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Our View: Radical change needed to put patients first

“Unfortunately, the patience and tolerance we have shown in our effort to support state hospitals and spare the Cypriot patient of inconvenience has led to the continued and progressive devaluation of our professional dignity.”
The above was part of an open letter from the union of government doctors Pasyki released on Monday to highlight the “ever-worsening” problem of under-staffing in state hospitals, which were on the brink of collapse. While nobody doubts the chaotic situation of state hospitals, it was incredible to read that hospital doctors felt their “professional dignity” was progressively devalued because of their efforts “to spare the Cypriot patient of inconvenience.”

Surely the value of their “professional dignity” should have been significantly boosted rather than devalued by offering a good standard of care to patients despite the difficult working conditions at hospitals. The personal satisfaction doctors derived from helping patients against the odds, as they claim, must counter the effects of working under pressure. At least, this is how an outsider would view the predicament of government doctors, who would have us believe that they are the most badly-treated professionals of our society.

Perhaps this is inevitable, given the easy working life they have enjoyed for decades, finishing work at 2.30pm and being paid overtime rates when they have to work after this time or at weekends. It was not exactly a taxing professional life, which is why now that they have to work harder because of staff shortages, they have been protesting so vociferously and threatening strikes. They were not accustomed to working under pressure at state hospitals so they are having great difficulty adapting to the new conditions.

The problem in most parts of the public sector is that everything is designed and organised to keep their workers happy rather than the people they have to serve. This had always been the primary objective of politicians, technocrats (themselves public employees) and union bosses, none of whom cared about the interests of the people the public sector had to serve. There has never been an ethos of customer care because the public sector was set up to serve its employees rather than the public.

State education, like the hospitals, is designed along these lines – teachers have an easy professional life that everyone would envy while children receive an embarrassingly poor standard of education. Primary and secondary school teachers, even with less justification than doctors, have also been protesting about understaffing and threatening strikes in the last month despite the excess capacity of the education system. Hundreds are seconded to the education ministry and teaching hours are reduced with years of service, not to mention the fact that schools are open only half the days of the year because this suits teachers.
As a result of the ‘workers first’ model, state education and healthcare are totally dysfunctional and incapable of performing their primary role – serving the public. They are characterised by low productivity, inefficiency, inflexibility and poor organisation, which ensure low standards. We are made to believe, however, that these unacceptable standards are exclusively caused by understaffing. While in hospitals this may be the case, the poor standard of care becoming worse, state schools, if anything, are overstaffed.

But even if staffing shortages existed, sound organisation, good management, proper planning and flexibility in work practices would have allowed the system to cope. But these do not exist because of the complete lack of a service culture that would put the interests of patients (and students) first. In the public sector they do not even do the basics such as setting targets and evaluating results in order to make improvements every year, less this inconveniences the indifferent, unmotivated workforce. Job performance is never evaluated so that the laziest, most incompetent and unproductive workers enjoy job security for life.

Again, this is because the public sector has no interest in the quality of service it provides. A patient’s life could be put at risk as a result of being treated by an incompetent doctor and dozens of teenagers might leave school not knowing how to write their name because of lousy teachers, but politicians do not care as long as the underworked, pampered public employees are happy. Poor service has always been the norm not only at hospital and schools, but in almost all public sector offices.
While staff shortages may have caused the standard of care offered at state hospitals to further decline, the problem is much deeper. Unless there is a radical change to the culture in hospitals that puts the patient always first no matter how many more doctors and nurses are hired the situation will not improve and the devaluation of doctors professional dignity would continue.

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