King Faisal Hospital has for the last one year been undergoing reforms and restructuring all targeting to improve the quality of services and its stature in the region and beyond. The reforms have seen various aspects of the hospital undergo changes some expected and some unexpected. The New Times’ Collins Mwai spoke to the hospital’s chief executive, Dr Emile Rwamasirabo, for insights on the reforms.
Since February last year, King Faisal Hospital has been undergoing reforms. How has the process been?
Beginning February 27, we rolled out a restructuring that saw the status of the hospital changed to a private company with limited shares. The only shareholder so far is government. But that was not the end point, the endpoint from the government’s perspective was to enter into a partnership with a well known reputable hospital group to uplift the hospital status in the region and at the same time to serve the local population better.
It was meant to cut down the number of people who go to seek treatment outside, whether government sponsored or private individuals.
During the process, there was a phase that raised eyebrows, where the hospital let go about 100 employees and sought out to recruit new ones. What was the point and how was it received?
When you restructure, you have to look at what you want to achieve, the qualifications that you want, and it is not unusual to have some employees let go. But, of course, in Rwanda, you do not just let people go; you have to look for alternative ways to get them new jobs, which we did.
The hospital had to also recruit new people to fill in gaps especially for specialty areas. We have been looking and are still looking for some specialty staff in some areas. Fortunately, all this process did not interrupt the services or the pricing of services, if anything we have seen an improvement in terms of performance that has also been noted in the revenue.
King Faisal Hospital gained autonomy from Rwanda Biomedical Centre; how has this changed the running of the facility for the better?
The move has assisted in decision making and reduced lots of bureaucracies. We are able to make our procurements quickly; we are able to make decisions faster. Hospitals of this nature need to be able to make independent decisions quickly because it is rarely predictable. We are now working in a better environment because of fast decision making. The impact is notable through how we deliver services now.
What stakes does the government have now in the hospital?
King Faisal is a national referral hospital and is at the top of the pyramid but still part of the healthcare system. We go by government health policy, government still partly owns the facility and still subsidises the hospital to some extent (between 15 and 20 per cent of our budget).
This puts us in a position where we have to work in line with government policies, though they do not come in daily management of the facility.
One of the features of a hospital of your stature is state of the art equipment and facilities for treatment. How does King Faisal Hospital currently fare in terms of equipment?
Hospital equipment is in two parts, one part is for diagnosis and another for the treatment. In terms of the diagnosis of diseases, we have latest equipment like the MRI (magnetic resonance imaging), which is the only one of its kind in a 500-kilometre radius, lookingat the line of people waiting to use the equipment, you notice that it is people from across the region. This is a positive development thanks to government support.
This is a positive move considering that about 15 years ago, most patients coming through our door had diseases that were infectious, but currently the number of non-communicable diseases and infectious diseases are almost at par, to deal with those conditions, we need to make appropriate diagnosis.
MRI is one of the tools to make such diagnosis. We also have more traditional equipment like CT scan. But you never stop equipment acquisition; we have plans to procure equipment to assist in the treatment and diagnosis of cardiac diseases, which is important because, increasingly, we are dealing with non-communicable diseases.
Equipment that is also very much needed currently is cancer management equipment, there are three key ways of treating cancer; drugs, surgery and radiotherapy. Rwanda will soon acquire radio therapy equipment; it will be a national project and will most likely be placed here. All these are plans we have with government to make this a one stop centre for management of diseases.
There is an initiative, Human Resource for Health, that seeks to build the capacity of local physicians. Is King Faisal a beneficiary of this project?
The initiative is a seven-year programme that aims at training specialists for the future. The original plan had in mind to train about 500 specialists locally by linking with 19 US universities to health facilities in Rwanda.
They are posted in various facilities including here, at the end of the programme it will have had a role towards our aim to increase specialists in the hospital.
Talking of specialty, how does the facility fare in terms of specialists in various areas?
As it stands, we have 50 doctors, 40 of whom are specialists. Of the 40, 17 are part-time, meaning they work in other facilities and also work here at times. This is a fair number but we need more as the number of specialty areas is about 60 and we need enough numbers for quality services.
