As medical science evolves rapidly with daily innovations, there is a growing tendency to apply untested techniques, often executed by under-trained professionals—whether Consultant Specialists, Resident Doctors, Nurses, Paramedics, or support staff. Today, healthcare delivery is teamwork, and any weak link—whether in competence or infrastructure—can drastically affect patient outcomes.
Each hospital admission follows a complex care pathway involving administration, diagnostics, clinical care, and support services. When adverse outcomes occur, blame typically lands on the attending specialist. However, in reality, multiple failures across the care process often contribute to such outcomes.
Lip Service to Patient Safety
Hospitals often shield themselves behind generic consent forms, signed at admission, to deflect responsibility for errors. In many cases, so-called “patient safety” boils down to a feedback form that receives no follow-up action. Hospital boards and trustees often remain unaware or unconcerned about quality assurance, focusing instead on financial performance. They lack the tools and understanding to measure quality in healthcare delivery.
Public Hospitals: Learning on the Patient
In government hospitals, newly qualified doctors and even students often practice unsupervised on critical patients. The lack of oversight and accountability can lead to devastating consequences for unsuspecting patients.
Priya’s Story
Priya, an MBA graduate from IIM Ahmedabad, brought her father to a reputed national teaching hospital for a chest infection. After initially being treated as an outpatient, he was admitted with pneumonia. What followed was a horrific ordeal of delays, inaction, and incompetence.
Despite a rising fever, no treatment was provided for hours. Blood gas results came four hours late. An attempted intubation by an inexperienced junior doctor resulted in cardiac arrest. Senior staff arrived late. Eventually, the patient was ventilated, but suffered irreversible brain damage. Priya’s father was kept alive in a vegetative state for two years before passing away. Priya resigned from her job to care for him, witnessing many similar lapses in the same hospital. Repeated inquiries exonerated staff, and no reforms followed.
Private Hospitals: Profit Over Patients
The private sector fares no better. Diagnostic and therapeutic procedures are often driven by revenue targets rather than patient need. Feedback forms are ignored. Infection control policies rarely reach the staff who need to implement them. Emergency care is frequently dictated by personal biases, not clinical evidence.
The absence of standardized protocols and systems allows decisions based on anecdotal experience, ego, or prejudice. This results in the wrong patients receiving inappropriate treatments, worsening outcomes.
Infrastructure Lapses and the Blame Game
Infrastructure norms, essential for secondary and tertiary care, are regularly ignored due to cost-cutting or neglect. Tragedies such as mass infant deaths due to infections or ICU fatalities caused by fires highlight the consequences of infrastructural negligence.
Hospital authorities only act after public outrage. The usual response is a blame game targeting frontline staff, while systemic issues remain unaddressed. Incidents are quickly forgotten—until the next one occurs.
VVIP Story
The Chairman of a corporate hospital was admitted to his own facility for a simple catheter change. Despite the procedure requiring no anesthesia and being suitable for his suite, hospital authorities opted for the operation theatre. A tooth extraction was scheduled simultaneously under local anesthesia. However, the senior anesthetist opted to administer general anesthesia to avoid any discomfort.
This led to vomiting—due to his full breakfast—and a prolonged struggle to intubate him. For two hours, his wife waited, unaware of the complications unfolding. He was finally wheeled out on a ventilator and taken to the ICU. He never regained consciousness and died ten days later. No critical event analysis was performed. The anesthetist was quietly removed from the panel and the case dismissed as an unfortunate incident.
Experience in the Developed World
Public outrage over such mishaps in Western countries led to sweeping reforms in medical education and healthcare delivery. Measures like Continuing Medical Education (CME), Continuing Professional Development (CPD), and periodic revalidation for medical licenses became mandatory, ensuring up-to-date and competent practice.
Patient Safety as a Core Metric
Globally, patient safety and related concerns have taken center stage. Clinical audits—similar to industrial quality measurements—now determine hospital performance, with financial metrics taking a backseat. Accreditation has become vital, especially for insurance and corporate-funded care. Any critical event undergoes thorough analysis to identify and mitigate root causes.
Just like “Corporate Governance” in business, “Clinical Governance” ensures better outcomes. This shift emphasizes systems, accountability, and evidence-based practice over technology alone. For India to reach international healthcare standards, leadership must prioritize these changes from the top down.
Until then, the promise of ‘medical tourism’ will remain a distant dream.
“First be kind, and then, first do no harm.” – Richard Smith, former Editor, BMJ
Author: Prof. Gautam Sen, MS FRCS Ed FRCS (Glasgow)
Chairman, Healthspring Community Medical Centers
Chairman, Wellspring Healthcare Pvt Ltd
First Director of Surgical Education, Association of Surgeons of India
Member, Board of Governors (2010–2011), MCI
drgautamsen@gmail.com
Disclaimer: Views in this article are entirely personal. No commercial interest.
