Dr. Fiaz Maqbool Fazili
A healthcare system is not judged by the magnificence of its buildings, the sophistication of its machines, or the number of specialists it employs. It is judged by a far simpler question: Can an ordinary citizen receive safe, timely, affordable, and compassionate care when it is needed most?
In Kashmir, that question has become increasingly uncomfortable.Almost every week, newspapers and social media carry stories of alleged negligence, delayed treatment, overcrowded emergency rooms, shortages of medicines, assaults on healthcare workers, and heartbreaking patient experiences. Public confidence appears shaken. Doctors feel demoralized. Administrators struggle to defend the system. Politicians promise reforms after every crisis.
Is Kashmir’s healthcare system truly collapsing, or are isolated incidents being amplified into a perception of total failure?The answer lies somewhere between these two extremes.The reality is neither complete collapse nor reassuring stability. The system continues to function largely because of the extraordinary commitment of thousands of doctors, nurses, technicians, and support staff who work under enormous pressure. Yet it also suffers from deep structural weaknesses that no amount of individual dedication can permanently compensate for.The time has come to stop searching for scapegoats and start repairing the system itself.
Beyond Headlines:Modern media operates in an era of instant outrage.A single adverse event can circulate across thousands of social media accounts within minutes, often before the facts are established. Public anger is understandable because healthcare deals with human lives. Every tragedy deserves investigation and justice.However, isolated episodes should neither become a licence to vilify an entire profession nor an excuse to ignore genuine systemic failures.The danger lies at both ends.Denying problems breeds complacency.Exaggerating every incident destroys trust.Neither serves patients.Healthcare is among the most complex systems created by society. Errors occur even in the world’s finest hospitals. The objective is not to create an error-free system—a practical impossibility—but a system that continuously learns, improves, and prevents recurrence.Unfortunately, that culture remains weak in many institutions.The Real Crisis Is On processes than Structural. Most healthcare failures are rarely caused by one negligent doctor.They arise from a chain of organizational weaknesses.When emergency departments remain overcrowded, junior doctors become exhausted.When diagnostic services are delayed, treatment is delayed.When medicines are unavailable, patients lose confidence.When referral pathways fail, tertiary hospitals become flooded with cases that should have been managed elsewhere.When accountability is absent, mistakes repeat themselves.These are system failures—not individual failures.Healthcare quality has long been explained using the Donabedian model: Structure, Process and Outcome.If the structure is weak, processes become inconsistent.If processes fail, outcomes inevitably suffer.Unfortunately, Kashmir currently struggles in all three domains.
Infrastructure Without Systems:Government has invested substantially in expanding medical colleges, district hospitals and tertiary institutions over the past decade.Yet infrastructure alone does not create quality.
A hospital building without efficient systems merely becomes a larger place where inefficiency occurs.Many hospitals continue to struggle with,overcrowded outpatient departments ,prolonged waiting times, inadequate intensive care capacity,obsolete equipment,maintenance failures,poor sanitation,fragmented patient flowweak referral mechanisms, need QR code queue management using barcode, scanning at crowded billing counters.The patient journey often becomes an exhausting maze rather than a coordinated pathway.
Human Resource Deficit:The greatest strength of any healthcare system is its people.Kashmir possesses exceptionally talented clinicians whose expertise is recognised nationally and internationally.Yet the workforce remains stretched beyond reasonable limits.Shortages of nurses, technicians, paramedics and specialists create enormous pressure on existing staff.Burnout has quietly become one of healthcare’s biggest threats.An exhausted doctor cannot consistently deliver optimal care.An overworked nurse cannot monitor every patient adequately.A fatigued technician becomes more vulnerable to error.No healthcare system can achieve excellence while expecting its workforce to perform indefinitely under chronic stress.
Accountability Cannot Mean Punishment Alone:Whenever an unfortunate incident occurs, the familiar cycle begins.Committee constituted.Inquiry ordered.Suspension considered.Media debates intensify.Then silence returns until the next crisis.This reactive model has achieved very little.Punishment has its place where negligence or misconduct is proven.But punishment alone never improves systems.Healthcare worldwide is moving towards the philosophy of Continuous Quality Improvement (CQI) rather than a culture of blame.
The central question should not merely be:“Who committed the mistake?”Instead we should ask:“Why did the system allow this mistake to happen?”Unless root causes are identified, similar incidents will continue.Quality Is Designed—Not Inspected:Quality cannot be introduced after a complication occurs.It must be designed into every clinical process.Every hospital should function through clearly documented Standard Operating Procedures (SOPs), evidence-based clinical pathways, checklists, infection-control protocols and regular clinical audits.Variation in practice should be minimized wherever evidence already exists.My International experience repeatedly demonstrates that standardization reduces complications, improves patient safety and lowers costs.Quality is not an event.It is a culture.
