May 5, 2010
This letter aims to comment on the issues affecting the health of the nation and the fundamental concerns arising from organizational structures, the system of leadership and recruitment into the leadership and political positions.
This letter aims to comment on the issues affecting the health of the nation and the fundamental concerns arising from organizational structures, the system of leadership and recruitment into the leadership and political positions.
There are challenges in our nation’s healthcare industry and the absence of political will and courage to address the problems will continue to make an existing bad situation even worse. The world is moving at a jet speed and no industry whether government, private or voluntary should be run like community self-help projects that is void of lines of responsibility and accountability.
It is hoped that your choice of the person appointed into the political position of Minister of Health was well considered on a fit-for-purpose criteria and not on the basis of any other remote reason that has over heated the politics and endemic rivalry which has sustained the barrier for growth and economic viability in the sector. The projection that one profession is superior to another and the members are more intellectually gifted is unfortunate and unnecessarily fanning the flame of destruction of partnership, collaboration and corporation which the industry needs in order to become viable and generate the productive capacity to serve and meet the needs of the public and ailing patients. All over the world, the emphasis is on equality and diversity. In Europe and USA there are legislative provisions to ensure that no individual or group put themselves above any other person or group.
The authority of the doctors lies on confirmation of diagnosis and decision about treatment options. Their role is not in core management and leadership unless they have undertaken the necessary training and gained reasonable experience and competency. The door to such training and development must be opened to any healthcare professional who has interest in leadership and management and wish to develop their career in that area.
Management is a graduate and postgraduate academic programme. In the healthcare industry, further competency based management training is required through mentorship and practice experience. All the professions in healthcare are interdependent and thrive better with efficient exchange of information, knowledge and learning from each other. The notion that doctors are the bank of clinical knowledge or the profession is better than any other is misleading and delusional. The most important source of knowledge and clinical information is the patient hence doctors and nurses are in the frontline in hospitals and clinics. It does not make the other health professionals less important. The contribution of each is to enhance quality, efficiency and effectiveness in clinical outcome (multi-disciplinary approach).
You have asked the new Minister of Health to sort out the internal rivalry. That is what he must do if he is wearing a political hat and not flying a specific professional banner. It cannot be done unilaterally without broader support from the other arms of the political spectrum. And the other health professionals must be reassured that the big management and leadership gaps in the industry will be filled with the people that are qualified and competent in that field.
The idea that a medical doctor must be the Minister of Health, the Commissioners of health at State levels, the Chief Executive (infamously referred as Chief Medical Director (CMD)) at hospital institutions and directors across all the departments is born out of superimposed residue of imperialist mentality. Similar mentality was propagated by a political interest that Nigeria can only be governed by the military and that ethnic minority cannot be president of Nigeria. On that kind of mentality a complete novice without skills or relevant knowledge would be put in a position of serious importance against the best candidate. When such is the case, as it sometimes proves to be, the consequences are often detrimental to the greater public interest. The role of the pharmacist is unique, so is the role of the nurse, the medical laboratory scientist, radiologist, bio-medical engineer, the porter, cleaner, caterer, secretary, etc. Health is not an industry where segregation and superiority complex should flourish. It has so far damaged clinical advancement, stunted the rate of organizational growth, strangulated innovation and creativity, eroded clinical accountability and management responsibilities. It has completely disempowered the patients and eliminated public trust and confidence. In today’s Nigeria, 1 in 5 children still die before their 5th birthday, maternal death rates remain very high compared to other countries with similar economic and manpower potentials and thousands die from preventable health conditions and accidents. In April 2010, my sister-in-law lost a baby that was born alive by caesarean section in Delta State because there was no oxygen to support the baby after 48 hours of labour. She was left to suffer the pain of labour for that long before a decision was made to carry out a caesarean section, without putting into consideration her past maternity history of C-section. The baby died and there was no explanation from any accountable person as to the cause of death and so no lesson could be learned. Therefore there is no means of preventing this familiar and avoidable infant mortality across the country.
The divisive superiority mentality which is being applied through threats, intimidation and coercion is causing the Nigerian public the opportunity to develop the business potentials of the national heath industry even though it’s a public service that is not primarily aimed to make profit. The fact is that it could still be managed to generate a certain degree of income for reinvestment. We as a nation must learn from the experiences of the progressive countries. It’s no use listing the high profile Nigerians that travel abroad for treatment and how much each trip and medical service cost. There, doctors treat, nurses care, managers manage and the bulk rests at the doorstep of the chief executive. If things don’t go as plan, a chief executive could lose his/her job. In Nigeria, doctors as CMDs are not positioned to lose their jobs as leaders of organizations, so they are not faced with the pressure that follows the role of that line of leadership.
