Quality care in a hospital is a combination of several standards and practices and not just the medical procedure. While medicine itself is an art that is based on science and clinical evidence, quality care also requires a culture that values not only the patient’s disease, but also his emotional wellbeing as well the confidence levels of his relatives. This is achieved by following systematic and consistent medical and non-medical protocols, including transparency and ethics. Unfortunately, most Indian hospitals hardly comply with these requirements. As a result, the ultimate purpose — treatment outcome and patient safety — is compromised. Indian healthcare professionals, who often have opportunities to observe these standards in developed markets, cannot avoid noticing the compromises made in hospitals in their own country. But most of them do not take up the challenge of bringing the much-needed change even if they are given an opportunity, and simply blame the low-cost nature of healthcare in India. However, there are a few bold men who have really attempted the change and even thrived in this highly competitive and price-sensitive market. Dr Mohammed ILlias Sahadulla, chairman and managing director of KIMS Group of Hospitals and a very successful medical professional and healthcare entrepreneur, is one of them. With his prolonged experience in a standardised global healthcare system as a professional and an entrepreneur, Sahadulla says it is the mindset that needs to be blamed for such compromises in Indian hospitals. Excerpts from an exclusive interview with editor CH Unnikrishnan
As we all are aware, India, which produces and supplies the best doctors and other medical professionals to the world, still struggles with low-quality healthcare delivery in its hospitals. Can we attribute this to the absence of a strict and mandatory regulatory mechanism here, or has it to do with India being a low-cost economy?
I would strongly differ with the argument that low-cost settings and lack of regulations are the reasons for poor quality of care. Though these factors may have an impact on the level of sophistication in infrastructure and equipment, poor quality of care is largely a by-product of an inferior mindset that doesn’t understand the importance of being transparent and ethical. Standardised care is not possible in such settings, as a system which defines the treatment and patient safety portfolios is not followed.
Look at many of our hospitals, both in public and private sectors, especially the corporate hospitals that are changing the face of Indian healthcare, where there is no dearth of investment. The automation, equipment and overall infrastructure are often better than many hospitals in the US or Europe. We also have excellent doctors, nurses and technicians in most of these hospitals. But, unless you utilise these capabilities in a systematic and well-coordinated manner to ultimately deliver better patient care or
experience, these investments have no meaning in totality. For example, a hospital may have the costliest scan, but if it doesn’t have a skilled technician or if the facility is not well-staffed to handle the patient, the ultimate objective is failed. This way, it is also important to see how harmoniously the doctor, nurse and other support staff work in a team to deliver a better outcome, how transparent are they in their communication with the patient and the relatives. A prompt patient turnaround time, ensuring patient safety, proper infection control and overall patient experiences, is also very important and critical while considering quality healthcare delivery.
Although quality regulations and accreditations can ensure a comparatively better outcome, it won’t ensure quality care and better patient experience unless the mindset is changed to make this happen at the level of very minute details.
How do you compare the standards of healthcare delivery, especially in the context of services provided in the West and India?
The quality of care is to be measured on certain parameters. When you compare globally accepted healthcare delivery standards, there are many parameters currently available to measure the quality. As I mentioned before, these parameters — we call it as Key Result Areas (KRA)— are often not really associated with financial investment, but largely on a system that is in place and the way it is followed. For instance, a system-driven approach for reporting medical errors, avoiding chances of repeated tests and multiple exposures to radiation because of bad results and wrong X-rays, ensuring patient safety while under medication or surgeries, close coordination within the medical team — including doctors, nurses and other staff — aimed at the outcome, avoiding communication gaps and maintaining complete transparency, among others.
From my long experience in the international healthcare arena, I can proudly say that India has great talents in this area of service, the country can pick up technical advancements, automation etc much faster. I mean the Indian is second to none in these respects. But unfortunately, it lags well behind when it comes to the quality of healthcare delivery. If I put it politely, India is at least twenty-five years behind the West.
Perhaps, a strong insurance regime (we are still predominantly an out-of-pocket healthcare spend market) could play a major role in India to help develop standardised protocols in healthcare delivery to a great extent as it happened in the West. So, we need to go a long way, but for that, what is required is a change in our mindset. Many of these quality parameters can be achieved voluntarily, instead of waiting for the compulsions of accreditation and regulatory measures.
India is talking big about medical tourism and won’t this kind (poor quality of healthcare delivery) of scenario have a negative impact on that?
Yes, it will have an impact. But we are moving forward and developing [it]. We talk about medical tourism as there is ample scope for developing that opportunity. Our costs are definitely low in several areas and we have excellent doctors and facilities. But even today, most of the hospitals are not well prepared to receive such patients. This is because a typical Indian healthcare system cannot address many of the obvious questions that a patient from the West or GCC could potentially ask. For example, a patient from the West or one of the developed markets could definitely ask questions like why you have chosen that medicine or procedure, why the surgery or are there better options etc.. With the traditional Indian hospital mindset, we are typically not used to such questions. So, change is inevitable, and I am sure we will be forced to change as the market grows.