The following series of posts will discuss common misconceptions about aspects of health care in a low to middle income country such as Papua New Guinea.
There are several common misconceptions about waiting times in public hospitals that the public often holds and need to understand:
1. Waiting Times Are Arbitrary: Many people believe that waiting times are random and without reason. In reality, hospital waiting times are often based on triage systems that prioritize patients based on the severity of their condition. Priority must be given to the critically ill and vulnerable. Even with stringent triaging tools not every patient who will need urgent attention will get seen promptly. This is heavily dependent on man power on the ground.
2. All Waiting is Due to Overcrowding: While overcrowding can contribute to longer waiting times, there are other factors at play such as the complexity of cases, availability of specialist staff, and the need for thorough examinations and tests. Each patient must be attended to appropriately and efficiently. Health workers cannot be rushed as this will lead to mistakes and dire consequences.
3. Emergency Departments Treat on a First-Come, First-Served Basis: Emergency departments use a triage system to prioritize patients. Those with life-threatening conditions are seen first, while less urgent cases may wait longer. Hospitals are not banks and shops.
4. Long Waits Mean Poor Service: A long wait time does not necessarily reflect the quality of care. It can be due to high patient volumes, limited resources, or the need to manage critical cases first. Critical cases must be managed with a full team and not one doctor alone.
5. Appointments Will Start at the Exact Time Scheduled: Delays can occur due to unforeseen circumstances, such as emergencies or previous appointments running longer than expected. This can cause a ripple effect on subsequent appointments. Emergencies are a common occurrence and cannot be anticipated.
6. More Staff Automatically Means Shorter Waits: Increasing staff alone doesn’t always reduce wait times. Efficient management, resource allocation, and streamlined processes are also crucial in managing waiting times effectively. If the right systems and the right staff are put in place to manage wards and clinics patients will be seen on time. Inexperienced staff will also contribute to slower patient turnovers.
7. Walk-Ins Are Always Faster: Scheduled appointments are typically managed to minimize waiting times. Walk-ins, especially in busy periods, can result in longer waits due to unscheduled demand. This is difficult for many non-emergency patients in the rural areas who find their way to the referral hospitals when they can afford it. Clinics must be utilised to ease the burden of increased patient volume in the emergency departments.
8. Waiting Times Are Consistent Across All Departments: Waiting times can vary significantly between different departments and types of services within a hospital. Emergency services, specialist clinics, and routine check-ups may all have different wait times.
9. Technology Can Instantly Solve Waiting Time Issues: While technology can help streamline processes and improve efficiency, it is not a silver bullet. Implementation, training, and integration with existing systems take time and resources. Hospital databases can be utilised to fast tract patient records and processing. Unfortunately, peripheral hospitals lack any technological resources and expertise to improve patient flow.
10. Complaining Will Always Speed Up the Process: While feedback is important, complaints do not necessarily lead to faster service. Hospital staff prioritize based on medical need and available resources. Health workers are human beings as well. The mental health and wellbeing of our staff is as much of a priority as the people they care for. So, respect and work with staff on the ground by communicating appropriately and effectively to improve the service and prevent unwanted problems.
Factors that contribute to longer waiting times
Longer waiting times in public hospitals in low- and middle-income countries (LMICs) are influenced by a combination of structural, systemic, and socio-economic factors. Some of the key factors include:
1. Resource Constraints:
– Limited Funding: Public hospitals in LMICs often suffer from underfunding, which affects their ability to maintain facilities, purchase necessary equipment, and hire adequate staff.
– Shortage of Medical Supplies: Frequent shortages of essential medicines and supplies can delay treatment and increase waiting times. This is a daily struggle in every hospital in PNG.
2. Workforce Challenges:
– Insufficient Healthcare Personnel: There is often a shortage of doctors, nurses, and other healthcare professionals, leading to longer queues and waiting times.
– Brain Drain: Many qualified healthcare workers migrate to high-income countries for better opportunities, exacerbating the shortage in LMICs. Bigger newer hospitals with better facilities will attract the best doctors and health workers while the smaller rundown centres will struggle to recruit staff to continue services.
3. High Patient Load:
– Population Growth: Rapid population growth in many LMICs increases the demand for healthcare services.
– Burden of Disease: High prevalence of communicable and non-communicable diseases increases the number of patients needing care.
4. Inefficient Healthcare Systems:
– Poor Management Practices: Inefficient hospital management and administrative processes can lead to delays in patient processing and care delivery.
– Lack of Appointment Systems: Many hospitals operate on a first-come, first-served basis without a structured appointment system, causing long wait times.
5. Infrastructure Deficiencies:
– Inadequate Facilities: Many public hospitals have insufficient physical infrastructure to accommodate the high patient volume, resulting in overcrowding and delays.
– Poor Maintenance: Aging infrastructure and lack of maintenance can lead to frequent breakdowns of critical equipment.
– Not enough adequality equipped health centres and district hospitals with doctors to manage the high patient volume that is put on provincial hospitals.
6. Accessibility Issues:
– Geographic Barriers: Patients in rural or remote areas may face long travel times to reach hospitals, which can delay treatment and increase wait times once they arrive.
– Transportation Challenges: Lack of reliable transportation options can hinder timely access to healthcare services.
7. Economic Factors:
– Poverty: Low-income populations may delay seeking care due to cost barriers, leading to a surge in patients requiring urgent care when they finally visit hospitals.
– Unemployment: High unemployment rates can increase the dependency on public hospitals, as people may not afford private healthcare.
8. Health Policy and Governance:
– Weak Health Systems: Poorly implemented health policies and lack of effective governance can lead to systemic inefficiencies.
– Corruption: Corruption at various levels of the healthcare system can divert resources away from patient care, exacerbating wait times.
9. Epidemics and Public Health Emergencies:
– Outbreaks of Diseases: Epidemics and pandemics can overwhelm healthcare systems, leading to significantly longer wait times for all patients.
10. Cultural and Social Factors:
– Health-Seeking Behaviour: Cultural beliefs and practices can influence when and how people seek medical care, affecting the distribution of patient load across time.
Addressing these factors requires comprehensive health system reforms, increased investment in healthcare infrastructure, better workforce planning, and effective management practices to improve the efficiency and quality of care in public hospitals in LMICs such as PNG.
Let us know what you think about waiting times in our public hospitals in the comments below.
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