Friday, June 12, 2015

The Future of Quality in Healthcare

The American Society for Quality has published a series of reports on the Future of Quality.  The collective is well worth reading.   I am responding to one of the reports by Devi Shetty who advocates for an approach to expand education and training to provide a greater supply of healthcare workers.

Devi Shetty gives a brilliant and innovative presentation on a vital piece of the Quality puzzle as it continues to perplex healthcare.  He correctly points out that the notion that international healthcare problems will always be solved by creating bigger institutions and better equipment is misguided, especially in developing countries.  The solution lies in having more locally trained staff with the skills to serve more people closer to home.  That, I believe is true, not only in with respect to cardiac and neuro surgeons, but throughout the whole complement of healthcare workers.

While my personal experiences in international healthcare are not as extensive as Devi Shetty’s I can say that I have had the opportunity to experience healthcare in southern and eastern Africa and in the Caribbean, and from those experiences I am concerned with the continuation of the secondary challenge.   Using the terms of a song first popularized nearly 100 year ago, “How Ya Gonna Keep 'em Down on the Farm After They've Seen Paree?"

There are many high quality training programs for healthcare workers in a wide spectrum of professions.  Many of these can be found in many developing countries including, but certainly not limited to Tanzania, and Jamaica.  The physician and nursing and laboratory worker graduates of these institutions are seen as “world class” and are welcome in countries all around the world.  And that becomes the problem; given a choice, many move to countries where they see more opportunity for themselves, and their families, and especially their children.  It represents the perpetual problem of the “brain drain”.  The home country suffers the double loss; the expense of the training, and at the same time receives none, or only a brief short term direct benefit.

The worst parts of the brain drain are that it is fair and unfair, reasonable and unreasonable, both at the same time.  Any person who has put themselves forward and learned a new skill has the right and obligation to give back to the community that provided them the skill, but at the same time has the right to take personal advantage and benefit from the skill’s potential.  If there are attainable positions with greater remuneration and associated perceived improvements for education and opportunities especially for children, it can create a difficult decision for many workers.  Sometimes, but certainly not always, the grass is greener on the other side.

Solving the brain drain challenge becomes not only a fiscal but a moral/ethical dilemma.  While some degree of mandated commitment to the home country (3 years? 5 years? 10 year?) may seem like a workable compromise, others may not agree.   I suspect that most or even all readers would agree that lifelong travel bans are not acceptable. 

So I as much as I agree with the value and importance of wider access to productive training and education, addressing improvements in healthcare through wider training may not be sustainable unless some broader challenging issues can also be addressed.

But it clearly is an important step forward.

PS:  For an interesting view of the Impact of Quality on Medical Laboratories, please visit:

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