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Khyber PK Government takes bold and courageous step to hand over all powers to the Medical Institutions.

Byline: Shaukat Ali Jawaid

Keeping up its promise of introducing revolutionary reforms in health sector, Government of Khyber PK has taken a bold a courageous step and handed over all powers to Medical Institutions under the Medical Teaching Institutions Act 2015 for the sake of good governance and they are not interfering in hospital affairs. Now every institution is run by autonomous Board of Governors. To be a member of the BOG he or she should not be a government servant, not a political figure, they must be professionals from different fields and they are selected by a committee formed by the Government. Credit for all this goes to Prof. Nosherwan K.Burki an eminent pulmonary physician from United States who is behind all these initiatives. Prof. Burki is a strict disciplinarian, who does not believe in compromises and he now heads the Board of Governors of Lady Reading Hospital, Peshawar.

The search committee constituted by the provincial government for selection of Vice Chancellors of Universities has eminent personalities like Prof. Atta Ur Rehman former Chairman of HEC, Prof. Sohail Naqvi Vice Chancellor Lahore University of Management Sciences (LUMS), Director Institute of Business Administration from Karachi, Vice Chancellor of Riphah University Islamabad and no one is from Peshawar. During my recent visit to Peshawar I had an opportunity to talk to a number of senior doctors as well as other healthcare professionals. It was heartening to note that there was tremendous emphasis on human resource which has been offered lucrative pay packages so much so that many experienced healthcare professionals from private medical institutions have joined the public sector medical institutions and healthcare facilities which is something unprecedented and unheard of.

Medical officers also prefer to serve in small town, rural areas rather than big institutions as they get more pay there. Of course there is some resistance from certain quarters as well to these reforms but with the passage of time, everyone will realize importance of these initiatives which is a mixture of what is practiced in UK and United States. Provincial Governments of Punjab and Sindh, if interested, can also benefit from this experiment.

Prof. Nosherwan K. Burki has the detailed CVs of all the faculty members with him and he monitors their performance even while sitting in United States. He visits Paksitan from time to time but holds meetings on Skype regularly. Other members of the Board of Governors of PGMI/LRH are Prof. Abdul Bari from Indus Hospital Karachi, Justice Ajmal Mian, Chief of Khyber Bank, Prof. Mian Tahir consultant surgeon from Saudi Arabia and Maj. Gen. Amjad Faheem who has served as Commanding Officer of a Combined Military Hospital.

In an exclusive interview with Pulse International, Prof. Arshad Javaid Dean, Lady Reading Hospital Peshawar explained in detail some of the salient features of these reforms which have of course received some resistance from some senior faculty members but gradually this resistance will go away as it offers numerous benefits to everyone. Prof. Arshad Javaid, it may be mentioned here had earlier served as Dean of PGMI from 20032010, Chief Executive LRH from 2011-2013. Under the new set-up he was appointed as Dean of PGMI during July 2016.

Prof.Arshad Javaid pointed out that the whole administrative structure has been totally changed. In the old set up Chief Executive and Medical Superintendent used to run the institution. But now there are five key persons which include, Dean, Medical Director, Hospital Director, Nursing Director and Finance Director. They are all independent and autonomous and no one works under any one. They are appointed on three yeas contract which is renewable. Their performance is monitored and if not found satisfactory they can be even replaced before three years. They are all independent and answerable to the Board of Governors.

Dean: He is responsible for the faculty, their development, training of undergraduates and postgraduates. In case of medical or dental college he or she is also principal of the college. As per rules the Dean will be a medical academic with either a PhD degree or a medical qualification such as MBBS or equivalent, plus a higher diploma such as FCPS, FRCP, FRCS, or a US Board certification or equivalent. The Dean will be of National and, preferably, International reputation in his/her field, which may be in the basic or clinical sciences, with at least 7 years administrative experience as head of a department, unit, program, or institution, with recognized leadership qualities, a track record in teaching, and a commitment to medical education and research. Selection committee for the Dean consists of one or two senior professors, One Associate, one Assistant Professor, Student's representative, Nursing Representative, representative of Administrative staff and two outsiders.

Medical Director Hospital Director are also there. Board of Governors is not members of the Selection Committee. Most of the staff working at PGMI/LRH had been recruited and interviewed by me and when I had to appear for interview in front of some of them was a unique experience Prof Arshad Javaid stated. While you are sitting on the other side of the table, it gives a different feelings. I remember when the nursing representative asked me some questions; I said that the nursing profession has not received due recognition and respect in Pakistan despite the fact that they are important members of the healthcare team. Their importance must be recognized, they must get due respect and when I said this, I could see tears in her eyes.

Medical Director: He or she is responsible for patient care, all the medical offices, house officers, equipment, and wards inside ward patient care. He should have atleast three years experience as Chairman, Prof. Head of the Dept.

