Korle Bu—wicked CEOs or challenged systems?
Madam Sylvia Ani-Akwetey, Rev. Prof. Seth Aryeetey, Mr Edward Annan, Reverend Botchway, all have one thing in common –members of senior management or the governing Board of Korle Bu Teaching Hospital that have been chased out through one public staff agitation or the other.
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Since the late 90s, it would appear that the premier hospital has done a fairly decent job of this and as someone recently observed, the place is always on fire. The latest to come under threat of this fire is its 18-month-old Chief Executive—Dr Gilbert Buckle, accused by the Senior Staff Association of mismanaging the facility (alleged payment of judgment debts) and also scrapping some allowances of staff.
As a medical student, I was fortunate to serve on a Committee of the Medical School with Prof. Frimpong-Boateng, then Head of the Cardiothoracic Unit and Prof. Mercy Newman, the head of the Microbiology Unit of the Korle Bu Teaching hospital. Two things struck me in a conversation one day; the Cardiothoracic Unit had autonomy and Prof. Frimpong-Boateng shared strategies he had used to secure and access ample funds generated by the unit. On the other hand, the Microbiology Unit had no access to its funds and appeared bogged down by bureaucracy in its attempts to undertake some improvement projects.
Patients concerns
And so here we are today. Somewhere in between the chronic agitation for removal of its top executives and the financial systems in place lies the patient. Ostensibly, all this is about the patient, right? And about our abiding concern for providing care that is safe of the highest quality and delivered in a respectful environment. Even so, the patients it would seem, have their questions. Questions about whether the hospital actually knows and is actively tracking its performance in areas such as patient satisfaction, laboratory turnaround times, post-surgical wound infections rates, prescribing patterns, the frequency of stock out of essential medicines and commodities in its emergency units, the number of patients turned away on account of the no bed syndrome, the maximisation of theatre space against the sheer numbers of specialists, medication errors etc. Do we actually know the numbers? Are we working to improve on them?
But with all the agitation in the media, we are not too sure. And since the recent agitation is about money for the payment of judgement debt and money for improving staff welfare etc., it is right after all that we follow the money trail. Mismanagement at which levels, one may ask? Certain pertinent questions need asking. I believe that answering these questions will begin to get us to the root causes of the systemic malaise that perpetually threatens to cripple Korle Bu. That said, the person that ask these questions or sets in place systems and processes to dig out answers to them ought not to become the enemy, for we really need to fully understand what is going on beyond all the agitations. In the process, we will hopefully discover loop holes, plug them, save money and hopefully, improve staff welfare.
Let’s follow the money
Are there indeed Budget Management Centres (BMCs) in Korle Bu Teaching hospital that have printed undisclosed quantities of unauthorised receipt books alongside the official receipts without the knowledge and/or approval of Central Management and the Controller and Accountant General? Which departments are these? How much revenue has been collected from patients using these unauthorised receipts? Were these revenues traceable to available accounting records of these BMCs? Are there individuals working within Korle Bu with their own receipts which they issue for services rendered within the aegis of the hospital?
Other questions remain –what is the full extent of the discrepancy between potential revenue from actual number of patients seen and those admitted to the wards and/or corpses admitted to the morgue and the actual revenue collected? Are there sub BMCs with documented revenue collections that cannot be supported by patient bills, thus preventing reconciliation between bills issued and revenue collected? What accounts for this? Who benefits? Are there indeed patients who have been billed but whose payments cannot be traced to the banking system?
Any breakthroughs at Korle bu?
Again, these are but harmless questions not imputing fraud yet. My humble submission is that the thorough and systematic search for answers in a thorough manner will clarify many things. We can also begin to explore more deeply how all these affects patient care –does Korle Bu have bold aims on quality of care, patient outcomes and affordable cost that drives senior management and staff and professionals every day? How are various ideas for improvement being harvested from various professionals and fed into new systems of continuous improvement? What are the breakthrough medical and surgical interventions that Korle Bu as a premier hospital is pioneering in this country?
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Ghanaians have a witty saying – “we will all end up in Korle Bu one day” or better still, “Korle Bu is always the last stop”. At that last stop, your profession or status may not matter much. In that moment of truth when you have a cardiac arrest and you are lying on the floor of the emergency room and there is stock out of essential medication, it will soon become clear why a total systemic overhaul is a burning imperative. Till then, we can sack as many chief executives as we want, including Buckle who has led a systems transformation effort in the National Catholic Health Service. For as long as the deep-rooted systemic questions remain unanswered, the current set up will continue to perfectly deliver the outcomes it is designed for, including possibly serving as a goldmine for some individuals while some honest and dedicated professionals suffer.
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