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Emerald Group Publishing Limited
Article Type: Editorial From: Leadership in Health Services, Volume 28, Issue 1
This issue is proud to include as its opening viewpoint the winning essay in the Champion for Change Award, 2014, organized by the Student Medical Leadership Association, at King’s College London. Students were invited to write a 700-word essay on the topical issue of improving quality care amongst an ageing population. The aim of the competition was to encourage students to think about how quality care, emphasizing on patient safety in particular, can be improved through effective leadership and management. Shreena Suchak, a fourth-year medical student won that competition. Her winning essay entitled The Medical Motorway leads this issue. Using the metaphor of a motorway, Shreena writes of the increasing number of elderly patients as a flow of traffic on unsuitable roads, leading to jams and delays. Her solutions are quite brilliant, emphasizing from “quicker patient centred routes” to primary care centres, better use of technology and “geriatric pit stops”, where teams work with shared checklists to streamline the process of diagnosis and treatment. This short essay really does represent creativity at its best, and our editorial team is happy to be able to showcase it in this way. Well done Shreena. Now all we need is the will to actually work on your ideas in practice!
Another contest – but this time in Morocco! We have two papers both written by the same author, Dr Sahel, about a particular quality contest implemented in Morocco and repeated every 18 months to help improve the quality management system in hospitals in that country. I take three things away from Dr Sahel’s description of and analysis of the contest that I believe are important:
1. Those hospitals that participated in the contest saw a sharp improvement in performance and better use of resources, though these did not always impact the quality of patient care. Clinicians were not always fully engaged in the quality approach.
2. Further, correlation does not always translate into cause, so just because there were performance improvements following the contest, it does not necessarily mean that the contest actually caused this. Other reasons could have been at play as well.
3. The assessment instrument to measure quality has to be constantly upgraded to keep up with the constant evolution of the health-care system generally, and costs can be a deterrent.
In some ways, this kind of an initiative is something like participating in the Malcolm Baldridge Awards. People can become excited about competitions. Hopefully, the initiatives are sustainable, and can be expanded to include all the departments in the institution including clinicians who play a vital role in health service delivery and need to be involved in the managerial process.
The next paper “Developing a Physician Management and Leadership Program in Newfoundland and Labrador”, written by Dr Maddalena, one of our Editorial Advisory Board (EAB) members, describes the leadership-building programme these two Canadian provinces have developed. As Dr Maddalena notes, the growing complexity of the health-care field demands ever greater leadership and management skills from physicians. This programme, collaborative in nature between the university, the government and the health authorities, addresses this need by incorporating the physician management leadership programme into its undergraduate medical curriculum. So far, the results of this program are showing that the programme has had some significant impact on the leadership and management awareness and application of skills on the part of programme graduates. As we noted above, physicians in Morocco are not too interested in the quality competition, which must detract from the overall organizational improvement. Perhaps, if they had the benefits of this kind of an undergraduate programme in the medical training, they might demonstrate more interest in the managerial aspects of the hospitals where they work.
Next, we have a paper discussing the medical tourism industry in Malaysia. As a teacher in international business, and having taught in a hospitality-based school, I am always in a quandary as to where medical tourism as a teaching subject belongs. More often than not, it seems to belong in the tourism quadrant, yet really, it is perhaps more appropriate as a business and health subject. As Dr Manaf himself notes, health travellers are travelling thousands of miles, not for spa treatments but for serious medical interventions. The overall value of the phenomenon – some $60 billion in 2008 and presumably much more now – is a huge number in terms of its potential impact on a country’s gross domestic product. Dr Manaf’s paper reflecting on the impact of medical tourism in Malaysia is an interesting one and makes some serious recommendations for this country to improve its global medical market, thus building its economic contribution to this country’s economy.
Finally, we have a paper on the merits of using lean as a tool to reduce wait times for patients in an Indian hospital. We know that lean has brought about many improvements in manufacturing, and is increasingly being applied in the health-care field. However, as this author indicates, most of the research has been conducted in the USA and other developed countries with sophisticated health-care systems. This paper addresses lean interventions from the perspective of a hospital in India in a less sophisticated context. One of the reasons I like this paper is because it really does reflect learning in action and has a real practical application. It examines how an MBA student studying Lean Supply Chain applied the lessons of lean to a project in a hospital in India, and how it had a considerable impact on the reduction of hospital wait times on the part of outpatients, and improved the labour productivity considerably. Lean can be a powerful tool partly because it changes the way we think about waste. In this case, the improvements have been maintained, which is impressive and to the benefit of patients and the hospital organization.
As I write this editorial, we are coming to the end of 2014, and in the USA, it is Thanksgiving Day. This year has indeed been a roller coaster of a health ride, with perhaps the Ebola crisis having the most global impact. Ebola reminds us of the need for serious and knowledgeable leadership, and not just from politicians, news media and the World Wide Web. There has been much fear and negative reaction against those who have been victims of the Ebola virus. Whether intentional or not, the spread of fear can have a larger negative impact on the health of populations than a deadly virus. As I reflect on the North American Thanksgiving holiday, I realize I am so thankful for organizations such as Medecins San Frontiers, whose members overcome their personal fear, and who work on the front lines to help those who are suffering. Our sophisticated medical models and institutions are light years from the conditions so many of the Medecins Sans Frontieres (MSF) doctors choose to work in.
Thanks to all our authors for their contributions to this issue. To play with Shreena’s metaphor, the medical (and health) highway is long with many side roads and distractions along the way. It differs for all of us who have to travel it. These papers suggest there are ways to make it more manageable.