Alfred Dawes | Bathroom and police audits

Last Sunday my column delved into the claims of the chairman of the Police Federation that basic supplies were lacking in the constabulary force, hampering his charges’ efforts at carrying out their duties. I called for an audit to assess the claims made. That edition of the Sunday Gleaner also carried stories on the atrocious state of several public hospital bathrooms. Dilapidated and dirty, the bathrooms were missing fixtures and had plumbing that was out of order. The expose’ resulted in Minister of Health and Wellness Dr Christopher Tufton requesting an audit of all public hospital bathrooms.

My interest piqued by the similarity in the stories, I had a conversation with a senior official in the Ministry of National Security, as well as with staff from some of the hospitals featured in The Gleaner articles. The other sides of the stories are interesting, to say the least, and emphasise how difficult it is to solve problems affecting various national institutions, due to our culture and attitudes.

To begin, I was informed that an extensive audit of the police force was already conducted. This looked at every conceivable area, including transportation, facilities, data management and training. The findings helped to guide much of the reforms currently under way, including rehabilitation of police stations and the digitisation of records present in the massive station diaries and ledgers that hold every bit of information generated by the police. For obvious reasons the audits were not shared publicly or with me in the interest of national security. With efforts already under way to mitigate many of the deficiencies identified, the official was quite surprised about several claims, especially one in which a service vehicle was non-functional due to a lack of engine oil.

STANDARD OPERATING PROCEDURES

There has been a review of the standard operating procedures (SOPs) for servicing and if a vehicle has no oil, it is a direct result of a failure at the local level to ensure that the maintenance schedules are kept. This was seen as a breakdown in established protocols and spoke to a deficiency in local monitoring and accountability. Not surprisingly, a similar breakdown in monitoring and adherence to SOPs was admitted by one hospital official as a cause of substandard bathrooms, even as they stressed the difficult situation in which they operated.

One hospital had established checklists to ensure minimum standards were maintained for their recently refurbished bathrooms. It was essential to know what needed to be replaced, because there was always something to be replaced, I was told. Patients steal every type of dispenser placed in bathrooms. Toilet seats are stolen as soon as they are replaced. Patients and visitors to the facility were observed bathing in hand sanitisers. Toilets are frequently clogged because sanitary napkins are flushed. The stories were all too familiar as I recalled dealing with the same issues during my stint at the Savanna-la-Mar Public General Hospital. Replacement of broken tiles and toilets were commonplace back then and it seems not much has changed. The bathroom monitoring implemented then served to inform the hospital management what stolen or destroyed items needed to be replaced on a weekly basis.

It is in that same environment that the current local hospital administrators fight to deliver healthcare to patients with scarce resources, while balancing spending on replacing what those very patients steal and destroy. Where they admit they are failing is that they can do better with monitoring and accountability.

NOT TO FOLLOW SYSTEMS

Jamaicans on average simply choose to not follow systems and processes. It is usually the outsized effort of one individual why a particular area or department does well. Systems and SOPs break down as a rule because the very people charged with upholding them subvert them in the name of expediency. This culture was blamed for the breakdown in monitoring of the bathrooms for them to end up in such deplorable states. It is the same culture that was alluded to as to why there are some deficiencies in the police force, such as a vehicle with a maintenance package but no engine oil.

In discussions with others representing other public bodies, the complaint is the same: yes, we have resource problems, but we definitely could do a better job of managing those meagre resources. If, as the Ministry of National Security official claims, there has been significant improvements in the resources of the constabulary force, then the complaints of the Police Federation chairman are a result of not only a lack of resources, but the overall management of resources and processes by the police, including the rank-and-file members of the federation. This unpopular opinion needs to be ventilated during future discussions involving the federation and the MNS about the lack of resources alluded to.

When the bathroom audit is completed, it is not enough to list deficiencies and the SOPs to be established in order to avoid a relapse. What plans will there be to ensure proper monitoring of the SOPs, and how will those charged with their implementation be held accountable? The patients and visitors will continue to break and steal. Wear and tear alone without malicious intent will inevitably lead to breakage, but a system must be continuously utilised to maintain a minimum standard. Maintaining that system is the key to success, not its conceptualisation or finding out after the fact what caused it to break down. Otherwise, we will be auditing everything and everywhere forever and ever.

- Dr Alfred Dawes is a fellow of the American College of Surgeons, and CEO of Windsor Wellness Centre. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and alfred.dawes@gmail.com.