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ILLUSTRATIVE QUOTES |
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a) “A big factor driving change in performance is salary. The biggest tool you have in a hospital is the staff. It’s very difficult to keep the staff if other ministerial departments pay more.” – QMMH higher management, non-clinical role b) “As for these shifts we are working, most people like them. They are used to working 12 hours shifts, while in government people are working 8 [or] 9-hour shifts. They say they are fine with the shifts. They only complain about money.” – QMMH staff, clinical role c) “For a tertiary hospital we should have people who are more experienced, but that’s the opposite because of issues of salaries we usually get. So [that is] quite challenging. We have newly graduated nurses coming to work here (…) we need people with skills that are mature.” QMMH higher management, clinical role
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d) “We feel we are understaffed (…) the nurse-patient ratio is one nurse to ten patients. But given the work that we are doing here and the quality of work that we provide to our patients (…) [and] the type of patients that we treat here - those that could not be treated anywhere else (…) we feel we are severely understaffed.” – QMMH staff, clinical role e) “There are no ICU specialists; [nor] emergency specialist.” – QMMH higher management, clinical role
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f) “The hospital, from what we understood at the beginning, was to reduce referrals and to train people. Train doctors, specifically local doctors, so that they then care for most of the patients locally. That is not happening as expected (…) There has to be a lot more effort with regards to developing the doctors (…) We don’t have a well-organized training program which should be there.” – QMMH higher management, clinical role g) “Queen Mamohato [is] not really empowering the [rest of the health] system (…) [The] job description talks about external capacitation, [via] internal and external interaction. But most of the time, the current system is not flexible enough to allow external participation.” – QMMH higher management, clinical role
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i) “QMMH is a symptom of what is broken in the system. Patients are flooding QMMH because it’s the only place that they feel they can get help. So QMMH ended up doubling [it’s expected] numbers of patients (…) some of these patients, maybe caesarian section for fetal distress, could have been done at a district hospital but they say they don’t have oxygen, so patients are referred (…) The entire health system needs to be strengthened.” – Clinic staff, clinical role j) “There are no resources in government institutions. (…) You tell [patients] to go to a hospital [and] they cry, they don’t want to go (…) the entire service delivery in government institutions is not functioning as one would expect it to (…) You walk into a [public] clinic and maybe there is only one nurse working there. It’s very difficult. People queue for very long time. I think it’s easier for people to trust Queen ‘Mamahato rather than the government institutions.” – QMMH staff, clinical role
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k) “Patients will be referred here [at QMMH] who don’t need to be here (…) there was no linen at the district hospitals so they could not do a caesarian-section (…) We can have a better functioning system. [That is] our challenge. We get unnecessary referrals.” – QMMH higher management, clinical role l) “[The existence of QMMH] has decreased the quality of care provided by the district hospitals because now if you go to the district hospital, people will just refer something that they could have treated locally. Refer. But we don’t see that from the filter clinics (…) I think [the presence of QMMH] has taken away the clinical skills of people [working in the districts].” – QMMH higher management, clinical role m) “Patients are coming late, they are referred late, and therefore the outcome is bad. So we can’t blame the hospital [QMMH] for the poor outcome of the patients. (…) Providers will waste time in the in private clinics up until it’s late, they will send a patient to QMMH when it’s late.” – Clinic higher management, clinical role n) “The closing of Queen Elizabeth II caused a lot of havoc in the whole [health] system, because Maseru did not have a district hospital. Only recently Queen Elizabeth II was opened [again] and only the outpatient department. Now you find that QMMH has literally becomes the district hospital [and] the referral hospital. (…) Service provision has been affected by trying to share resources between managing primary cases and high-risk cases. And the bulk of patients that come here are primary care patients.” – QMMH higher management, clinical role
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