I read with interest the health minister's direction to hospitals to stop chasing after ISO (International Organisation of Standardisation) certification. Pursuance of ISO certification by government hospitals has certainly been nothing more than a series of mundane paperwork to claim efficiency at the expense of far more relevant clinical issues.

For private hospitals, ISO certification has been used as a marketing tool to announce to the public, displayed by numerous congratulatory advertisements in newspapers, that they finally have achieved international standards in servicing the public. Nothing can be further then the truth.

The efficiency of a hospital cannot be measured by ISO standards which are related more to IT, electronics and industries that deal with data management. Indeed, ISO at one point gained a reputation for being slow, bureaucratic, congested, and insensitive to feedback from both vendors and their customers.

While many in the industry knew its applicability to healthcare was inappropriate, none have really pointed out that its priority was ill-advised. A reader once noted while visiting a friend, that a sizable portion of the roof on the second floor of the Seremban General Hospital had collapsed with water leaking, although the structure was only a few years old.

Incredibly almost to the day, a year ago on July 27, the health minister in a speech to commemorate the renaming of the hospital to Hospital Tuanku Jaafar, announced among other things that this same hospital had achieved MS ISO 9001: 2000 status and won many other awards including 'Baby Friendly Hospital', 'Husband Friendly Hospital' the Rotary Club Award and the Asian Hospital Management Award. The reader rightly pointed out that he could not see the relevance of accreditation when more importantly the roof needed fixing.

Perhaps hospitals in this country should measure success by being more clinically pertinent. The ambulance service is a good place to begin. If there is an accident can ambulances respond within 15 minutes without breaking down, getting lost or running out of petrol? At the scene, can they extricate the victim without snapping his neck or resuscitate a patient with a coronary successfully?

If the patient arrives at hospital alive, will there be a team of doctors who can continue giving treatment? Will the specialist/registrar/anesthetist be around to render urgent surgical services if the victim requires an operation? Will laboratory and imaging services be promptly available?

If he survives the surgery, will he have the benefit of close monitoring or will he be wheeled into an open ward of 40 patients with two staff nurses and two student nurses with the attendant occasionally helping out in the observation charts? If he recovers from his accident and surgery, will he then have to put up with potentially fatal infections such as MRSA (Methicillin Resistant Staphylococcus aureus) because hand washing among health personnel is not the norm?

If he has lost a limb or indeed becomes paralysed will he have the benefit of home nursing and physiotherapy? If he has sustained a head injury, at follow-up will he get his serial CT scans done on time or would he be told that his now often postponed CT scan appointment has to be postponed by yet another six months because the only machine is down or the radiologist has been transferred?

If he was discovered to be a diabetic or hypertensive would he then be shunted off to a peripheral clinic with no access to a physician unless the medical officer there gives him a fresh referral letter? And if he survives all this and manages finally to get back to hospital to see his specialist and get his CT scan done, would he finally be told that his medical record cannot be located because the hospitals spanking new computer system is down?

And finally to add insult to injury, would he be informed that his much needed Socso/Medical Insurance report for his claims cannot be completed on time because his file has been misplaced and his specialist has resigned?

ISO certainly will not be helpful in this situation because this is a human problem. Which is why doctors and nurses have to tend to this very real human problem without being too automated. You cannot function in a vacuum of false presentations based on ineffectual standards that do not carry direct value to your patients who are always the central focus in healthcare.

Perhaps Fidel Castro's Cuba which trains doctors from all around the world, insisting that they return to treat their country's poor despite Cuba not having a strong economy, may yet show the West that more than technology, human nature is what counts when you deal with the sick.