[David Brindle] Doctors are the Best Hospital Managers, study reveals

Would hospitals have fared better over the last 30 years if doctors were in charge? New research suggests they may have done…

Almost 30 years ago, what was then the biggest change to the health service since 1948 was ushered in by a report that noted: “If Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge.”

That report, by Sir Roy Griffiths, led to the introduction of general management of hospitals in place of decision-making by consensus and organisation by administrators. It was not a template for getting rid of leadership by doctors – Griffiths said they should become more involved in running budgets – but in practice few were appointed to the new general manager posts. The men (and a few women) in suits took over.

There is today little challenge to the thrust of what Griffiths recommended. But the failure to engage doctors in management is lamented widely. And a new study raises the thought that hospitals might have fared better over the past three decades if more doctors had been encouraged to seek, and been selected for, chief executive roles.

The research has been carried out by Amanda Goodall, a visiting fellow at Cass Business School in London, who has found a clear correlation between high-performing hospitals and leadership by doctors. Her study is based on US hospitals, but she sees no reason why similar results would not be found in the UK. Surprisingly, she says it is the first analysis of its kind.

Goodall took the top 100 hospitals in each of three specialties – cancer, digestive disorders and cardiac care and surgery – as ranked by the respected US News and World Report league tables for 2009. She then researched the backgrounds of their chief executives. Of the top 100 cancer hospitals, 51 had chief executives who were qualified doctors; of the top 100 units for digestive disorders, 34 had medical chief executives; of the top 100 cardiac centres, it was 37.

The remarkable thing about these figures is that, according to other research, there are some 6,500 hospitals in the US and only 235 are led by doctors. So the high-performing doctor-leaders identified by Goodall come from a very small pool indeed.

Her study, to be published in the US journal Social Science and Medicine, further established that doctor-led hospitals had quality scores some 25% higher than other units. And when she stripped out of her analysis of the three lists of top 100-performing hospitals those that featured two or three times (52 in total) she found that the correlation still held strong for the remaining 160 units that featured only once.

Goodall, whose principal post is that of senior research fellow at the IZA Institute in Bonn, Germany, says: “It seems that age-old conventions about having doctors in charge – currently an idea that is out of favour around the world – may turn out to have been right all along.”

Her next step is to examine the correlation over a longer timescale.

This notion that practitioners make the best leaders is becoming familiar territory for Goodall, whose previous work suggested that many of the best universities are headed by academics. It’s something that Julian Le Grand, professor of social policy at the LSE and a former senior policy adviser to Tony Blair, instinctively goes along with.

“I was always rather impressed with the quality of the doctor-managers I met in the NHS,” Le Grand says. “They have that great thing that they command the respect of their colleagues, which is a fundamental problem where chief executives come in from outside.”

He adds: “I’m reasonably convinced by the evidence of [Goodall’s] research. I think we should be moving as fast as possible to try to encourage doctor-management, as well as academic management of our universities. “

David Brindle is the Public Service Editor of The Guardian

Culled from The Guardian, UK. 16.30 WAT. 20-08-2014. Original article here -> http://www.theguardian.com/society/2011/jul/19/doctors-best-hospital-managers-new-research

NMA Strike: Questions Nigerians Never Asked, by Obinna Aligwekwe

I have been reading my News Feed with very keen interest the last few days.

The truth is, even if GEJ ends up recalling the sacked Resident Doctors, whatever was left of the chord between Doctors and the masses has been finally broken. The mass euphoria that greeted the sack was not surprising, but only goes to confirm the level of ignorance and Double Standards Nigerians live daily.

When Lecturers go on strike, the masses blame Government, when Tanker Drivers go on strike, Government is blamed, when even the Police went on strike during OBJ’s era, the Government was blamed. But somehow, the Doctors are mysteriously at fault when its their turn:

1. Nobody asks about how it is that the Government breaches agreements from year to year, agreements of which salary IS JUST ONE COMPONENT. The same Government that makes the promise breaches the same EFFORTLESSLY and waits for the last day of a strike action notice to re-commence negotiations over the same issue.

2. Nobody asks about how it is that a Doctor’s hazard allowance is 5,000 naira monthly (at the risk of contacting, HIV, Ebola, Hepatitis, Yellow Fever and all other deadly diseases), while a Senator/HOR member takes several times that amount for entertainment allowance.

3. Nobody looks at how facilities within the Hospitals severely undermine the capacity for the Nigerian Doctor (and other health care Professionals) to be efficient, part of the reasons for which they go on strike.
Yet, at the commencement of each strike, the reflex action is to vilify them. People have severally talked about the Hippocratic oath. I say to you, if you cannot read the whole document……,you deserve pity, for you do not know who is actually killing you.

