Book captures many problems, successes of LUTH

THE former Chief Medical Director (CMD) of the Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun, has captured his life at the helm of affairs in a book titled ‘My Life, My Medicine: The Story of a Chief Medical Director.’

The 295-page book with 14 chapters was published by Com-Heal Nigeria Limited in partnership with The Centre for Epidemiology and Health Management Lagos and printed by University of Lagos Press and Bookshop Limited.

Osibogun in the preface to the book captured the many problems encountered and successes achieved as the CMD of the unarguably biggest and most patronised hospital in Nigeria. He noted: “Every manager knows that planning is very crucial to success in any organization and that a failure to plan is a sure plan to fail. So I had no doubt in my mind that a plan was required to guide me as I took over the leadership of the hospital.

“The very first step in planning was to identify the problems of the organization and where possible quantify them in terms of magnitude. The identified problems would then need to be prioritized using various criteria including economic and social importance, number of persons affected, and availability of possible solutions and ease of solution among others.

“My rapid assessment of the hospital showed that the hospital had a brand reputation as one of the first set of Teaching Hospitals in Nigeria. As at 2006, the hospital had contributed to the training of several doctors and health workers who had become prominent professionals and this was in itself a major advantage.

“One major disadvantage, however, was that the hospital infrastructure had aged and was poorly maintained the hospital had some 40 paediatric incubators with not a single one working; the cooling system in the hospital’s modular theatre had collapsed. None of the six theatre suites in the complex could be safely used for surgery without sweat drops from the surgeon’s forehead dropping into the operating field. The hospital’s main theatres had relocated into the Accident and Emergency theatres. A total number of surgeries performed throughout 2005 was 900. Under the circumstances, the postgraduate colleges withdrew training accreditation for several programmes. Services were compromised and in that context training was impossible and research difficult.

“Many of the problems identified were not entirely due to the fault of previous hospital managers but can be attributed to persistent public policy somersaults and inconsistencies. For example, a directive would come from Abuja that all Accident and Emergency patients must be seen and treated without any insistence on any payment. However, government never made any budgetary provisions to cover the cost of such treatments. Secondly, as would happen anywhere in the world, patients who either were unable or unwilling to pay for treatment would rather present in the Emergency Room where they know that by government policy, they must not be turned back. As I tell my postgraduate students, whenever you match equity against quality, quality will suffer!

“The letter appointing me as the Chief Medical Director of the Lagos University Teaching was very specific in fixing a time frame for me to turn round the hospital so that it began to fulfill its triple mandate of service, training and research. I was directed to turn round the hospital within two years. The task seemed daunting and I must confess some of my colleagues did not believe I would be able to make a difference since in their opinion. I was not a Surgeon!

“While some other hospitals had their views on the VAMED Project, I can say that we were able to take charge and operationalise over 80 per cent to 90 per cent of our equipment in a timely manner. We were able to put the Linear Accelerator into use even before commissioning and we had been using ours for six years before a sister institution which also got a linear accelerator could start using its own. Obviously, there is more required than the provision of an equipment or facility, hospital managers must keep their eyes on the ball to keep projects operational.

“Hospital Managers must, therefore, keep their eyes open for opportunities. The VAMED Project was one great opportunity and I therefore followed it conscientiously to ensure that as much as possible we put the equipment and facilities to use and therefore began to solve some of the service delivery problems of the hospital.

“In trying to reposition the Lagos University Teaching Hospital, I adopted what I will refer to as a Systems Approach. Mckinsey’s criteria for success included the 7-Ss, which are Systems, Staffing, Structures, Skills, Style, Strategy and Shared Values. In my approach at the Lagos University Teaching Hospital, I adapted Mckinsey’s 7-S Framework to suit our environment and the work at hand based on my analysis of the situation of the Hospital.

“We sent a team comprising of Surgeons, Anaesthetists and Nurses to Manssoura Hospital, Egypt for training in Renal Transplantation; a team was sent to Bosnia-Herzegovina for further training in Renal Dialysis; another team went to Frontier Lifeline Cardiac Centre in Chennai for training in Cardiology and Open Heart Surgery; a team was sent to the Academic Hospital in Hanover, Germany for training in Intensive Care while a team was sent to the Italian Mediterranean Institute in Milano for training in Bone Marrow Transplantation. Individual specialists were also sent for training in Laparoscopic Surgery and Endoscopy in India and the United States of America.
Several Resident doctors were also supported for training in various specialties in different parts of the world. Of course, the areas that enjoyed support were carefully selected in line with the vision of the Hospital and you should never try to please everybody!

“As we developed the human capital, it was recognized that we needed to also urgently work on the infrastructure and equipment. Of what use would it be to have highly trained personnel with no tools to work with? In fact we lost our trained perfusionist to poaching while we were still trying to develop infrastructure and equipment for Open Heart Surgery. We were lucky he was the only impatient member of the team as we were able to perform 3 cases of Open Heart Surgeries within 6 months of his abandoning ship.

“We were able to partner with a Nigerian Biomedical Engineer at the Imperial College, University of London (Dr. Hippolite Amadi- he later became a Professor at same institution) who had designed incubator modules with which he resuscitated old or dead incubators at a cost less than 20 percent of a brand new one. Using this frugal approach we were able to re-commission the number of incubators, which we put back into service over a period of time. That way we were also able to have saved far more babies than we would have been able to if we had decided to buy new incubators from the little available resources.

“Professor Amadi also made sure that we jointly published in scientific journals, our incubator activities and the effects on neonatal survival.

It is hoped that the little experiences I am sharing in this book will be useful particularly to Hospital Managers and others interested in the progress of institutions.”