Dr Muhammad Dogo-Muhammad, a former Executive Secretary of the National Health Insurance Authority and the Chief Medical Director of Baze University Hospital (BUH), Abuja, in this interview with SADE OGUNTOLA, speaks about his interventions in boosting health services in the hospital and other issues.
What role do you see telemedicine playing in the future of hospital care, especially in resource-constrained environments?
Telemedicine plays a significant role in hospital care by enhancing patient access to services without travelling, especially for specialists who may not be available locally. Also, patients can schedule virtual visits at times convenient for them, reducing the time spent waiting for appointments and minimising disruptions to daily life. Telemedicine improves health outcomes and increases efficiency by reducing patient and hospital costs, lowering transportation expenses, and minimising the need for physical infrastructure. Similarly, it enhances monitoring through remote patient monitoring tools integrated with telemedicine, allowing for continuous tracking of patients’ vital signs and health metrics, which can alert healthcare providers to potential issues before they escalate. Telemedicine can facilitate educational sessions and resources, empowering patients to take an active role in their healthcare decisions and management.
If you could provide one key piece of advice to policymakers in the healthcare sector, what would it be?
For me, one key piece of advice to policymakers in the healthcare sector is to focus on the mandate of the ministry/department/agency (MDA) with a view to achieving the set goals and objectives of the organisation. Of course, we must pursue everything with utmost commitment, sincerity, and purpose.
What strategies have you implemented or observed that significantly improve operational efficiency within hospital settings?
Operational efficiency at the BUH leans a lot on the principle of “demand-driven expansion” of our services. By adhering to this principle, we have maintained a very slim workforce with much savings in our running costs. Services like catering and cleaning services were outsourced. Interestingly, BUH has been self-financing itself for over one and a half years now. Thus, there has been an efficient utilisation of limited resources ab initio, and now that the influx of patients is picking up, we are able to improve the generation of revenue. Within the short period of our services, we have seen efficient utilisation of limited resources and improved productivity as we grow.
What continuous quality improvement initiatives have you prioritised at BUH, and what outcomes have you seen from those initiatives?
Continuous Quality Improvement (CQI) in a hospital setting is a deliberate and well-defined process that is driven by the idea that there’s always room for improvement. Thus, it is a systematic process of identifying strengths and problems with the processes, collecting data, analysing the data, testing potential improvements and deployment of those improvements that work. It is teamwork that members are selected from all levels of the hospital that have different roles and perspectives in patient care or other processes under consideration. The CQI team should be of a manageable size of five to eight members, but this may vary. However, there should be at least a member who takes on a clinical role, technical expertise, day-to-day leadership, and project management capacity. Inputs from the end-user, the patient, are also very important.
CQI initiatives are varied, which include clinical, financial and operational such as decreasing medication administration errors, reducing medication-related adverse events, increasing patient and/or staff safety, and optimising sepsis care, urethral catheter infection, bedsores and patient fall rates. Others include shortening the average patient hospital stay, reducing post-operative infection, reducing hospital readmission, lowering use of opioids after surgery, improving electronic medical record documentation and increasing patient and/or staff satisfaction.
In our hospital, we are working on the time it takes a patient to get attended to fully in the outpatient (patient throughput), how long it takes to get the results of investigations from the laboratories and radiology departments, the preoperative care of patients, the functionality of the Electronic Medical Records (EMR) and how the various sections of the hospital operations interact with it.
It’s instructive to remember that there are tools/models that are used to drive CQI in the hospital. Therefore, before implementation, consideration for the most effective model that is in harmony with the corporate culture of the hospital was factored. I was opportune to study Six Sigma in one of the modules that I attended in the USA during my MBA in International Health and Hospital Management course in 2005. There are other models like Lead, Care, Lead Six Sigma and Plan-Do-Study-Act (PDSA). I find PDSA more practical and very cyclical, especially when dealing with an identified problem. So, it’s reactive, while Six Sigma is proactive.
So far, there is a general improvement in the throughput of patients; results of investigations are being uploaded on the EMR faster, and various segments of the hospital processes that have dashboards on the EMR are running smoothly with fewer complaints. Lastly, the perioperative care of the patient is very good.
As we all know, CQI has no “titrating point”, so we shall endeavour to push the goalposts, as there is always room for improvement (the status quo will always be pushed to newer levels).
What role does BUH play in community health initiatives, and how do you measure the impact of these programmes?
