Patients’ comfort, staff welfare, my utmost priorities at UCH —Professor Otegbayo

Now that you are the Chief Medical Director of University College Hospital, Ibadan, what particular challenges have you identified within the hospital and how ready are you to tackle them?

The tripartite function of the UCH includes clinical services, (those are the services we render to our clients, mainly patients); the second is training and the third is research. The problems that I have identified with clinical services include the inconvenience that our patients experience when they come to us. I want to remedy that by ensuring that our patients have a good experience when come here so that they can recommend us and come back again. One of the hardest problems is that we have multiple points of payment for services, sometimes far away from the location of the service itself. I believe patients should be able to come even alone without relations and get access to our services. We will like to render what is called patient-centered administration which is where we look at all the activities that revolve around them.

The current administration has created a department called total quality management and one of their mandates is to audit our services, to look at our clients’ satisfaction and make recommendations to the management so that management can look into it and implement. I want to make use of that department effectively so that we can give the best to our patients. I may not be able to identify everything for now but by the time we ask them to do the audit of our services particularly to our patients, who are external stakeholders, we will like to look at their recommendations and act.

We want to reduce the physicality of what our patients go through while trying to get our services. Sometimes our clinics are overcrowded and some patients have no spaces to sit down while waiting for the doctor because we are choked. We are going to expand the space. I was discussing with the Director of Works and the Minister of Health when he was giving me my certificate. Some of the ways I think he can help us is to expand the space. UCH is expanding in terms of clients’ subscription but our physical structures in some service areas still remain the same. We need to do a vertical extension of the clinic areas by at least one floor so that we can create adequate space for our patients and also for our doctors, nurses and those who work in the clinic areas.

We also want to make payment easy for them by increasing the number of service points and introduce the use of POS and other means of electronic finance management. We also want to make sure that the hospital runs a full IT. ICT is a major thing that relieves stress in many organisations and we want to tap into it. Already we have discussed with some IT experts concerning how they can partner with us and give us the blueprint which we will faithfully implement.

The hospital is supposed to be a training hub for the whole of the nation if not West Africa because we are the flagship of Nigerian teaching hospitals and we want to remain so and surpass what we have been doing. This hospital is a tertiary hospital but it is my dream to make it a quaternary which is the fourth level of clinical practices. We are supposed to be tertiary even though I know we are not fulfilling the requirements for a tertiary hospital. My dream is to surpass it so that all the activities that can be accessed or sourced outside the country can be sourced in UCH.

In terms of training, we want to  train healthy human capacity for the nation just like the University of Ibadan has done a few years back. They changed their admission process to preponderantly postgraduates in the ratio of 60 to 40; 60 percent postgraduate and 40 percent undergraduate which means that they will train many PhD and Master’s students, thereby providing the manpower for other universities. The same is the dream I have for the University College Hospital so that we can train health manpower and send them across the world and not just Nigeria because our products are all over the world.

The third arm of our tripartite function is research. By the time you put good clinical services and training in place, research easily follows because you have facilities and equipment, you have the personnel, the wherewithal and the ambiance to carry out research. So those are the things I intend to put in place.

 

Speaking about having better and improved patients’ experiences in the UCH, there is also the case of non-availability of drugs. How will you address that?

We are aware that a lot of private pharmacies are springing up outside the hospital and many of our patients go there. I have tried to raise questions with the pharmacists along the line as to what is causing the non-utilisation of our pharmacy departments. One of the things patients talk about is waiting time. They have to queue and wait for so long before they have access to the services they want.

Then the pharmacists on their own talked about the suppliers not being paid on time and because of that the drugs that we buy in UCH come at higher prices than what the private pharmacies get it. The way I intend to solve this one is we will ensure that there are trucks. We will ensure that we pay our suppliers on time and in addition to that I intend to establish a drug compounding unit so that some of the drugs we buy from the pharmaceutical companies can be compounded in our own hospital.

Even in the 70s to the early 80s, the pharmacy units used to compound some drugs like cough syrup for children and pain killers like paracetamol. You didn’t even need to buy from outside but all those things are history now. We want to bring the lost glory along that line which is something I need to discuss with the board of administration. I intend to bring in private partners so that we have a pharmacy within UCH under strict control because we have to be sure that they are selling the appropriate drugs and I will identify the place within the hospital. We don’t need to have another building. It is just to restructure. I invited the Director of Works and told him that he should start working on that idea so that we will structure the building that looks like a warehouse and make it a pharmacy. That way, our patients will not have to go outside the hospital to get the drugs.

