Rising health care prices in the US are leading employers outside the health care sector to lay off employees, according to a new study co-authored by a Yale economist.
The study, published June 24 as a working paper by the National Bureau of Economic Research (NBER), found that when health care prices increased, non-health care employers responded by reducing their payroll and cutting the jobs of middle-class workers. For the average county, a 1% increase in health care prices would reduce aggregate income in the area by approximately $8 million annually.
The study was conducted by a team of leading economists from Yale, the University of Chicago, the University of Wisconsin-Madison, Harvard University, the US Internal Revenue Service (IRS), and the US Department of the Treasury.
“When health care prices go up, jobs outside the health care sector go down,” said Zack Cooper, an associate professor of health policy and of economics at Yale University. “It’s broadly understood that employer-sponsored health insurance creates a link between health care markets and labour markets. Our research shows that middle- and lower-income workers are shouldering rising health care prices, and in many cases, it’s costing them their jobs. Bottom line: Rising health care costs are increasing economic inequality.”
“Rising prices are hurting the employment outcomes for workers who never went to the hospital.”
Zack Cooper, Yale economist
To better understand how rising health care prices affect labour market outcomes, the researchers brought together insurance claims data on approximately a third of adults with employer-sponsored insurance, health insurance premium data from the US Department of Labor, and IRS data from every income tax return filed in the United States between 2008 and 2017. They then used these data to trace out how an increase in health care prices, such as a $2000 increase on a $20 000 hospital bill, flows through to health spending, insurance premiums, employer payrolls, income and unemployment in counties, and the tax revenue collected by the federal government.
“Many think that it’s insurers or employers who bear the burden of rising health care prices. We show that it’s really the workers themselves who are impacted,” said Zarek Brot-Goldberg, an assistant professor at the University of Chicago. “It’s vital to understand that rising health care prices aren’t just impacting patients. Rising prices are hurting the employment outcomes for workers who never went to the hospital.”
Hospital Mergers Raised Prices
For the new study, the authors used hospital mergers as a vehicle to assess the effect of price increases. From 2000 to 2020, there were over 1000 hospital mergers among the approximately 5000 US hospitals. In past work, the authors found that approximately 20% of hospital mergers should have been expected to raise prices by lessening competition, according to merger guidelines from the Department of Justice and the Federal Trade Commission. These mergers, on average, raised prices by 5%.
“We can use our analysis to estimate the effect of hospital mergers,” said Stuart Craig, an assistant professor at the University of Wisconsin-Madison Business School. “Our results show that a hospital merger that raised prices by 5% would result in $32 million in lost wages, 203 lost jobs, a $6.8 million reduction in federal tax revenue, and a death from suicide or overdose of a worker outside the health sector.”
The study also showed that because rising health care prices leads firms to let go of workers, a knock-on effect of hospital mergers is that they lead to increases in government spending on unemployment insurance and reductions in the tax revenue collected by the federal government.
“It’s vital to point out that hospital mergers raise spending by the federal government and lower tax revenue at the same time,” said Cooper. “When prices in the US health sector rise, it’s actually a net negative for the economy. It’s leading to fewer jobs and precipitating all the consequences we associate with workers becoming unemployed.”
Only 16% of South Africans can afford private healthcare, and many low-income earners cannot afford healthcare and must rely on community clinics. These facilities are under intense pressure as they often cannot cope with the demand. For many workers, getting medical attention at these facilities means waiting for hours and being unable to work for a day and therefore losing wages. However, things could change if the pioneering efforts of a dedicated nurse with the financial backing of Standard Bank reach their full national potential.
“We assist this sector by working longer hours than do local government clinics that only open five days a week. Our services are available seven days a week at R300 per visit. Those able to pay for primary healthcare often must travel long distances to get to pharmacy-based primary healthcare clinics, mostly in the suburbs. The Rapha Clinic has been strategically placed between the city and the townships so that it can be easily reached by people commuting from their homes to the city,” says Ntombi Skosane, founder of Rapha Healthcare Services.
For Skosane, the clinic, which is located in the Montana area of Pretoria, realised her dream of being able to fill a vital gap in providing primary and basic healthcare to her community.
