Some time ago when I was trying to grow our medical practice, my partner and I brought in a marketing team to assist us with promotions. After a few days on the job, Fern, our guru, decided that we were not ready for her services just yet and we needed to fix our business as she had nothing to work with. Quite taken aback at this blunt evaluation, I swallowed my pride and asked her to elaborate.
We had no systems in place to make and track appointments. Our staff was not trained in customer service and the systems we were so proud of were not being utilised. This inevitably led to patients falling through the cracks and at one point a shouting match between who would immediately be an ex-employee and a patient. Fern’s experience taught her that if a marketing campaign were successful, there would be an increase in traffic that would overwhelm the systems of any organisation, leading to greater customer complaints. The bad publicity would do more to damage the brand of the organisation, making marketing efforts and expenditure counterproductive.
Armed with that knowledge, we retooled the office before starting the marketing campaign. It was an outstanding success. Our limitation being the only thing Fern nor anyone else could fix, we could not spend enough time in the office because of other commitments. I have used a similar approach in building Windsor Wellness, albeit with terrible teething pains and frustrations. Unfortunately for users, the public health system does not have to worry about the public relations fallout with the collapse of their systems when utilisation increases.
The marketing campaign for the vaccines has been relatively successful. Unfortunately, this has been assisted by the rising deaths coming closer to home. My own vaccine-hesitant staff were only moved to take the jab when the brother of an office manager died from COVID-19. The long lines at blitz sites are a testament to the efforts of the team at the Ministry of Health and Wellness (MOHW). Persons begin lining up from 5 a.m. in order to make the cut-off time. Others are forced to try at different sites and at different days before they are successful. And with this marketing success, the cracks are widening in the system.
Staffing and logistical challenges are causing confusion and long waits at vaccination sites. With late starts and early cut-off times, we are only reaching an unsatisfactory percentage of persons who are willing to take the shots. Were this not a race against time to save lives amid a deadly wave of COVID-19, we could chalk this up to “only in Jamaica” and laugh it off. But it is not funny. People are dying from COVID-19 far more than before. The sick are overcrowding the hospitals. We need to get as many persons as possible vaccinated as fast as we can to save lives and decrease the load on the hospitals.
The Ministry of Health and Wellness and the four regional health authorities have maintained a cumbersome bureaucracy that is as efficient in moving things along as a constipated colon. The implementation of the regional health authority model was meant to allow decisions to be made closer to the trenches and allow for supply chains and staffing to fit the demands of the geographic regions. This has been a colossal failure and we are constantly reminded of the failure of the bureaucracy across several outbreaks and administrations.
Ministers come and go. A resignation or reshuffle will not solve the intrinsic bureaucratic bungling and inefficiencies characteristic of the ministry and regional health authorities. The cock-ups with testing, PPEs and now vaccine roll-out and oxygen shortages mean that they have failed the Fern Test. Whenever you have increased utilisation of your services whether from successful marketing, or just organic growth in demand, if you are unable to deliver, it means you need to fix your business.
For the MOHW this means that several top bureaucrats as well as whoever they have been grooming must go. Chains of command and reporting relationships must be revisited and the whole organisational structure torn down and rebuilt with a focus on efficiency rather than paper trails that stymie any meaningful attempts at improvement and reform.
REVISIT THE WHOLE IDEA
To go a step further, it may be time we revisit the whole idea of the regional health authorities that have failed us time and time again. Recreating the bureaucracy of the MOHW four times while maintaining the original MOHW bureaucracy is a colossal waste of taxpayers’ money and, unfortunately, lives.
The gulf between private practitioners and the MOHW needs to be bridged immediately. Too many private doctors complain about the way the MOHW has hugged up the COVID-19 response even when they cannot manage to execute programmes. With roughly half of the GDP per capita spent on private healthcare, it is only logical to assume that private providers have or can find the resources to play a significant role in the national response.
Instead of calling out the bureaucracy, politics demands calling out the ministers. That has been the play of all opposition parties. A minister by himself cannot fix an entire broken system. Maybe it is time both parties agree to drain the swamp.
Dr Alfred Dawes is a general, laparoscopic, and weight-loss surgeon; fellow of the American College of Surgeons; Follow him on Twitter @dr_aldawes. Send feedback to firstname.lastname@example.org and email@example.com.