My new, tougher role that changed hospital’s fortunes

On August 6, 1975, a notice went round the Aga Khan Hospital.

It had been signed by Dr Storrar, the executive director who had been appointed after dismissal of three successive administrators to improve the financial state of the hospital, which was still making losses every year.

It read as follows: His Highness has invited Mr Yusuf Kodwavwala to succeed me as executive director. This has the unanimous approval of the Board of Management.

His Highness has asked me join the board as an ex officio member; therefore, I will be visiting the hospital frequently. I ask you all to give Mr Kodwavwala wholehearted support, which you have given me during the past three and a half years.

As the notice implies, I had not applied for the position, but had been sounded out. The main objective of the exercise was to bring down the annual deficit and the fact that Dr Storrar wanted to retire.

He had already retired from Canada after a long stint as an administrator in a teaching hospital in Montreal, and he had taken the job at the Aga Khan Hospital for a couple of years.

When I was sounded out, I said I could make the hospital break even on its recurrent budget and insisted on retaining my surgical practice.

SURGICAL PRACTICE

I argued that I was trained as a surgeon and the experience would go to waste.

Furthermore, like the smoker’s fingers missing ubiquitous cigarette, my hand would miss the scalpel, and I would most likely suffer from withdrawal symptoms.

As for doing two full time jobs, I was confident that with my organisational ability; I could fulfil my dual responsibility well.

Just as well that I insisted on this clause because when the contract ended, which unfortunately happened on an unhappy note, I had to resort to my surgical practice full time.

It was associated with more teaching at Kenyatta National Hospital, where I taught since the only medical school in the country then was inaugurated in 1967, with an initial call from the Association of Surgeon of East Africa that our region needed more medical schools combined with the help of teams sent from Glasgow and Canada.

Another reason for my insistence was that my surgical practice was providing the badly needed revenue to the hospital, and stopping it would be like cutting my wings when I wanted to fly.

My patients filled roughly a quarter of the general surgical wards and the private wing.

Since Dr Storrar took charge, every year I received a letter from him and the Aga Khan thanking me for patronising the hospital.

Deliberately forfeiting the right was like taking the carpet from under my feet and denying the hospital the benefit of my lucrative practice. My two points went home and I won the argument.

PATIENT SATISFACTION

I took office on October 1 and went into my new assignment with my usual verve and intense focus on my objectives, which were straight forward on paper — increase the income, cut down the expenses and in the process balance the budget.

Simple arithmetic, which my father had taught me when I was a toto. The former involved improving services and thus increasing the bed occupancy of the hospital.

It also meant persuading the sessional consultants to patronise the hospital. The consultants, especially those belonging to the same ethnic group as mine, proved resistant or downright non-co-operative.

To do adequate justice to the subject will require additional space and time; therefore I will deal with it in the next column.

Improving the services meant raising the standard of discipline among staff and boosting their morale, both pretty low when I took over.

The first lesson I learnt when I got in the saddle was to revise my views about patient satisfaction.

Until then, I naively believed that a patient was admitted to hospital for medical treatment or to undergo a surgical operation and if that went smoothly, he/she must be satisfied. Not so.

The patient’s perception of a good hospital is based on a conception of a five-star hotel with medical and nursing services thrown in.

WIND OF CHANGE

Food, accommodation, standard of auxiliary and supportive services, check-in and checkout, especially settlement of bills, all weighed in their judgement.

That meant every member of staff, from the cleaner to the finance clerk, had to be re-orientated.

Care, courtesy, compassion, cleanliness and competence, all rhyming with Kenya became my clarion calls. To instil discipline, I set an example by practising what I preached.

I would arrive at 7am, when sweepers and gardeners reported on duty, and leave at 9pm, when the night trolleys were going around the wards.

While Marie was putting our two children to bed, I was putting the hospital to sleep. It naturally took a toll on my family life.

In return for the hard work I expected from my staff, I made sure that a wind of change blew through the corridors.

I improved their living conditions and terms of service. I changed the Christmas party for the lower paid workers to barbecue, serving nyama choma instead of cakes that were served in colonial times.

All this in consultation and with the approval of their union and the senior administrative staff.

ICU PROJECT

I also learnt that illnesses don’t occur during office hours only and extended the working hours of the pharmacy, laboratory, physiotherapy and X-ray departments so that office workers could easily access them. This incidentally augmented the income too.

As for the expenses, having worked there for 15 years, I knew where the wastage was and how to plug the holes.

I abolished the traditional ‘white elephants’, although it meant treading on influential toes. The result of the measures we had put in place was reflected in the accounts — we had converted a deficit budget into a break-even budget.

We made a surplus, which was used in building and equipping the Intensive Care Unit, the first in Kenya.