“As a nurse with 30 years in both the public and the private sector, I believed that I could open a clinic where I could establish a community service offering quality healthcare at affordable rates. The growing success of our operation shows that I was correct,” she adds.
Using her experience of clinics as a guide, Skosane has opted to have Rapha offer nine core services ranging from antenatal care and family planning to assisting with immunisations and wound care, as well as helping those with chronic illnesses and HIV testing and counselling.
“The Rapha Clinic met the stringent guidelines for being considered for a grant. These included an assessment of the viability of the business by the Standard Bank Enterprise Development Funding Committee, the commitment and required personal investment of the owner, and the sector in which the business operates. Although the business was operating successfully, it needed financial assistance to reach its full potential. In this case, the company needed additional stock and equipment to deliver a full service. After considering the application, Standard Bank purchased the required equipment for Rapha,” says Naledzani Mosomane, Head of Enterprise and Supplier Development at Standard Bank.
Skosane says that acquiring additional medical and surgical stock, emergency trollies, a vaccine fridge, wheelchairs, and air-conditioning through Standard Bank meant that the clinic would be able to attend to more patients more efficiently.
Rapha may be just a single clinic, but new outlets are being planned for Gauteng and the North West Province. Ten new clinics are being considered, as are health assessment centres in partnership with gyms and medical aids.
“We believe that Rapha Healthcare Services has a bright future. We look forward to playing a central role in growing the nation’s small business sector and developing relationships with a new generation of entrepreneurs,” says Mosomane.
Thinking about getting a new desk for your practice? That might be a good idea. Viruses, including SARS-CoV-2, can get passed from person to person via contaminated surfaces. But can some surfaces reduce the risk of this type of transmission without the help of household disinfectants? As reported in ACS Applied Materials & Interfaces, wood has natural antiviral properties that can reduce the time viruses persist on its surface – and some species of wood are more effective than others at reducing infectivity.
Enveloped viruses, like the coronavirus, can live up to five days on surfaces; nonenveloped viruses, including enteroviruses linked to the common cold, can live for weeks, in some cases even if the surfaces are disinfected. Previous studies have shown that wood has antibacterial and antifungal properties, making it an ideal material for cutting boards. But wood’s ability to inactivate viruses has yet to be explored, which is what Varpu Marjomäki and colleagues set out to study.
The researchers looked at how long enveloped and nonenveloped viruses remained infectious on the surface of six types of wood: Scots pine, silver birch, gray alder, eucalyptus, pedunculate oak and Norway spruce. To determine viral activity, they flushed a wood sample’s surface with a liquid solution at different time points and then placed that solution in a petri dish that contained cultured cells. After incubating the cells with the solution, they measured the number (if any) infected with the virus.
Results from their demonstrations with an enveloped coronavirus showed that pine, spruce, birch and alder need one hour to completely reduce the virus’ ability to infect cells, with eucalyptus and oak needing two hours. Pine had the fastest onset of antiviral activity, beginning after five minutes. Spruce came in second, showing a sharp drop in infectivity after 10 minutes.
For a nonenveloped enterovirus, the researchers found that incubation on oak and spruce surfaces resulted in a loss of infectivity within about an hour, with oak having an onset time of 7.5 minutes and spruce after 60 minutes. Pine, birch and eucalyptus reduced the virus’ infectivity after four hours, and alder showed no antiviral effect.
Based on their study data, the researchers concluded that the chemical composition of a wood’s surface is primarily responsible for its antiviral functionality. While determining the exact chemical mechanisms responsible for viral inactivation will require further study, they say these findings point to wood as a promising potential candidate for sustainable, natural antiviral materials.
A widely available drug helps prevent upper gastrointestinal bleeding in critically ill adults on a breathing machine, according to the results of a global study and meta-analysis led by researchers at McMaster University.
The research, published on June 14, 2024 in The New England Journal of Medicine and NEJM Evidence, investigated the effect of the gastric acid suppressant pantoprazole, which is primarily used to treat heartburn caused by gastroesophageal reflux disease (GERD).
