A series of recent articles and editorials about incidents occurring at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) have raised legitimate concerns about patient safety and quality of care in the nation’s largest hospital. We would like to share our ongoing efforts to improve care for our patients.
We have already installed CCTV cameras installed in all strategic places in the hospital premises and in the BBS programme we have mentioned that more CCTV cameras would be installed to strengthen surveillance. The information on CCTV installation being held up due to budgetary constraint is wrong because we have an approved budget of Nu 2 million to set up control room and networking for CCTV for the FY 2017-2018. We have installed a total of 72 CCTV cameras in strategic locations in the hospital premises since September 2017.
The statement, “Despite the reality, hospital management remained complacent reacting only when activities, especially of criminal nature occurred,” is not true. In fact, since the establishment of Quality Assurance & Standardization Division (QASD) in JDWNRH beginning 2017, incident reporting policy had been instituted which mandates all the incidents to be notified and reported to QASD. An incident database had been maintained with the office. Each incident is analyzed for human errors that may have occurred in patient care and any organizational issues that might have contributed to the incident.
A report is then prepared with recommendations for improvement. The findings of the investigation are also shared with the caregivers and heads of departments involved in the incidents to implement corrective actions. The office debriefs and monitors implementation of suggested corrective actions in the concerned departments. Such practices existed even before QASD had been instituted.
We are of the view that it is not fair to state that JDWNRH lacks institutional monitoring and accountability. JDWNRH have been working hard and trying our best in fulfilling our mandates with the minimum lapses within the given resources and situation. We have been implementing all our plans and policies efficiently and have institutionalized monitoring and support system in place.
Though the planning of health human resource is expensive and time consuming owing to long training period, the Ministry and JDWNRH have been planning its human resource based on retrenchment of doctors and advancement of science and technology. The Ministry has been sending many doctors for specialization. However, the question of priority comes into play when developing HR requirement of the hospital since Ministry of Health (MoH) also needs to cater to the need of the two regional referral hospitals and 28 district hospitals. As is the situation in other parts of the world, Bhutan also faces short supply of Specialists. The pay package that we can offer to the Specialists from outside is not attractive enough for them to come and work in Bhutan. The hospital management is well aware that the Gyne-oncologist will retire in two years and the HR division has plan to send a gynecologist for training within the next two years. The hospital had also planned to send one gynecologist for training in maternal-fetal medicine for the past 5 years but we could not identify one due to the limited pool of gynecologist.
Therefore, it is not justifiable to state that that JDWNRH does not have proper HR planning. Over 200 Standardizing operating procedures have been recently reviewed, using checklists, speaking up for safety, and a commitment to be more respectful and aware of patient and family concerns. Our journey to improvement will continue and bring change in the system.
(Published on May 29, 2018)