Information obtained online provides that the US health industry, which by one estimate generated $740bn in revenue last year, represents one-sixth of the country’s economy. In the UK, the National Health Service is the largest employer of labour after the Chinese Army and Indian Railway. Putting a doctor who is not trained or skilled in management into a management position in healthcare or hospital organization simply because he/she is a doctor is absolute gambling with positions of responsibility. It takes a combination of theoretical knowledge of management and leadership with practical experience of analyzing complex corporate strategies and making tough decisions about the services, the public, market, culture, economics, technology and politics for goals to be achieved. This is very different from the science of treating and curing the sick, which the doctors are trained for and are best at.
The corporate affair of healthcare institutions is not a domain for a named profession. What is required are teams of highly educated, trained and skilled people in the field of management and leadership. They may be doctors, nurses, pharmacists, medical laboratory scientists, nutritionists, lawyers, accountants, economics, historians, or a management strategist or health management specialists. All that they need is the right training, mentorship and support to climb through the ladder of competency and skills acquisition for leading and managing the various departments and services.
Here are some crucial solutions that would be vital to turn the industry around from its present state of disarray, arrogance of the professionals, clinical and management incompetence and insensitivity to patients and public needs. In addition, there is need to deliver on workforce productivity, economic viability and services expansion. Nigeria deserves healthcare institutions that merits the title ‘Centre of Excellence’ by its productive activities which will make it fit for the president and ministers to go for treatment. In order to take the industry to that higher level the following recommendations need to be implemented.
• It is important that positions are created to separate the role of clinicians from that of politics, leadership and management. E.g at the highest level, Nigeria need to have: Principal Medical Adviser for the Federation or National Chief Medical Officer with core authority to give pronouncements on clinical matters based on professional knowledge. The position of minister is political and he/she can only project a national diplomatic interest and responds to the changing mood of the public about the quality and consistency of healthcare services they are receiving
• Each health institution should be allowed to create its own corporate identity with power to hire qualified and skilled people and fire those that are incompetent, be they doctors or cleaners.
• The heads should bear the brunt in the event of corporate failures, whether it arises from quality of clinical productivity, financial impropriety or inability of the organization to respond to the health needs of the local community.
• The title of Chief Executive should be created and orientated for corporate leadership and so direct the title of Medical Director to clinical leadership where it rightly belongs. This is the situation in most advanced and proactively developing nations. It does not remove the chance for doctors, pharmacists, nurses etc from applying for such positions if that becomes their new career interest.
• Services should be properly analyzed, designed, re-engineered or redesigned to take account of hidden problems in the community and new disease trends. In this line, I would like to mention services that will remove shame and support families that are suffering in silence; e.g, incontinence, dementia, alzheimer’s disease, mental health, chronic leg ulcer etc which are often hidden away or the sufferers abandoned on the grounds of superstition.
• Design and allow a structured management system for Ambulance and community patient transportation services
• Create training, development and research department in every healthcare institutions where students from all fields in the healthcare sector are sent on placement for learning and practical experience
• Make it mandatory for all institutions in the health industry whether publicly run or privately owned to create customer care services and complaint management system.
• There should also be a risk management and quality assurance system for ensuring that lessons are learned from non-fatal mistakes and explanations are provided for sudden or unexpected deaths.
To implement the stated ideas and achieve great result, efforts should shift away from negative paradigm of retrogressive stereotype and baseless disintegrative class syndrome. The new paradigm should be one of unity, mutual respect with aims and goals centered on the public and patients. It is therefore necessary that the change agents strongly communicate the benefits of change which is centered on service quality, organizational growth and workforce development. All that it will take is commitment and the courage of fitting square pegs in square holes. It does not require the intelligence of a rocket scientist and there is no magic to it apart from engaging everyone and ensuring that the change is properly communicated through all the relevant channels. If there are variations in ideas of how best to improve the nation’s healthcare system, the government should create opportunity for relevant intellectuals with great ideas to do presentations at conferences. Through that, we can gradually introduce competency/evidence based management and clinical accountability.
David Eboh, BA (Hons) MBA, PGDipHE, MIHM, AssCIPD
Health Management Consultant
United Kingdom
[email protected]
[email protected]
Tel: ++7956 378019
Author: “Strategic Concept for Managing Healthcare in Nigeria” Published by Tamere House 2008
“Health Before Hospital: Issues, Concepts and Strategies for Affordable and Accessible Healthcare Services in Sub-Saharan Africa” (To be published 2011)
Also author of several articles on Nigeria’s healthcare online and in Daily Newspapers
Cc:
Minister of Health
President, Nigerian Medical Association (NMA)
President, National Association of Nigerian Nurses and Midwives (NANNM)
President, Pharmaceutical Society of Nigeria
President, Association of Medical Laboratory Scientist of Nigeria
President, Nigeria Labour Congress
Minister of Labour
President, Nigeria Union of Journalist
There are challenges in our nation’s healthcare industry and the absence of political will and courage to address the problems will continue to make an existing bad situation even worse. The world is moving at a jet speed and no industry whether government, private or voluntary should be run like community self-help projects that is void of lines of responsibility and accountability.
