satisfied.

Customers expect attention and communication from their service providers, whether it is at the bank or in a hospital. The hospital patient is however unique. This is primarily because a hospital is not a natural place where anyone would want to visit unless they absolutely had to. The hospital is largely an unfamiliar and scary place for many. This is part of why it is important to make the experience a less painful, if not happy one, for the patient.

One key element which impacts the quality of care is the waiting period. Long waiting periods simply aggravate an already fragile situation. A patient who comes in for an appointment and has to spend 45 minutes in the waiting area before being attended to is more likely to be dissatisfied with the quality of care than one who is promptly seen to. Patient satisfaction has been proven to be inversely related to waiting time. This is not surprising.

In order to reduce waiting times, the first thing a facility needs to do is actually track a patient from the time they entered the facility till the time they left. This can be manually done by the staff, using timing chits which are given to the patients upon arrival at the health facility, with the time the patient gets to each station being documented by the staff at that station. It can also be done using hospital management software, many of which have this feature. It is important to actually measure this index, because it is in measuring the index that you can actually do something about it, and then you can actually see later if you did succeed at it. Generally speaking, even though there is no specific ideal waiting period per se, studies generally agree that thirty minutes is a reasonable maximum. I personally think that for a patient who actually scheduled an appointment and shows up on time, fifteen minutes should be the maximum amount of time they spend waiting to see the doctor. Some other factors which may affect the patient’s satisfaction include the condition of the waiting area, whether or not the staff are friendly, and the availability of entertainment. All these factors can either enhance or diminish the patient’s experience.

It is incumbent upon hospital managements to adopt proper strategies to curb prolonged waiting periods in their facilities. The impact of poor customer service on hospital earnings cannot be overemphasized. Whereas previously patients did not have many options, that situation is fast changing, with the springing up of various health centers particularly in the city. While it may be true that those other facilities may not offer any superior customer service, the patients have not found out yet and will leave your facility first, which will lead to a loss in revenue and possibly reputation for you and your facility. The social media age has brought with it some challenges for health service providers. Various online platforms afford aggrieved patients the opportunity to vent their displeasure publicly. An aggrieved patient could easily post a negative public review.

What factors affect the waiting period in hospitals?

The first factor is inadequate staff strength. Many facilities do not want to invest properly in manpower, and will staff a busy reception with one receptionist to attend to dozens of patients at a time. This of course slows things down significantly, and adds several minutes to the waiting period.

If the number of nurses are disproportionate to the number patients waiting, those patients are going to end up spending longer than expected periods of time waiting.

Other hospital workers such as laboratory technicians, pharmacists and even accounting staff must be adequate. It can be quite irritating for a patient to spend 15 minutes with their doctor and 30 minutes trying to pay to the cashier.

When hospitals fail to hire the right number of staff, the few left doing the work quickly get overwhelmed and become inefficient as a result. The patient bears the brunt of this inefficiency. Names get misspelled, folders get misplaced, minimal attention is paid to the patient, the tendency to be curt with the patient increases by the hour, and the end result is a disgruntled customer right at the beginning of the provision of the service. It is important to adopt best practices from around the world and implement them in our health facilities. There is no need to reinvent the wheel. There are simple algorithms that can tell you how many patients one receptionist can safely attend to, and how many nurses are required to take care of 5, 20, or 50 patients. Some health facility owners are only interested in meeting the bare minimum requirements of staffing, even when their patient load strongly suggests otherwise. For example, the Ministry of Health stipulates that a hospital must have at least 8 full-time nurses, while a clinic must have at least two full-time nurses. The management of the facility must apply the common sense to know whether or not their eight or two nurses are adequate to meet the needs of the patient. If a clinic sees one hundred patients in a day, it would be nonsensical to keep only two full-time nurses on staff. Sometimes too, because of the penny – pinching approach of some business owners, they fail to attract the right caliber of staff. Owning a health facility can be lucrative if done right, and many non-medical persons are opening clinics. This is a good thing for the community because there is increased access. Some of these facilities, however, are primarily profit-driven, which leads the owners to cut costs wherever they can. Unfortunately, they may even cut cost on the essentials, which includes manpower. The outcome of this is facilities that are overcrowded with patients and manned by inadequate staff. 

Service delivery can be greatly enhanced by the right tools. For instance, the use of an electronic sphygmomanometer can greatly streamline the flow of patients in a busy clinic OPD. The use of an infrared thermometer instead of an axillary thermometer can have the same effect. These two equipment alone when properly deployed can cut the patient’s time spent at the nurses’ station in half.

