Patient care options abound

Ask most people what drew them to the Cayman Islands and you will invariably find pristine beaches and a year-round tropical climate amongst the principal answers.

Ask the HSA’s new Medical Director Dr. Greg Hoeksema and you will elicit a much different response.

‘The reason that I took this job is that it offers an opportunity to improve the whole country’s health system,’ he said.

Mr. Hoeksema has spent the past 22 years as a doctor and administrator with the US Navy – a post that took him around the world.

This is Mr. Hoeksema’s third stint on a tropical island; past military deployments have included postings in Hawaii and the tiny Italian island of La Madellena.

Add to that the numerous deployments on what he describes as ‘the ultimate island’, US Navy Aircraft carriers, and it’s fair to say Mr. Hoeksema knows more than a little about the challenges of providing medical care on small islands.

‘There aren’t a lot of medical crisis situations that I haven’t been faced with, especially the question of ‘how do you get someone access to care’,’ he says.

Mr. Hoeksema spent the past three-and-a-half years as the civilian equivalent of Chief Operating Officer of the United States Naval Hospital in Yokosuka, Japan. Like the HSA’s operations throughout the Cayman Islands, the hospital was a primary care hospital with some specialist services that also had outlying medical clinics, including some on remote islands.

‘The administration and organisation of a military hospital is really no different to this,’ he says. ‘You have similar challenges and the same strategic goals of patient access; patient safety; quality medicine; and evidence based medicine.’

Quality healthcare focus

Mr. Hoeksema, who is charged with ensuring that HSA patients receive the best possible medical care, arrives at a time when community confidence in the HSA appears low.

In late October, 65 per cent of respondents to a poll said they had little or no confidence in the HSA.

Although he is doubtful that perception matches the reality of the care patients are receiving, Mr. Hoeksema has a host of ideas he wants to look at to improve patient outcomes.

‘My basic mindset is that anything is possible and it will all be driven by one single consideration: what is best for the population in Cayman.’

Pointing to the cost of medical evacuations and the limited coverage for them under some insurance policies, Mr. Hoeksema said he would be looking to other facilities in the region to see if patients in Cayman can get better value for money.

The spiralling cost of medical care in the US – where some hospitals are asking for guarantees of $500,000 before accepting emergency patients – offers ample incentive.

‘It’s certainly something we are going to explore. I’m going to make personal on-site visits to the hospitals that support us in Miami and the hospitals that may be able to support us in Jamaica,’ he said.

Another regional option worthy of further exploration is Cuba, he said. ‘My understanding is that there are some very nice medical facilities there and that is another area we are going to explore.

‘From a regional perspective we are going to look at what the opportunities are and what is available to us.’

But the relationship with overseas medical providers may not necessarily be strictly one-way. He sees opportunities for the Cayman Islands Hospital to draw patients from other countries in the region as well.

‘We are going to look at the areas in which we could become a centre of excellence at this hospital.’

One of those areas could be in cardiac care. Although the Cayman Islands Hospital has a visiting cardiologist, he said a business model analysis will be done to determine whether Cayman could become a regional center of excellence for cardiac care.

‘There is not much question in my mind that the population here is not large enough to have a full time interventional cardiologist on staff here,’ he said.

‘Having said that, if you just look at it in those black and white terms then you are never going to say ‘what are the possibilities’?’

Mr. Hoeksema says he has been impressed with the quality of Cayman’s five district health clinics. A continued focus on using the clinics could help reduce wait times for patients and make medical care more convenient for them, he said.

Highlighting the work HSA Research Coordinator Dr. Laurence Vanhanswijck has been doing on childhood obesity in the Cayman Islands, Mr. Hoeksema said he will look at other medical research possibilities, but only when they can improve patient outcomes.

‘At the end of the day I am a simple Iowa farm boy. Some of that stuff is terrific conceptually, but the bottom line is, how does it impact patients? We need to invest our energy and money in things we are pretty certain will improve the health and wellbeing of patients in Cayman.’

Importantly, he believes the hospital has the most important organisational foundation in place – ‘a remarkably dedicated staff.’

‘Our staff have an emotional investment in our hospital and want it to be as successful as it can be,’ he said.

Although he is still new to the role, he too sees the work ahead of him in personal terms.

‘At the end of the day this is [the community’s] hospital and this is my hospital. If nothing else I have a very personal vested interest in making this the best it can be because this is my family’s hospital.’