MPROVING QUALITY HEALTH CARE IN THE HOSPITALS

Dr.T.V.Rao MD
Today India is a fast health care giving nation, in the World, hundreds of Medical and Nursing
Institutions, apart from many Private and corporate hospitals attracting many patients. It is certain
soon the patients will realise what is good for them whom to consult for their care and this process
many high tech and well-built institutes may not do a good business as heath care costs are
increasing and the paramedical and Medical professionals migrate to the newer opportunities and
even for few more benefits, In looking at the facts many low profile hospitals survived with the few
dedicated medical and paramedical staff, the expectations of the poor or a rich patient is little
human care. When someone really become sick the machines will not matter, and find the human
touch and concern is the most important, bring the greater rapport with patients, and reduce
litigation's after more than 4 decades in the medical profession if I become patient I wish to be
treated by good human being and not a great Doctors, and with little of my resources I wish not be
experimented with costly diagnostic experiments which many Doctors do for the benefit of built in
advantages in the system we live. In a very developed Nation like USA the patients want attention in
spite of high technological interface as with health care professionals who are most frequently at
patients bedsides, nurses play a central role in ensuring the quality of hospital care that patients
receive, and their vigilance is an important defence against medical errors. But when they are
overburdened with nonclinical demands and system inefficiencies and failures, patient care suffers
and disillusioned nurses often leave their jobs. We should not forget if the faster the people are
leaving the Institute without valid reasons we should take feedback what makes them to leave, they
leave certainly when the young people have no opportunities to learn from seniors and system is not
considerate, it means we will have faster turnout of employees. A significant challenge all over the
world is to provide high-quality, patient-centred care is the high turnover of nursing staff. The
national average for nursing turnover in U.S. hospitals ranges from about 8 percent to 14 percent
per year, and the rate for nurses on medical/surgical units may be even higher. It means it is much
unavoidable factor even in India and even may be much more in Kerala as many looking for
opportunities in high tech hospitals and more lucrative jobs abroad. Research has shown that 70 to
90 percent of errors in hospitals result from badly designed systems of care. Close to 40 percent of
all unanticipated hospital deaths occur on medical/ surgical units. I wish every hospital should have
an audit of mortality and prolonged morbidity after the care by a particular unit, and I think it is
essential unless we have self-assessment of matters of care in our hospital and it may not sustain
with time as every untimely death and dissatisfied relatives of the patient will bring down fall and
reputation of the highly qualified professionals Learn what quality improvement activities are
underway in our area, learn from other hospitals how they are managing the matters and ask how
you can contribute and to improve ourselves. I think the first face of the hospital is our causality
departments every one and the relatives who accompany patients take the matters into serious
consideration when the matters go wrong. Many upcoming hospitals are empowering the human
resource departments with good communication in times of crisis in hospitals across the nation,
teams of doctors, nurses, other front-line staff, and administrators are working with patients and
other stakeholders to improve the quality of hospital care. To a truly Professional Nurse or a doctors
the life is very stressful the impact on health care staff is real. Staff health is poorer in health care
than in other sectors, as we see in many nursing mothers and pregnant staff and stress and sickness
rates too are higher. Unless these stresses are recognized and dealt with, health care staff are at risk
of burnout and can become disengaged from their patients. This does not excuse the failings by staff
working in hospitals, but this burnout and disengagement is undoubtedly a factor we need to
consider where the quality and compassion that patients need is lacking. Many health care staff
believe they are surviving, not thriving. Staff stress should be addressed across the system rather
than as an individual problem or weakness for the benefit of patients, staff and the system as a
whole. We cannot blame the maters on few in a Developing countries like India and major errors
happen in the developed country too. Unites States Statistics show As many as one-fourth of
hospital deaths might be preventable; nearly 180,000 people die each year partly as a result of
iatrogenic conditions. Moreover, as much as one-third of some hospital procedures expose patients
to risks without improving their health; one-third of drugs prescribed are not indicated; and one-
third of laboratory tests showing abnormal results do not get followed up by clinicians (Dubois and
Brook 1988; Brook et al. 1990; Leape 1994; Institute of Medicine 2000). We need to address the
matters on a priority finally, extensive involvement of hospital staff across multiple units may also
strengthen the effectiveness of Quality improvement efforts by promoting a quality culture. That
is, pervasive participation in QI promotes shared values about the importance of continuous
improvement, using data and scientific methods to identify problems, communicating openly, and
collaborating to implement solutions. Quality care is the need of the Hour neglecting will perish not
only Institutes, Medical colleges, and even the popular doctors in the high regard, the choice is yours
to realize where we stand and think and understand the problems with positive attitude. It is
essential for the Upcoming Institutes and Medical Colleges should have work audit of Departments,
Senior consultants and Professors should interact with administrators and managements, every 6
months to bring before the administrators and managements problems in work place in improving
the services to improve the quality performance, and to find better solution to improve the quality
assurance which is an never ending topic if we wish to survive in the competitive world.
Dr.T.V.Rao MD Professor of Microbiology, Travancore Medical College, Kollam Kerala