With the recent interest in the burden of non-communicable diseases (NCDs) as a significant public health challenge worldwide, BUH has chosen to partake in lending a hand by helping to increase awareness about the conditions locally and nationally. NCDs, which include conditions such as stroke, diabetes, chronic respiratory diseases, and cancer, account for a substantial percentage of global morbidity and mortality. The World Health Organisation has reported that approximately 71% of all deaths each year are attributable to NCDs, with low- and middle-income countries, including Nigeria, often bearing a higher burden due to limited resources for prevention and treatment. The economic impact of NCD includes rising healthcare costs and loss of productivity due to chronic ill-health. The burden of non-communicable diseases is vast, impacting individuals, families, and societies. Addressing this challenge requires a coordinated global effort focused on prevention, education, healthcare access, and policy change to reduce risk factors and improve health outcomes. Therefore, BUH has lent itself to organising annual free cancer screening and health education about NCDs in its community. The community response to these programmes has been overwhelming.
How important is public education in preventing health issues, and what initiatives does BUH have in place to educate the community?
Health education prevents health issues, fosters informed decision-making, promotes healthy lifestyles, and improves individual and public health outcomes. Therefore, BUH prioritises the health education of its patients. Caregivers are encouraged to spend quality time with patients to educate them on their illnesses, the available treatment options, and preventive measures against future occurrences. There are plans afoot to use the traditional and new media to propagate more health awareness messages to achieve preventive health further.
What procedures are in place for crisis management and emergency preparedness, particularly during epidemics or natural disasters?
BUH has a clear protocol for responding to medical emergencies by forming a standing rapid response team. Also, we regularly train our staff in emergency procedures, including CPR and the use of emergency equipment. Indeed, the design of Baze University Hospital had emergency preparedness in mind; hence, its corridors are wide and fitted with gas points such that the corridors can quickly transform into emergency wards to accommodate mass casualties like what happened during the recent COVID-19 pandemic. Also, the hospital has a standing committee on occupational safety and health that is responsible for continuous risk management by identifying, treating, and mitigating any potential hazard that poses risks to the hospital and its stakeholders.
How do you ensure that hospital staff are adequately trained to respond to emergencies or disasters?
Baze University Hospital conducts regular weekly clinical meetings for its staff to update their knowledge about current practices in the different healthcare fields, including hands-on training on cardiopulmonary resuscitation (CPR). Also, the hospital’s workers are encouraged to attend the certifying courses, sometimes with the hospital’s sponsorship, for recertification in the Cardiac Life Support and Advanced Cardiac Life support programme to ensure they are current and ready to respond to medical emergencies.
What were the primary goals in establishing BUH, and how have those goals evolved over time?
BUH improvements are targeted at processes using root cause analysis to identify inefficiencies and areas needing enhancement. We adopt and implement standard operating procedures (SOPs) based on evidence-based practices in all our units and departments. Also, as a patient-centred organisation, BUH engages patients in planning their care and incorporates patient feedback into the quality improvement process to understand patients’ needs and experiences.
How does the hospital collect and respond to patient feedback, and what mechanisms are in place to ensure continuous improvement?
Baze University Hospital places a high premium on patients’ feedback, as it is the only way to measure our performance. Therefore, there are many channels for feedback, including social media. Also, there are accessible lines of communication through our telephones and website, which we audit regularly to ensure we don’t miss valuable information from our valued clients. Management relays such feedback to the appropriate units and departments as the basis for continuous process improvement.
What are some of the flagship specialised services offered at BUH, and how do they compare to other hospitals in the region?
Baze University Hospital is a multi-speciality hospital with competencies in medicine, surgery, obstetrics, gynaecology, and paediatrics, with highly experienced and well-accomplished personnel. Also, the diagnostic capacity of the hospital is second to none, with competencies in histopathology and nuclear medicine, haematology and blood transfusion, and chemical pathology. Similarly, the hospital has one of the most modern radio-diagnostic units equipped with the latest MRI, CT scan, digital X-ray, echocardiogram units, and ultrasound machines.
What role does the latest technology play in patient care at BUH, and can you provide examples of cutting-edge innovations currently in use?
Technologies play a crucial role in patient care across various dimensions, enhancing the quality, efficiency, and accessibility of healthcare services. At BUH, we have leveraged the different dimensions of technology to improve our service quality and infused efficiency into our system for optimal patient satisfaction. Some of these technologies include electronic health records (EHRs), which streamline patient information management, allowing ready access to and sharing of patient data quickly and securely, which improves coordination of care and reduces the likelihood of errors. Also, for data analysis, the hospital deploys artificial intelligence (AI) and machine learning to analyse vast amounts of patient data to identify trends, predict outcomes, and assist in diagnoses to personalise treatment plans based on individual patient data. At BUH, we have a patient kiosk at the hospital’s reception that allows patients to access their health information, schedule appointments, and communicate with their healthcare providers, fostering greater engagement and satisfaction.
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