Please let all Nepalis know how an honest and able Nepali professional faces extreme resistance from dishonest and corrupt (un)professionals. More from Dr. Koirala,
Hello everyone:
After 108 days of taking charge of TU Teaching Hospital, I have decided to resign from the position of Executive Director. I wanted to remain silent and step aside, but I find that thousands of people have taken it seriously and want to know the reason behind my decision.
First of all, the Dean of Institute of Medicine and I were appointed at the time of crisis in the IOM and teaching Hospital. Similarly, I was also asked to help rescue Teaching Hospital by the Dean and TU Authorities. I ha d agreed hesitantly because the hospital had a total negative balance of about 66 crores and many suppliers and parties were not paid. The hospital staff had not received their salaries on time for several months.
Moreover, the taxes were not paid although they were deducted from staff, nor were the “Sanchaya Kosh, Nagarik Lagani Kosh”. So, we were meant to take certain stern steps to rescue the Teaching Hospital from the brink of collapse. Let me share my feelings about my term at Teaching Hospital. There were many important Positive changes within Teaching Hospital, some of them being the following:
1. We actively stopped deliberate referrals of patient from our Emergency (and the Outpatient clinics) when the beds were available in the hospital. That helped strengthen the ethical practice and increase revenues.
2. We took legal action against those involved in financial irregularities and those violating discipline.
3. We enforced electronic attendance and observation of timing in all the work areas(the stage was already set by previous administration).
4. The revenue generated by the hostpital went up significantly and it became possible to pay salaries on time.
5. We , with the help of Deans office, cleared many of the previous dues including the taxes, “nagarik lagani kosh” etc, making our staff “legal”
6. We scrapped the “lunch break” in all the service areas with public contact.
7. We scrapped the system of paying overtime for an “undertime” work- paying extra for regular, even work less than regular hours- which saved us about 7 million rupees a year.
8. Expenditure in the operating rooms and in the wards went down by almost 20% despite the increase in workload, by tighter regulation and recording of surgical materials.
9. We facilitated the expansion of the services (The credit of construction of new buildings goes to the previous Directors): we shifted surgical and Skin OPD to a new block with much better facilities; we opened up a new ward for Department of Medicine; an additional operating room was opened; and additional trauma operating room is set to be launched; ENT services are being shifted to a previously constructed but underutilized Block (although most of the preparation was done by prior directors); Radiology and Endoscopy services were given more spaces to help provide more convenient services to people; Anew blood sample collection desk was opened, and additional cash collection counter is added to help reduce the crowd.
10. Pharmacy service is streamlined with 24 hour coverage. It already is generating revenue, and with addition of more drugs and disposables the revenue is guaranteed to go up.
11. We fixed almost all of the procedural problems in procurement. And nobody could point out a single episode of bribery except one small case of 300 rupees, in which case the person involved was recommended to be fired.
12. Lower level staff worked very hard to keep the hospital clean, keep the traffic in order, hospital security became much more empowered to make the hospital complex look like a hospital.
13. Individuals and private firms donated a significant quantity of medical and surgical equipment amounting to more than one crore in 100 days (the Ministry of Health needs a special mention for a crucial support by providing equipment when there was zero money to buy anything.)
I truly appreciate the hard work my administration staff did to get all this done. I appreciate the support of some senior professors, zeal of young faculty and technical staff that encouraged me to work harder. We would achieve nothing without the strong support from the Dean of IOM Dr. Prakash Sayami.
Now let me mention the obstacles I faced during this period.
• Not every Department Head complied with the system. The University Teacher’s Association and Unions kept showing resentments with tighter regulations. At times they spread unfounded rumors to defame the Dean and other authorities and kept exerting undue pressure. It became extremely painful when some of the “leaders” and “clean” professors started justifying patient referrals out of the Hospital.
• There were certain burning issues with financial liabilities of the past, which I could not comfortably sign cheques. I has requested for a special audit until my term commenced, which could not be done.
• The authority to make decision on financial and administrative matters had always been seized by the central office of TU, against the general Government rules and regulation. Dozens (or more) files of daily procurement have been lying for weeks in the central office to be approved. The intention for this to be so is unclear to me (clear in some cases), noting that the University gets closed for one or another reason for more than several months a year). By the way, our precondition to take charge of the Hospital (and deans office by the dean) was that more financial and administrative authorities would be given to IOM.
• The TU has not given the funds for the salaries of permanent staff as per the rules, citing that Government has not released money either. I can tell that it is impossible to generate money from the general public for salaries, recurring expenditure and equipment needed.
• The hospital has started making little more money, but just enough to pay for salaries and some recurring expenses. How can we generate extra money to pay for the huge debts/liabilities carried over from the past? This, I had put forth to the appropriate authorities and Government before taking up the job. They had promised to help but this help has not materialized. I feel it is unjust not to pay the parties off for their supplies and ask to keep supplying stuff to the hospital.
• Last but not the least, I have been doing two full time taxing jobs: run a busy cardiac surgical program and a full time administrative job. This also became a final tipping factor in my decision making process. I will continue to run the Department of Cardiothoracic and Vascular Surgery at the Manmohan Cardiothoracic Vascular and Transplant Center in the same Teaching Hospital Premises.
Finally, I would like to summarize by saying that this short period has been effective in many ways and disappointing in some ways. We have done what I think could be done by individual efforts; To take it to the further height, the system should also be conducive. We have proven that this institute can function well if honesty, wisdom and patience is exercised by all the concerned. Let me urge everyone to rise above party politics and help get a new leader to carry on with the agenda of clean deal.
I thank every on inside and outside the country who showed deep concern about our institute; I promise you all that I will still be in the public sector and be part of yours.
Bhagawan Koirala
No comments:
Post a Comment