It is hoped that your choice of the person appointed into the political position of Minister of Health was well considered on a fit-for-purpose criteria and not on the basis of any other remote reason that has over heated the politics and endemic rivalry which has sustained the barrier for growth and economic viability in the sector. The projection that one profession is superior to another and the members are more intellectually gifted is unfortunate and unnecessarily fanning the flame of destruction of partnership, collaboration and corporation which the industry needs in order to become viable and generate the productive capacity to serve and meet the needs of the public and ailing patients. All over the world, the emphasis is on equality and diversity. In Europe and USA there are legislative provisions to ensure that no individual or group put themselves above any other person or group.
The authority of the doctors lies on confirmation of diagnosis and decision about treatment options. Their role is not in core management and leadership unless they have undertaken the necessary training and gained reasonable experience and competency. The door to such training and development must be opened to any healthcare professional who has interest in leadership and management and wish to develop their career in that area.
Management is a graduate and postgraduate academic programme. In the healthcare industry, further competency based management training is required through mentorship and practice experience. All the professions in healthcare are interdependent and thrive better with efficient exchange of information, knowledge and learning from each other. The notion that doctors are the bank of clinical knowledge or the profession is better than any other is misleading and delusional. The most important source of knowledge and clinical information is the patient hence doctors and nurses are in the frontline in hospitals and clinics. It does not make the other health professionals less important. The contribution of each is to enhance quality, efficiency and effectiveness in clinical outcome (multi-disciplinary approach).
You have asked the new Minister of Health to sort out the internal rivalry. That is what he must do if he is wearing a political hat and not flying a specific professional banner. It cannot be done unilaterally without broader support from the other arms of the political spectrum. And the other health professionals must be reassured that the big management and leadership gaps in the industry will be filled with the people that are qualified and competent in that field.
The idea that a medical doctor must be the Minister of Health, the Commissioners of health at State levels, the Chief Executive (infamously referred as Chief Medical Director (CMD)) at hospital institutions and directors across all the departments is born out of superimposed residue of imperialist mentality. Similar mentality was propagated by a political interest that Nigeria can only be governed by the military and that ethnic minority cannot be president of Nigeria. On that kind of mentality a complete novice without skills or relevant knowledge would be put in a position of serious importance against the best candidate. When such is the case, as it sometimes proves to be, the consequences are often detrimental to the greater public interest. The role of the pharmacist is unique, so is the role of the nurse, the medical laboratory scientist, radiologist, bio-medical engineer, the porter, cleaner, caterer, secretary, etc. Health is not an industry where segregation and superiority complex should flourish. It has so far damaged clinical advancement, stunted the rate of organizational growth, strangulated innovation and creativity, eroded clinical accountability and management responsibilities. It has completely disempowered the patients and eliminated public trust and confidence. In today’s Nigeria, 1 in 5 children still die before their 5th birthday, maternal death rates remain very high compared to other countries with similar economic and manpower potentials and thousands die from preventable health conditions and accidents. In April 2010, my sister-in-law lost a baby that was born alive by caesarean section in Delta State because there was no oxygen to support the baby after 48 hours of labour. She was left to suffer the pain of labour for that long before a decision was made to carry out a caesarean section, without putting into consideration her past maternity history of C-section. The baby died and there was no explanation from any accountable person as to the cause of death and so no lesson could be learned. Therefore there is no means of preventing this familiar and avoidable infant mortality across the country.
The divisive superiority mentality which is being applied through threats, intimidation and coercion is causing the Nigerian public the opportunity to develop the business potentials of the national heath industry even though it’s a public service that is not primarily aimed to make profit. The fact is that it could still be managed to generate a certain degree of income for reinvestment. We as a nation must learn from the experiences of the progressive countries. It’s no use listing the high profile Nigerians that travel abroad for treatment and how much each trip and medical service cost. There, doctors treat, nurses care, managers manage and the bulk rests at the doorstep of the chief executive. If things don’t go as plan, a chief executive could lose his/her job. In Nigeria, doctors as CMDs are not positioned to lose their jobs as leaders of organizations, so they are not faced with the pressure that follows the role of that line of leadership.
