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The recent death of 4-day-old Dera Nur Anggraini after
she could not access neonatal intensive care (NICU) has drawn widespread
attention. 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 behavior of its doctors. It is impossible
to prevent our patients from visiting hospitals in Malacca, Malaysia, or
Mount Elizabeth Hospital in Singapore for medical check-ups or treatment as
they rarely receive such a professional service in Indonesian hospitals.
Jakarta Governor Joko “Jokowi” Widodo’s 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
apologized to Ayu’s parents, but neither could raise the dead.
Any attempts to humanizing Indonesian hospitals are central to addressing
such an absolutely heartless 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, knowledgeable about human
management systems, instead of career physicians.
Hospital management calls for people with managing skills, over physicians
that 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’ behavior, including the inhumane treatment of patients;
physicians’ degenerate behavior, preferring examination fees from their
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 communications.
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. While a nurse is rarely consulted
for face-to-face communication, the physician rarely reviews nursing notes
written in the patient records.
Hospital watchdog officers must stay or work in hospitals with a view to
assisting patients in accessing their rights. Yet this does 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.
Concerning the KJP program in the capital city of Jakarta, the idea to put
an extra 30 percent of beds as class III for both public and private
hospitals intended for use by the poor should involve the insurance
industry and healthcare providers.
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, making
hospital mismanagement even worse. The unavailability of a help desk in
many hospitals or lack of access to a call center 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 will
change nothing for a better health service, 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 organizational teams. ●
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