In short, one of the major determinants of customer care is the waiting time in hospitals and clinics. The level of satisfaction by the patient is inversely proportional to the length of the waiting period.

It is important to objectively measure and track the waiting period so as to be able to effect any meaningful change.

The waiting experience needs to be improved for the patient, with proper attention needing to be paid to the air-conditioning, the provision of refreshments and entertainment, and the availability of reading material.

The right caliber and number of staff must be hired, and the right tools must be deployed in order to streamline patient flow.

These will go a long way to affect one of the key determinants of the quality of service.

January 6, 2019 / by HeiDoctorGhana

THE NEED FOR STANDARDIZATION IN THE HEALTH CARE SYSTEM IN GHANA

All things being equal, you should get the exact same experience in the same industry every single time. That is what standardization is about. If I fly Emirates or Delta or American Airlines fifty times, I should have no ordinary way of knowing which specific pilot was in the cockpit. The takeoff experience should be the same, and the landing experience should be the same too, all things being equal. You don’t want to board a flight not knowing what to expect. That is called standardization. The airline industry has almost perfected this art and science. Now I am not talking about whether they serve you potato or beans. As important as that is, that usually has nothing to do with whether you arrive safely at your destination (unless you have some kind of food allergy).

One important outcome of standardization is automatization – the elimination of discretion from the dispensing of a service.

For example, no matter the cook, kitchen hand or chef in a McDonald’s, a hamburger at McDonald’s will taste the exact same way. This is so unlike your local bread baker – one day the bread is soft and tasty, and the next day the bread is half – burnt, depending on the mood of the baker.

Whereas such discrepancies can be acceptable when it comes to bread, in terms of health care it could mean the difference between life and death. If a patient presents to two different facilities with the same complaints at the same time (if that were possible), the clinicians at both places should be able to come to the same diagnosis or diagnoses. Otherwise, one of them is wrong. It’s that simple.

That is called standardization. God is the architect of standardization. A second has the same value in Accra as it does in Beijing, Sydney, and New York City. If it weren’t so, there would be no way to compare various athletic competitions held in different cities at different times.

The Airline Industry understands this very well. A typical preflight checklist consists of well over 30 items for the pilot and crew to check before takeoff. A Boeing B-17 prototype crashed in Dayton, Ohio, in 1935. The pilots, both of whom were killed in the crash, had “forgotten” to disengage the gust locks before takeoff. The result was costly for Boeing and the pilots’ families. The management and engineers of Boeing introduced the checklist into their operations. Checklists have since become the industry norm in aviation. The industry figured that it was simpler to have it written and checked off every time than to rely on the pilots’ good intentions.

In 2014, a Gulfstream IV crashed during takeoff at Bedford-Hanscom field in Massachusetts, killing all four passengers and three crew members. It was found that the crew had failed to disengage the gust lock. Not only that but if they had run a preflight control check, they would have found out that the gust lock was still engaged. In fact, in that case, the National Transportation Safety Board found out from the plane’s records that 98 percent of the plane’s previous 175 flights were conducted with incomplete flight control checks. Further studies also found out that many business jets conducted only partial control checks before takeoff – a significant 15 percent of them. About two percent actually performed no checks whatsoever.

These numbers are much better where commercial airlines are concerned, because of tighter regulatory controls. In fact, it is the introduction of these standards, coupled with innovation, which has made flying the safest mode of transport. If automobile drivers would engage the same level of seriousness to their trade, traveling by road for many people would be much safer.

According to Investopedia, Standardization is a framework of agreements to which all relevant parties in an industry or organization must adhere to ensure that all processes associated with the creation of a good or performance of a service are performed within set guidelines. This ensures that the end product has consistent quality and that any conclusions made are comparable with all other equivalent items in the same class.

In essence, where standardization is applied, the quality of a good or service should not vary widely from point to point.

Many of us have had various experiences with healthcare providers. We have our favorite and least favorite doctors and nurses. Now, where proper standardization is in place, you should not be too worried whether or not your favorite health worker is on duty, because you will get the same quality of service from whoever is on duty.

The Health Sector has embraced some degree of standardization, especially when it comes to the field of surgery. Properly ran operating rooms use checklists. There is very little room for assumption, right from the proper identification of the patient, to the signing of consent forms, to the draping of the patient, to the type of incision, to the manner in which knots are tied.

