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Let’s Cruise towards Better Health Care

By Shakira Choonara
on June 19, 2015

Sometimes even an Emerging Voice and Future Leader (hear me…) can feel a bit out of touch with our times. Now that many desperate people are trying to cross oceans and seas on very shabby boats, hoping for a better future, this January I embarked on the spectacular MSC Opera, a luxury cruise from the Cape of Storms to the stunning Namibian Dessert. Ahum.

Still, I thoroughly enjoyed it. It struck me, that I was out in the middle of nowhere but every service imaginable was of high quality and at my fingertips. I felt almost like Kate Winslet in you-know-which-movie. Of course, there were downsides such as seasickness, long lines to get on board and a swarm of people (it’s not really as exotic and posh as it looks on the fancy website). Overall, though, these cruise liners are extremely well-coordinated, considering that there are approximately 2000 guests on board the MSC Opera, 728 staff members, 878 cabins and a gross tonnage of 59.058 tonnes. If you think about it, in terms of volumes, cruise ships are quite similar to hospitals. In South Africa for example, Chris Hani Baragwanath Hospital has approximately 3200 beds and 6760 staff members – this is around the size of some of the bigger MSC liners.

Now, even if do fancy a few guilty pleasures now and then, I’m no fan of the private sector. But there are times that we have to admire (or envy) how well some private sector entities and industries function. While we’re worried about water scarcity, MSC boasts impressive machinery which converts seawater into drinking water for their ships. These cruise liners don’t run at a loss or have problems with suppliers like many of our health facilities do, instead they’re able to stock up food and all the necessary supplies before setting sail. The liners have massive budgets and huge storage spaces including cold rooms on board. Every single guest is accounted for through a card system, and if you miss the ship (as I almost did) the liners can account for exactly who is missing. It literally is an impressive operation; staff are friendly, you are provided with an entertainment itinerary every morning, rooms are spotless and all 728 staff have uniforms which are dry-cleaned and pressed every day. Cruise ships are often in the middle of nowhere, yet you can order a newspaper of your choice. Ah, the wonders of capitalism!

I could not help but think, why is it that cruise ships can function so well in the middle of nowhere, yet many health systems on land do not function this well? A systematic review in PLOS medicine (2012) found that there is no evidence to back up claims that the private sector is more efficient and accountable in low and middle income countries (LMICs). But let’s not get into the debate around public sector versus private sector efficiencies here – we have plenty of health economists for that. I’m aware making a comparison between cruise liners and the health system is probably not methodologically sound, but sometimes one just has to break the rules especially where logic is concerned. Although I agree it is important to acknowledge differences in terms of resources, tax dodging capacity and the like between hospitals and cruise liners (or other very efficient private industries, like aviation), there are certainly some lessons around functioning and co-ordination which might be applicable in our never-ending quest to strengthen our health systems.  Perhaps it’s about getting answers to some of the following difficult questions:

  • Why is it that a cruise liner serves approximately the same number of people as a hospital but functions so much better and provides quality services?
  • How do cruise liners ensure guest satisfaction (at least if we forget about the Costa Concordia for a moment) yet many hospitals cannot ensure patient satisfaction?
  • How is it that cruise liners have sufficient stock and necessary supplies on board, yet our health facilities face drug shortages?
  • Why is a cruise liner spotless and many of our health facilities anything but? (The abundant sea water probably helps, but still…)
  • What are some of the lessons or ethos of the private sector that the public sector needs to adopt?

Dare I say I think it is possible to cruise towards better health care, but for this to happen maybe we need to stop thinking of health systems as being complex and perhaps draw on some simple and logical lessons from well-functioning private entities such as cruise liners?

Ready for the guillotine!

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