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Humanising Indonesia's hospitals
Publication Date : 26-02-2013
The recent death of 4-day-old Dera Nur Anggraini after she could not access neonatal intensive care (NICU) has drawn widespread attention around Indonesia. The baby’s family checked 10 hospitals across Jakarta but none were able to admit the baby because their NICU facilities were fully occupied.
Though no hospitals rejected Dera, the tragic death suggests how hard it is to provide proper medical treatment for poor people. Not long ago, people were shocked to learn that Ayu Tria Desiani, a 9-year-old girl, had died in Harapan Kita Hospital after she could not get immediate treatment in a ward crowded by a film crew shooting an Indonesian soap opera.
These cases are just the tip of the iceberg in terms of the country’s hospital management and the poor behaviour of its doctors. It is thus understandable that our patients prefer hospitals in Malacca, Malaysia, or Mount Elizabeth Hospital in Singapore for medical check-ups or treatment as they rarely receive such professional service in Indonesian hospitals.
Jakarta Governor Joko “Jokowi” Widodo acknowledged that hospitals were overwhelmed with patients seeking treatment following the launch of the Jakarta Health Card (KJS) program, and Health Minister Nafsiah Mboi’s apologised to Ayu’s parents. But neither could raise the dead.
Any attempts to humanise Indonesian hospitals are central to addressing such an absolutely avoidable incident. Attention must be paid to hospital management reform. It is high time for hospitals to be under the control and leadership of professional managers, instead of career physicians.
Hospital management calls for people with managing skills, over physicians who are simply engrossed in their own expertise. While dealing with life or death matters, it is ironic that many hospitals provide poor services owing to their failure to put “the right man in the right place” principle into practice.
Wide-ranging criticisms leveled against the Indonesian hospital service and physicians’ behaviour, including the inhumane treatment of patients, pushing for higher examination fees from queuing patients instead of longer consultations for them; and medical malpractice cases, suggest deep-rooted problems in the country’s hospitals regarding human resource management, medical treatment and physicians with ivory-tower mentalities.
Reforms in hospitals should deal with the differences in the statuses of providers in hospital medical or surgical wards, which are often a hindrance to improving the quality of service delivery and communication. Physicians rightly bear all of the authority and responsibility for patient-related decisions.
They, however, are not intimately involved in working with others when intervention efforts are undertaken.
Floor group meetings held by hospital staff typically do not involve physicians in discussions of individual patient bedside care. When physicians do their rounds, attending to patients, they usually first review the medical records, view the recent test data and other measures, then consult with the patient directly.
Hospital watchdog officers must stay or work in hospitals with a view to assisting patients in accessing their rights. Yet this would not improve hospital management to the full without taking severe sanctions into account if the staff and manager are found guilty of neglecting patient care.
Physicians need to change their service and treatment for the better in order to increase patient satisfaction. They must give more of their time and energy so that the patients come back. Frankly speaking, the patients’ need for extra special care is not necessarily transferable to beautiful facilities and the latest models of electronic equipment. Rather, physicians are required come down to the patient level and listen. That starts with service.
It is equally crucial that patients receive proper education in respect of their rights. Schools and universities play a vital role in raising early public awareness of people’s rights to medical treatment. There should be better and practical curriculum design, not only to equip people with a complete legal understanding of their rights as patients, but also to encourage them to have extensive knowledge of medical treatment and healthcare.
Patients’ low awareness of their rights has contributed to their poor bargaining power before hospital administrators and physicians. The unavailability of a help desk in many hospitals or lack of access to a call centre accommodating patient complaints underlines a miserable scenario, where patients’ rights to medical treatment are compromised.
There are countless attentive, open-minded physicians in this country who are properly serving their patients. Nevertheless, good physicians can not bring about better health service on their own, as they do not march shoulder-to-shoulder with hospital management reform, which involves teamwork, quality relationships within teams and communication dynamics within and among organisational teams.
The writer is a lecturer in the faculty of cultural sciences, Andalas University.