Don't get sick in Candelaria, Zambales

My grandmother has been in the local hospital in Candelaria, Zambales since I got here from Manila. She has anemia and she's 91 years old.

When I finally got to see her the following day, I was shocked at the state of the room she was in. The tile floor was dirty and the grout very dark. There was a rack for an airconditioner, but no airconditioner. The window panes are broken or missing. The sink was slow. The toilet was plugged. There were mosquitoes and flies and ants and other tiny crawly things.

The "private room" came with two hospital beds with fitted sheets and nothing else, a plastic cupboard, and a metal piece that looks like a shoe rack. You bring your own pillows, your own blankets, your own chairs, your own fan, your own plates and spoons and forks, your own bath tissue, your own soap, your own food and water. If medication or dextrose is needed, you have to go to the pharmacy and buy it yourself. If you need blood, you have to buy your own styrofoam cooler and ice, go to Red Cross yourself, buy the blood yourself, and transport it yourself. Oh, yeah, I forgot... They *do* provide you with a plastic bedpan. But that's all they do: provide it and nothing else.

I understand very well why they provide minimal supplies and minimal service. It's a poor community, most people have no health insurance, and a large part can't afford their health expenses. The hospital can't get any return on their investment. In fact, they might not even get their investment back at all.

The staff isn't probably paid much. So, it's entirely understandable that the staff does very little. The nurses come by to take blood pressure, pulse, and temperature readings, follow the doctors around on their rounds, then sit and gossip at the nurses' station.

My grandmother was still getting extreme chest pains everytime she moves or is moved even after her blood transfusion and even with the nitroglycerin patches. Everytime she got up to eat, we would wait for at least 15 minutes after she gets up for the pain to subside before she could start eating. She was cleared for release day before yesterday, but she was in so much pain that we couldn't even get her into a wheelchair. So my aunt asked a female doctor to allow her to stay a while longer; the doctor, who isn't my grandmother's regular doctor, reluctantly agreed.

My aunt was wondering why the doctors were anxious to discharge my grandmother in her condition. She said that she discussed it with a technician last night and she was told that the hospital's efficiency is based on the mortality rate in the hospital. The higher the mortality, the lower the hospital's efficiency rating is. So, it's no wonder that, if they think a patient is about to die, they shoo them out of the hospital.

Well, to be fair, it's not all bad. Some of the doctors *are* competent. Dr Duque (my grandmother's doctor), in particular, treats his patients and their families with respect. He explains what's wrong and why he proposes certain medications. He answers questions and clarifies his answers until he's understood. All that and with great consideration for his patients and their families. And there was one nurse who came in one night to take my grandmother's blood pressure, saw the pain she was in, and agreed to come back later.

Mediocre employees use up their time and energy in meeting minimum expections, which usually covers only basic technical knowledge and skills. On the other hand, when employees are very capable technically, they can devote more energy to customer service, to finding better ways to improve the customer experience, to going beyond what's required of them. It's no wonder then that, when customers get great service, they also get the impression that the service provider is technically proficient, with good reason.

In addition, management must be careful about how they measure competence. In service-oriented companies, like technical support and call centers, if management measures how fast representatives turn calls around, they get representatives who don't listen to customers and give stock answers that may not address the customer's concern at all. The customer feels they were dismissed too abruptly and they go to the competitor with better customer service. A hospital *is* a business. If their efficiency is measured by how quickly they churn out patients, they'll pick and choose the easy cases and send home the patients that need care the most. Unfortunately, in small towns, hospitals are a monopoly. So patients and their families have little or no recourse.