NHS could learn from developing countries about efficiency, conference hears

When i started the "Justin Fadipe Hospital" project (JFC) twelve years ago, i was armed with only one idea: 'Reproducibilty'

How can i reproduce the qualities i had seen in hospitals i consider excellent without also recycling their weaknesses?

With only half a million dollars in my kitty, i was determined to push ahead with a centre that can 'cure the sick' and 'teach the students'

we were able to do this through a 3 stage development strategy transiting from primary level to secondary to tertiary care over estimated time intervals, convinced that if efficiency is enthroned, the project should be able to grow itself intrinsically to necessary heights.

reading the account from Viren Shetty, Senior VP N-H hospital india, gives me comfort for reason of shared disposition.

Of course india has a population advantage to my island of only a 75000 people and so economy of scale is helpful for NH far more so than for JFC but the core philosophy of 'doing more with less' has been our guiding compass and the reason we continue to thrive in a highly competed market.

Our desire for quality outstrips our desire for profit.

in a public service structure, quantity tends to threaten quality; but in a private setting such as ours, quality tends to threaten quantity.

The number crowded at the gate in a public service structure, knocking up for contemporaneous service creates a pander where what is ultimately available to the one is that which may be unavailable to the next.

This law of inverse relation mediates an unspoken contract between the one and the rest of the crowd milling at the gate.

Thus clinic appointments, consultant access, bed availability, operating promptness, nursing and medical care (with sufficient one on one passion), pharmaceutical obligations are all watered down by sheer volume of simultaneous demands on what may be an inelastic resource base. add to this the exhaustibilty to which dispensers of the service are vulnerable.

In a private setting, the quality of care jacks up cost, creating the possibility of inaccessibility to those with less disposable incomes.

How to have the benefit of quantity without its shortcomings and the advantage of quality without its tendency for loss of numbers has been our main focus;

it became evident that Experience and Interest are two indispensable, perhaps the most important, attributes.

experience prevents a doctor from having to waste three cannulae attempts to establish just one venous access and interest induces him to want to do it or teach another rather than delegate whilst he is smoking away on a sofa.

Experience gives the doctor a skill at a good history taking and interest forces him to actually use that skill; and use it so exquisitely to sift and minimise use of wasteful investigations to arrive at diagnosis that a disciplined history taking and clinical combing would have guaranteed with actionable accuracies

Experience minimises the total number of sutures used in a gastrectomy and interest guarantees that the intervention is not left at the hands of rookies without adequate or on site supervision or half the operating time is spent on in-session jokes.

Experience allows the nurse to mix drugs properly and the interest forces her to want to do the mixing.

Experience allows the rank and file to have a place for everything and everything in its place and interest allows them to be able to bend backwards if necessary to achieve the orderliness.

Experience teaches how to see and recognise the harbingers of poor hygiene; the interest forces the maid or doctor to keep short nails, clean hair, tidy habits, each of which improperly done, can predispose to hospital infections, increasing unnecessarily hospital length of stay and thus bloating costs.

same goes to the surgeon or physicians or any with contact with the pt who may be at the low end of their immune statuses.

Interest allows the staff to swicth off an air conditioner that is idling uselessly, the fan running in an empty office, the lights on in an unused room, the tap dribbling in an unattended pipe, the stationery disappearing into black holes, appointment schedules unsanitised and a host of other things that add to running costs.

Efficiency is not small, but small things lead to efficiency.

experience informs the administrator the perils of unevenhandedness in dispensation of rewards and penalties and interest allows him to stay the course; fostering high morale amidst staff and thus potentiating enthousiasme for rightful application of their experience and interest.

The combination of experience and interest leads to cost saving efficiencies.

When running costs are reduced through efficiency, the savings can be passed into the dual track of expansion on the one hand and reducing patients' fees, on the other, therefore countering potential loss in numbers without compromising quality.

Profits passed into ego-trips and aggrandisements do not nothing but reinforce a culture of indiscipline among the rank and file apart from short changing growth verticalities.

If patients and their care are made the central goal of the mission, the project is a win-win for both the sick and the proprietors.