Patients in the intensive care unit (ICU) who need a breathing machine (mechanical ventilator) also receive pantoprazole to prevent upper gastrointestinal bleeding, caused by stress-induced ulcers in the stomach. Concerns emerged about whether this complication of critical illness had disappeared over the years, and about side effects of pantoprazole, including increased risk of death in the sickest patients. The research provides critical care teams with certainty about whether the medications should be used in practice.
“This is the largest randomized trial on this topic in the world, led by Canada. Physicians, nurses, and pharmacists working in the ICU setting will use this information in practice right away, and the trial results and the updated meta-analysis will be incorporated into international practice guidelines,” said lead author and principal investigator Deborah Cook, a professor in the Department of Medicine at McMaster.
Global randomized control trial
The Reevaluating the Inhibition of Stress Erosions (REVISE) Trial was a randomised control trial that compared the effect of pantoprazole to placebo in critically ill adults on a breathing machine. The trial was run in 68 centres in eight countries and over 4800 patients underwent randomization. Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo but not in a lower risk of death.
Clinically important upper gastrointestinal bleeding occurred in 25 of 2417 patients (one per cent) receiving pantoprazole and in 84 of 2404 patients (nearly four per cent) receiving placebo. At 90 days, death was reported in 696 of 2390 patients (29 per cent) in the pantoprazole group and in 734 of 2379 patients (30 per cent) in the placebo group.
Updated systematic review
Researchers conducted a meta-analysis of 12 randomised trials of proton-pump inhibitors for GI bleeding prevention in 10 000 critically ill patients to summarise the current evidence on the outcomes of gastrointestinal bleeding, mortality, pneumonia and C. difficile infection.
The medications were associated with a reduced incidence of clinically important upper gastrointestinal bleeding and may have little or no effect on mortality. The evidence also showed the medications may have no effect on pneumonia and little or no effect on C. difficile infection.
The research was funded by the Canadian Institutes for Health Research, the Accelerating Clinical Trials Fund, Physicians Services Incorporated of Ontario, Hamilton Association of Health Sciences Organization, and the National Health Medical Research Council of Australia.
A humorous remark at just the right time can go a long way. Benevolent humour helps medical assistants (MAs) cope positively with their stressful working day, according to a new study published in the journalBMC Primary Care. Researchers surveyed more than 600 MAs to find out how they experience their work and what style of humour they use in their daily working lives. They found that if the respondents preferred light, well-intended humour, they were more satisfied with their work and received more positive feedback. Dark humour, such as sarcasm, was more likely to have disadvantages.
Medical assistants mostly work in primary health care, especially medical practices. In Germany, working as an MA requires a three-year vocational training. The daily work routine of MAs can be very demanding. They are responsible for administrative work and, for example, taking blood samples and applying wound dressings. This new study by Martin Luther University Halle-Wittenberg (MLU) and the Federal Institute for Vocational Education and Training (BIBB) aimed to investigate how humour helps them get through their day.
“Medical assistants are in very close contact with patients for most of the day. They have a lot of responsibility and experience a lot of stress,” says Julia Raecke from BIBB, who is doing her doctorate at MLU. It has long been known that humour can help healthcare workers cope with stress. “However, little is known about the consequences of different humour styles. We set out to investigate those, as it should make a big difference, whether MAs use puns or sarcasm when dealing with patients. Talking to people that are potentially sick requires a lot of empathy and verbal dexterity,” explains Professor René Proyer, a psychologist at MLU.
The two researchers conducted an online survey of more than 600 MAs. The aim was to understand better the relationship between job satisfaction and different humour styles. In addition to the kind of humour they prefer, respondents also provided information about their well-being in the workplace and how competent they feel at work.
If the respondents preferred positive and benevolent humour, they were in general also more satisfied with their work. But not only that: “MAs with a preference for light humour stated that they received more positive feedback and were more likely to feel that they were making a difference at work,” says Julia Raecke. Surprisingly, presumably negative or dark humour did not score worse across the board. “Even though satire and irony are considered dark humour, we found no negative correlation with the respondents’ well-being,” adds Raecke. In contrast, cynicism and especially sarcasm had negative effects. Yet, this does not mean that sarcasm should be condemned completely. “A short sarcastic remark among colleagues might help to release frustration,” says René Proyer.
