The healthcare industry does not include only doctors and patients. The hospital employs a large number of employees who are integral to the delivery of healthcare.
The doctors provide medical services and are individually accountable.
However, the non-medical hospital employees are not individually accountable before any commission or council. They are collectively accountable under the hospital umbrella. It is a form of vicarious responsibility.
There is no doubt that individual accountability enhances the quality of services. The patients’ relatives approach the admitting doctor even for non-medical issues, as no fixed hospital employee is usually allotted for their patient.
According to many patients’ relatives, nobody takes direct responsibility except the admitting doctor.
Accountability is being answerable and responsible for one’s actions, decisions and professional conduct. The admitting doctor meets the patient’s relatives regularly to provide medical updates. However, no fixed administrative officer is assigned to meet daily to solve non-medical issues.
The operation ward managers keep changing and cannot be keep updates of specific patients. Many search for any known employee in the hospital for help. The present system in Calcutta appears to be too much “doctor-centric”.
This may be one of the many reasons for patient exodus to South India and Mumbai.
In 2017, the state government created the West Bengal Clinical Establishment Regulatory Commission (WBCERC) by a special act. It was a positive step that greatly benefited common people.
The commission monitors, regulates and supervises the functions of non-government clinical establishments. It examines and considers complaints against corporate hospitals, but not doctors.
This facility is available at no cost, and the complaints registered are instantly addressed. There is hardly any waiting list. The commission has granted compensation against clinical establishments in innumerable cases.
However, there is no provision to identify and directly penalise any negligent hospital employee.
The Oxford Handbook of Healthcare Management has examined this important issue of accountability.
Accountability is a word that is loaded with meanings that strike fear into the heart and soul of our healthcare system.
It also states that since the end of the 1980s, healthcare has shifted from an era of responsibility to accountability.
In the healthcare industry, the nurses, pharmacists, administrators, dieticians and billing experts play crucial roles.
Every job is important and should not be considered a “nine-to-five”.
This presentation addresses the concern of common patients, their families and well-wishers.
Patients’ perspective
Most patients agree that in the last decade, the corporate hospitals of Calcutta have made a significant contribution to healthcare.
Quality infrastructure and medical facilities comparable to national standards are now available.
However, patients have some reservations and share personal experiences with their doctor.
Some experiences are as follows:
CASE 1: My wife, aged 30 years, needed a gynaecological operation. I admitted her to a reputed corporate hospital. To my utter surprise, both males and females were admitted to the same general ward, separated just by a curtain. When I objected, the service manager said that this was unavoidable. Understanding that I could not afford a single room, my wife reluctantly agreed. Her mother was extremely annoyed. My self-esteem was shattered.
CASE 2: My elderly mother fell out of bed late at night. When I arrived at the hospital early the next morning, no staff took responsibility. I was helpless.
CASE 3: The wrong medication and diet were given to my patient. When I complained, I was advised to meet the admitting doctor. There was no redressal as I could gather no evidence.
CASE 4: The estimate that I was given before admission had exceeded phenomenally. I had already paid more than ₹3 lakh. When I pleaded, only a concession of ₹8,000 was offered. I paid the full amount.
CASE 5: On the day of release, my brother was asked to fill out the feedback form regarding services at the hospital. He could not make any negative comment as readmission was necessary. No feedback was asked from me, though I maintained liaison with the service departments.
However, when medical outcomes are good, complaints are usually forgotten, though they leave deep scars.
Additionally, patients do not file complaints on all occasions, as it leads to harassment.
Bad behaviour by hospital staff is alleged but cannot be easily proven.
Patients’ relatives do say that private hospitals are very costly, but it has to be borne. Many wonder why the erring employees cannot be questioned directly.
Generally, patients feel more comfortable filing complaints against accountable individuals rather than corporate hospitals with their own legal department. There is a general perception that the hospitals defend their employees even when they are negligent.
Individual accountability of all healthcare personnel will definitely improve services. The patients’ perspective may differ from the administrative or legal point of view.
Finally, it is the patient who is admitted and treated. They keep the system functional.
Gautam Mukhopadhyay is a surgical oncologist trained at Tata Memorial Hospital, Mumbai. He has been working in Calcutta for the last three decades