The COVID-19 pandemic has pushed the medical and para-medical staff to the brink. In the past two years, we have seen several news reports about the medical staffs’ hard work and diligence. The government has tried to ensure that treatment for COVID-19 patients is freely available at all government facilities, including village level and home-based care for COVID-19 patients isolated at home.
But seldom do we care to ask about the experiences of patients who underwent COVID-19 treatment at public health facilities. What was their experience? This information is essential, as a positive patient and family experience in the hospital often results in better overall health outcomes for the patient.
The John Hopkins Medicine puts inpatient experience under the patient safety and quality category. In the US, the quality of hospitals is compared to the delivery of care provided to the patients. Also, in the era of value-based healthcare, one strives for the most optimal outcomes and experiences from patients’ perspectives. So, patient experiences have become a key quality indicator for healthcare intending to drive quality improvement of hospital care. Thus, it is not just the personnel and infrastructure needed to be in place, but what is also essential is the quality of the care delivery.
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In trying to gauge this experience, we interacted with several people who tested positive with COVID-19 in 2021. They were inpatients across ten public health facilities in Ri Bhoi, West Jaintia Hills, East Khasi Hills and South West Khasi Hills District and four private hospitals in Shillong. Public facilities were either a primary health centre, a community health centre or a government hospital. Of these, 74% of the people opted for a government facility, 20% opted for a private facility, and 6% were in home isolation after visiting the health centre.
On reaching the government health centre/hospital, all the patients stated that they received immediate treatment except for 3%, who said they had to wait in the emergency room for a long time. Also, the doctors were available in all the government facilities except for the same patients (3%) who had to wait. All patients were transferred to the Isolation Ward or COVID-19 ward, where there was a consultation with the doctor at least one to three times a day. Fifteen per cent (15%) of the patients had recollected poor communication with the hospital staff. A 20-year-old patient said after they tested positive, they were shifted to the isolation ward, and there was no clear communication on what needed to be done.
Also, there were a few instances that patients complained of the ill attitude of the hospital staff towards them. A male patient of 40 years said, “The staff showed a bad attitude towards us.” Many patients also observed that there were a limited number of doctors and nurses in the health facilities, and they had to cater to a large number of patients. This also added to poor communication and services. A 57-year-old man from Ri Bhoi said, “There is less number of health staff to treat a large number of patients and this leads to a stressful environment.”
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The patients were also provided with basic medication without payment, though some patients purchased medicines outside the health facility. A few of them had an X-Ray done, for which they didn’t have to pay. There were 54% of people who had to purchase medicines; this amount ranged from Rs 500-Rs 50,000 with an average expenditure of Rs 16,750. This was less compared to patients treated at private hospitals, where the average expenses were about Rs 55250.
Most patients raised the issue of high costs of treatment or medicines, since 90% of the people we interacted with were self-employed, including daily wage earners.
Although people had to pay, one-third of them were happy with the services. A housewife aged 36 years who was an inpatient in Civil Hospital, Nongpoh said. “I feel I have received the best care from the doctor and nurses.” Also, a woman of 24 years who received services from Civil Hospital, Ialong said, “yes, I am happy with the services provided to me during my stay at the hospital.”
We observed that 41% of the patients used the Megha Health Insurance Scheme (MHIS) card, yet they mentioned that the deductions made were quite minimal, and therefore, they had to still pay quite a substantial amount on their own.
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From this interaction, three aspects have come out clearly. People would want the government to enhance MHIS’ coverage, some patients had experienced poor communication with the staff of the health centre/hospital care while other patients were satisfied with the services they received during their COVID-19 treatment.
We are encouraged by the good comments and applaud our health force, who have been working 24×7 to provide the needed services during this pandemic. However, when we examine the ‘communication’, it is important to note that this is an important component of quality improvement. Studies have shown that clear communication with patients had positive effects, as they know what to do and what to expect. This reduced readmission and prevented even life-threatening events. In their research, Ong et al (1995) reiterated that clear communication is of great importance in the world of medicine. Effective physician-patient communication is vital as it is related to favourable health outcomes such as increased patients satisfaction, compliance and overall health status. Quality improvement in our public health facilities can start with qualitative indicators such as empathic and caring interpersonal interactions between doctors and patients encapsulated in clear communication with patients, good staff attitude and a good ward environment.
Having said this, it is imperative to note that for effective communication (verbal and non-verbal), there needs to be an increase in the number of healthcare workers. This will ensure that the staffs are not overworked and get adequate rest. They have been on the frontline of this pandemic for almost two years now. If we cannot empathise with the long working hours of our health personnel and do not do anything to ease their burden, we cannot demand much more than what they are providing at the moment.
Dr Melari Nongrum is an Associate Professor at the Indian Institute of Public Health, Shillong. Dr Nandaris Marwein is Assistant Professor at the School of Social Work, Martin Luther Christian University, Shillong.
(Authors’ note: This research was supported by the Thakur Family Foundation. The Thakur Family Foundation has not exercised any editorial control over the contents of this research.)
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