According to the researchers, humour is one of several factors that influence well-being at work. “Knowing about the effects of humour and different styles can help to make conversations with patients more pleasant. That said, waiting rooms are not supposed to become comedy clubs. It’s more about using humour consciously and appropriately,” concludes Proyer.
The results of the study could help to develop new training programmes. For example, Raecke is investigating whether the social and emotional skills of MAs can be improved with the help of online training.
Image-based online study shows no benefits, however, of virtual room designs incorporating the golden ratio
In an online study, virtual hospital rooms designed according to the principles of evidence-based design or the principles of Feng Shui were associated with greater potential benefit for viewers than virtual representations of standard hospital rooms. Emma Zijlstra of Hanze University of Applied Sciences in the Netherlands and colleagues present these findings in the open-access journal PLOS ONE on June 5.
Hospital designers might consider employing specific design principles in an effort to improve patients’ experiences. Growing evidence suggests there are beneficial outcomes from an approach known as evidence-based design. For instance, exposure to more daylight in hospitals is associated with lower stress and pain. Other well-known design approaches include Feng Shui, a Chinese system based on hypothetical energy flow, and the use of proportions following the golden ratio.
Despite these well-known options, experimental evidence on their relative benefits in hospitals is lacking. To help clarify, Zijlstra and colleagues randomly assigned each of 558 study participants to view online representations and information about a virtual hospital room designed with one of four approaches: Feng Shui, the golden ratio, evidence-based design or, as a control, a standard design from a real-life hospital. Only people who had previously been hospitalized at some point in their lives were invited to participate.
After experiencing the virtual rooms, participants completed a questionnaire that included standard measures of anxiety and other outcomes. Statistical analysis of their answers showed that, compared to participants who viewed the standard rooms, those who viewed rooms with evidence-based design reported less anxiety and greater senses of control, social support, distraction from negative thoughts, and pleasantness of the room.
Feng Shui design was not directly associated with lower anxiety, but participants who viewed the Feng Shui rooms did have greater senses of social support, positive distraction, and pleasantness of the room. There was no evidence for any benefits of golden ratio-based design.
On the basis of their findings, the authors suggest that rooms designed according to the principles of evidence-based design or Feng Shui might benefit patients. They note similarities between the two approaches, such as incorporation of greenery. However, they caution, it is unclear how well these online findings might translate to real-life hospital settings.
The authors add: “To our knowledge, this is the first and largest randomized controlled trial linking design principles, partly ancient and world-renowned, directly to anxiety in hospital rooms. This study showed that both Feng Shui and Evidence-Based Design are capable in effecting anxiety and it is important that large follow-up studies are conducted to examine the effect of specific design features.”
The healthcare sector in South Africa is beset with numerous challenges, ranging from high turnover rates to skilled staffing shortages and complex regulations in addition to stressful working environments, and communication barriers.
Despite these formidable obstacles, patients have the right to expect top-tier care from their medical facilities. Here, specialised Temporary Employment Services (TES) providers can become indispensable partners, adeptly assisting medical facilities to navigate these challenges in their quest to ensure a seamless continuum of care.
Streamlining healthcare staffing to counter shortages
Specialist TES providers offer a multifaceted remedy to the relentless staffing challenges in healthcare. Capable of promptly supplying temporary staff to bridge immediate gaps, TES providers ensure that all resources have already been rigorously screened, recruiting qualified professionals to function as a buffer against high turnover and staffing scarcities. Through tailored training, specialist providers ensure that their temporary staff placements align seamlessly with organisational expectations to consistently uphold care standards. Furthermore, specialist TES providers alleviate the burden of complex healthcare regulations on management and staff by taking on the responsibility of handling the entire employment relationship, from end to end, including managing human resources and labour relations components, as well as payroll. This provides significant relief for healthcare facilities giving them the staffing resources that they need, without the additional administrative complexities involved with recruiting, on-boarding and managing such resources.