Hospital Director: He looks after other services in the hospital, paramedics, sanitary staff and security staff. He is also the drawing and dispersing officer dealing with finance. He is not necessary to be a doctor but must have administrative experience.

The Medical Director in consultation with the Dean and the Hospital Director, and in agreement with the Clinical Executive Board (CEB), may from time to time close existing departments, establish additional departments, and/or establish and vary the jurisdiction of existing departments. The Hospital Director, the Medical Director, and the (CEB) after considering the recommendation of the Chair of the relevant department, may subdivide a department into sections. Nursing Director: For the first time nursing profession has also been given recognition they deserve and the Nursing Director is also autonomous. She looks after the nursing staff and reports directly to the Board of Governors. At the Nursing hostel they are trained in skills Lab.

Finance Director: He looks after the financial aspects. All these people have their proper job description and there is no overlap.

Administrative structure of the medical intuitions, hospitals, Prof. Ashad Javaid stated has also been radically changed. In the past low level staff like Deputy Medical Superintendent used to was run it.

Now there are Managers for each section. There is a Manager for OPD, Bed Managers, and Manager for Casualty. Ward Clerk is responsible for beds.

Pharmacy Services: Pharmacy service in the hospital has been revamped completely. It is headed by an experienced pharmacist who is offered an attractive salary package. The objective is to provide everything free to the patients.

Pharmacy and Therapeutics Committee: It is an advisory group composed chiefly of physicians and pharmacists and representatives from various departments of the hospital. The committee serves as the organizational line of communication between the Medical Staff and the Pharmacy Department.

Physiotherapy Department. It has been renamed as a proper Rehabilitation Department. It has been equipped with lot of new equipment.

Previously human resources were lacking. Now lot of new appointments has been made. We have inducted five hundred nurses and another one thousand nurses are being inducted shortly. So LRH will have fifteen hundred more nurses.

LRH Faculty. In the past just to create one post one had to request the finance department and it used to take too long. Now the Academic Council has been fully empowered and they can sanction new posts. One hundred forty nine (149) new Faculty position have been created. We have already appointed fifty Assistant Professors and others are being interviewed. They are selected by the Faculty, Dean and Chairs of the Departments.

Chairperson or Head of the Department: Chairperson of the Department post is advertised. Anybody can apply for that from the hospital or outside the hospital.

Selection committee interviews them and selections are made on merit and not on the basis of seniority. Chairman of the Dept. can be a Professor, Associate Professor or even Assistant Professor. It is not based on seniority who is going to become the chairperson or Head of the Department. Initially there was lot of resistance to this but since Prof. Nosherwan K. Burki is a strict administrator, he did not compromise on it and got it implemented.

Academic Council: It consists of the Heads of all the Medical School departments plus two faculty members elected by the faculty - one each from the basic and clinical science faculties, Dean, Associate Dean Undergraduates, Associate Dean Postgraduates and Associate Dean for Research. Two members of the Academic council are elected by the faculty.

Promotion Policy: Under the new system everybody gets promoted after eight years. Promotion is initiated by the Dept. promotion committee, goes to Institution Promotion Committee and then to Dean who notifies it and informs the Board of Governors. There is a blend of locally trained, foreign trained and this combination works well. In fact it is working much better and they learn from each other as well. We interview them on Skype as well since some people apply from overseas. We advertise these posts overseas. Recently we had two posts of Rheumatology for which four applied and all of them were so good that we selected all of them and got the posts sanctioned by the Academic Council. Foreign trained physicians are much more conversant with professionalism, ethics, communication skills etc.

Accelerated Promotion: Minimum period for promotion is fixed by PMDC. Then we have accelerated promotion for those who are extra ordinary talented. They have to fulfill some criteria which is as under:

1. Eight scientific papers published in a standard peer reviewed medical journal as first author.

2. Documented evidence of excellence in clinical care.

3. Documented evidence of excellent teacher.

4. He or she must be a supervisor of CPSP.

Again promotion is not linked to seniority but based on merit. Previously if there was no post, people were not promoted unless a post became vacant or was created. Now there is no problem there can be two to three professors in a department. In the past Professors used to have their personal kingdoms in Wards which has now all gone. Selection criteria are transparent. That is how the faculty is selected. Last year only 78 faculty members were promoted. This year 149 more faculty members are being selected of which 70 have been selected while others are being interviewed.

Attractive Pay Package: The Government has offered a very attractive salary package for the faculty members. When I retired in Grade 21 my pay was Rs. 1,70,000/- but now the pay scale for various faculty positions is as under:

1. Assistant professor

Rs.2,50,000/- per month

2. Associate Professor

Rs. 3,00,000/- per month

3. Professor.

Rs. 3,50,000/- per month.

