There is a powerful story in the Gospel of John that I believe healthcare professionals—and indeed healthcare systems—should read again through a different lens.

John 5:1–9 tells us about a man who had been disabled for thirty-eight years. He was lying beside the Pool of Bethesda in Jerusalem, among a great number of people who were sick, blind, lame and paralysed.

He had been there for years. Then Jesus came to him and asked a remarkably direct question:

“Do you want to get well?”

The man's response was revealing:

“Sir, I have no one…”

Those four words have stayed with me.

“I have no one.”

 For me, this is not only a story about healing. It is also a story about access, vulnerability, prioritisation and the failure of a system to adequately respond to people with different levels of need.

And when viewed through the lens of modern healthcare, the Pool of Bethesda offers an extraordinary reflection on why triage matters.

A crowd of sick people, but no visible triage system

Imagine the scene.

There were many sick people gathered around one location. They did not all have the same condition, the same level of disability, the same urgency or the same ability to reach the available opportunity.

Yet they were all gathered around the same pool.

This sounds remarkably familiar to anyone who has worked in a busy hospital.

Patients arrive.

Some are critically ill.

Some are moderately ill.

Some are stable.

Some are vulnerable because they are elderly, children, physically disabled, confused or unable to advocate for themselves

Others may have the strength, mobility, family support or confidence to push their way through the system.

The fundamental question therefore becomes:

Should healthcare access be determined by who can compete most effectively for scarce resources?

Absolutely not

That is one of the reasons triage exists.

Triage is more than putting patients into colours

Triage is sometimes misunderstood as simply assigning patients a colour or placing them into categories.

It is much more than that.

At its heart, triage is about clinical prioritisation.

It asks:

·      Who needs attention first?

·      Who can safely wait?

·      Who needs immediate intervention?

·      Who needs referral to another service?

·      Who is vulnerable and may require additional support to navigate the system?

This is important because the first person to arrive is not necessarily the sickest person.

And the person who speaks the loudest is not necessarily the person with the greatest clinical need.

A patient who is unconscious cannot advocate for himself.

A paralysed patient may not be able to move quickly.

A frightened child cannot explain symptoms like an adult.

An elderly patient may not understand where to go.

A patient in severe pain may not have the strength to negotiate the system.

 Therefore, a good healthcare system must have a mechanism for identifying need, rather than simply responding to noise.

That mechanism is triage.

 “I have no one”: the patient-navigation problem

The man's statement to Jesus is particularly significant:

“I have no one.”

He explained that when the opportunity came, someone else got there before him.

His problem was therefore not simply his physical condition.

There was also a barrier to access.

He needed assistance.

He needed someone to help him navigate the pathway to the resource he believed could help him.

This is where modern healthcare can learn an important lesson.

A patient should not be left to figure out the healthcare system alone.

The patient may enter through an emergency department, outpatient department, maternity unit, paediatric unit or another entry point.

1.    But where should that patient go next?

2.    Who identifies the urgency?

3.    Who connects the patient to the appropriate service?

4.    Who ensures that the patient does not get lost between departments?

5.    Who follows the patient's movement through the system?

This is where patient navigation becomes important.

And this is why I believe the future of triage must move beyond sorting patients.

We need integrated triage and navigation.

From triage to integrated patient flow

Modern hospitals are complex systems.

A patient may move from triage to a clinician, laboratory, imaging, pharmacy, ward or another specialist service.

At every transition, there is an opportunity for delay, confusion or loss of continuity.

A patient can be correctly triaged and still experience poor care if the next part of the system fails.

This means that effective triage should not end with:

“This patient is red.”

It should continue with:

“Where does this patient need to go, how quickly should they get there, and who is responsible for ensuring that transition occurs?”

That is the difference between triage as categorisation and triage as a patient-flow system.

 The Bethesda lesson for the “no-bed syndrome”

This has particular relevance to healthcare systems struggling with overcrowding and limited bed capacity.

When a hospital is congested, the natural response is often to say:

“We need more beds.”