Addressing skills gaps to raise the bar on healthcare resources
Maintaining consistent levels of patient care without compromising quality is challenging in the face of staffing shortages and high turnover rates. With so many specialised healthcare staff, including ICU personnel, leaving for better opportunities abroad due to financial considerations, such an exodus necessitates urgent strategies to retain and fill gaps within healthcare facilities. Specialist TES providers are already playing a critical role in addressing these concerns by focusing on nurse competencies and facilitating targeted courses to upskill their resources. These courses address critical gaps in patient safety and empower nurses to provide better care. Through the development of these essential courses, such as ECG interpretation and cannulation, TES providers are taking significant steps to ensure nurses possess the necessary skills and knowledge. This proactive approach not only enhances patient care at a facility level, but also contributes to nurse competence and job satisfaction, ultimately benefiting the healthcare ecosystem.
The strategic advantages of enhancing workforce dynamics
In addition to operational bolstering and sector-specific upskilling, specialist healthcare TES providers present strategic benefits for healthcare facilities. Access to a diverse, extensive talent pool makes it simpler for medical organisations to find the ideal fit for each role, effectively mitigating the risk of hiring mismatches usually associated with permanent placements. Medical facilities also benefit from the cost-effectiveness of the TES operating model, which aligns with the dynamic nature of healthcare to optimise resource allocation. This is particularly important in hospitals where patient occupancy levels fluctuate daily. Many healthcare organisations now operate with a 50/50 ratio of permanent placements and temporary resources, which gives them the flexibility to accommodate the ever-shifting demands of patient care staffing, while safeguarding the delivery of quality care. By efficiently managing both permanent and agency staff, TES providers optimise recruitment efforts and ensure that the right candidates are placed in suitable roles, benefiting the healthcare organisation’s operations and patient care. TES providers uphold patient confidentiality and provide comprehensive training, ensuring staff are cognisant of privacy protocols and handle sensitive information appropriately.
Boosting patient care excellence: the vital role of specialist TES providers
In an era where healthcare value is intricately tied to workforce excellence, TES providers play a pivotal role in elevating the sector by helping medical facilities conquer their industry-specific challenges, enabling the fundamental mission of enhancing patient well-being. Ultimately, Specialist TES providers represent a crucial element in the healthcare sector’s quest for excellence, as their strategic approach to staffing not only addresses immediate needs but also upholds patient care standards, while easing administrative burdens, and enhancing workforce competencies. As such, collaboration with specialist TES providers is a progressive strategy that medical organisations should prioritise to effectively navigate the intricate challenges of the healthcare landscape today while significantly enhancing patient care outcomes.
With only 22 090 nurses to serve the country’s public health sector of more than 50 million citizens1, urgent intervention is required to bolster their numbers and protect the wellbeing of our nation. After all, without their tireless dedication, who will be there to guide you through the corridors back to health? writes Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa (IPASA)
As the global healthcare industry commemorates International Nurses Day on 12 May, it is an opportune moment to reflect on the role of nurses as the heartbeat of healthcare systems globally. Amid turmoil and triumph, nurses stand as the unsung heroes and compassionate caretakers who embody empathy, endurance and expertise.
In South Africa, where healthcare challenges often loom large and resources are stretched thin, nurses serve as the frontline warriors, bridging the gap between suffering and healing. Yet, despite the invaluable role they play, a concerning trend looms.
Minister of Health, Joe Phaahla, recently revealed a pressing concern – the anticipation of a staggering 30% of South African nurses retiring within the next decade, and 38% retiring the decade thereafter. Compounding the issue, 5060 vacancies remain unfilled on the back of crippling budget constraints1.
Representing over 90% of global healthcare workers2, nurses are indispensable in the healthcare ecosystem, and addressing this impending crisis of their reducing numbers demands comprehensive and multifaceted solutions that approach the challenge from every angle.
The nurse shortage crisis in South Africa stems from multiple factors. Firstly, the escalating healthcare needs of a growing population, compounded by the burden of infectious diseases such as HIV/AIDS, have strained the healthcare system to breaking point.
