GROOTE SCHUUR HOSPITAL: Leading the Fight Through Innovations in Process, Service and Leadership

Nestled in the slopes of Devil’s Peak in Cape Town is Groote Schuur Hospital (GSH), the renowned training ground of many of South Africa’s finest doctors, surgeons and nurses. The facility was officially opened in 1938 in Observatory, just a few minutes from the main University of Cape Town campus, and found global fame in December 1967 when young UCT-educated surgeon Dr Christiaan Barnard completed the world’s first successful human heart transplant.

As the hospital has gone on to grow and build new wings in the years following the ground-breaking operation, the theatres in which the operation took place have been carefully preserved for posterity in the form the Heart of Cape Town Museum. Tourists are taken through the entire process, culminating in Washkansky’s receipt of the donor heart via a gruelling nine-hour operation necessitating the skills of over 30 medical personnel.

Since the first successful implementation of this major medical procedure it has saved tens of thousands of patients’ lives in every corner of the world. It remains one of the hospital’s primary specialisms, where strengths otherwise lie in transplant services and cancer care as well as specialities in all medical and surgical sub-disciplines, psychiatric, neurosciences, obstetrics, gynaecology and neonatal care.

A LEADING INNOVATOR

“We are well-known for performing the first heart transplant worldwide,” recognises CEO Bhavna Patel, “but we always say that this is not the only thing that has put us on the map.” Patel has stood as GSH’s CEO since 2013, and is also a specialist a specialist in family medicine and public health after working as a General Practitioner for 10 years.

“Since 1967 we have done so many other things that make us proud as a hospital, and so many other innovations have also since come to the fore.” GSH enjoys a partnership with the University of Cape Town, Patel’s own alma mater, ranked by several international and authoritative indexes to be the best university on the African continent and among the best 200 universities worldwide.

“GSH is a specialist and sub-specialist hospital, and we are very closely linked to the University of Cape Town and provide the teaching platform for their undergraduate and postgraduate students,” offers Patel by way of further background, “as well as a platform for research.

“Clinical services, teaching, training and research – these are our primary activities. As an academic health centre, we strive to provide outstanding tertiary and quaternary care for the patients of the Western Cape and beyond, and promote excellence in teaching and research.”

This goes hand-in-hand with GSH’s overarching vision. “Leading Innovative Healthcare” it asserts, admitting some 80,000 inpatients per year and around half a million outpatients, and performing 25,000 operations all of the more complex, higher acuity nature.

“We are the only hospital in the country where authentic quaternary procedures like heart transplants are taking place,” Patel details. “We also perform liver, kidney and bone marrow transplants and have started a lung transplant program as well as other high-end procedures such as the transcatheter aortic valve replacement and laparoscopic surgeries.

“There are many examples of activities where we are the only public sector hospital offering the services.” With 80% of the population accessing public, rather than private, healthcare, reaching every citizen with the same level of care is becoming a growing concern across the whole of medicine and healthcare, and GSH is leading the way in its ground-breaking service.

LEARNING COVID LESSONS

“Apart from priding ourselves on innovation,” Patel goes on, “we are very focused on exemplary and effective leadership, making sure that the hospital functions well and the patients receive the very best care.

“2020 threw us totally overboard,” she admits. “We were turned upside down, and this is really where our leadership came into its own. We had to hold it all together for our staff, make sure that patients were cared for and ensure the availability of the facilities to allow the medical and nursing staff to do their work. We developed a homegrown leadership development programme which stood us in excellent stead, making our managers more resilient, adaptable and able to cope.

“After everything that has gone on we have realised that our priority in 2021 has to be on staff wellness and safety,” she summates. “To this end, we appointed a wellness team to ensure that, as wave after wave batters us, the highest level of support and counselling is provided by our team of psychologists, psychiatrists and occupational therapist specialising in mental health. It has been truly invaluable to morale.

“Our second major point of learning from Covid,” Patel says, returning to the crucial lessons of the pandemic, “was around the major cause of death of people who contracted the virus – over 50% had diabetes and hypertension,” she reports.

“It brought crashing home that, without drastic intervention, we are going to see more and more young people developing these chronic illnesses, and if we don’t start to tackle this right now then in four or five years time we will have a huge health burden on our hands.”

How are we going to do things differently? This was the burning question for all at GSH, and Patel reveals that, like many players in the healthcare sphere, the hospital’s vision is far-reaching. “We started looking at our three- and five-year trajectory post-Covid” she says, “because there is no way that it could continue to simply be business as usual.

“We need a health system redesign and restructure,” Patel declares of the result of GSH’s considerations. “This cannot be solely what happens at Groote Schuur hospital, rather it has to impact every aspect of the services along the entire patient journey – the whole continuum from the clinic, to the day-care facilities and district hospitals and finally to us, a specialised service centre.

“Learning the lessons of the last 18 months – that is our real aim at present.”

LASTING IMPACT

These systems and initiatives, whether developed pre- or mid-Covid, have been implemented throughout the hospital and sustained in everyday practice today to bring lasting improvements to crucial areas like waiting times and patient flow. “Improvement process initiatives like these are vital in offering the staff across the whole hospital a systematic way of dealing with any issues they face,” Patel explains.

“They are able to provide the solutions to the problems they perceive which gives a sense of ownership and pride in what they achieve, and the resulting motivation to continue.”

These seemingly small adjustments go to show how innovating does not always have to mean the latest in science, technology or procedures. Ground-breaking accomplishments could just as easily be related to process as to service, quality or strategy, and while not always greeted with international acclaim, all have contributed to improving the quality of patient care provided and received.

Seeking new and different solutions to existing challenges is the crux of innovation, and GSH is in the privileged position of being able to capitalise on the extraordinary intellectual and creative capital of its staff body to transform the way in which healthcare is delivered both within the hospital and more widely.

“The calibre of our people means that they are always seeking out new ways of doing things,” sums up Bhavna Patel. “This has brought us entire lists of hospital firsts in the world, in the country, in the province where we are based and at the hospital itself.

“This should illustrate just how motivated our people feel to try out new things, the openness we promote and the freedom our experts are given to explore,” she closes. “Always with the best interests of the patient at heart, it boils down to the pride we take in continually finding improved ways of operating, to retain our status as a leader in innovative healthcare.”