Published on : 31 July 2017

Dismissal of hospital directors, competition for a new manager profile

Prime Minister Edi Rama's speech with hospital directors:

 

Thank you for being here!

Today, I would like to communicate with you about an overview of the current situation of our hospitals, and a preliminary plan of measures. Of course, if we look back and see where we are, there are undoubtedly important things accomplished, but if we look to the people who receive the service, and if we look at the perspective of where we need to be, the situation is far from satisfactory.

It is true that the list of drugs for hospital use has been considerably lengthened, and a continued supply of our hospitals with medicines and medical supplies has been guaranteed, and the old wound of chronic lack of medication has been cured if not totally at least to a considerable extent, and also we have managed to double the funds for cytostatic drugs.

Also, a continued operation of the main biomedical equipment has been ensured, firstly because it was possible to put into full use the devices that were available, and finally, under the regime of long-term maintenance contracts, for the maintenance with a risk full coverage for possible defects, or warranty replacement for parts consumed by the daily use. Secondly, new and important new devices have been added, although the need for biomedical equipment has not been exhausted.

Today, the service is also provided in new or completely reconstructed centres, especially by the TUHC departments, but also in other institutions of our hospital network. Undoubtedly there are obvious and tangible changes in diagnostic and curative devices. Suffice it to mention the scanner and magnetic resonance in the Trauma University Hospital, or the linear accelerator of neurosurgery and oncology, the hemodynamic cabinet and so on, ranging from the regional hospital of Shkoder to the regional hospital of Berat and so on. Meanwhile, the implementation of a radical modernization plan of the TUHC, the General Surgery services, Paediatrics, and the construction of a completely new and ultramodern hospital of internal diseases, is also being funded.

Providing services through Public Private Partnerships, Haemodialysis and the sterilization of new surgical instruments have greatly increased the quality of service delivery, either for a long-time persecuted group of patients in need of haemodialysis, or in whole for all service providers. The termination of the partnership contract for the lab service will end, I believe once and for all, the phenomenon of lack of realization of laboratory examinations in hospitals.

Medical Emergency is also in a process of radical transformation. This transformation has started with the establishment of the National Emergency Service. We believe that with the full extent of the new Emergency System, we will have a qualitative change of this service to citizens throughout the republic's territory.

Today, there are 10 free and revised health packages, even in non-public hospitals provided by the Compulsory Health Insurance Fund. There is also a significant number of service beneficiaries who could not access to these categories up to yesterday. Here, I don’t mean just the 1050 dialysis patients, but the 14.000 patients who have received free-of-charge cardiologic interventions in public and non-public hospitals.

Kidney transplantation in private hospitals with public funding for 33 patients has also been a success story. Cardiac Emergency Service works around the clock, as does the Vascular Cerebral Emergency Service that did not exist at all before.

The financing of healthcare for cardiovascular diseases will be expanded this year, foreseeing also the financing of interventional cardiopulmonary care for around 5900 patients, or 250% more than in 2013. 

Also, the budget is allocated for the financing of orthopaedic prostheses, not only in Tirana but also in some hospitals in the country. Chemotherapy cabinets have been set up in Shkoder, Durres, Elbasan, Korça, Vlore, and in the University Hospital "Shefqet Ndroqi". There’s been a significant reduction in waiting times for different examinations, from 6 months to 2 weeks for coronary angiography; from 6 months to 2 weeks for heart rate test; from 3 months to 1 month for magnetic resonance imaging; from 2 months to 2 weeks for the scanner.

Undoubtedly, it is very important that medical specialties were restored after an inexplicable and very harmful 3-year gap. There are about 600 new doctors in various specialties that are being trained to join the medical staff in the country.

This year's budget also finances a significant increase in the salaries of health personnel, with an average of 10%, thus increasing by 25% their net income compared to the beginning of this work in 2013.

The other side of this coin is concerning and shows something which I believe is essential, the simple truth that health is indisputably expensive, requires funding, infrastructure, but health requires hospitals management in the first place. All data, whether taken officially or through public complaints. We’re talking about an unacceptable management level.

Mismanagement is the main cause of the current situation of our hospitals, one of the main and untold causes, although there is also a great dose of negativity associated with the image of doctors in Albania. Of course, doctors have their own responsibility, but it is the task of management to motivate them, make them be in the right time and in the right place, and not get away with press statements of regret when a physician is attacked, which is undeniably a barbaric phenomenon, but also a phenomenon which we will see as an expression of an energy accumulated in the territories of hospitals due to mismanagement.

Our hospitals may not have yet the infrastructure we want and aim to have, namely a modern hospital infrastructure with quality services across the spectrum, but nothing justifies and nothing can overcome the feeling of shame for the state that hospitals don’t are examples of cleanliness and hygiene. This is the main requirement for every premises where public service is provided, let alone for hospitals. Unfortunately, today our hospitals are not examples of cleanliness and hygiene, and the ones to be held accountable for this are you, the directors of hospitals. We don’t need either infrastructure or reforms and great plans in order to keep them clean.  

