Living in La La Land

 I must admit, I was really quite excited about working on this new project with Adventist Health on improving the way in which the hospital stores and manages patient files and data. I mean, you should see the state of the current filing system for the notes. The hospital stores all old records in 5 massive shipping contains. I went to see them with the Data lead Pady. He’s currently in the process of ‘organising’ all the files, and by organise, I mean picking them up from the piles they lie in on the floor, and placing them on the shelves he has bought (at great expense) in order of year. Still not a great way to organise patient notes, but it’s better than the floor system operating previously. This data QI would make a huge difference to the hospital, not only would old files be accessible for clinical staff, but it would allow management staff to keep track of what is actually happening in the hospital. The current problem doesn’t just exist here in Maluti but many hospitals across the globe. If we did this right, it’s the kind of project that could get published in a national journal and then could be replicated all over the world!

The old 'filing' system

The day after our meeting with the American’s, me and Sarah sat down with our QI lead and CMO and worked through the task. We knew that in order to get this project approved by management, we would need to somehow show that it could make the hospital money, and not just cost them money (because as I have already explained, the hospital has no money). Luckily our QI lead, a lady called Mem’ Ntoate, is not only extremely smart and passionate, but also knows the hospital better than anyone. Together, we figured out that by not being able to keep track of patients being admitted, the hospital was losing money in unpaid bills. Anyone with an outstanding bill could return to the hospital, get a new ‘patient ID number’ as they are unique to each visit not each person, and any outstanding debt wouldn’t be attributed to them. Using a few contacts from my network of doctors back home I was quickly able to learn how other hospitals in various parts of the world have found a low cost, low tech solution to this problem. We discussed this with Mem’ Ntoate and she explained how the hospital had tried many of these systems previously and explained why each one of them had failed. We were starting to narrow down our list of possible solutions and work out a strategy of selling our big idea to management. It felt like this project might actually be possible!

The new and improved shelf system

Before the Americans left we had another meeting with them. They had put us in touch with a lady on their team who had done projects like this previously in other hospitals they had worked in. They seemed to have in their team and expert on everything. Speaking with her it became clear that they had much bigger plans than anything me, Sarah, Mem’ Ntoarte or the CMO could ever had imagined. Unbeknownst to us, the Americans had been having meetings themselves. They didn’t just want to a project to create a unique patient identification number (a tall enough order in itself), they wanted to totally digitalise Maluti hospital and turn it into a paperless system, a totally mammoth task! There are still hospitals that I have worked at in England that haven’t achieved this goal (shout out to Fairfield General). In the meeting the American started talking about how they wanted to bring in new servers to store data on, create a digital computer network, buy all the staff ipads, and bring a version of HIVE to Maluti Hospital (Hive is an amazing but very expensive and colossal medical data system used mainly in the states but has been implemented in a few NHS trusts in the UK. The system is so massive and generates so much data that it has led to near bankruptcy in the one trust in Manchester that adopted it, resulting in massive staff redundancies to balance the books). The Americans saw mine and Sarahs role less as joint leaders on this project, and more in the remit of dogs body, running around collecting data and doing audits for them on request. The main part of the project, the implantation of this mega IT system, wouldn’t even be done whilst we still in the country. They just wanted us to do all the leg work for them to make it happen.

Their plans were huge, and to be honest I was quite shocked that this is what their ‘expert’ had recommended. Converting an entire hospital to a paperless system in a region that still has regular black outs with every big storm (of which there are MANY), didn’t seem like a smart idea. The hospital frequently has to rely on its generator when the power cuts to keep the lights on and the water pump working for running water. Will it be able to handle supporting this mega HIVE system as well charging every single staff members ipad. Also, the wifi in the hospital is patchy at the best of times and frequently goes down for weeks until a technician from the capital is able to visit this remote mountain village. There are currently over 10 different networks running across the hospital as each one can only hold a maximum of 30 people at a time, and has the range about the radius of a hamster wheel. They would need to import a brand new wifi system from South Africa (as this is quite literally the best available in Lesotho) if every member of staff was to be on the same network. With all these extra IT systems being discussed I couldn’t help thinking, can the power supply to the hospital even support this? Do they plan to upgrade the national grid to the region too? And what happens when the ipads brake? There isn’t a single apple store in the whole of Lesotho, let alone up her in the rural mountainside of Mapoteng. Maybe they were planning on building this too? Will they also be providing 24/7 technical support for this computer system to help staff re-log in at midnight when they have forgotten their password, or to resolve the inevitable system failures which are bound to happen at some point (probably quite frequently with the power surges here)? This project was starting to look like an absolute fantasy. I’m not sure that just providing more money to a single hospital will solve the problems surrounding lack of national infrastructure, but then again I have no idea how much money this church based organisation actually have. It also didn’t seem like they had even consulted the local team. It felt more like they were just telling us what they were going to do to the hospital, not with it.

And so with that, I gracefully bowed out of this inevitable cluster fuck of an idea. Back to the far less glamours project on lab investigations then.