During your restructuring and reforms process, there was a move to have all military personnel working at King Faisal referred back to Kanombe Military Hospital, yet you are trying to recruit specialty doctors, is this not taking one step to the front, one step backwards?
That was an administrative process, the Rwanda Military Hospital is also in the process of modernising the institution. They also need the specialists. Military hospitals all over the world are some of the top hospitals in terms of service provision; they also need to get to that level.
However, that doesn’t mean that they abandoned their clinical duties and roles here. These doctors and specialists still come here on part time basis and attend to patients. At the military hospital, they have administrative duties and give more support to their parent institutions. Patients do not feel the impact of this, it has not interfered with the services accorded to patients.
The hospital was also supposed to upgrade its information management system, how much progress have you made and what can clients expect from this?
Hospitals need to have capacity to be able to manage and retrieve information very fast and reduce the delays while referring back to previous patients’ records. The hospital management information system is to be adopted by all hospitals in the country.
It is a long process; we are currently in the process of finishing the first Phase and about to embark on the second phase. We have already seen some changes as people no longer have to line up to get files as it was previously the case.
When the doctors enter the patient details in the system, they are able to get previous information and treatment about the patient during past consultations which enables the patient get better quality services.
The information that is not in the system is still in the old files and is at times used when doctors need previous information.
In the reforms process, there must have been some emerging issues, some that you may not have fore seen. What are they and how are you dealing with them?
Like any other company, our main problem is cash flow; we have to cover the operating costs and generate revenues and at the same time develop such as infrastructure and equipment acquisition.
We still have government subsidies but they have been reduced from what they previously were. You have to work harder now and make sure that you do more with less capital. This is a challenge to make sure that the cash flow goes well without denying patients quality services considering that we have not increased our fees. We only have to find more efficient ways of working by adding our working hours and weekends.
Another emerging issue is human resource. When you are operating on a private basis like we are, you do not just manage the services that were there, you have to come up with new services that are on demand to generate more revenue. At some point we get stuck as we would like to offer some services but fall short of the human resources that are required. Some of the areas like transplant surgery would be ideal to diversify into.
For us to attract and retain professionals from other countries who are to fill these positions, we are supposed to give them more incentives than what they get in their countries. These are professionals that are on high demand across the world and as much as we want to have them, it is hard getting and retaining specialists.
Another issue that requires attention is the facility infrastructure. This facility is more than 30 years old and constantly requires rehabilitation. There are projects in the pipeline to rehabilitate the hospital and to renew some of the equipment and not wait till they have failed for us to overhaul them. We need to get new equipment for areas such as radiology and laboratory.
Are you still open to have other partners on board for funding purposes?
This facility has a name in the region, we are discussing with potential partners to see how we can come to a win-win partnership. We need to have more private partners come in, to capitalise it.
We are looking at attracting partners to make sure that the hospital is rebranded and have a regional and African perspective. We want the facility branded so that people from the region feel that they can come to Rwanda for treatment.
What can people look forward to in the near future?
In the near future this facility will have a new look. We have quite a number of people that are interested in working with us toward our targets. We want to have a hospital that will be reliable and reputable in diverse areas such as cardiac surgery, transplants and offer to our people the services they deserve.
We wish to share the facility with the region as we have found out that in a radius of 500 kilometres, there is demand for our services. That calls for us to have a world class facility. It requires financial resources, good management and more specialists; this is a package we are putting together.
How have you faired in the previous assessments by the various health stakeholders?
We have been performing well, but we can do much better. We can improve the quality of services especially by improving our customer care. When you look at the complaints that come in monthly, you notice they have gone down, but personally I am not satisfied and feel there are a number of things that can be improved.
The staff is certainly working better today. The level of professionalism is much higher now. This is true especially for the nursing staff, which is probably the best in the country and the better part of the region. But it requires more training to get to a level where we can feel comfortable.
This is also true for medical staff, they need to be more exposed to international levels of service delivery that are applied across the world, not only King Faisal staff, but medical personnel all around the country. This will definitely have an impact on how they perform. We try as our means allow for them to undergo frequent refresher sessions.