For those who say Essential Services cannot go on strike, please HIDE YOUR IGNORANCE. I will give you instances where Doctors have gone on strike, even in saner societies. The records are verifiable. (please note that while I am talking about Doctors, other emergency services like the Police and Fire-service are also recorded to have gone on strike in Brazil and UK respectively)

1.The United Kingdom where I work has one of the most stringent rules concerning strike action, yet there is no law banning any group from striking. Even Doctors. And you know what? Doctors went on strike in 2012!!.

2.When I worked in the Carribean, Doctors went on strike in 2010!!

3. Even while Isreal was bombarding Gaza, ISREALI DOCTORS WERE ON STRIKE.

Now, where did the UK and Trinidad Government differ from their Nigerian counter-parts?
1. The Governments acted swiftly and decisively. They did not wait for the strikes to linger before a pot-bellied minister comes and lazily addresses a press conference that negotiations have begun.

2. The Governments HONOURED their agreements.

3. NOBODY ever dreamt of sacking them en masse. Of course the issue should not even arise when agreements have not even been honoured.

I am not saying you must understand the technicalities of the medical field to appreciate the stance of Nigerian Doctors, you do not have to. Its all COMMON SENSE, but I have become increasingly aware that even common sense is not that common.

Anyway, this is just for the records. The rubicon has somewhat been crossed. I would not advocate any revenge or vindictiveness on the populace, but I think its high time the relationship be properly defined. Within the context of appropriately caring for the patient, it should be quid pro quo.

The greatest emotion should be empathy, not sympathy. It should be Professional and Impersonal, not Informal and Personal. Where finances are involved, its either you have your money or go to Government to heal you. I went through great lengths for my training which my parents paid for (it was not free). I spent over 6 years in University while most others spent 4, with a few spending 5.

My counter-parts abroad who obtained loans to train are still paying off their loans years after graduation. Even after graduating, I will spend years training myself to become a specialist. If we were to go by your principles that those in these categories are students and should not be paid, then a Doctor would be well over 40 years (or 45 depending on the specialty) before he earns his first salary, but I know common sense is not common.
When I go to you for services, you even jack up your fees because I am a Doctor. I have other bills to pay (They do not disappear you know). I also have mouths to feed. Sometimes, I am the SOLE BREAD-WINNER. I went to study medicine to help humanity, but like everyone else, to be able to make a decent living.

So, my friend, you are free to rejoice that they have been sacked. But be ready to appropriately share the burden of an irresponsible government. The Doctors have borne it for so long. Records show Doctors never striked in the past, other bodies did it for them, then they started when it was obvious other bodies had their problems and Governments were not listening, but then they still kept emergency services open, now they are so hardened some can even walk away from emergency posts during a strike, and you still cannot smell the coffee? SORRY.

[Laz Ude Eze] NMA vs FG: 15 Consequences of Nigerian Doctors’ “Sack”

The purported sack of resident doctors and suspension of residency training means the following, at least for now (You may add to the list):

1. NMA Strike continues
2. No doctor works in teaching hospitals, therefore, no teaching for medical students.
3. Medical Students stay longer in medical schools; parents/guardians will spend more for their training and less money for other expenses.
4. No health care service delivery in govt-owned hospitals.
5. No delivery of specialist clinical services in more than 90% of tertiary hospitals in the country.
6. Doctors and other health workers continue to provide health care services in private hospitals to people who can afford them.
7. Overcrowding and reduced quality of health care in private health facilities.
8. No access to health care services for more than 70% of Nigerians who may not be able to afford them in private hospitals.
9. Suspension of ongoing clinical research in tertiary health facilities.
10. Bad business for pharmacists and pharmaceutical companies.
11. Good business for alternative, traditional or voodoo medicine practitioners.
12. Growing loss of confidence in the health system.
13. More quackery,
14. More complications/morbidity and deaths from treatable/curable health conditions.
15. Worse health indices for Nigeria.

Government and people of Nigeria, THINK!!!

#Ebola: WHO Made Huge Mistake, says an International Development Worker who fled Liberia

As the outbreak of Ebola Virus Disease persists in some West African Countries and the US, Mr Luckmore Jalisi – a development worker in Liberia who was forced to flee the country by the fatal disease narrates his ordeal. He berated the Liberian authorities, WHO and the global community for not responding quick enough until the virus had caused several irreparable damages. Mr Jalisi who is severely traumatized also made suggestions on how to overcome the Ebola challenge. Please read the details in Jalisi’s words;

Mr Luckmore Jalisi

“I need some psycho social help, events of the past few months especially the last 6 days have been traumatizing. Seeing dead bodies hasn’t been easy. I have had, almost 6 sleepless nights. I was even scared of my own bed, scared of my spoon, my folk or my cup or even phone. Every time I hear an ambulance sound, my guess was always correct. I could not hungry anymore. Traveling from one country to another. At the same time I feel like I am a coward, I spent a year working in Liberia made friends, some who have died in this crisis. The fact that I could get evacuated and my local friends and local workmates remain there traumatize me. Of course there are those Liberians who hold American passports, they are leaving in drives. What about the poor women, youth and children I worked with whose only hope is Liberia? That is really traumatizing- I failed- Its gloomy. There is serious under reporting of medical cases.

