Maintaining the order within the Nigerian Hospital

Let me start with some terms used and what they mean when you say it anywhere in the world apart from my country Nigeria.

Chief Medical Officer (CMO) is the title used in many countries for the senior government official designated head of medical services, usually at the national level. The post is held by a physician who serves to advise and lead a team of medical experts on matters of public health importance.The post of Chief Medical Officer dates back to Victorian times. The equivalent title may go under different names across countries, for example known as the Surgeon General in the United States and the Chief Public Health Officer in Canada.

Consultant (medicine): In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior hospital-based physician or surgeon who has completed all of his or her specialist training and been placed on the specialist register in their chosen speciality. Their role is entirely distinct to that of general practitioners, or GPs. Consultants accept ultimate responsibility for the care of all the patients referred to them, so the job carries significant personal responsibility. A physician must be on the Specialist Register before he or she may be employed as a substantive consultant in the National Health Service (NHS). This usually entails holding a Certificate of Completion of Training (CCT) in any of the recognized specialties, but academics with substantial publications and international reputation may be exempted from this requirement, in the expectation that they will practice at a tertiary level. "Locum consultant" appointments of limited duration may be given to those with clinical experience, with or without higher qualifications.

Nurse Consultant! Yes the term does exist and Nurse Consultant is a nurse who usually identifies problems and develops solutions. The business is usually operated from a home office and reports are sent to the customer. Some work may be required at the customer’s facility. When you work and where you work are usually at the discretion of the nurse. The consultant must be a registered nurse. Certification in the field is optional.

In the US, a consultant pharmacist focuses on reviewing and managing the medication regimens of patients, particularly those in institutional settings such as nursing homes. Consultant pharmacists ensure their patients’ medications are appropriate, effective, as safe as possible and used correctly; and identify, resolve, and prevent medication-related problems that may interfere with the goals of therapy. In the UK's NHS, the term consultant pharmacist refers to a pharmacist who has advanced roles in patient care, research and education in a specific medical specialty or expert area of practice.

Hospital CEOs generally come from a medical background and almost always hold a Masters of Hospital or Healthcare Administration. Prior to becoming CEOs, they must have about 8-10 years of experience in administrative, management and healthcare positions. The hospital CEO is the highest ranking official in the hospital organization, and he or she also has the toughest job.

Hospital CEOs are responsible for overseeing day to day operations, serving as moral leaders who articulate the hospital’s mission and vision to the public community, and being the leaders in developing strategic vision and policies for the hospital. The CEO usually works alongside a team consisting of the CNO (Chief Nursing Officer), CMO (Chief Medical Officer), COO (Chief Operating Officer) and the CFO (Chief Financial Officer)- this is the hospital’s executive management team.

In studying this list of “20 New Hospital CEOs to Know”, it seems that most of the CEOs have a couple things in common:
They served as COOs of hospitals before. COO, the Chief Operating Officer, delegates’ day to day operations and reports to the CEO, who is usually too busy to review production quotas and operations daily.
They held a Masters in Healthcare Administration, Business Administration or Nursing from an accredited university.
They held previous positions in strategic management, business and executive leadership. (Meaning medical expertise aren’t all CEOs need to have!)
They had about 15 or more years of experience in healthcare before they became the CEOs of major hospitals. (Patience is a must.)

Some notable examples of head of top hospitals around the world are; Delos M. Cosgrove, MD CEO and President Cleveland clinic, Ohio who received his medical degree from the University of Virginia School of Medicine in Charlottesville and completed his clinical training at Massachusetts General Hospital, Boston Children’s Hospital, and Brook General Hospital in London. His undergraduate work was at Williams College in Williamstown, Massachusetts.  Robert E. Rich Jr. is the Director and Chairman of the Board of same hospital. Robert E. Rich, Jr. is Chairman of Rich Products Corporation, the largest family-owned frozen foods manufacturer in the United States, based in Buffalo, New York. With a net worth of $3 billion he is listed at number 592 on the Forbes 2014 list of global billionaires.  He has been a member of the board of trustees of the Cleveland Clinic since 2002.

Prof. Dr. Guido Adler is the Chief Medical Director and Chairman of the Board Heidelberg University Hospital Germany. Guido Adler studied medicine and received his doctorate in 1977. His appointment as a specialist in internal medicine followed in 1986 by appointment to a professorship at the University of Marburg and then the branch name for Gastroenterology.

