Professional courageous, ethical leaders are needed to bring a change in healthcare delivery system


 Int. Medical Conference at SMDC Lahore

Professional courageous, ethical leaders are needed
to bring a change in healthcare delivery system

Health is a Service and not a Product, hence do the procedure
right to have good quality of life - Prof. Paul Brach

Let us motivate our learners, concentrate on professional
development, provide feedback, and incorporate learner
centered approaches - Dr. Nasir Bhatti

LAHORE: Prof.Paul Barach an eminent medical educationist from USA was the guest speaker in one of the Plenary Sessions during the First International Medical Conference organized by Shalamar Medical & Dental College on the last day of the conference February 5, 2017. The topic of his presentation was Designing and Implementing a Safe Healthcare Delivery and Education. He pointed out that one must have the courage to lead. Most people are not happy to change. Faith and effective Trust are the important values of the medical profession. Hence it is important to decide how to prepare the doctors and nurses to be faithful.

Prof. Paul Barach along with Prof. Cess van der Vieuten photographed at the 
First Int. Medical Conference organized by Shalamar Medical & 
Dental College from February 3-5, 2017.

Speaking about doctor patient relationship Prof. Paul Barach referred to the science of disease and biology of science of clinical practice. He also talked about cost value equation. Better doctors and nurses will ensure health of the population.  Healthcare, he opined, was a service and not a product, hence one has to do the procedure right to have good quality of life. So far we have been evaluating health as a product without realizing that it was a Service. For a positive outcome, we need to create a culture of professionalism. Many patients die due to medical errors.  It was a major cause of deaths in one of the studies. We have lot of funds but they are not utilized in an effective way. Free market is bad, we need controls and proper monitoring. We see amazing profiteering which is not profit but greed, he remarked.

We see stories about the use of unsafe blood. There are problems with the regulatory mechanism. One often reads reports of HIV infected blood being used in Transfusion. He also referred to the press reports highlighting company representatives selling Stents and disposables direct to the patients in Pakistan for stenting and interventional cardiology procedures which is bad. Medicine, he further stated, was a social service. Most of the countries in the developing world including Pakistan spend very little percentage of their GDP on Health. He then asked how often doctors wash their hands after touching the patients? Surgeons are reluctant to share their data. There are more chances of patients dying if they are operated on weekend or on holidays. Similarly there are more chances of death if the surgeon is on vacation hence it was up to the leadership to take charge for that period. Do not leave the patients on Saturday and Sunday with trainees. In case of extended work ship, there are more chances of traffic accidents. We should be concerned about higher dis-satisfaction among Emergency Medicine and Critical Care doctors.  There are lot of problems. It is the responsibility of the management which leads doctors and nurses to make mistakes. Administration must design reliable systems. There should be standards for designing the hospitals. Engineers and designers should be involved in building the hospitals. Human factor has an impact on health care. Mismanagement, inadequate training and inadequate supervision can lead to disasters.

Continuing Prof. Paul Barach also discussed in detail the problems and pitfalls in healthcare team members. One can have structured templates to reduce errors. His advised to  the hospital administration  was to create opportunities for staff for open honest communication encouraging people to speak up. Studies have shown that training programme for the medical teams has led to significant reduction in mortality. Most doctors do not wash hands, do not report Adverse Drug Events. Socialization of people into a culture is more important. There is a difference between a service and a product and healthcare professionals should know everything. He concluded his presentation by stating that professional courageous, ethical leaders are needed to bring a change in healthcare delivery system.

Dr. Nasir Islam Bhatti from John Hopkins University USA was the next speaker in this plenary session. He spoke on Assessing Surgical Competency.  He was of the view that one must have a passion in what one is doing. In mentorship, our objective is to train better surgeons. They must be courteous but competent which will improve the quality of surgeons.  For this one must select the good people for training. He also referred to intra operative competency assessment. We used to be trained one hundred twenty hours per week but now there has been significant reduction in training period. Postgraduate’s jus spend 6% of their time in operating room. Studies have shown that 38% of the Residents were not confident that they can do the job. Almost 80% of Chief Residents proceed for Fellowship. We need to create a system and induce a cultural change. In the present system there is inability to provide personalized feedback. We need multiple evaluators and they must do their job in time. We need to think outside the box to come up with some solutions. Feedback should be given to the residents within twenty four hours.

  Prof. Zahid Bashir Principal Shalamar Medical and Dental College presenting
a memento to Dr. Nasir Islam Bhatti at the plenary session on February 5, 2017.

Continuing Dr. Nasir Bhatti highlighted the importance of App based evaluations, crowd outsourcing, use of simulation based data, and learner centered teaching and evaluation. We must encourage and improve self-evaluation and develop milestone based curriculum. Let us give control to Residents of their training. Ask them which Professor they wish should give lectures. Teachers should not teach but they should act as facilitators and sit with the students. Consultants can also give recorded feedback if they are busy. Dictated feedback is also very valuable. We must create a culture where Residents and Faculty use App, let us encourage people to use App. Professors should be mature, adults should be encouraged but do not make it mandatory. There are not short cuts.  Let us have an honest professional self-assessment, practice that focuses on which takes you beyond the current level. It is important to have well defined learning objectives, precise measurement and motivated learners. Let us consider entry level skills testing and incorporate learner centered approaches. Let us achieve efficiency in assessment. The role of personal intents was the main factor in making the Residents and Trainees better. Let us motivate our learners, concentrate on professional development, provide feedback, facilitate deliberate practice and incorporate learner centered approaches, he concluded.

Dr.  Somaya Hosny from Egypt talked about Quality assurance in Higher Education. She discussed in detail the principles of quality assurance, guidelines for quality assurance, Gaps and Weaknesses in our system which needs to be plugged. She laid emphasis that let us conform to academic standards and provide appropriate opportunities for learning. We must protect students’ rights to get good education, ensure cost effective education and increase community confidence in graduates. Transparent criteria for appointing faculty, reasonable workload and ensuring job satisfaction was also important. The systems should be supportive for research and we must have a rewarding system based on performance. Affiliations with reputable institutions will ensure high academic standards. The administration must prove appropriate learning resources, offer equal opportunity for quality learning. Fair assessment and timely constructive feedback is essential.  We must respect the students input and offer better mentoring.  The system must ensure customer satisfaction.  Involvement of leadership, all the stake holders’ participation and all decisions should be based on evidence and continuous improvement. She emphasized the importance of producing competent medical graduates and service to the community should be the aim of every college.

Continuing Prof. Somaya Hosny said that quality assurance leads to achieving accreditation. Leadership plans and builds a system, efficient team manages the conflicts and establishes quality enhancement cell. It is important to define the scope of authority and responsibility. Let us ensure human resource management, develop job description and qualification, assess properly and keep all the records. It is also important to ensure safe working environment, develop a Reward and Recognition system. Integrate and manage any complaints, appraise actual performance and opt for external review.

Dr. Kamran Moosa an Engineer by profession was the last speaker in this session who talked about Quality Assurance with Outcome Based Education in Higher Education. He was of the view that quality without conviction was not possible. Tuition was a National dilemma. If the teachers teach and students learn, there won’t be any need for Tuitions. He then referred to wrong laboratory reports based on which surgical procedures are performed. Understanding and application of knowledge is the outcome we should be looking at.  Have we tested the competence of the doctors? Does our examination system reflect the quality of competence? Our teachers get frustrated when students ask questions. Most of the teaches do not know how to teach, they do not engage the students and do not use indigenous examples. Teachers, he opined, should work as a Guide and Facilitator for the students. They are not taught leadership. Many teaches lack capability to teach and we need to develop students learning outcome, he remarked.

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