How can we improve patient care?

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Improving patient care has become a priority for all health care providers with the overall objective of achieving a high degree of patient satisfaction. Greater awareness among the public, increasing demand for better care, keener competition, more heath care regulation, the rise in medical malpractice litigation, and concern about poor outcomes are factors that contribute to this change.

The quality of patient care is essentially determined by the quality of infrastructure, quality of training, competence of personnel and efficiency of operational systems. The fundamental requirement is the adoption of a system that is ‘patient orientated’. Existing problems in health care relate to both medical and non-medical factors and a comprehensive system that improves both aspects must be implemented. Health care systems in developing countries face an even greater challenge since quality and cost recovery must be balanced with equal opportunities in patient care.

Non-medical aspects

The fact that the patient is the most important person in a medical care system must be recognised by all those who work in the system. This single factor makes a significant difference to the patient care in any hospital. In developing countries financial constraints often lead to compromised quality of care. This can be corrected by the introduction of management systems that emphasise cost recovery. Our experience shows that a system should first be developed to attract patients who can afford to pay for high quality services and such a system should then be extended to non-paying patients. This system has the advantages of high quality care and good cost recovery. Some of the issues that need to be addressed to improve patient care are listed below.

1. Access. Accessibility and availability of both the hospital and the physician should be assured to all those who require health care.
2. Waiting. Waiting times for all services should be minimised. In most developing countries, the high demand for services often makes this a huge problem. Nevertheless, it has to be addressed effectively through continual review of patient responses and other data and using this feedback to make the necessary changes in systems.
3. Information. Patient information and instruction about all procedures, both medical and administrative, should be made very clear. Well trained patient counsellors form an effective link between the patient and the hospital staff and make the patient’s experience better and the physicians’ task much easier.
4. Administration. Check-in and check-out procedures should be ‘patient friendly’. For example, for in-patients, we have instituted a system of discharging patients in their rooms, eliminating the need for the patient or the family to go to another office or counter in the hospital and waiting there for a long time. This has been favourably received by patients.
5. Communication. Communicating with the patient and the family about possible delays is a factor that can avoid a lot of frustration and anxiety. The creation of a special ‘Patient Care Department’ with a full time Administrator has helped our institution significantly and has enhanced our interactions with patients and their families.
6. Ancillary Services. Other services such as communication, food, etc. should be accessible both to patients and to attending families.

Medical aspects

The medical aspects of patient care are much better understood by most health care providers. This is dependent on the quality of medical and technical expertise, and the equipment and quality assurance systems in practice. The following factors contribute to the improvement of patient care.

1. Trained Personnel. A well-trained ‘Eye Care Team’ is critical to providing high quality care with desirable outcomes. Lack of adequate personnel and lack of adequate training facilities for the available personnel are major problems. The temptation to recruit untrained or poorly trained people should be resisted. The number of training programmes must be increased, and the existing programmes must be improved. Making a uniform basic curriculum available for all training institutions/programmes should help bring about standardisation.
2. Quality Eye Care. There is significant concern about the outcomes of cataract surgery, and other common surgical procedures. Incorporation of quality assurance systems in every aspect of patient care is critical. For example, adherence to asepsis in the operating rooms will help reduce post-operative morbidity and proper training of ophthalmologists in diagnostic techniques will help achieve better control of sight-threatening diseases.
3. Equipment. All the necessary equipment must be in place and properly maintained. This is vital to the performance of the medical system and contributes significantly to better results. Eye-care equipment of acceptable standards is now available at reasonable prices, and this must be accompanied by appropriate maintenance systems.
4. Use of Proper Instruments. Good quality instruments are now available at lower costs. With the development of proper inventory control systems for a given operation, the costs can be lowered.
5. Use of Appropriate Medications. Access to low cost medicines is an absolute necessity for appropriate care.
6. Use of Newer Technologies. It is important to continually employ newer technologies that improve the quality of care. Of course, this must be done with reference to cost-efficiencies.

Improvement of patient care is a dynamic process and should be uppermost in the minds of medical care personnel. Development and sustenance of a patient-sensitive system is most critical to achieving this objective. It is important to pay attention to quality in every aspect of patient care, both medical and non-medical.