The British Virgin Islands Health Services Authority
The healing power of positivity
Business View Caribbean interviews Natasha Lettsome, BVIHSA Marketing & Communications Manager, as part of our focus on best practices in Caribbean healthcare.
On Wednesday, Sept. 6, 2017, Hurricane Irma came screaming through the Caribbean, leaving total devastation in its wake. The British Virgin Islands were blindsided by the full brunt of the storm that day, and the British Virgin Islands Health Services Authority (BVIHSA), through its main facility, Peebles Hospital on Tortola, became a beacon of light, literally. In the immediate aftermath, the hospital had electricity and some semblance of internet, so residents and stranded tourists could contact their loved ones. The doors were opened, people were fed. Many slept there because it felt safe and secure.
The fact that the building stood up to Category 5 winds that basically flattened everything around it is a testament to the high quality of its design and construction. The hospital became the communications point; even the central government was operating from inside the facility. All that, and the unprecedented amount of critical medical care provided, was a huge factor in BVI’s return to some sort of normalcy.
Natasha Lettsome, BVIHSA Marketing & Communications Manager, experienced the hurricane first-hand and recalls, “Afterward, people were just so grateful to be alive. There was so much love and positivity moving through the community. I think that was one of the reasons we rebounded so quickly. We were all just so thankful of having survived. The resiliency of the BVI is all about our people.” Lettsome was living in a house nestled on the side of a hill with a fabulous view of the sea, when Irma made landfall on the BVI as a Cat. 5. She shares, “All the windows and doors upstairs blew in. It seemed to go on forever. When the eye of the hurricane came over my community and we came outside and looked down the hill, we thought that everybody down there must be dead because you couldn’t see where the sea started and the land stopped. Everything looked like ocean, and we knew houses and hotels were supposed to be there. It was very frightening.”
A testament to the strength and fortitude of its people, BVI was open for business shortly after the storm. Many of the beaches and the natural beauty remained intact. Today, hotels are coming back on stream; restaurants are open; and the tourism product can still capture the heart of anyone coming to the BVI. The significant unifying role that the BVIHSA, the Peebles Hospital, and its dedicated staff played during that time cannot be understated, and still continues to this day.
Along with Peebles Hospital on Tortola, the BVIHSA oversees nine community clinics on the islands of Tortola, Jost Van Dyke, Virgin Gorda, and Anegada and employs 625 people. Working with an estimated budget of $40 million, its services include: Audiology, Emergency, Hemodialysis, Infection & Prevention Control, Laboratory Services, Medical Imaging, Nutrition and Dietetics, Pharmacy, Physiotherapy, Social Services, General Surgery, Obstetrics and Gynecology, and Pediatric Care.
The BVIHSA is managed by a Board of Directors appointed by the Minister for Health and Social Development and is administered by its CEO, Dr. Ronald Georges. When Dr. Georges came onboard, last year, he inherited a full slate of ongoing agenda items. Among them, accreditation for the Territory’s healthcare system and the promotion of medical tourism in the BVI. “The hurricanes caused a lot of delays and issues,” says Dr. Georges. “Those items are still high on the agenda, but at this point, we have to deal with the aftermath, and the rebuilding and recovery at the same time, which is particularly challenging.”
Due to the storms, the first review for accreditation was delayed. Hopefully the first assessment will take place later this year. The Authority is seeking accreditation through DNV (Det Norske Veritas), but there is much work ahead to get back on track with the process. Medical tourism is still on the agenda, and is predicated on obtaining accreditation and having an efficient organization. There has been some discussion with The Atlantic Clinic (TAC) and they have done some pre-work with regards to medical tourism, but being accredited is critical, because that will allow U.S.-based, third-party payers to pay for services rendered in the BVI. Once accreditation is obtained, the BVIHSA will be in a better position to attract additional medical tourism services providers.
Reflecting on the hurricane aftermath, Dr. Georges explains, “What the storms really showed us was the need for proper disaster resilience and mitigation, and proper planning and the exercising of those plans to deal with small, medium, and large-scale disasters. After Irma, the seat of government had to move from the Central Administration Complex into the hospital because the hospital is actually one of the strongest buildings in the Territory. After the storm, it housed government services and ministries and the National Emergency Operations Center. “That really drove home for us the importance of disaster mitigation and emergency planning,” Dr. Georges stated.
Much of 2018 was focused on recovery and rebuilding; and repairing damaged infrastructure, while utilizing the concept of “build back better and stronger”. The BVI Health Services Authority is now reviewing and finalizing disaster plans. They’ve sent some forward for approval at the government level and others are still to come. With so much to coordinate, it’s expected to take two or three years to complete.
Dr. Georges is also intent on improving the way the Authority and all of its components operate together. “Think of the organization as an organism,” he avers. “We run a system – a hospital and clinics. We want to see all the systems in place and properly sorted out. So, we have to look at our structures to make sure they are laid out appropriately, that they function efficiently, and are aligned to the organization’s goals and priorities. That’s an ongoing process, because you’re always constrained by budgets, and it’s difficult to make changes very quickly, especially when you’re a public sector organization. Change has to be incremental. So, it’s more of a shift to a more efficient and effective structure.”
A major goal is to redevelop and restructure the quality department to ensure that everything is delivered according to a standard in the areas of patient safety, environment of care, risk management, and infection control. It all ties together with the accreditation – improving quality and effectiveness of the organization. One change that Dr. Georges believes will improve the organization’s effectiveness concerns its information systems. “We are transitioning our information systems to a new more efficient product,” he notes. “That transition process is very intense and takes a lot of effort from the organization. It’s being done in phases – Phase One is finance and HR; Phase Two is clinical; Phase Three is additional products, such as cost accounting, etc. So, the main focus, this year, is getting Phase One completed and then starting towards Phase Two.”
Dr. Georges would also like to see changes in the Authority’s reimbursement structure: “In terms of our recurrent budget, most of that comes from the National Health Insurance, which was created by regulation under the Social Security Act that requires all legal residents to pay into the National Health Insurance system. Providers are then paid on a per service basis. However the BVIHSA is paid on a global budget with the balance of the operating budget coming from co-pays. The thinking is that the Authority will try to transition, on some levels, to a fee for service model, once we’ve finished the information system and are able to generate the appropriate data.”
Some public health goods, like immunization and child health, should probably still stay on a global budget or capitation-based payment, whereas secondary and tertiary care might be on a fee for service budget. That’s the direction the Authority is heading, which would create a lot more flexibility in the organization to develop new services and to increase efficiencies.
A wonderful new capital project, Nurse Iris O’Neal Medical Centre in Virgin Gorda, is on the verge of completion; being built to the same outstanding standards as Peebles Hospital. “The quality of our infrastructure is extremely high and this facility will be no exception,” Dr. Georges states. “We were given an “A” rating on the PAHO Hospital safety index – one of only two hospitals in the entire region. The facility was struck with a direct hit from what was possibly the worst storm in recorded history in the Atlantic and, yes, we suffered some damage, but that did not stop the hospital from functioning, and the Territory’s government ran from the facility for about three months afterwards. Our vision is to build similar facilities throughout the Territory to serve the populations in those areas. We have a dedicated staff and we have the potential to be one of the leading facilities in the region, once we get it right.”
AT A GLANCE
WHO: The British Virgin Islands Health Services Authority
WHAT: The statutory body that oversees the Territory’s healthcare providers
WHERE: Tortola, British Virgin Islands
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