But they cannot do practice outside but be part of institutional practice. For the old faculty members there is no compulsion, they are given option. They can do institution based practice or continue doing private practice but for all new selections, it is mandatory as they know it is the rule.

Research: It is for the first time that a teaching hospital has got Rs.10 Million for Research. We have also got Rs.12 Million Academic Grant. It is used for all academic activities, including travel grants which we can offer.

Leave Policy: Fifteen days education leave is there. If someone is invited to chair a session or present a paper oversea he or she gets another fifteen days leave. It is in addition to twenty two days earned leave.

Accidents and Emergency has been made Dept.of Emergency Medicine. We have appointed twelve Physicians in Emergency and they are being trained for their capacity buildings.

With the help of International Committee of Red Cross (ICRC) we are busy in capacity building of all others like ambulance drivers, staff who transfer the patients. For nurses Skills labs has been set up in the Nursing School. There are training courses for them. We have a monthly academic calendar which consists of workshops, courses, symposia, Web Cast Updates, Journal Club etc.

Institution Management Committee: It is headed by the Dean. Other members include Associate Deans for Undergraduate, Postgraduate education, Research. Then we have the Academic Council in the organizational structure helped by Department Chairpersons and the Faculty. Hospital Director can sanction upto Rs. Twenty five lac. If more funds are required he goes to the IMC which is headed by the Dean, with few chairpersons as members and they take the decision. ACR has been replaced with Yearly appraisal system which has been introduced.

Clinical Priviliges Committee: The Clinical Priviliges Committee (CPC) reviews the application for credentialing that the applicant has training, competence, licensure or registration to perform in the proposed area. CPC decides what one can do and what he or she cannot. Their work is monitored and after two years once he or she is competent enough, they are allowed to do other procedures. That is how patient safety is ensured. Only physicians who are members of the medical staff and who have admitting priviliges approved by the CPC and assigned by the Department Head can admit patients to the hospital.

Institution working Timing is 8.00 to 4.30 five days a week. Everyone has to display his identity card and mark attendance which is a must. Total hours they are supposed to work-in a week are fixed. If anyone has worked for less hours, this is deducted from their leave and if their working hours is still less, it is deducted from their salary. Weekly we have three Clinicopathological Conferences (CPCs). One medical, one surgical and allied and one common. It is attended by all faculty and TMOs form 8-9 am. Their attendance is shared with them. Library is renovated. It has IT facilities, digital library and Computers on each table with internet connection.

New Medical Building

A new Medical Block six story building is fast nearing completion. It will have 14 Operation Theaters, High Dependency Unit and ICU. Auditorium will have seating capacity for three hundred fifty people. It will also have a parking facility foe one hundred Cars. It is expected to be ready in a year's time. It will also have 350 beds and a cafeteria. Equipment worth two billion rupees has been sanctioned and the total cost of the project is over four billion rupees. Once it is commissioned, Lady Reading Hospital bed strength will be more than two thousand beds which will make it one of the largest public hospitals in the country, Prof. Arshad Javaid remarked. All this will improve Postgraduate training as well as patient care as we are going to have more faculty staff. The associate Deans have planed structured training programmes and there is continuous monitoring of the staff.

We had planned a twenty bed Intensive Care Unit in the new Medical building but since Prof. N.K. Burki wanted it to be of international standard with required space, it has been made a nine bed ICU.

Senior registrar post has been abolished. All SRs have been promoted as Assistant Professors. We have introduced post Fellowship Specialist Registrars known as SPR. They are inducted for three years. There is structured training in every specialty for SPRs who are not allowed any private practice. They are paid Rs. 1,20,000/-(one lac twenty thousand) attractive salary. During their training they will be given credit for experience equal to Senior Registrar and Assistant Professor for future selection purposes. As such their experience as SPR is counted for entry for the post of Assistant Professor. We have also created Trainee Registrars posts for those who have completed their FCPS training but not done FCPS. They are appointed on contract till they pass their Exam. They get Rs. 83,000/- per month. Medical Officers are being weeded out. They are just there not interested to improve their qualifications.

The whole academic ladder for the faculty position is like this:

* House Officer,

* Trainee Medical Officers,

* Trainee Registrar,

* Specialist Registrar (SPR),

* Assistant professor,

* Associate Professor

* Professor

Clinical Audit: Government has hired services of an international firm and asked them to do clinical audit of all the three big teaching hospitals.

We have also introduced Media management. The Government has also started Sehat Sahult Card which is provided to the deserving families. It entitles them to seek medical care at public and private medical institutions worth Rs. 30,000 rupees to three lacs. Drug budget has been increased ten times to ensure availability of all drugs are freely available in the hospitals, Prof. Arshad Javaid concluded.
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Publication:Pulse International
Article Type:Report
Geographic Code:9PAKI
Date:Apr 15, 2017
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