How Come Doctors are Infallible?

Are doctors infallible? This is a joke right? Of course we know better after reports many incidences of medical mistakes, unfortunate incidences and outright malpractices in the press and huge malpractice awards. Should doctors be subject then to oversight like other professionals? Apparently not most doctors don't take kindly to regulation and patient safety standards and policing fearing it will infringe on autonomy, patient confidentiality and other reasons. While Malaysia was fomenting in anger over the death of Teoh Beng Hock here I was cooped up at the KL Convention Centre attending the APHM Healthcare Conference 2009- Applying Best Practises in Healthcare Delivery. Given the choice I would have like to attend Teoh Beng Hock's funeral to show my abhorrence at his treatment and death.

The conference about how to apply best practises in the delivery of health care and learning how other countries are doing it. The number one consensus statement of this conference is the fact that Doctors especially specialist are not interested and downright against this proposal. I am surprised or should I be surprised that doctors still live in the stone age compared to other professions.

The second message is that to get compliance there must be management commitment, communication and the signal to doctors that implementing best practise should be non punitive but information sharing. Doctors should be asked what they want to know more about their own practise in terms of outcomes and complications.This process is slow and laborious -it took 5 years to have a decent level of reporting form the KPJ group. In Taiwan incidence reporting is done online and a high profile person is in charge, even then reports from doctors as opposed to other staff only constitute 2%.

Another important aspect of improving standards is to communicate to staff how their functions integrate to the functioning of the hospital.

At lunch I was fortunate to meet the Quality Coordinators of Loh Guan Lye Specialist Centre and
learn from them concerning implementation of quality assurance. Their duties include reports and analysis of incidents reports, root cause audits on ISO, ISQ etc. They also shared that each department has more than 10 KPIs for each year with bonus tied in. So employees bonus are subject to Hospital KPI, departmental KPI and own performance.

The second day of this conference 22nd July was mainly devoted to teaching undergraduates what about patient safety. WHO has started a World Health Alliance for Patient Safety and one of the aims is to insert this very important subject into the undergraduate curriculum of medical schools. It is very difficulty to teach new tricks to old docs so the only hope is the new future docs?

Ismail Merican the DG for Health ( yes the one who stood by the government report on Kugan's post mortem and Anwar's sodomy report) spoke that in 2010 online reporting will be required of public hospitals on safety issues. This should improve safety issues as it will then be compulsory. But the implementation of this aim may or may not be efficient as it is always a question of delivery of the public service will come to question.

The third day the conference was divided into 4 tracks I attended the one concerning Hospital Financial Management for non Financial Manager: 1.Lower Staff Cost through Labour Management Models 2.Reducing Non Labour Cost through Cost Management and Supply Chain Management 3.Recognizing and Understanding the Revenue Cycle. Labour cost needs to be studied and a unit labour cost and total volume correlated. The supply chain is well managed already but there are perhaps still some opportunities here for management. Lastly in the revenue cycle the overarching theme is this: The more effort you put into precertification the less problem you have everywhere else. 70% of our business is from insurance now, it follows that preadmission vetting and communication is of extreme importance to patient satisfaction and future collection. More effort needs to be expanded here.

The application of best practises is already a fact in some countries and in many hospitals eg in Korea they have yearly survey of hospitals and in Taiwan the infrastructure of a universal accreditation is in place. It follows that our hospital has to be ahead of this curve.