I wish I was brave enough like Dr. Lena Fiore Kendricks in The movie ‘Tears of the Sun’ who had many options and could be evacuated but said no, she couldn’t leave the people she had made a part of her life. I feel I am a failure, they have no where to go. That’s my greatest guilt conscience, hospitals remain closed, doctors and nurses are running away because they cant take it anymore. No protective gear is given to them while the politicians wine and dine ( Ellen Johnson, The Nobel Peace Prize Winner and her health minister threw a party last weekend) while doctors have no protective gears. Schools are closed, kids remain without education

I know the WHO is giving hope, but hope is little. They made huge mistake from the beginning by not paying attention to this global health crisis when it started, they only got alarmed after two incidents

1. Patrick Sawyer Traveling to Nigeria infecting folks there. The fear according to me is that the so called urgency we see now only came because of the belief that Nigerian brothers and sisters travel a lot, so the moment Ebola reached Nigeria, it could reach Europe or North America. Behold world was alarmed!!!!

2. After the two brave American fellow aid workers and Spanish nun got infected. Also remember that a Congolese nun was infected but couldn’t get airlifted as did her Spanish colleague- She died in Liberia.

Already thousands had been infected and hundreds (at least those reported) had died. They are not worthless they are important too. First responders-doctors and nurses died, they are my heroes, they up their lives.

The bottom solution to this crisis is governance and systems. years of post conflict aid have not gone towards health systems strengthening. The UN has poured billions since the war ended, so are the donors like USAID, UkAid, EU and AusAid and Scandinavian Countries. Where did this money go?”

#Ebola: 10 Action Points for Nigerian Government by @HAPPYNigeria

Ebola Virus Disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe and highly fatal illness in humans. Currently, there is no known cure for the disease. However, early diagnosis and prompt access to supportive care offer the best hope of survival among infected individuals and limits the risk of further spread. More than 700 people have been killed in the ongoing outbreak across West Africa, including an American Citizen, Patrick Sawyer, who recently died in Lagos. It is a regrettable fact that the Nigerian health system currently has limited capacity to handle a disastrous epidemic of such a humongous magnitude as Ebola might bring.
HAPPYNigeria recognises and commends the efforts being made by the government to halt spread of the virus both within the country and across West Africa. We hereby issue in good faith the following ten-point call-to-action to sustain and enhance the preventive measures already being taken by the Nigerian government:

1. Assemble an Ebola task force comprising of scientists (epidemiologists, laboratory scientists, infectious disease physicians, etc), public officials, and civil society leaders to put together and implement an immediate national response plan. This task force should work hand-in-hand with the Nigerian Centre for Disease Control (NCDC) and the Federal Ministry of Health.
2. Continue the national public health campaign to sensitise health workers and the general public on signs and symptoms of the disease and appropriate actions in suspected cases.
3. Issue travel alerts for Nigerians regarding travel to countries with burgeoning outbreaks.
4. Establish a monitoring system for Nigerians living in the worst affected countries and establish an evacuation and quarantine plan.
5. Conduct a rigorous contact tracing and thorough investigation on people that came in contact with the Late Patrick Sawyer. Do the same for the unnamed Nigerian whose corpse was returned from Liberia and placed in a morgue in Nigeria in July 2014, and also ascertain a definitive cause of death in this case.
6. Resolve, without further delay, the ongoing impasse with doctors to ensure a viable health workforce that can combat any eventualities.
7. Address, as an emergency, the deficient infection control policies, infrastructure, and processes in Nigerian health facilities.
8. Heighten border control and disease surveillance at our land borders, most importantly the Lagos-Seme border, and at all international airports in the country.
9. Call an ECOWAS regional health summit to develop an aggressive regional response, including a temporary suspension of the ECOWAS treaty on free movement of persons until the epidemic is stemmed.
10. Strengthen the national disease surveillance and epidemic response system in Nigeria.

Signed:
Dr. Charles Chima, MSc, DrPH
Global Health Advisor, HAPPYNigeria
cchima@happynigeria.org

Dr ‘Femi Akinwumi
Executive Director, HAPPYNigeria
fmakinwumi@happynigeria.org; @fmakinwumi

Dr Chima is a global health expert with multinational experience in disease prevention and management of health programmes.
Dr Akinwumi is a community health physician with extensive experience in health intervention and advocacy.