Another factor is the restricted capacity of the private sector to train nurses comprehensively due to existing regulations. Moreover, poor working conditions, particularly in the public sector, and comparatively low salaries have led to high turnover rates, prompting nurses to explore alternative career paths or seek employment opportunities abroad3.
While there are many challenges to defusing the proverbial ticking time bomb which is the declining number of qualified nurses in South Africa, increased investment across the board is critical to strengthening their ranks.
Despite financial investment being central in realising this, addressing the problem demands a focus on improving the working conditions of nurses. Healthcare facilities must prioritise nurses’ well-being by offering competitive salaries, manageable workloads, and opportunities for career growth. By creating a supportive work environment, South Africa can retain more nurses and deter them from seeking opportunities abroad3.
Furthermore, granting private hospitals full participation in nurse training programmes is crucial. Private sector entities, such as Netcare, have the capacity to train as many as 3,500 nurses annually. However, limited accreditation from the government hampers their potential contribution to resolving the nurse shortage. Expanding private sector involvement in nurse training could substantially increase the number of trained nurses in the country3.
In addition to these measures, collaborative efforts between the government, healthcare institutions, and nursing organisations are essential. Such partnerships can identify and implement strategies to alleviate the shortage, including targeted recruitment drives, mentorship programmes, and initiatives to improve nurses’ job satisfaction and work-life balance3.
Innovative approaches to addressing the nurse shortage in South Africa extend beyond traditional solutions. Telemedicine platforms are emerging as a promising tool, allowing nurses to deliver care remotely and reach patients in underserved areas.
Additionally, community health worker programmes are being expanded to complement nursing services and extend healthcare access to marginalised communities. Furthermore, initiatives to empower and support nurse entrepreneurs are gaining traction, encouraging the development of innovative care models and healthcare solutions.
These diverse approaches reflect a multifaceted response to the nurse shortage crisis, leveraging technology, community engagement, and entrepreneurship to strengthen the healthcare workforce and improve access to care for all South Africans.
April 16 2024 – The Chris Hani Baragwanath Hospital School officially opened in its new location today, marking a key milestone in the partnership between Wits University and the academic hospital. The school caters for all learners in need of longer-term and chronic treatment for various paediatric conditions. Learners between Grades R and 12 are taught.
“Sick children have multiple needs, and it’s our duty to ensure that they don’t miss out on any schooling. Everyone deserves the right to be educated and to contribute meaningfully to their communities as adults,” said Professor Shabir Madhi, Dean of the Wits Faculty of Health Sciences.
Professor Madhi noted that the previous school building will be used as a campus for medical students and to grow the university’s teaching and learning footprint at Chris Hani Baragwanath Academic Hospital.
The school district representative for Johannesburg Central, Ronica Ramdath, said that often sick children forfeit their education, which can be mitigated through the correct teaching approach and through supportive facilities. “When I first came to the school some years back, I was amazed at the teachers’ dedication. I remember seeing a teacher load all their educational resources in a bag and walk to the paediatric ward to teach sick children. Today, these children all benefit from such support,” she said.
The Wits Faculty of Health Sciences heads of schools were present, together with hospital and teaching representatives.
Meanwhile, Professor Madhi said that the university’s wifi is available at Chris Hani Baragwanath Hospital, underpinning Wits’ commitment to invest in a world-class academic hospital facility. “We are very proud of our footprint at the hospital and hope to continue to add value through research and clinical work,” he said.
Spotlight visits Rahima Moosa Mother and Child Hospital and sees progress for the struggling hospital but also the reality that there’s a long road ahead to undo what a health ombud report suggests has been years of neglect and poor management.
Rahima Moosa Mother and Child Hospital serves up to 2 300 people admitted per month as well as 10 000 outpatients each month. (Photo: Denvor de Wee/Spotlight)
By Ufrieda Ho for Spotlight
It’s been a year since a damning Health Ombud’s report on the Rahima Moosa Mother and Child Hospital (RMMCH) was released. This month also marks the end of the last deadline the Gauteng Department of Health had to act on recommendations in the report.
At 80 years old, RMMCH is an iconic landmark on the western edge of Johannesburg. But it has gone from a one-time outlier for excellence to being in steady decline, marked by what the Ombud’s report criticised as incompetent leadership, neglect and crumbling infrastructure.
