Public hospitals need corporate culture for growth

Medics last week raised an outcry when Mr Richard Leserian Lesiyampe was appointed as the new chief executive officer of Kenyatta National Hospital. The trend that began a month ago with the minister’s rejection of the Moi Teaching and Referral Hospital board’s reappointment of Prof Mengich as CEO was continued.

Judging by their comments on the social networking sites, the decision attracted a lopsided condemnation. The few neutrals and supporters were overwhelmingly buried by the dissenting voices.

The objectors’ views boil down to the belief that a person not versed in medical matters is unfit to lead a hospital. This stems from the traditional view that hospitals and the health sector are not included in mainstream business operating environment. Therefore, they don’t want to be judged on the same management standards as these other enterprises.

Many want their performance to be pegged on different targets for example, instead of how much revenue is collected or how it was used, they want to be asked how many patients were served. This is why the presence of the “managers” was not welcome.

So is it such a bad thing to appoint a non medic as a CEO?

Is the person in a hospital a patient or a client? Is the facility offering “a service” or ‘a packaged product”? The answers to these questions determine the whole hospital’s management structure. Hospitals that see clients instead of patients agree to be judged on the same targets as other enterprises. This is the difference between public facilities and private ones. Because of this, some of our facilities are not running optimally.

Prof Nyongo’s decisions I guess are partly informed from his travels to foreign hospitals. Worldwide, the idea of hospitals being perennial money swallowers and social enterprises is losing its acceptance in society. Governments now want businesslike management and running of all its facilities; hospitals included.

Outsourcing hospital management is the way to go. The shift is to gradually have business administrators running these facilities. The concept initially started as a response to public outcry over the sorry management of some facilities. The success of these “managers” has made them popular. State run facilities are hiring consultants to streamline facilities with a poor history of services delivery. Indeed some states are outsourcing the entire management of their hospitals.

The objections will be even higher when the government moves to the next phase and hires managers for district hospitals. A complete overhaul of the hospital management architecture is inevitable just like the banks. As we warm to Public-Private Partnerships and outsourcing, my bet is that in the future even the old hospital management committees will be disbanded.

If a facility collects only Sh10 million against a target of Sh80 million and has a huge wage bill; what prevents the government from agreeing to a proposal by a health management organisation (HMO) to pay the facility Sh50 million, streamline its operations and keep the rest? This is the novel pitch a HMO with experience in hospital management should make. All the government has to do is supply the medicines and pay the facility’s core staff. I won’t be surprised to see the government take an about turn and buy in on this concept. Especially as counties gain more autonomy.

Outsourcing saves taxpayer’s money and improves performance since these contracts are hinged on delivery of benchmarked results. Weak excuses sometimes given by the state machinery as to why things aren’t how they should be, won’t be tolerated.For starters let’s give Prof Nyongo’s appointees a chance to prove themselves.

Omete is a medical doctor.