And being a private initiative, that is profit-driven, they will be able to put in place all the drugs that we may not have. So it will be complementary.

 

Investigations indicate a need for harmonisation of services not just for staff but especially the challenges posed by bureaucracy and factionalisation within various interest groups within UCH. How would you harmonise these various factions, departments and staff hierarchies?

There is a popular dictum that he that must come to equity must come with clean hands. When your staff know that you are fair and just and that you have their interests at heart and you take care of their welfare, you are likely to have a peaceful and harmonious relationship with them even between the various departments. There has been a lot of distrust between the leadership of some professional groups and it wasn’t like that before, so we had to cast our mind back. At what point did we miss it? What changed and how do we bring that back? When I was the director of clinical services in this hospital from 2010 to 2014, I didn’t support my own professional group even when they were wrong and I was very fair to various interest groups. I believe that is one of the reasons why people feel I should be the one to lead them.

Though I must have made some enemies but I believe that I made more friends than enemies. One has to look for things that will reunite other than divide. I have to put their interest at the centre of my heart and make sure that I take care of them. By the time you take care of staff’s welfare, their interests, listen to them and you run an inclusive administration where they know that they are stakeholders, there will be peace and harmony. The average member of staff wants to show or believe that he is part of this and sincerely speaking, I believe that the hospital is not about the chief medical director,  it is not about me. It is about the collective legacy which is project UCH and nobody is small, whether a cleaner or the top professor. So everybody’s interest has to be factored into administration. And I believe when we do that there is going to be harmony.

 

Concerning the incessant strikes that has been a major problem in the history of Nigeria, how would your administration address strikes?

The issue of incessant strikes or industrial actions is something that has become a sine qua non in recent times of government enterprise and it is a bad signal. Personally I don’t support strike in any form. In fact in 1995, 1996 when I was the president of the association of resident doctors, we never went on any local strike. The only strike that we went on was national which I didn’t have control over. I want to be a peace maker and a conflict resolver. We are going to use alternative conflict resolution and also trouble-shoot.

It is not when there is crisis that you start to cut the people that work with you. For instance, I have it in mind that from time to time I pay visits to these various professional groups, go to their secretariats, eat with them, dine with them and bring myself close to them. That way I will open my doors for them to vent their angers, to open up and tell us what their concerns are and if such concerns are attended to easily and readily you are unlikely to have any serious confrontation with them. The only ones that I may not have control over are the national strikes declared by their national body that is not based in UCH maybe because of agitation with the government. That is an external strike and not local. But I can assure you that as for that of local it is going to be one of my priorities and in fact I also tend to create a department of special duties and industrial harmony will be one of the functions of that department so that from time to time we put heads together and prevent crisis rather than solve crisis when it has occurred. Even for the one that is national, UCH is usually a hotbed for such things and that is understandable. UCH is the primus inter pares among hospitals therefore even if there will be industrial action at the national level, UCH must as a matter of compulsion be part of it. I can always call them, talk to them and take whatever measures I can either by talking to the board or even talking to the minister about their issues.

 

There is a department of radiotherapy in UCH but we find that Ghana has been one of the countries most travelled to by Nigerians for treatment of related cases. How do you hope to improve on what is already available to make sure that medical tourism doesn’t go abroad?

One of the problems has been that the equipment like linear accelerator have not been available in UCH for quite a while and people go to where it is available but in the course of writing my vision for the hospital I discovered that the government just bought two for the National Hospital in Abuja but I also learnt that it was MTN who helped them to acquire the linear accelerators.

When I was with the minister of health it was one of the things I discussed with him because I wrote it in my vision statement that we will get it. I was pleasantly surprised when he said one is already being installed. As I speak with you it has not yet been commissioned but they have dug the bunker where they will put it and work is going on. When I take over office I will pay a visit to the place and see the level of activity. We will do whatever we can to hasten the completion. There is a Kobus60 machine which the current administration bought but there is a limit to what it can do. My idea is to create internal health tourism so that all the things that people are going for in India and Ghana (which is a shame as far as I am concerned) will be available here.

