Public vs Private Healthcare

Healthcare in the public sector is beset with challenges ranging from limited resources, aging equipment, a revolving door of unmotivated staff, and an overall demotivated team. This article is written based on my own experiences in two Caribbean countries. It showcases some key differences between the behaviour of staff in public and private hospitals in the region.

Efficient Delivery

Private hospitals exist for profit and are always searching for a method of competing and reducing operating costs all while increasing profits. Much of the efficiencies sought after come with a continuous analysis of processes. This analysis may be purely derived from the need to ensure the highest levels of certifications are achieved or maintained which attracts patients to their facility.

From my observations in the public sector the need to improve the efficiency is one that is a lot more reactionary. Did someone experience a fall down these stairs? Oh no - let's ensure that patients in our care are not at risk of injury as a result of aging infrastructure. The need to improve efficiencies are never driven by a strive to compete in the sector. Public hospitals exists to only service the needs of the community and usually only worry about reducing costs in the face of budget cuts.

The contrasts in my experience are night and day - any physician operating in both worlds can support this view. A private hospital is a proactive institution while a public hospital is reactionary.

Growth requires Reinvestments

The need to increase efficiencies usually come at some costs. During the analysis phase it might be noted that the introduction of a Pyxis Pharmaceutical Dispenser may save the hospital thousands of dollars over a 5 year period and reduce the need for one on staff pharmacist. For a private hospital this is an easy sell - The Pyxis will be paying for itself easily within a few years of being introduced despite the initial high upfront cost. Private Hospitals are also not shackled to bureaucratic red tape to procure a high valued item; instead, where there is a justified spend - this can easily be approved by a board that values the need for increased operational efficiencies.

In a publicly funded hospital there is a stark difference in the approach:

• Who will pay for it? Usually, public hospitals in the Caribbean are poorly funded and rely heavily on private donors to invest in infrastructure - much of what is critical to the care of patients.

• Reductions in staffing. If the efficiency increases due to the introduction of a new process- in this case, a machine - then it is not likely to see a change in the staff complement. This is usually despite the fact that the new process can now be done with less. In the majority of cases, it is true that the staffing was never adequate to begin with.

Laser Focused Team

Increasing operational efficiency also leads to the development of staff that are focused on delivering quality at lower costs. This happens in every department of a private hospital, from the billing department to the clinicians and even the kitchen team. The teams are usually laser-focused on trying to keep a check on the costs while ensuring that the billable costs to the patient always result in a profit. Team members are also incentivized to ensure that their abilities to lower costs and increase profits are always rewarded. The inverse is true; underperformers are quickly reprimanded, moved or dismissed in an effort to fail quickly and take corrective actions.

A team in the public sector, based on my observation, does not need to ever focus on identifying a process that can be improved. They must operate in an environment that protects themselves and delivers healthcare with just the resources at hand, leaving a focus on the profit to the finance team upstairs. This mindset from staff results in issues with billing, unrealized costs, abuses in resources and further degradation of the quality of patient care due to unnecessarily high costs. There are a number of factors that lead to this behaviour; the bureaucracy involved in processes, the lack of incentives and a lack of involvement in efficiency management that is needed from all members of the team.

Summary

The delivery of healthcare in the Caribbean between private and public hospitals is wide and varied. The outcomes are unfortunate but can be improved. In a future article, I will look at a few suggestions to tackle the disparity and close the gap in the quality of healthcare facilities.

Talent Retention

Brain Drain happens when a country fails to secure its most highly educated citizens, leaving a vacuum of competency in several sectors. The phenomenon has wide reaching impacts on economies, especially in developing countries where talent now has to be outsourced to companies from more developed countries that are better equipped to retain talent. For example, in Jamaica the ICT sector contributes heavily to brain drain in a somewhat self fulfilling prophecy. ICT companies will outsource to foreign companies instead of using their resources to hire local talent and in turn, because there is limited focus on hiring locally, many citizens are compelled to leave. In some instances they may even work at the foreign entities these Caribbean firms outsource. There must be a change in the approach of to talent acquisition and retention that would be beneficial to Jamaica and the wider Caribbean.

