In medicine, quality and governance are crucial to improving standards. Corporate and individual accountability for clinical performance should be demanded and failure to live up to responsibility should be legally punitive.
The medical profession in Jordan is very good at selling itself as a major contributor to the economy. One hears constantly about the excellence in healthcare provision in Jordan and of the high quality of doctors; the reality is very much different.
Jordan's significant leap into 21st century medicine has brought benefits to its people and helped the expansion of a booming private sector that accounts for 34 per cent of the nationally available hospital beds. It is unfortunate that celebrating this success has allowed complacency to set in and standards to have fallen significantly.
In the 1970s and 1980s, the Royal Medical Services (RMS) set the standards and led the way in offering Jordanians high-quality medical care and investing in high-quality medical training. The RMS has been crucial in offering other health sectors the trained medical, nursing and other healthcare professionals. Unfortunately, this is no longer the case.
Access to good medical training is far more difficult than used to be the case. There is almost no access to international surgical training. We are no longer able to send our young doctors to gain surgical exposure abroad. In surgery, our excellent services are concentrated in few senior surgeons. The new Jordanian surgical graduates are far below the standards that are required for the 21st century medicine.
Moreover, Jordan's social fabric has changed since those golden years. Changed social values no longer reward hard work and academic achievement. Our society no longer rewards talent and ability. Wealth, family connections, class privilege and cronyism are more determinant of social position than hard work and education.
Medical ethics is also rapidly changing, and it is sadly the case that this has reached worryingly unacceptable levels.
The medical profession is in a moral vacuum. This is also complicated by lack of governance and regulation which, in turn, has created an environment that is ripe for deteriorating standards, deteriorating medical ethics and lack of social responsibility.
The absence of regulation is crucial to our predicament. The government has to realise it has the responsibility to impose such regulation. Many services in Jordan have regulatory boards. The medical services do not. Self regulation and monitoring of standards have clearly failed.
Raising the standards of medical training is essential. Quality is mandatory; quantity is no defence for poor quality.
It is common sense to acknowledge and utilise existing Jordanian skills and set policies to incorporate such skills in training programmes. Competition based on talent and ability will improve standards. A cultural shift is needed where doctors appreciate the limitation of their training and seek help and advice when needed; an attitude of life-long learning is essential and professional development programmes should receive government financial help.
Government-driven initiatives in governance and a drive to stop poor practices is crucial to reversing the deterioration of our medical services. Ideas for good practice could include clinical risk reduction programmes, evidence-based day-to-day practice, detecting and investigating adverse events, detecting poor clinical performance and dealing with it early on to prevent harm to patients, and collecting high-quality data to monitor clinical care. All medical institution in Jordan should be challenged to produce data that reflects clinical outcome.
Success of any healthcare system is measured by the strength of the public confidence in it. Today, Jordanians are wary of failing medical standards and deteriorating medical ethics. Pockets of good medical practices are swept by the tide of mediocrity and corruption. Hard work and discipline is devalued. Self regulation is no longer acceptable and a new framework for continuously improving the quality of medical practices and safeguarding high standards of care is needed to create an environment in which excellence in clinical care flourishes.
Political courage is needed. Only government-sponsored regulations could attempt this. Lack of leadership is proving a disaster for the Jordanian healthcare services. The government must act.
By Ibraheem Hijazi
© Jordan Times 2009
