Healthcare system in urgent need of reform

The news that the wrong patient had undergone brain surgery at Kenyatta National Hospital due to a mix-up spread fast around the world. But this was not the first case of medical error in Kenya.

In 2015, an expectant Elizabeth Akala died after being left unattended and in pain at Kakamega Provincial General Hospital. Alex Madaga had died a month earlier after being shuttled between hospitals in an ambulance for over 18 hours.

Uproar follows such high-profile cases but soon it’s back to business as usual. Kenyans should be outraged that such events keep occurring. Being among the most innovative people in Africa and beyond, why can’t we craft a way out of the preventable medical errors?

DELIVERY SYSTEM

Paul Batalden, a healthcare improvement pioneer, stated that “every system is perfectly designed to get the results it gets”. In our case, the errors are a result of the healthcare delivery system design. In the recent case, it appears the hospital did not employ evidence-based processes such as surgical safety checklist and technologies like barcoding to track and identify patients.

Akala’s death reveals the possible underlying problems with healthcare workers’ training and systemwide incentives to provide patient-centred high-quality care.

In the case of Madaga, apparently, he was not admitted to private hospitals for lack of down-payment and an empty bed in the ICU ward at KNH.

Medical errors are not unique to Kenya. In the United States, an estimated 200,000-410,000 patients die every year from preventable medical errors.

MEDICAL ERRORS

Quantifying the harms associated with medical errors and suggested viable solutions from an interdisciplinary group of experts may spur a movement to reform. But in Kenya, there is no reliable systemwide incidence and prevalence data to measure the magnitude of the problem.

Reform should include universal access to emergency care. A hospital shouldn’t turn away a critically ill patient because of lack of money.

In the US, all hospitals — private and public — are required under a 1986 law to stabilise and treat anyone presenting themselves in an emergency department regardless of their ability to pay. However, the government also created programmes to reimburse hospitals for uncompensated care.

CHRONIC CROWDING

Reform must also focus on KNH’s chronic overcrowding. A possible solution is to enhance a hub and spoke model where patients are triaged at the initial entry into the system and sent to the most appropriate centre.

Some can be sent to outlying hospitals or clinics, depending on their acuity, to avoid delays and re-transferring.

Another approach would be to ‘nationalise’ selected county hospitals and disperse some of the services and personnel from Kenyatta there. KNH can supplement this with the deployment of telehealth for specific services to serve more patients at local hospitals instead of traveling to Nairobi.

Also crying out for review is how the government pays for services. The trend elsewhere is to tie payments to select quality measures, like medical errors and patient experience, under a value-based payment system.

REFORM

Central to the reform is a workforce that is well trained, including on customer service, and handsomely paid and works in an enabling environment.

Developing a culture of patient safety and patient/family-centred care will be the building blocks for a safer, fairer and affordable high-quality healthcare system.

But the government alone can’t fix the broken system, however. To solve some of these entrenched problems, all stakeholders must come together to overhaul the system.

 Dr Mose (PhD), assistant professor at East Carolina University, USA, is a health policy and management expert. [email protected]