It is known that Jamaica ranks highly on the Human Flight and Brain Drain Index, second only to Samoa. If we ever needed a confirmation of what has been seen from many families in Jamaica - then this ranking is it. Interestingly our Caribbean neighbors, the Bahamas, ranked 120th on the index.

I have participated in several recruitment activities in Jamaica, focused on identifying talent from an early stage and worked to engage and secure the young and brilliant minds before being snatched up by the likes of Google, Meta and Amazon. Recruiting isn’t easy as I have had to formulate convincing arguments to attract talent and persuade them to remain in Jamaica. Considering the realities of high inflation and interest rates which has only been exacerbated by global conflicts such as in Europe where there is rapid rise in food and fuel costs, it has proven difficult. The outlook seems bleak and increasingly disparaging to a company looking to participate in a global economy.

The grass is always greener..

A young graduate in 2022 has more access to large multinational firms than they did in 2009. The COVID-19 pandemic proved to be a catalyst in the era of remote work and since then the world has seen a sharp increase in remote work opportunities with better incentives to foster a healthier balance between work and personal life. High-paying remote work opportunities also increased from 4% (December 19, 2019) to approximately 15% in 2022. I am inclined to believe that remote work is here to stay. With increased accessibility, better working terms and a higher compensation package, traditional company structures and practices will fail to attract the kind of talent they would need to succeed. My prediction is that individuals will become uninterested in recruitment drives and even more disenchanted with compensation packages that promise health insurance at most.

Jamaican companies have now seen its own mass resignations especially during the pandemic where productivity remained high - but demands increased. Managers are now asked to participate in employee engagement check-ins and one-and-ones to ensure that staff remain motivated and committed to the company. The effectiveness of these check-ins are constantly eroded by migration push and pull factors. Jamaican companies rely too heavily on foreign firms which instead of encouraging their employees to stay it encourages them to leave. It is difficult surmise their value within the company when hired foreign consultants earn more but are required to do the same job or less.

Cauterize the wound

It takes a sudden dramatic act to stop the loss of tech talent. It involves acknowledging the hard truths that employees will work if given the right tools, environment and a healthy work-life balance that fosters personal development.

Pay talent - retain talent:

It goes without saying that the demand for talent must be met with a salary that can retain said talent. As a former part-time lecturer in the Department of Computing at the University of the West Indies, I have seen companies such as Goldman Sachs or Google appreciate our own local talent and lure them with attractive and unmatched compensation before they've even received a degree in hand. Why don't we appreciate our own similarly?

2021 global report - Randstad

Attractive salary & benefits is the most important driver globally (62%) and scores highest among women (65%) and middle-educated employees (66%). Furthermore, women, those with mid-level education, and Latin American residents consider as many as eight employer attributes as important in an ideal employer, compared to the global average of seven.

Dispel the myth that North American knows best:

Too often do we look outside to bolster our teams with talent that do not understand the Jamaican context. I have been involved in discussions with consultants from Fortune 100 companies that have sought to influence product direction with their own misconceived notions of demand for features. I have been fortunate to see several instances where, under the guidance of local talent, these product directions are stymied with the appropriate research and proven with adoption with locally developed ideas. We know our audience better than anyone else does.

Remote Work Destination:

Jamaica is an amazing country that enjoys wonderful and consistent weather year-round. People dream of sitting on the beach and writing code - yet it's not taken advantage of. During the pandemic we saw a myriad of countries opening up borders to facilitate remote work and increase potential revenues from these workers spending.

The country benefits by having talent present physically in the same space as a college graduate looking to depart. This encourages a diffusion of ideas that wouldn't be seen outside of conferences hosted in Jamaica. The success of Tech Beach Retreat demonstrates that people are interested in Jamaica as more than the stereotypical Reggae and Tourist attraction..

Summary

The brain-drain is bad, but it can be slowed and maybe even stopped. With a simple reallocation of time and resources it is very possible. The continued over dependence on larger firms to bolster the Jamaican workforce, is simply not sustainable.