The field of obstetrics, because of the huge outcry against maternal mortality, has adopted stringent standards as well, and these have led to significant reductions in maternal mortality, even though the situation is still largely unsatisfactory because of the inadequate numbers of suitably qualified health professionals.

Other fields within the health sector need to begin to adopt similar systems in order to enhance the quality of healthcare delivery. For example, instead of leaving the management of the patient to the discretion of the practitioner, some things need to be standardized. These industry standards do exist but are not being practiced universally. Because of this discrepancy, a patient with the same complaints will get two very different management systems from two hospitals a few blocks from each other. Whereas the specific treatments may differ from practitioner to practitioner, the diagnoses should not. A patient who presents with diarrhea and vomiting to a hospital, for example, should always have their electrolytes checked and corrected, in addition to being rehydrated. A diabetic patient who reports for review needs to have their eyes checked as a matter of protocol. Their urine should be checked for microalbuminuria.

Even though various checklists have been developed over the decades by various reputable bodies, many health professionals still rely on their own discretion in the management of patients, with the inevitable results of inconsistency and unreliability in the delivery of health services. One study conducted in Sub-Saharan Africa revealed that eighty percent of anesthetists said they did not know about the WHO surgical safety checklist or did not use it.

There are algorithms that have been developed, tested and found to be effective. It will pay a great dividend to both service providers and patients alike if service providers begin to actively make use of these checklists. There are internationally accepted guidelines for the management of virtually any condition under the sun. This does not mean that a certain outcome is necessarily guaranteed, but it does largely eliminate avoidable errors. In the United States, hospital errors are the third leading cause of death, after heart disease and cancer. That is a whopping 250 000 people dying out of medical errors. In Ghana, the statistics are not available for obvious reasons, but you can take a good guess.

You see a checklist ensures that you don’t miss anything important.

An auto mechanic who uses clearly developed checklists to diagnose his cars and solve problems will outperform a very brilliant mechanic who simply relies on his guts. That is why McDonald’s is a globally successful restaurant business, and your neighborhood eatery is struggling to stay afloat.

An “average” doctor who meticulously sticks to proper industry standards and uses checklists judiciously will deliver greater value to his patients than one who relies on his instincts alone. It is time that we fully embrace the use of timesaving and lifesaving standards in the health sector.

January 5, 2019 / by HeiDoctorGhana

LONG WAITING TIMES – THE BANE OF HEALTHCARE SYSTEMS

 

The length of the waiting period is inversely proportional to the patients’ perception of the quality of healthcare delivered, and the patient’s satisfaction. The longer your patients wait to see the doctor, the less satisfied they will be. It is really that simple.

 

No one likes to wait for long periods for a service, and healthcare is no different in that regard. Healthcare is quite different in other regards though in the sense that the people who come to the hospital are generally not too eager to be there in the first place. Most people would usually not go to the hospital or clinic unless they absolutely had to. Queuing up at Disneyworld is not the same as queuing up in a hospital OPD. The former has the promise of certain fun. The latter generally holds no promise of any kind of fun for the patient. Prolonging their waiting times for longer than necessary just complicates matters.

 

Patients have been known to get angry and walk off after waiting for great lengths of time. Others have lost their calm and assaulted health personnel. The loss in revenue and reputation to health facilities cannot be overemphasized. This is one area many hospitals have not paid attention to. They used to get by with the nonchalance because patients did not have too many options to choose from. One particular study of the waiting times at a major health facility in Nigeria showed that the patients waited anytime between 60 to 180 minutes just to see the doctor. They spent on average about 5 minutes with the doctor. As scandalous as that sounds, it is quite representative of what pertains in many health facilities, especially public health facilities, which are generally overwhelmed by attendants and understaffed at the same time. In order to change the status quo, there must be a strong political will to overhaul the healthcare system.

 

The situation in the private sector is quite varied. On one end of the spectrum are some facilities that are battling for survival, with low patronage. Those are not the subject of this post. The other end of the spectrum is made up of facilities which are just like the busy public facilities, with congested waiting areas and short consulting times. For the hospital owner who didn’t use to care about the length of the waiting period, it is time to wake up. This is because patients are becoming aware that they have options. Those that cannot afford the options would simply pray for the day they acquire enough money so they can seek better experiences elsewhere.

There are a few factors that are responsible for the long waiting times in the hospitals.
First is the inadequate staff numbers that are deployed to tackle the disproportionately high numbers of patients. It is not uncommon to see one receptionist attending to dozens of patients at a time. This scenario plays up because for some owners of health facilities, especially people without any medical training, healthcare it is simply a game of numbers, where they are interested in making the barest minimum amount of investment and yet reap high returns.