In May 2022, the hospital suffered a public low point when paediatric gastroenterologist, Dr Tim de Maayer, penned an open letter, slamming multiple failings at the facility. Public outcry from the letter, complaints from hospital users, and a widely circulated video of pregnant mothers sleeping on hospital corridor floors prompted the ombud’s investigation.
When Spotlight visited the hospital at the end of February (2024), there were positive outward signs that recent maintenance work had been completed, per the Ombud’s recommendations. Some areas have been painted and surfaces where underground sewer pipes had to be unblocked have also been tarred. The stench from overflowing sewage appears to be a thing of the past. Renovations to the antenatal care ward, shown in the video that went viral, are also near completion and the ward is expected to be operational again by the middle of March.
More signs that RMMCH is blipping on radars again include a new granite plaque at the entrance ready to be unveiled to commemorate the hospital in its 80th year. On noticeboards were flyers that advertised a community fun-walk for the end of February. It was an event intended to “reconnect” hospital staff with the immediate community it serves.
The hospital is also part of the roll-out of the provincial health information system (HIS) and admin staff were seen enrolling new patients on the system. The HIS is a long-awaited system to modernise patient file storage and make patient files accessible at facilities province-wide. Spotlight previously reported on the system.
These encouraging advances since the Ombud’s investigation get the thumbs up from hospital insiders. But they flag that even though the Gauteng Department of Health has announced a six-year renewal plan for the hospital and R53 million was approved in December 2023 for the next phase of renovations, the department is playing catch-up and still dragging its feet.
CT scan empty promises
For Dr Z, the biggest of her current concerns is that the hospital’s CT scan has not been in operation for the past 14 months. Dr Z asked not to be named because of the risk of victimisation.
“We have to beg other hospitals to do our scans. So even when you have a patient who actually needs a CT scan, you think twice – you ask yourself do they really, really need it or should you just watch them for another couple of months. It’s very demoralising and we keep hearing empty promises from management,” Dr Z says.
A shortage of clerical staff means clerks are shared between departments, resulting in inevitable administrative glitches and delays, Dr Z says.
There is also a growing need for child mental health services but the hospital doesn’t have in-patient psychiatry services and only has sessional psychological services.
“We serve an ever bigger community that has changing needs but our infrastructure has stayed the same and our staff numbers have not increased,” says Dr Z. The doctor has worked at RMMCH for nearly two decades – “my second home” she calls it.
The hospital has around 1200 staff members. They serve up to 2300 people admitted per month as well as 10 000 outpatients each month.
Dr Z tries to stay hopeful, saying “we look to the positive things and we do what we can”, but RMMCH can be a daunting place to work. Safety and security has resurfaced as a concern this February. This comes on the back of a car hijacking that took place in the hospital’s parking area at the beginning of the month. The Ombud’s report also looked into the hijacking of an intern’s car that took place in its investigation period.
Parking too is a daily frustration – there are only 300 parking spots for staff on the hospital campus but at least 400 vehicles that need a place to park at peak times. Visitors are told to park on the streets.
‘Mr Fixer’
Acting CEO of the hospital Dr Arthur Manning met with Spotlight to answer questions put to him and to the Gauteng Department of Health.
Manning took up the job in September 2022 as part of the Ombud’s recommendation to redeploy the previous CEO, Dr Nozuko Mkabayi, whom the government oversight body found to be a dismal failure.
Manning calls himself “a fixer”. His role, he recognises, has been to help stop the slide for RMMCH, also to boost staff morale, restore communication channels and regain the community’s trust in the facility.
“We are a system under pressure and we know there is burnout and low morale but we have improved counselling support and we try to recognise and thank people. We held a nurse’s awards dinner last year exactly for these reasons,” he says.
Manning says the hospital organogram was last updated in 2006, but he has submitted a revised one to the Gauteng Department of Health. It makes the case for more admin and support staff, more junior and training doctor posts and bolstering psychiatric and psychological services. These, he says, are especially necessary because services for children are particularly neglected.