If we are the giant of Africa, we have to set the pace. It aches my heart when I hear that some things are being done even in Nigeria. For instance, the University of Benin Teaching Hospital carried out stem cell transplantation for sickle cell patients. To me, UBTH is not even among the first generation hospitals and we have the human capacity. I believe that the commitment of the chief executive and the board of management has to be tuned to us to remain the flagship of teaching hospitals in Nigeria and dictate the pace while others follow. Granted, the government may not have enough fund but I believe we have the goodwill, we have the brand name as UCH to raise funds from high net worth individuals and corporate organisations and to me I believe that is one major function of the chief executive; to look for fund locally, regionally and internationally and that I intend to do, God helping me.

 

From research it was discovered that in Nigeria, we have almost one doctor to 22,000 people. How do we encourage medicine as a profession and how do we get more doctors recruited into the system?

The sad news I have for you is that many of our doctors are leaving. In the early 80s when there was brain drain people that were leaving were the old doctors who were going to the Middle East, to Saudi Arabia, Qatar and all that but now we have the young ones going and when you are losing your young ones, you are mortgaging your future. So it gives me a kind of sad mood when I look at it and see that the future of medicine in Nigeria is doomed. We will not feel the effect now. It is when this older generation, including myself, leaves the stage and we don’t have people to replace us.

Virtually, every week I sign some doctors who want to go for training abroad and they don’t come back. I don’t blame them. Initially, I used to tell the young ones not to go. There is so much in this country and there is great potential. But from the look of things, when a doctor cannot pay the school fees of his children in a private institution, there are less options for him. Some of them are rickety whereas they have the potential to do the same work they are doing here elsewhere and live normal life. When they see their colleagues who have relocated coming back home and they see what they are doing, they become intimidated. They look like riff raffs even though those coming from abroad are not doing as much as they are doing here.

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There are some retention strategies that the government can look into. Although this is not the job of the chief medical director but of course the chief medical director is engaged in some external activities and he has a voice, so to say, that the government can hear through the minister or through the board of management.

Two things are responsible for  health workers leaving. One is their remuneration. Second is ambiance of practice or what is called job satisfaction and how do they get job satisfaction when you overwork them? Some people work round the clock and they break down and when they break down they commit errors. You now set up a panel  to punish them. That is unfair. We have to look into the job welfare and provide the facilities to work.

One of our orthopedic surgeons came to me yesterday. He was just lamenting. He said he went to Germany and within a week he was able to do 200 cases but here he hasn’t done up to 50 in six months. These are highly specialised surgeries that he learnt. And one of the reasons why I pity surgeons is because there is a kind of atrophy of their skills when they don’t use it because unlike we physicians that speak grammar their own is manual dexterity and when you don’t do a procedure for quite a while you lose your skills. So why would somebody like that want to sit down here when he knows he can be in Germany, earn more, live a better life and have everything at his beck and call.

How do you create the ambience for job satisfaction? You make the equipment they need available and make things comfortable for them. I just saw one of our doctors eating bean pudding. On asking why he was there instead of being in the theater he said even his patient has been incubated but when the surgery started there was nothing to snack on in the theater. That surgery will last five hours. Part of the time he spent there was lost man hour which will be a loss to the patient and to the hospital.

I have spoken to some of the senior surgeons that I intend to set up a theatre management committee and I spoke to a dynamic young man who will be in charge of that committee. They will look into all these things and make recommendations to the management when I take over and I believe the hospital will implement many recommendations. We have also worked abroad before and we know when you are doing your procedures there is a fridge for milk, for coffee, for apple, for cake provided by the management and that keeps you on your job.

Of course government will need to increase budgetary allocation to our hospitals because our health indices are very poor in this country and one of the reasons is just that the allocation of funds is poor. But I believe the chief executive should not just be waiting on government subventions alone. For instance, in last year’s budget, government allocated 3.9 percent of the GDP to health. Meanwhile, African Union met in 2015 in Abuja and allocated a minimum of 15 percent. We are not even close to average. That is a failure mark. So I believe the government will need to be encouraged. Those who have the voice at the high places should help us.

 

What should the staff of UCH expect from your administration?

They should expect a management that has ears and that listens to their cries. The attention of the management would be drawn to their complaints. I don’t even want praises. I don’t want anybody to praise me for anything because I’m just doing my bit. Somebody else will come in a matter of years and do his own bit but I will listen to them. I want to run an open door policy. I want to run an inclusive administration where every stakeholder can have their say. Of course that does not mean that everything they say would be carried out by the management because you have to be responsible for the decision you take. We look at it and look at what people are complaining about, what they are suggesting and add that to our own naturally endowed initiatives and come out with what is the best.

We are going to form a number of committees. Already I have a kitchen cabinet and I told them to draw up terms of reference for three committees to start with.