Clinical Audit: The Missing Link:( review periodically, Can we do better, One of the greatest deficiencies in our healthcare system is the absence of regular clinical audit.Clinical audit is not fault-finding.It is systematic self-improvement.Hospitals should routinely examine:mortality rates,infection rates,surgical complications,medication errors,waiting times,patient satisfaction,readmission rates, referral delays, adverse or sentinel events.What gets measured gets improved.Without data, healthcare operates largely on assumptions.
Strengthening Primary Healthcare:Perhaps the greatest weakness in Kashmir’s healthcare delivery lies outside tertiary hospitals.Primary Health Centres and Community Health Centres should resolve nearly 70–80% of common illnesses.Instead, patients often bypass peripheral facilities and directly approach tertiary hospitals.The result is predictable.
Medical colleges become congested with patients requiring both primary and super-specialty care.Specialists spend valuable time managing conditions that should have been treated much earlier.This overload compromises care for genuinely complex cases.A strong referral system supported by electronic health records and coordinated communication between institutions is urgently required.The right patient must reach the right hospital at the right time.
Decongesting Tertiary Hospitals: The Missing Reform…
No healthcare system can function efficiently if every patient, irrespective of the severity of illness, converges on SKIMS or SMHS Hospital. Today, tertiary and teaching hospitals are overwhelmed not only by highly complex referrals but also by patients with common ailments that could be safely managed at district hospitals or secondary-care facilities.
Unless we decongest our tertiary and teaching hospitals through a robust, technology-driven referral policy, the cycle of overcrowding, prolonged waiting times, delayed surgeries, and compromised patient care will continue unabated.
Suggestion :Jammu & Kashmir urgently needs an integrated referral grid linking all three tiers of healthcare delivery—the Directorate of Health Services (District Hospitals and Community Health Centres), tertiary teaching institutions (SKIMS and Government Medical Colleges), and accredited private hospitals. Such a network should be supported by electronic referrals, e-consultations, telemedicine, shared electronic medical records, and real-time bed availability, ensuring that the right patient reaches the right facility at the right time.
Every patient does not require treatment at SKIMS or SMHS, just as every illness does not require a super-specialist. A patient with uncomplicated pneumonia, controlled diabetes, or routine surgical conditions should receive timely care closer to home. Tertiary hospitals must remain available for advanced trauma, organ failure, complex cancers, neurosurgery, transplant medicine, and other highly specialized services for which they were established.A rational referral system is not about denying patients access; it is about ensuring equitable, timely, and appropriate care while preserving the capacity of apex institutions to deliver excellence where it is needed most. Without such reforms, scarce specialist expertise will continue to be consumed by conditions that can and should be managed elsewhere, creating misplaced priorities and avoidable delays for those whose lives truly depend on tertiary care.
Digital Transformation;Healthcare in Kashmir remains insufficiently digitized.EMR-Electronic Medical Records, integrated laboratory systems, telemedicine, digital appointment scheduling and referral tracking should become standard rather than exceptional.
AI or any modern Technology cannot replace compassionate clinicians.,or communication gapsBut it can eliminate duplication, reduce delays and improve continuity of care.Digital health is no longer optional.It is essential infrastructure.
Patient Safety Must Become Non-Negotiable;
The first obligation of medicine remains unchanged:
Decongesting Tertiary Hospitals: The Missing Reform
No healthcare system can function efficiently if every patient, irrespective of the severity of illness, converges on SKIMS or SMHS Hospital. Today, tertiary and teaching hospitals are overwhelmed not only by highly complex referrals but also by patients with common ailments that could be safely managed at district hospitals or secondary-care facilities.
Unless we decongest our tertiary and teaching hospitals through a robust, technology-driven referral policy, the cycle of overcrowding, prolonged waiting times, delayed surgeries, and compromised patient care will continue unabated.
Jammu & Kashmir urgently needs an integrated referral grid linking all three tiers of healthcare delivery—the Directorate of Health Services (District Hospitals and Community Health Centres), tertiary teaching institutions (SKIMS and Government Medical Colleges), and accredited private hospitals. Such a network should be supported by electronic referrals, e-consultations, telemedicine, shared electronic medical records, and real-time bed availability, ensuring that the right patient reaches the right facility at the right time.
