Boosting medical directors’ leadership, managerial skills

Several studies and experts have blamed the poor health indices in the country and performance of general and teaching hospitals on lack of leadership and managerial skills of Medical Directors (MDs) and Chief Medical Directors (CMDs).

However, stakeholders are unanimous that boosting the leadership and managerial skills of medical directors will improve healthcare services in hospitals across the country and sector performance.

A study published in British Journal of Gen Practice and titled “Leadership and management for all doctors” sums it up: “Doctor’s frequent role as head of the healthcare team and commander of considerable clinical resource requires that greater attention is paid to management and leadership skills regardless of specialism. An acknowledgement of the leadership role of medicine is increasingly evident.”

Indeed, despite substantial investment in health, the healthcare care industry in Nigeria is characterized by poor service delivery and poor health outcomes. As part of the Lagos state governments drive to improve the quality of care in the state, the Lagos State Ministry of Health (LSMoH) in partnership with the Healthcare Leadership Academy (HLA) and the Health Strategy and Delivery Foundation (HSDF) have formed a collaborative aimed at strengthening the capacity of Medical Directors of General Hospitals in Lagos State in institutionalizing clinical governance and improving the quality of services rendered by the facilities that they lead.

To achieve this, HLA, in partnership with HSDF and LSMoH, last week, held a two-day Leadership and Management Training Programme for all 26 Medical Directors of General Hospitals of the State focused on the development of their personal leadership and communication styles.

Also, 12 of LSMoH’s newly appointed MDs have been admitted to the HLA’s Healthcare Executive Leadership Programme (HELP) which is designed to equip them with the fundamental skills required to provide quality health services, maintain financially sustainable organizations and positively impact their local community.

Lagos State Commissioner for Health, Dr. Jide Idris, told journalists, at the opening of the two-day event, that the programme is expected to benefit Lagosians ultimately through improved service delivery and practices and increased high quality patient centred care. The training was facilitated by recognised Human Resources (HR) and leadership experts including Habiba Balaogun, Adeboye Martins and Nneka Mobison.

Idris said the main reason for the training is because there are certain things the government is trying to do in terms of reform agenda and it is essential in the context of the health insurance scheme in Lagos state with the objective to ensure quality care.

He noted they cannot effectively deliver in the hospital setting without the appropriate leadership and that is why medical directors of general hospitals of secondary care facilities should undergo the training, because they cannot effectively run the hospital up to managerial aspect to build capacity in line with what the State has to do in the health sector.

Idris said that the bottom line is how to provide quality care to the people because patients need to be satisfied with quality of service and the hospital system is quite complex, so people should understand as they find a way to address the complexity to see that patients receive the best of care.

Executive Lead, HLA, Dr. Hala Daggash, said the work they do are trying to support the work of the medical directors across the state towards the achievement of strategic objectives and to achieve the relative potentials to the fullest with the ultimate aim of improving service delivery within the facilities.

Daggash explained that this is just small part of the broader parcel of the HLA as well as the sister organisation, HSDF. HLA is a platform that provides context-specific leadership, management and quality improvement training to healthcare professionals. The HLA currently has three bespoke programmes, and has successfully trained over 150 multi-disciplinary healthcare professionals, empowering them on their journey to becoming change agents who catalyze transformation in the African healthcare space.

Chief Executive Officer (CEO) of HSDF and Founder, HLA, Dr. Kelechi Ohiri, said HSDF is a non-profit indigenous firm established in December 2013. The organization was established to improve the quality of decision-making and execution in the health sector through the use of evidence. HSDF is active in the Federal Capital Territory (FCT) and 14 states across all six geopolitical zones. He said HSDF works in four key areas namely performance management (improvement of data quality and reporting of health programmes and on the national health data platform), service delivery and innovation (focused on private sector engagement and quality improvement), health systems strengthening (works with government to strengthen primary health care systems on the supply, demand and governance domains) and public health advisory (focused on working with government in improving malaria, Prevention of Mother To Child Transmission of HIV/PMTCT, EID, nutrition programmes and interventions).

Ohiri said HSDF has engaged with Lagos State government on various platforms such as its private sector engagement programme which aims at bringing together private sector facilities by building alliances and networks as well as providing peer support and learning. Also in Lagos State, it has engaged actively with the government through its quality improvement initiative and currently supports 40 facilities within the state in a large-scale improvement effort to address the burden of maternal and newborn health in Nigeria and also improve patient satisfaction.

Daggash added: “We are established to transform healthcare delivery not just in Lagos state but Nigeria and Africa at large. We are charged with transforming healthcare delivery by developing a generation of leaders and change ambience in service delivery and governance of services. Our role in this effort is to support the government in our capacity as part of broader support being offered to the state by our organisation.”

The HLA boss, said the objectives of this organisation is to motivate the leaders and to spur them to think about some actions they would like to undertake within the facilities’ that would be geared in improving service delivery and improving safety, quality of care and patient’s safety within the facility. The Commissioner added: “The first step was to restructure the system because to us it was haphazard but based on collective effort. The ministry should do what it is supposed to do in terms of planning, policy reforms and programme development and let the service providers provide the service and play their specific roles.”