Our hospitals are today evidence of a serious legacy of many years of deterioration. Especially when it comes to meeting the needs of specialist doctors in regional municipal hospitals across the country. This is an inherited wound but, on the other hand, our medical staff cannot lack for a moment the willingness to respond in time and with quality to the patient. Ultimately, the patient deserves the former one.

I do not want to make inappropriate comparisons, but I do not believe that hospitals were a parable of modern infrastructure, modern equipment and ultra-funding before the 90s. If we make a comparison of the level of hygiene and the level of readiness of staff, we are not 27 years ahead, but we are 270 years back. Who is responsible for this? Hospitals management. You are.

Hospitals need to be funded on the basis of the activity they perform and on the basis of their performance, and this is obviously a process that needs to be advanced in view of hospital autonomy. But the essential element of today, tomorrow and always in this process, is hospital staff. It is precisely this staff that has the great responsibility for good administration as well as the human and financial resources they have available.

Above all, this staff must be at the forefront of work to make the right and timely decisions, in order to respond appropriately to all needs, with ethics and dignity. And at this point, there is certainly still much to do to have a well-deserved health service for people.

But in this stagnancy of desperate cases and examples with regard to the most elementary things, there are very meaningful examples, both of the THUC, of the hospital "Shefqet Ndroqi" and of the Hospital of Trauma. And we’re not talking here about a comparison of funding with other hospitals. It is a comparison between what a manager and a leading staff can do with the same money. The external environments of THUC, "Shefqet Ndroq" or those of the Hospital of Trauma are not the result of any overfunding. They’re the result of the fact that the direction has eyes and hands.

One of the great injuries I mentioned is the lack of specialists. You all come from outside of Tirana. But, how can I answer the question about why there is no application despite the fact that the government has undertaken a costly initiative for the state budget, for financial compensation for all doctors who provide service in hospitals outside Tirana where there is a need for a special health service, for consultations and surgical interventions? Zero applications for these services by directors of regional or municipal hospitals. Tell me, who is to be held accountable for this, except you?

Our idea was not simply that those doctors offer services that pay 100,000 ALL per day, but also convey their experience as part of the ongoing training of regional hospital doctors, and especially in those hospitals where there are significant specialty gaps.

Not only do you bear responsibility for not having submitted a single application, but you are held responsible for the fact that as a result of non-compliance with these requests, all the people in need of these services address to Tirana hospitals. You are held accountable for the fact that hospitals here are overloaded, and instead of having this load reduced following the measure taken by the government, they have to cope with flows that necessarily increase beyond a reasonable rate the stress of the staff, and definitely affect the quality of services. You are held accountable for people’s endless comings and goings. Not to mention the costs patients have to pay, only because you don’t apply for a doctor from Tirana.

Moreover, the willingness of these doctors, but above all, the willingness of the managers of the three Tirana hospitals, is complete and it is enough to bring a case, implants in Gjirokastra, a scandalous case. Instead of cooperating with the managing staff and the director of the Hospital of Trauma here for the implants, the latter were refused because there were no specialists. And these refusals translated into costs for the people who would go to Tirana to receive the service. You are to be held accountable for this.

We are talking about hospital service packages according to the referral system that should not be sent from one door to another, in endless strays, because the municipal hospital does not answer. Not because it cannot, but because it doesn’t want to. The regional hospital doesn’t want to bear responsibility, and everybody does but one thing, outsource whatever they can to university hospitals in Tirana. This increases artificially the waiting lists also for surgical interventions that have low or medium complexity. This creates endless queues that are unjustifiable for the government, for consultations with patients who can be treated in their hometowns, from where they are compelled to travel here. Whose is this responsibility? This concerns neither the budget nor infrastructure.

Whereas, directors of university hospitals in Tirana were supposed to complain about overload of applications by you requiring specialist doctors. Not only they cannot complain, but they haven’t received a single application. The budget allocated by the government for specialized services of doctors outside Tirana, and their readiness – I’ve spoken personally with many doctors, and they have no problem it – to go and serve outside Tirana, are your responsibility. 

Now, let’s look at the other part, which is the most dramatic, the most tangible and the most offending to the average person.  

How many people in need of a service meet a closed door, as there aren’t any doctors or nurses when they need them? Have you ever counted them? Have you ever asked how many people in need, who are neither your relatives nor recommended by an MP, have to wait in hospital yards only because there are no doctors or nurses to serve them? Who is responsible for this? The government’s program? Infrastructure? Budget? It is you!

And there is nowhere these people can complain because nobody listens to them in the offices of hospital directors, let alone find a solution to their problems. You just have to listen to them, and doctors and nurses will be there when people need them, because they will know that there is somebody who takes care of these people. Are they inviolable to the extent that they can spend their working days in the coffee shops, and nobody can tell them anything? Who has entitled them to do so? It was you.