 

The healthcare industry can be successful, even lucrative when run properly. The vast majority of investors in the health sector, I am sure, have noble intentions of actually delivering quality service. Some owners, however, are only interested in making a profit. They sacrifice patient satisfaction for a higher return on investment. Some too can simply not help it because they do not have the funds to hire the right number of staff members. They may have jumped into the healthcare industry believing that it was lucrative, only to have the shock of their lives when they realized that it called for much more than they were able or willing to invest.

 

Another factor that can affect patient satisfaction is the quality of the waiting period. No matter how naturally patient someone is, it is much easier to wait in a beautifully furnished and air-conditioned waiting area than to wait in a crowded, hot and humid “waiting” area with no air – conditioning and no entertainment. The socialist approach to healthcare whereby governments indoctrinate the people to believe that they should expect “free” healthcare has created the situation whereby the government cannot provide decent health facilities for the general population. (Sometimes the government is able to build a beautiful edifice but cannot get it to run efficiently.) Unfortunately, some private health facilities have bought into the dogma of socialist healthcare. They provide the bare minimum at socialist prices. The end result is that they are not able to efficiently run their facilities. A well designed and properly furnished waiting area goes a long way to improve the patient experience. People will appreciate the value you provide, and they will recommend your facility to their family and friends.

 

Whereas there is no specific “right” waiting period, it is generally accepted that most patients will be happier with a health facility if they waited for no longer than thirty minutes to see their doctor.

 

Hiring the right number of staff in the beginning, and scaling up to meet increasing demand is the way to go. If your clinic is just starting off and not so busy yet, instead of hiring a receptionist, assign a nurse to your front desk. You can have the nurses rotate. Once your patient load begins to increase, you need to hire a full-time receptionist well trained in customer care. Or you can simply hire an extra nurse to share the workload. It is important that you have a pleasant person at the front desk. It is easier for patients to wait when the front desk person is patient and pleasant. The person at the front desk must be suited to the kind of clients you seek to attract to your facility. If your goal is to compete with the government health posts for patients, then you should hire accordingly. There is nothing inherently wrong with that. Just know that it will be very difficult for you to beat the government in a price war. The government can offer everything for “free’’ because it doesn’t need to work for the money – it can simply extract more taxes from you to pay for the freebies.

 

If your target is to attract middle and upper-class patients, hire appropriately. You need to respect your patients. Do not put someone at your front desk who is rude, does not communicate well, and always has gum in their mouth. That would just not cut it for your patients. Your business will soon begin to suffer, as your customers discover a facility with a nice receptionist who doesn’t chew gum or frown her face often.
Sometimes the bottleneck is in other parts of the patient flow through the hospital. For instance, you may have very smart receptionists, but your nurses may be inadequate or simply slow. Worse still you may not have the right number of doctors to take care of the patients. A lot of common sense must go into running a health facility. If you have 100 patients in your clinic you cannot have just one or two doctors on duty at the time and be “fine.” You ought to actually sit down and think it through. Does that proposition make sense to you? If you were among the 100 patients waiting would that be acceptable to you to have only one or two doctors?

 

Sometimes the problem is with the cashier, or the laboratory, or the imaging department if you have one. If your “laboratory” takes 4 hours to run a basic test, it might be a good idea to outsource this to a proper laboratory which would give you timely and accurate results. It is inappropriate for your patient to spend 13 minutes with the doctor and yet spend 20 minutes trying to pay their bill to the cashier. You might need to hire a few more cashiers.

 

The thing about fixing these issues is that you cannot correct what you don’t measure. You need to actively measure the average waiting time in your facility, and also find out how long patients spend altogether when they come. You can use a timing chit which you give to the patient at the time they enter the facility, and which will be endorsed at each station as the patient progresses through the system in the facility. When you collect about one hundred chits, you will have sufficient information to make a judgment. Some simple arithmetic will give you the average waiting time.

 

If you are unable to do this, however, you can find a good statistician. If you cannot afford the fees, you can get any high school Math teacher and have him help you. Just make sure you pay a fair price for the help. Paying for the help will help you take it seriously.
Once you have the data, you can begin to look at areas where the patients have been spending the most time. (I can almost bet that is unlikely to be their doctor’s consultation.) You can begin to make changes to your system that will greatly impact on the perception of the quality of care your patients get from your facility.

January 3, 2019 / by HeiDoctorGhana