Sometimes we certainly do.

But beds alone do not solve patient-flow problems.

A hospital can have beds and still experience congestion if patients are not appropriately assessed, prioritised, transferred, discharged or referred.

 Consider a busy emergency area.

There may be patients requiring immediate resuscitation.

There may be patients awaiting admission.

There may be patients awaiting investigations.

There may be patients who could safely receive ambulatory care.

There may also be patients occupying valuable clinical space because the next stage of their care has not been coordinated.

This is why healthcare systems need to think beyond bed numbers and begin thinking about functional bed capacity and patient flow.

Every bed should be viewed as part of a moving system not simply as a piece of furniture.

The sickest patient should not have to win a competition

This may be the deepest lesson I take from Bethesda.

A healthcare system should never force vulnerable patients to compete for care.

The patient who is strongest should not automatically receive attention first.

The patient who arrives with the loudest family should not automatically move ahead.

The patient who knows how to navigate bureaucracy should not automatically receive faster care.

And the patient who is physically unable to move quickly should never become invisible.

Clinical need must determine priority.

That is the ethical heart of triage.

Triage, therefore, is not merely an operational tool.

It is also an equity intervention.

It gives the vulnerable patient a voice when they cannot advocate for themselves.

Nurses are central to this transformation

Nurses have historically been at the frontline of patient assessment, prioritisation, monitoring, coordination and advocacy.

This places nursing in a unique position to lead the transformation of triage.

 The nurse-led triage model of the future should be clinically rigorous, evidence-based, digitally supported and integrated across the hospital.

 It should connect:

Assessment → Prioritisation → Navigation → Referral → Bed Management → Clinical Intervention → Monitoring → Outcome.

 This is the direction in which I believe healthcare must move.

Not simply faster triage.

Smarter triage.

Not simply more beds.

Better patient flow.

Not simply more services.

Better integration between services.

The question we should ask

The Pool of Bethesda leaves us with a question that remains relevant thousands of years later:

What happens to the person who has no one?

In today's healthcare system, “having no one” may mean having no family member to assist you.

It may mean being unable to communicate.

It may mean not understanding the system.

It may mean being physically unable to move quickly.

It may mean arriving at a hospital where departments function in isolation.

Or it may simply mean becoming another number in an overcrowded waiting area.

Healthcare systems must be designed so that such patients do not disappear.

We need systems that see them.

Systems that assess them.

Systems that prioritise them.

Systems that navigate them.

Systems that protect them.

 From Bethesda to the future of African healthcare

Africa's healthcare systems are under pressure from growing populations, workforce shortages, increasing disease burdens, limited infrastructure and constrained resources.

We cannot solve every challenge overnight.

But we can redesign how patients move through the resources we already have.

Triage offers one of those opportunities.

When properly designed, nurse-led integrated triage can become more than an emergency-room function.

It can become a hospital-wide patient-flow architecture.

It can connect emergency care, outpatient care, maternity, paediatrics, medical and surgical services, laboratory services, diagnostics, bed management and referral pathways.

The goal is simple:

The right patient.

At the right place.

At the right time.

With the right level of care.

That is not merely a clinical ambition.

It is a health-system imperative.

“I have no one” must never describe our healthcare systems

The man at Bethesda had been waiting for thirty-eight years.

His story challenges us to examine what happens when vulnerable people are placed in systems where access depends on their ability to compete.

Jesus saw the person others had apparently overlooked.

Healthcare systems must learn to do the same.

We must build systems that identify the vulnerable early, prioritise according to clinical need and actively navigate patients toward appropriate care.

Because the future of healthcare cannot simply be about treating more patients.

It must be about seeing patients better.

And perhaps this is one of the most important lessons the Pool of Bethesda can teach modern healthcare:

A patient should never have to compete for care simply because they are too vulnerable to reach it.

The question is no longer only:

“Who came first?”

The better question is:

“Who needs us most and how do we make sure they get there?”

That is the promise of integrated triage.

That is the promise of patient navigation.

By Sara Nana Yeboah