Georgetown hospital faces many problems, managers must take blame
-Ramsammy says in frank critique

By William Walker
Stabroek News
October 13, 1999

The Public Hospital Georgetown is in trouble and has been for a long time, Chairman of the hospital's board, Dr Leslie Ramsammy, said last week at a retreat held to arrive at a strategic plan for the institution.

In a frank assessment of the institution, Ramsammy related that the night before when he left the hospital there was raw sewage oozing up through the brand new laboratory floors.

Ramsammy listed among the many problems: "No water, no electricity, sewage back up, security breaches, abandoned buildings, incubators that don't work, sterilizers that break down, theatres that close down, wards that are filled, wards that are empty, demoralized staff because of low salaries, poor working conditions, not enough drugs, the wrong drugs, ...long waiting times, no doctors for Accident and Emergency." And Ramsammy laid the blame for most of these problems at the feet of the hospital's past and present management.

He noted that the responsibility of the management of the Public Hospital Georgetown to provide equitable and effective health care "is not just a part of the job but is a moral obligation."

As board chairman of the hospital, Ramsammy vowed: "We will refuse to embark on a path just for the sake of doing it. Instead we will approach problems with a strategic view..." a holistic vision of what the hospital's role and functions are meant to be.

Necessary new approaches include information-based decision making. He cited the maternity ward which in 1997 comprised only ten percent of the beds in the hospital while maternity admissions were 37% of all admissions and 25% of all bed time. Since then through a programme of reducing the days a new mother stays in the hospital from an average of 3.5 to two days, resources have been more effectively utilized elsewhere.

It is hoped that through the one-day strategic planning retreat held last week at the Park Hotel, officials will draft a mission statement, prioritize key issues facing the hospital and document goals to address each issue with suggested timetables.

It is Ramsammy's contention that the hospital does not necessarily need more money but must use what it has more efficiently. He said that the solution is to be found in the management applying some of the ethics of business such as continuous quality improvement, total quality control, customer satisfaction, cost benefit analysis, and employee involvement.

On the last point he noted that it was common wisdom that the doctors and managers were important players in the running of the hospital but "what about that lady in the kitchen, the maid who must clean up, the security guard at the gate?.... Their importance is lost even on themselves and a lot of the fault is ours."

Director of Medical and Professional Services, Dr Madan Rambarran spoke to Stabroek News after the retreat and described how the workshop had broken up into smaller groups to identify and prioritize problems independently. What was heartening, he said, was that the groups prioritized the problems in very similar ways and the solutions were along the same lines. This showed that the management was "on the same wavelength." The main problem was deficiencies in management as Ramsammy had noted. It was concluded that an improvement in management would inevitably lead to an improvement in services to patients. Another area of concern was the lack of trained personnel and the hospital's inability to attract and retain qualified mid-level staff such as operating room nurses and doctors as well as managers in the finance and personnel departments. An in-hospital training programme has been proposed and with expected operational efficiencies it is hoped that the hospital would be in a position to retain trained personnel with better salaries.

Rambarran mentioned that as a result of the workshop whose findings will be included in the strategic plan, small improvements should be seen in service within a few months as recommendations are adopted in an ongoing process.

The strategic plan for the Public Hospital Georgetown, which is now autonomous and managed by a management committee, is part of a larger Inter-American Development Bank and government sponsored programme to divest the responsibilities of health care away from the Ministry of Health to regional health authorities and hospitals to effect a more efficient delivery of services.

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