Information obtained online provides that the US health industry, which by one estimate generated $740bn in revenue last year, represents one-sixth of the country’s economy. In the UK, the National Health Service is the largest employer of labour after the Chinese Army and Indian Railway. Putting a doctor who is not trained or skilled in management into a management position in healthcare or hospital organization simply because he/she is a doctor is absolute gambling with positions of responsibility. It takes a combination of theoretical knowledge of management and leadership with practical experience of analyzing complex corporate strategies and making tough decisions about the services, the public, market, culture, economics, technology and politics for goals to be achieved. This is very different from the science of treating and curing the sick, which the doctors are trained for and are best at.
The corporate affair of healthcare institutions is not a domain for a named profession. What is required are teams of highly educated, trained and skilled people in the field of management and leadership. They may be doctors, nurses, pharmacists, medical laboratory scientists, nutritionists, lawyers, accountants, economics, historians, or a management strategist or health management specialists. All that they need is the right training, mentorship and support to climb through the ladder of competency and skills acquisition for leading and managing the various departments and services.
Here are some crucial solutions that would be vital to turn the industry around from its present state of disarray, arrogance of the professionals, clinical and management incompetence and insensitivity to patients and public needs. In addition, there is need to deliver on workforce productivity, economic viability and services expansion. Nigeria deserves healthcare institutions that merits the title ‘Centre of Excellence’ by its productive activities which will make it fit for the president and ministers to go for treatment. In order to take the industry to that higher level the following recommendations need to be implemented.
• It is important that positions are created to separate the role of clinicians from that of politics, leadership and management. E.g at the highest level, Nigeria need to have: Principal Medical Adviser for the Federation or National Chief Medical Officer with core authority to give pronouncements on clinical matters based on professional knowledge. The position of minister is political and he/she can only project a national diplomatic interest and responds to the changing mood of the public about the quality and consistency of healthcare services they are receiving
• Each health institution should be allowed to create its own corporate identity with power to hire qualified and skilled people and fire those that are incompetent, be they doctors or cleaners.
• The heads should bear the brunt in the event of corporate failures, whether it arises from quality of clinical productivity, financial impropriety or inability of the organization to respond to the health needs of the local community.
• The title of Chief Executive should be created and orientated for corporate leadership and so direct the title of Medical Director to clinical leadership where it rightly belongs. This is the situation in most advanced and proactively developing nations. It does not remove the chance for doctors, pharmacists, nurses etc from applying for such positions if that becomes their new career interest.
• Services should be properly analyzed, designed, re-engineered or redesigned to take account of hidden problems in the community and new disease trends. In this line, I would like to mention services that will remove shame and support families that are suffering in silence; e.g, incontinence, dementia, alzheimer’s disease, mental health, chronic leg ulcer etc which are often hidden away or the sufferers abandoned on the grounds of superstition.
• Design and allow a structured management system for Ambulance and community patient transportation services
• Create training, development and research department in every healthcare institutions where students from all fields in the healthcare sector are sent on placement for learning and practical experience
• Make it mandatory for all institutions in the health industry whether publicly run or privately owned to create customer care services and complaint management system.
• There should also be a risk management and quality assurance system for ensuring that lessons are learned from non-fatal mistakes and explanations are provided for sudden or unexpected deaths.
To implement the stated ideas and achieve great result, efforts should shift away from negative paradigm of retrogressive stereotype and baseless disintegrative class syndrome. The new paradigm should be one of unity, mutual respect with aims and goals centered on the public and patients. It is therefore necessary that the change agents strongly communicate the benefits of change which is centered on service quality, organizational growth and workforce development. All that it will take is commitment and the courage of fitting square pegs in square holes. It does not require the intelligence of a rocket scientist and there is no magic to it apart from engaging everyone and ensuring that the change is properly communicated through all the relevant channels. If there are variations in ideas of how best to improve the nation’s healthcare system, the government should create opportunity for relevant intellectuals with great ideas to do presentations at conferences. Through that, we can gradually introduce competency/evidence based management and clinical accountability.
David Eboh, BA (Hons) MBA, PGDipHE, MIHM, AssCIPD
Health Management Consultant
United Kingdom
[email protected]
[email protected]
Tel: ++7956 378019
Author: “Strategic Concept for Managing Healthcare in Nigeria” Published by Tamere House 2008
“Health Before Hospital: Issues, Concepts and Strategies for Affordable and Accessible Healthcare Services in Sub-Saharan Africa” (To be published 2011)
Also author of several articles on Nigeria’s healthcare online and in Daily Newspapers
Cc:
Minister of Health
President, Nigerian Medical Association (NMA)
President, National Association of Nigerian Nurses and Midwives (NANNM)
President, Pharmaceutical Society of Nigeria
President, Association of Medical Laboratory Scientist of Nigeria
President, Nigeria Labour Congress
Minister of Labour
President, Nigeria Union of Journalist
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