Looking ahead

Observing the health care systems going through changes in the current pandemic is déjà vu if you know the history of health care.

There was a day, when we had leprosy hospitals, TB hospitals and in the recent past HIV hospitals because we were afraid that these patients will infect others or there was stigma associated! Soon the mainstreaming concept came in and slowly TB, HIV and to some extend Leprosy got mainstreamed, of course with infection control practices, isolation wards for MDR TB etc. being part of regular health care system.

This season is one for creating COVID-19 wards, hospitals, and care centers. I am sure once COVID-19 becomes an endemic, we will get back into mainstreaming of COVID19 care and setting up systems for infection control, respiratory illness isolation systems etc.

Similarly, there is the déjà vu of health care systems. With increasing complexity of care, in COVID19, nurses are coming to the forefront and wards and systems are being managed by nurses. Doctors manage major treatment decisions and rest is managed by nurses. I remember a day when Nurse matrons ran hospitals! Somewhere in the last few decades we moved out of such models to a doctor focused health care systems!

The care provision systems itself is déjà vu. Large numbers of patients with COVID19 were managed at home including with home oxygen support. In HIV/TB also we went through this change. And in the last decade, we have seen palliative care, chronic illness care slowly moving back to home. There was a time when health care was primarily done at home! Institutions changed the whole paradigm.

Can we use the post pandemic season, not to go back to business as usual, but revisit and re-envision health care structures and systems?

One – to relook at hospital practice and models, where all hospitals have robut and mainstreamed infection control practices for blood borne, respiratory illnesses and other infections, as part of regular health care. Models of hospitals where there is mainstreaming of such illnesses. Respiratory isolation wards, other systems for similar potential future pandemics?

Two – can we look at a Nurse run health care system, supported by other professionals. The in patients wards/departments led by a nurse and the doctors and rest staff working in the ward reporting to that  Nurse in charge For e.g - Head of Medicine ward - is a nurse, and the whole team (including doctors) reports to that person, and create similar departments in all areas. Restructure hospital this way with nurse practitioners and nurse administrators taking leadership roles both in administration and clinical management.

Three – can all our institutions include home care as part of the health care system. 30 to 40 % of patient management be decentralized to home and set up systems for the same.

The other area has been where critical care systems have been enhanced by Oxygen plants, oxygen concentrators and critical care beds. Can we reposition our hospitals to optimally utilize this infrastructure that was set up for a pandemic, which might soon pass or become endemic? Can each hospital that has infrastructure put in, replan their future based on the same?

Let us not return to business as usual but look at how we can learn from the history and change our systems and structures.