Dr. John Cowell is the Official Administrator of Alberta Health Services in Canada. In place of the AHS Board, the Official Administrator will have responsibility for the governance of AHS, working in partnership with Alberta Health to ensure all Albertans have access to high quality health services across the province. The Administrator is accountable to the Minister of Health. Dr. Cowell trained as a doctor at Toronto Western Hospital. He studied at the University of Toronto where he received a Bachelor of Science with honours in Biology and Medicine, a Master of Science in Physiology, and an M.D. in Medicine. He is certified by the College and Family Physicians of Canada and the Canadian Board of Occupational Medicine; has a fellowship in occupational medicine with the Royal College of Physicians and Surgeons of Canada; and is licensed with the Alberta College of Physicians and Surgeons.

Dr Chong Su Lin,Chief Executive Officer  Prince Court Medical Center, Kuala Lumpur, Malaysia Dr. Chong Su-Lin, MBBS London, MBA London has been the Chief Executive Officer of Prince Court Medical Centre Sdn. Bhd since May 2012. Dr. Chong is also the National Key Economic Areas (NKEA) adviser to the Minister of Health, has 16 years of working experience in the corporate healthcare sector.

In the hospital setting where patient care is at the centre of everything, a doctor is the head of the team as he is the only one that has full custody of that human being that has just walked in for treatment. It is important to note that as the head of a team he is to ensure that every member of that team is carried along and on same page at all times which is part of the cause of this problem we face in Nigeria public hospitals. Everyone should know his/ her role and perform them to the best of their abilities.

When trying to change nomenclature of what obtains and what we have studied all our lives, we create chaos in the system. I will give you an example with a situation where you have a matron in a ward who is not a certified consultant nurse giving an express directive on how she wants to run the ward based on her wealth of experience but in her team she has a certified nurse consultant who believes she is well read and more qualified than this matron who is in that capacity by virtue of his or her work experience. There will be lapses in the ward and the patient being at the receiving end will suffer.

In medical school we are already aware of what the hierarchy in the field is and what everyone’s role should be. These other health care givers consultant certification has not been established in the Faculty of Health sciences curriculum in Nigeria and their roles are not well defined to ensure what the chain of command will be. Let us try to think about this decision before collapsing the health sector. Being in the system for a while, I know that the relationship between health workers in the hospital has not been too good and most times the doctor is seen as the cause of this break down. That is partly right because as the leader of a team, you should ensure everyone in the team is satisfied with decisions taken at all times. This system we are trying to bring into the hospital setting will only bring confusion, negligence and more bad blood. Instead, let us spend more of our energy in defining the roles of everyone in the hospital so as to make it more effective. There is no reason why a nurse cannot write prescription of some common drug refills. A nurse or medic should be the one to setup an I.V line take blood samples and monitor vitals with other minor procedures depending on level and field of training. We should have nurse assistants, medics and medical assistants to reduce the work load and make things more effective in the hospital. From my experience in the hospital setting in the U.S and in Nigeria I have seen that the work load on the physician in Nigeria is way too much and other professionals should be trained to do most of these common procedures.

Talking about the nationwide strike in Nigeria, we learn the hard way in the country and a strike was the Nigerian Medical Association (NMA) giving the government an easy way out. Left to me I would prove my point by making the government see how disorganized that system can be. I will not advocate a strike action but something more drastic that will fix the whole problem after making it chaotic. 

First I will go to court to first challenge this position and explain what this position means. Then I will make public a directive that all case files should have name of the physician in charge cancelled and replaced with the consultants in other fields to protect Doctors in case of eventual patient outcomes. Then I will publish around the hospitals the role of the physician and what is expected from every other health worker with treat of litigation and sanctions to any doctor who goes outside his roles to perform other duties. With that line of action it will become obvious that a lot of duties have been placed on the Doctor and they will either start training health workers to fill the vacuum or we re-negotiate terms of hospital management.

It is not my call so therefore doctors are now on strike and that is just to protect hierarchy where I can make a decision and go to sleep not afraid of a change in directives by a consultant in other fields who will not take the fall if anything goes wrong with the patient. Remember that when a patient is not satisfied with care given they take it out on the doctor in charge. No one will listen to you if you try to explain that it was the fault of another consultant in a different field left to them they came to see a doctor. Therefore we either maintain the way things are run or patients should be shared to other health care givers so that we can all be held accountable for patients.