Every patient does not require treatment at SKIMS or SMHS, just as every illness does not require a super-specialist. A patient with uncomplicated pneumonia, controlled diabetes, or routine surgical conditions should receive timely care closer to home. Tertiary hospitals must remain available for advanced trauma, organ failure, complex cancers, neurosurgery, transplant medicine, and other highly specialized services for which they were established.
A rational referral system is not about denying patients access; it is about ensuring equitable, timely, and appropriate care while preserving the capacity of apex institutions to deliver excellence where it is needed most. Without such reforms, scarce specialist expertise will continue to be consumed by conditions that can and should be managed elsewhere, creating misplaced priorities and avoidable delays for those whose lives truly depend on tertiary care.
First, do no harm.Every hospital should establish active Patient Safety Committees empowered to investigate adverse events scientifically rather than emotionally.Medication errors, falls, hospital-acquired infections and procedural complications should be openly reported without fear.
A “Just Culture” encourages learning rather than concealment.Fear suppresses reporting.Transparency improves safety.
Mental Health Cannot Remain an Afterthought:Decades of conflict, uncertainty, unemployment and social stress have produced an enormous psychological burden across Kashmir.Yet mental health services remain inadequately staffed and underfunded.Depression, anxiety, substance abuse and trauma magnitude often underestimated require sustained institutional investment.Mental healthcare should become an integral component of every district hospital rather than an isolated specialty.
Restoring Public Trust:Medicine ultimately depends upon trust.When trust disappears, every adverse outcome becomes a confrontation.Doctors begin practising defensive medicine.Patients become suspicious.Violence against healthcare workers increases.Everyone loses.Trust cannot be rebuilt through slogans.It requires transparency, communication and empathy.Patients deserve honest explanations.Doctors deserve dignity and protection.Administrators deserve constructive criticism rather than political scapegoating.
Accreditation Should Become Mandatory:Healthcare quality cannot depend solely upon individual commitment.It requires institutional systems.Mandatory phased accreditation of government hospitals through recognised quality standards should become a state priority.
Accreditation compels hospitals to improve:patient safety,infection control,medication management,documentation,leadership & management standards,emergency preparedness,KPI-quality indicators,risk management.The process itself transforms organisational culture.
Leadership Matters:Healthcare reforms succeed only when leadership consistently demonstrates commitment.Hospital administrators must move beyond paperwork.
Management by walking around—( Gemba rounds , surprise visits as we say MOH Madam Sakina ji and Director SKIMs .Dr.Ashraf Ganie doing shoukd be frequent along with regular ward and wash room visits, listening to patients and frontline staff, observing processes firsthand—often reveals problems no file ever captures.Visible leadership creates visible accountability.
A Shared Responsibility:Healthcare cannot improve through government action alone.Doctors must embrace lifelong learning.Administrators must promote transparency.Politicians must invest wisely rather than react episodically., Vip culture and protocol’s should not affect common manMedia must distinguish investigation from sensationalism., wait for completion of inquiry not to fix blame prematurely .Citizens must use healthcare responsibly and respect those delivering it.Violence inside hospitals can never become an acceptable response to grief.Healthcare is a partnership.Every stakeholder has obligations.
From Blame to Improvement:The greatest transformation required is philosophical.We must move away from asking:“Who should be blamed?”towards asking:“How can this system perform better tomorrow than it did today?”That is the essence of CQI-Continuous Quality Improvement.Quality means doing the right thing the first time, improving it the next time, and sustaining it every time.This is not idealism.It is modern healthcare management.
Is There Hope?Yes.There is every reason for hope.Current MOH despite constraints seems to be positive to induce change .Kashmir possesses outstanding clinicians, committed nurses, talented young professionals and expanding medical institutions.What remains missing is not competence.It is coordination.Not intention.But implementation.Not policies.But systems.The healthcare system is not beyond repair.It is waiting for courageous leadership willing to replace episodic crisis management with evidence-based reform.
The future lies not in constructing more buildings alone but in building safer systems.Not in defending failures but in learning from them.Not in blaming individuals but in strengthening institutions.The health of a society reflects the values of its governance.Every patient deserves dignity.Every healthcare worker deserves support.Every hospital deserves systems that enable excellence rather than merely expect it.Kashmir now stands at a defining moment.The choice before us is clear.
We can continue reacting to each crisis after it occurs—or we can finally build a healthcare system where quality, accountability and patient safety become everyday practice rather than occasional aspiration.
The time for reform is not tomorrow.
It is today.
Dr. Fiaz Maqbool Fazili is a Senior Consultant Surgeon, Healthcare Policy Analyst, Clinical Auditor, and an international expert in healthcare quality, patient safety, and hospital accreditation. He writes regularly on healthcare reforms, quality improvement, and public policy in Jammu & Kashmir.