Also, the number of usable beds in our regional hospitals is very low, and therefore these hospitals cannot meet people’s needs. The way hospital care is distributed is very problematic. Therefore, what occurs in a paradoxical way, but understandable, is that Albanians take advantage of a small portion of hospital are paid with the money of the taxpayers. As a consequence, the request for hospital care at a hospital regional or municipal level, goes decreasing.

Of course, your immediate dismissal from duty starting tomorrow, is not the solution to the problem, but it is just the beginning of the solution.   

The objective is hospital autonomy, but what hospitality autonomy can we actually have, if we do not have hospital management, the capacity to have managerial autonomy? Ultimately, hospitals are companies. They’re not barns where veterinarians deal with the cows according to their mood. In order for us to have a reliable and feasible hospital autonomy, and for the transfer of money from the centralized budget of the Ministry of Health to hospitals does not turn into a new problem of loss of money and corruption, we need hospital staffs and clinical structures take responsibility for managerial autonomy.

This requires, first of all, awareness that this challenge cannot be faced just by saying so. You can be an excellent doctor, but it does not mean you're a great hospital director. Just as you can be an excellent hospital manager, but it does not mean that you know about diseases.

Therefore, I want you to understand my request for you to resign, addressed to all directors of regional and municipal hospitals. Meanwhile, every managerial team in each hospital, including the three leading teams in Tirana, the leaders of which I cannot tell to resign because they have proven to have eyes, ears and hands, will undergo a public contest, the purpose of which will be to invite all those who have managerial capacities and competences, whomever thinks they have them, including everyone among you, if you thinks you have them, to run for managing these structures that are so important for hospital service.

The same with happen with the other sectors, but we’re here to discuss hospital service. These public competitions will be overviewed by competent people, and everybody can attend them, from all paths of life. Candidates can apply from abroad, from Tirana, Tropoja or Konsipol, they can be business people, people from academia or the health sector. 

How can we think that we are able to build a dignified, ethical, non-offending health service, if we don’t end the offending of our professionals, starting with nurses? This is not your responsibility. I cannot transfer this responsibility, which is of politics’, of the pie’s policy, to you because a considerable part among you is product of this policy, but it is unbelievable that in the heart of Europe, in the 21st century, nurses are appointed by the parties. It is offensive to any nurse who knows how to do the job, but s/he is not a party member. Not to mention nepotism with regard to nurses appointment. Nepotism, blood ties to politics. It's a catastrophe!

We are working to have the employment and promotion system of all nursing staff organized as entirely separated from politics, and do the same for the teachers through an online platform based on annual tests, and in the hospitals of the Republic of Albania to have employed the best nurses that this country has available. Recruitments with maximum transparency and, above all, a fair competition system that any person who wears a white coat, should test themselves, instead of using the ties with a party or a relative in order to get into the system.

We need to transform some small hospitals into day-care hospitals that provide medical visits from specialists, and ensure medical emergency 24/7. Whereas, hospitalizations should be made in larger hospitals, mainly regional ones, but in the meantime we must consider the transformation of the functionalities of these hospitals also into community health centres, so that they can maximise the efficiency of human resources and of the money we spend for healthcare. For a transitional period up to the final completion, or let's say the needs in general for specialist doctors all over the country, we must focus to the request and response of specialist doctors of the university and regional hospitals who are willing to go deeper for specialized clinical services which we have funded, but it does not happen.

We also need to move forward with the cost of examination in order to go toward hospital autonomy, so that the Ministry of Health will separate from tenders once and for all. But the money dedicated to hospital companies must be dedicated on the base of costs and of a very detailed protocol for examination costs.

I believe that we have every chance to get out of an eyeless, heartless, handless hospital management phase. We have every chance that, despite the shortcomings, despite poverty, we can have clean and renovated hospitals. Above all, have our hospital staff ne on duty as long as they are paid.

Hoping in your understanding, in the understanding of hospital leaders, to take on moral responsibility for everything that has been lacking, also as a contribution to raising awareness that anyone who wants to lead hospitals, should have these a priority of their work, I encourage anyone who thinks that what I'm saying does not stand, to compete and prove that s/he can be a good manager. S/he can be the best manager among those who will apply to run regional and municipal hospitals of the Republic of Albania in the next four years.

I want to believe that the rest of the leading staff will do their job by addressing these problems in this transitional period before the public competition starts nationwide, which I believe will start in September, immediately with the creation of the new government. The first decision of the new director of the new Ministry of Health will be the opening of the public competition for the entire management team of each hospital.

Many thanks for attending this meeting, and many thanks for the understanding of anyone who is understanding of what I said. Who is not understanding, there is nothing to do but comfort them by telling them that time will prove who is right, and I would be the happiest person if you proved me wrong.

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