Idris continued: “The government is investing hugely in the sector in terms of infrastructure and staff but if you look at the health sector as the production system, you have input, money, infrastructures, staff we also have output, but what we are having now is not commensurate with what we expect it to be and we need to improve on that.

“We want to do it in form of health insurance scheme, to improve access, the issue of quality care, treatments, protocols, safe guidelines and to build capacity of leaders in the sector, access in the issue of universal healthcare coverage. Everybody in the system should be able to have access to health delivery because some do not have access either because they do not have hospitals around or shortage of staff and issue of money.”

He revealed that under the scheme, both private and public care providers will be used to form synergy and join resources together for people to get better care. Every Lagosian has to contribute something and if you are paying you have the right to request for quality care.

“The primary healthcare has a crucial role to play, it is the basic care. If you enroll you are entitled to some specific benefits and make sure those packages come with benefit packages. The services providers are in three categories; either you are primary care provider, secondary care provider or tertiary care provider. The primary care providers are for the all the primary care services and facilities involved. We need to raise the quality of care and whatever they cannot treat at that level would be referred to either the secondary or tertiary. We are accessing the quality of facilities, so where there are gaps we need to fill them. The private facilities are set to meet criteria because they can equally provide primary care services. We are not limiting primary health care just to public facilities,” he highlighted.

Idris said the government is meeting with the informal sector; we are having the stakeholder’s analysis to analyse and advocate to them with the feedback, they are interested and waiting for us. If you are in Lagos it is compulsory and you must enroll.

The commissioner continued: “The overall context is leadership, the overall thing is clinical braveness and what clinical braveness is addressing is the issue of quality care and patient’s satisfaction. You must have good leadership to ensure that, because they are inter-related. Governance, leadership set direction in any firm.”

Daggash added: “In the past two years since our inception, we have trained approximately 150 multidisciplinary healthcare professionals, ranging from clinicians, to executives, administrators, and policymakers, across all the six geopolitical zones of Nigeria. In this time frame, our participants have implemented over 60 capstone projects which they have used to identify, articulate and effect changes that needed to occur within their organisations and the larger healthcare space. Participants reported that their projects along with the faculty feedback, gave them the opportunity to put to work all they had learnt in class and has helped them continue to evolve. Various elements influence participants choice in capstone projects and their projects vary in scope.

“This particular programme is getting them to think around about the immediate and long term goals of what they are meant to achieve and to help them develop strategies, then translate them to actual practice. The main goal of this training is for the populace to benefit from the improved practices of delivering care, better patient’s centred care, giving the patients the priority that they deserve.”

She added: “Healthcare Strategy Development Foundation supports Lagos state in various ways, in different work streams that actually supports the state, like the one that help to improve performance management and that is done through making better data driven decisions. It is the decision making that based on actual data. We also offering training that improve collaboration on performing networks that can aid in shared learning and peer networking,”

Daggash continued: “We also run a programme that has the capacity of reducing maternal and neonatal mortality. We support at these levels some sort of training and building capacity. Our role is to build capacity of leaders and front line workers to tackle the health problems of the country.”

Meanwhile, the Royal College of General Practitioners (GPs) along with the other medical colleges, are developing strategies and aiming to increase awareness through educational support and signposting of events, both nationally and at faculty level. The First5® GPs (an initiative to support new GPs from completion of training to the first point of revalidation at five years) hold regular leadership study days, and many deaneries have comprehensive packages enabling all their trainees to access leadership throughout their training.

The Academy of Medical Royal Colleges has recently developed a joint faculty (Faculty of Medical Leadership and Management) for all medical students, trainees, and doctors of any speciality to continue to support the development of knowledge and skills.

The quality of patient care and healthcare delivery overall in Nigeria remains far from optimal, and this is often aggravated and evident in government health care institutions. The economic and social cost of disease also remains high, undermining productivity and development. The lack of a national policy and a clear strategy on healthcare quality as well as the absence of a regulatory body tasked with the monitoring and implementing of the quality standard in facilities have contributed significantly to the poor quality of care and poor health outcomes in Nigeria.

In a bid to tackle some of these multi-faceted issues that have contributed to dismal country level statistics on health outcomes, the Lagos state Government has embarked on a drive to improve the quality of care and service delivery in the state. Under the leadership of the current commissioner Dr. Jide Idris, Lagos State’s Health system has been significantly upgraded, through a comprehensive Health Sector Reform agenda covering systems reorganization, human resource development, infrastructural development, revitalization of the primary care system, healthcare financing, health promotion and disease prevention activities. There have also been administrative steps to improve leadership and management through the reshuffling, recruiting and empowerment of leadership at senior and front line levels with the General Hospitals.

The HELP programme ended with the MDs utilising the tools and methods from the training to develop immediate and longer terms goals and plans for their facilities.