Groote Schuur Hospital's unsatisfactory service: ineffective patient flow

This is an edited version of an email I sent Groote Schuur Hospital's director of outpatients Dr Tunc Numanoglu on March 7.

On Thursday 7 I called one of Groote Schuur Hospital’s (GSH) outpatient clinics over a period of an hour about an appointment.  The phone was either engaged, rang unanswered or twice a person who didn't identify which department it is answered, mumbling almost incoherently.  To my question if she's the receptionist to make appointments, she replied that person was “on tea” and will be “back at 9.30” despite it already been 9.45 and the second time 10.30 when I called.  On tea for an hour?  I didn't understand and gave up. 

I emailed the hospital’s outpatients director, Dr Tunc Numanoglu, asking him to refer my request to them. 

I was at the clinic last October for test results. An appointment for that date was made soon after my previous visit in August.  I waited from 9am until after 2pm to be seen by the doctor because a report had been misplaced they allegedly had trouble tracking down. They requested an unsigned copy from the issuing department but didn't try very hard despite it being down the corridor and around the corner. 

 A sign on the clinic's wall says patients with appointments should not wait longer than one hour to be seen. But a nurse alleged “Mr Johnson is impatient” (sic) when after 1pm I told them I had places to go and would leave if the report didn't arrive soon. Morning shift doctors and some other staff go off duty or on lunch at 1pm. The afternoon shift begins at 2pm.  

The clinic wasn't particularly busy that day.  It had a full complement of doctors of five specialists including one professor and half dozen nurses.  At 2pm when a fellow patient who had just arrived heard how long I had been waiting, and yet to be seen, he said he would have made a fuss long ago. 

Eventually, a doctor saw me about 2.15pm.  He knew I had been waiting “over three hours because of a missing report” probably because I had earlier complained to staff, not him, though, because he just came on duty. Gossip like that travels fast, but not so much when it comes to attending patients.

At the end of my examination, during which time the doctor had to leave and confer with someone about the unsigned report – the one that was missing – he said I must return in six months, i.e. April 2019, presumably when I would be discharged.  However, by that time – it was 3.20pm – the receptionists had already left for the day (there are at least two receptionists) – there was no one at the counter.  I left the folder with the nurse to whom the doctor told I must return.  I said the same. 

It’s the clinic's practice to call patients with appointments and not the other way around. I've not heard from them since.  I think they've forgotten.  I put it out of my mind until this week when during a visit to my GP I mentioned my “lost” appointment.  She said I must call and insist on one.

Perhaps the clinic’s medical staffs including its head of department reviewed my folder and decided a follow-up visit is not necessary.  If so, I would have appreciated the courtesy of been informed. Note my August visit was without a hitch – I was out there in two and half hours after tests and an examination.

My observations of the hospital at different times is they have more than adequate medical staff, in fact, perhaps too many so that they duplicate each other's work.  But the problem, which doctors in private practice with knowledge of the Western Cape Health Department (WCHD) also mentioned to me, is the inefficient and ineffective patient flow (see here). 

For example, at my visit to the ER in July 2018, it took three nurses over an hour to admit and triage four patients including me when the process – blood pressure, temperature, blood sugar and ECG if necessary – should take only a few minutes.  By then more patients had arrived. The one who attended me responded to my question about the delay that the ER is busy (the triage room wasn't then).  

But that's not it.  Instead, as I told her, there's a lot of walking around by staff – they disappear to who knows where – including and especially doctors while patients wait. 

During October 2017 over a period of one to two hours I watched two doctors in the walk-in ER clinic wander off. One returned with to-go coffee in her hand from the cafeteria on the other side of the hospital while what initially were a few patients turned into a dozen.  

This wouldn’t happen at a private facility.  The problem is many staff perhaps think because it’s the state and state patients they’re not obliged to perform quickly, efficiently and not waste people’s time (see below).

GSH is a 24/7 hospital but at the ER they have only one senior doctor – the head of department – to review patients for discharge, referral or approve tests like CT scans.  Since she works during the day only, patients admitted during the night that could be discharged or referred onwards must wait, blocking up the facility.  Ditto during the day when it appears she reviews cases only at 8am and 4.30 to 5pm. 

Last year a GSH ER doctor came close to admitting to me the ER's problems except for not wanting to speak ill of his employer.  My GP, who volunteered at another WCHD hospital, Victoria Hospital, came to a similar conclusion as I did: people's – patients' and staffs' – time is being wasted by an ineffective system and they need an engineer to advise them on patient flow.  She rather volunteered with an international medical NGO. 

Despite Premier Helen Zille's fulsome praise about the purported good standards of the province's public health system, the South African Health Review's 2016 survey of users' perception of service is a low 53%, the third lowest in the country with a national average of 58%, and the TAC said the system is “failing the people who rely on it”.

One of the problems is WCHD, like the government including the DA-run Western Cape, doesn't really listen to its clients and citizens and has a combative – passive-aggressive really – approach to everything.  They personalise issues and criticism as the nurse did that I was allegedly impatient, and on a different occasion, I was “angry” (GSH CEO Bhavna Patel) when all we're doing is pointing out shortcomings and areas that could improve.

What annoyed me about my experience last October, one I've experienced before at the hospital including with disastrous medical results for me, is not the wait, which I had done and was prepared to do had there been a reason, but the discourtesy and inconsideration as I was referred from one person to the next – four nurses – and no one was willing to take responsibility for finding out where the damn report was and when it was coming.  A phone call would have sufficed.  But they couldn't even do that.  The nurse who told me she had requested a copy had gone on lunch without telling her colleagues to check on it in her absence.

As far as they are concerned, patients are there at their leisure, not the other way around, a common attitude of those in the WCHD's and government's employ.  They lack the patient-centred approach despite claiming that’s what informs them, and they believe they have all the answers and refuse to listen.  Until then, poor service and patient care will continue.

Postscript: Numanoglu emailed on March 12 apologising for me not been able to contact the clinic (note not for the poor service; this is their curious, elliptical way of "apologising" without accepting culpability) with a date for an appointment.

Minor updates 26/03/2019.