The broken CT scanner at Rahima Moosa Mother and Child Hospital. (Photo: Denvor de Wee/Spotlight)
On the matter of the CT scanner, he says “procurement is underway”. It’s a planning failure that the machine is five years beyond its expected lifespan and was not replaced sooner, resulting in the current gap. Manning says the Gauteng Department of Health is now piggybacking on Limpopo’s procurement contract. Piggybacking refers to provisions in the Public Finance Management Act, that under certain conditions, allow a department in one province to procure goods and services via a contract that a department in another province has concluded with a service provider.
According to Manning, the Gauteng province is currently concluding an X-ray equipment tender that has delayed the procurement of the CT scanner for RMMCH. “Without a tender in place, procurement is more difficult,” he says. Approval to use Limpopo’s tender contract cuts out some red tape and means the CT scanner and maintenance contract has been secured at the price of R30 million. By May, he says, the hospital will also have an MRI-scanning facility.
Staff helps to spruce up waiting area
Manning has been credited by some for shifting morale and competently overseeing the interventions set out by the Ombud’s report. On a hospital walkthrough with Spotlight, he engages casually with staff and patients. He’s also evidently proud of staff-driven initiatives to improve the hospital experience for patients. He points out a freshly painted waiting area in one of the departments where children are playing with new toys and crawling on bright green astro turf. More than half the money for this project came from doctors and nurses raising funds cycling and running in race events in the city.
Keeping staff motivated means their concerns and working conditions – including the parking problem and safety and security – have to be priorities, he says.
Cars are double and triple-parked in the overcrowded staff parking area. Currently, informal management of this is done via Whatsapp groups. People on the groups are notified to move their cars as spots free up. Manning says the hospital is working to secure nearby grounds for additional parking. On safety and security, he says the hospital has stepped up collaboration with local police and the community policing forums to increase patrolling around the hospital especially around shift changes. He adds: “We have expanded our CCTV camera coverage, requested for armed security control and we’re exploring panic button systems.”
A bigger budget and a permanent CEO
There are two key outstanding issues from the Ombud’s report. The first is reclassification of the hospital that is also an academic and training hospital, from a regional facility to a tertiary hospital.
“This is something that involves national, but when reclassification is done it will means RMMCH’s budgets and grants will be adjusted and we will be able to do so much more,” says Manning.
The second issue is the appointment of a permanent CEO, which Manning says is “being handled by central office”. He side-steps a question on whether his name is in the mix. It’s expected that an announcement on the new CEO will take place in April.
Professor Ashraf Coovadia is academic head of Paediatrics and Child Health at Wits University and heads up this department at RMMCH. He says Manning has “been good for RMMCH” but he says above the level of CEO, it’s the Gauteng Department of Health that needs to get its house in order . He says there has been a lack of communication, consultation, transparency and decisive action from the Gauteng Department of Health for years.
“A CEO can do only so much. When we have having acting heads in so many departments who are in acting positions for forever, it’s a joke. It means decisions don’t get made or decisions don’t get made for the long run and this compromises how the hospital is run and the care we give patients,” he says.
He adds that when there is less “hospital floor” consultation and more bureaucratic centralisation from the department it alienates doctors and nurses. “It becomes more and more difficult to try to motivate especially junior doctors who start off wanting to give back to the public health service but become so frustrated they don’t stay.”
Back to the 1900s
Like Dr Z, Coovadia highlights the CT scan issue, as well as the long delays and the excuses for the delays.
“Working without a scanner takes us back to the 1900s; we are not practising modern medicine and we are not able to diagnose patients early enough,” he says.
Coovadia adds that even though water and electricity supply issues at RMMCH have improved, infrastructure fixes remain patchy. “There are fewer issues of burst pipes and flooding, but it’s still happening.”
Coovadia has been with the hospital for 26 years, he knows better than most the precariousness of the situation and why the hospital is not yet out of the woods. He says: “The negative attention on the hospital did bring about some positive change. But it can make you cry when you see the slide over the last ten years… The hospital is not collapsing, but there are daily collapses.”
NOTE: Coovadia is on the board of SECTION27. Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
