Tag Archives: Hospital

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

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

doctorsAlmost 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

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My Frustrations with the Nigerian Health System

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Hospital Ward

Hospital Ward


Kindly have a closer look at this photograph for a few seconds. What does it tell you? The photo was first posted on facebook by Mr Appolos Okafor on April 16, 2013. He wrote, “When can we learn to do the right thing at the right time? Can someone believe this is one of the federal teaching hospitals in the southeast undergoing repairs under the watch eyes of patients admitted in one of the wards who were suppose to be evacuated to a safer ward until the repairs are over? Please is this condition safe for patients battling between life and death?”

The subsequent day, Mr Okafor posted the photograph again with another statement, “Repairs are still ongoing in of the Federal Teaching Hospital in the south-east at the detriment of patients admitted and whose high blood pressures needs a quiet environment and not an environment where hammer and other iron materials are struggling on whose voice should be heard aloud.” He also followed it up with this, “A country about to celebrate its one hundred years in existence still admit a patient in an environment like this”.

Mr Okafor is my neighbour in my hometown – Okposi, Ebonyi State of Nigeria. I grew up knowing him and all members of his family. He’s a gentleman and a graduate professional. As I write, he and his family are mourning the death of his younger sister whom he had taken to a tertiary healthcare facility for medical care. The sister has only lived for about three decades. On April 26, 2013, Mr Okafor posted the above photograph yet again and wrote “Federal teaching hospitals in Nigeria are built to provide adequate medical services in well-built environments. Can someone believe that I took my beloved sister Uzomaka to one of the acclaimed best teaching hospitals in the southeast for medical treatment but all I got was uncaring attitude of people who swore to uphold the tenets guiding medical profession, worst still, I lost her under this condition”.

Obviously, Mr. Okafor was and is still very upset, who wouldn’t be? At this time I do not know her late sister’s medical history. Even if I do, I can’t disclose it. I sent a message to him to ascertain the exact hospital that this happened but yet to get a response, understandably. From his facebook posts since they got to the hospital, I could sense emotional stress which got exacerbated by Uzoamaka’s demise. Mr Okafor is not satisfied with the quality of health services the sister got. Whether the alleged poor healthcare services caused the death of his sister may be arguable. However, the fact that Uzoamaka and other patients in the hospital deserve the best possible quality of care in a good environment is unarguable.

Late Engr. Ogonna Okike

Late Engr. Ogonna Okike

The news of Uzoamaka’s death only worsened the emotional trauma and grief I was grappling with. I have been mourning the death Engr. Ogonna Okike, a bosom friend of mine of close to 20 years who died last week. Mr. Okike is also in his 3rd decade of life, marked one year anniversary of his marriage a couple of weeks ago and was preparing to present his daughter for church blessings on April 28th. Ogonna, the only son of his parents died in a fatal auto-crash close to Enugu, leaving behind his 3 month old daughter, young wife, widowed mother and sisters. His death came at a time I was mournfully remembering Engr. Ukpa Nwankwo, my childhood friend who died at the age of 28 years from severe head injury sustained after a road traffic accident two years ago. Ukpa would have been alive if there was a functional emergency management system in my state. He was my classmate in primary school and we were called twins while we were growing up.

Late Ngozi Nwozor-Agbo (L)

Late Ngozi Nwozor-Agbo (L)

Last year, I lost one of the most intelligent ladies I’ve ever known. Mrs Ngozi Nwozor-Agbo initiated the Campus Life page on The Nation newspaper and I was one of the pioneer campus writers. As the editor, she helped to make me a better writer and we formed an intimate relationship. She died in a process that should have brought joy and smiles on everyone’s face – childbirth. Like Ogonna’s wife, Ngozi’s beloved husband became a widower one year after his marriage. Ogonna and Ngozi provided immense emotional support to me while I was mourning Ukpa’s death. Some months before Ukpa left us, Ogonna and I had mourned the death of our friend and former high school classmate, Chidiebere Osuu. Chidiebere was an accountant and was one of those who died while participating in physical drills during a recruitment process of one of the federal parastatals. His family is yet to get over his death. Chidi’s death came about 6 months after a friend and professional colleague, Dr Gaby Ifewulu died from a fatal accident. Gaby was the best graduating doctor in 2008 at the University of Nigeria, Nsukka. He achieved this feat few months after I lost my cousin Chukwuma. Chukwuma died at the age of 25 in a fatal vehicular accident close to Benin.

Did I get you bored or confused with this narrative? Were you able to keep count of the number of people I’ve lost? Did you observe all of them were in their 20s or 30s? You can imagine my state of mind recounting this number of losses within a 5 year period. Is it not enough to get one confused, frustrated or even depressed? You may now understand why the narrative (possibly) got confusing at some point, please bear with me. It hurts me more because as a physician, I do know that some of them would have been saved had a well-equipped emergency ambulance arrive the scene of the accidents in good time. I’m very upset because no woman in this age and time is supposed to die from childbirth. I am mad at the situation because our country has both the human and material resources to make our health system strong enough to prevent these kinds of deaths. We don’t have a policy framework to regulate health services in Nigeria and both the National Assembly and the Presidency have refused to make the National Health Bill become law for more than 10 years.

I won’t be able to write everything in my mind because it’s enough to write a book and I have decided to write one in the near future. If you are upset with the deplorable situation like me, we need to act. We need to put more pressure particularly on the local and state governments most of whom are not serious about health system strengthening. I must acknowledge that good progress has been made in some areas of our health sector in the recent past but there is still a lot to do. We have lost too many productive young people already; our economy is in danger and the future of our country bleak if this trend is allowed to continue. The ball is in our court!

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