PIMS needs an autonomous administrator, board of governors, says ombudsman’s report

Islamabad
The Pakistan Institute of Medical Sciences (PIMS), being the service delivery arm of the Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), should be administered by an autonomous Board of Governors, which should be empowered to appoint an administrator for the hospital-from the public or private sector — with a market-based remuneration commensurate with the appointee’s qualifications.
This is one of the key recommendations enshrined in the Federal Ombudsman’s Committee Report on ‘Transforming PIMS into a leading centre of excellence.’ According to the 145-page report, a copy of which is available with this scribe, the Committee has recommended that “PIMS should operate as a truly autonomous and state-of-the-art centre of excellence, which is only possible if it is managed by a high-powered board that draws support from both the government and private sector.”
It may be recalled that the Committee was constituted by the Ombudsman in response to media reports about complete breakdown of critically important medico-surgical equipment at PIMS when Dr. Shahid Nawaz, head of the department of cardiology, was assassinated within the hospital premises in February this year. Its purpose was to conduct a study of the quality of services, infrastructure and security at PIMS, and to propose measures for reformation of the hospital.
Led by former secretary health Anwar Mahmood, the Committee comprised Dr. Farhat Abbas from Aga Khan University, Maj. Gen. (r) Azhar Mahmood Kiani from the Rawalpindi Institute of Cardiology, and Dr. Fazle Hadi, former executive director of PIMS. The report also reflects the perspectives of professors and heads of department of PIMS, senior parliamentarians, health experts, civil society representatives, ministers, and members of PIMS associations and unions.
The Committee has proposed that the Board of Governors should be chaired by the president of Pakistan/chancellor of SZABMU, and have as its members, the minister of finance, minister of Planning Division, leader of opposition in the Senate, vice chancellor of SZABMU/CEO of PIMS, and Surgeon General of Pakistan, and two eminent health experts who have headed major academic or health institutions. The board may also co-opt two persons in the field of philanthropy or public service, the report states, while the administrator of the hospital would be the member/secretary of the Board of Governors.
Meanwhile, the report also recommends hiring of an administrator for PIMS from the public or private sectors. The administrator should hold an MBBS, post-graduate qualification in hospital management, and at least 20 years of experience in hospital management, including at least 10 years in a teaching hospital. The administrator should report to the Board of Governors, it states.
The Committee considered two solutions to the existing dichotomy and overlap of functions and responsibilities arising from the merger of PIMS with SZABMU. First, to amend the SZABMU Act of March 2013 to separate PIMS hospital from the administrative control of the university and instead affiliate it with the university for teaching purposes. This, the Committee believes, will lead to restoration of the previous position of PIMS as an attached department of the federal government, and pave the way for settlement of the current confusion. The other option is to retain the present status of SZABMU/PIMS as per the University Act 2013. In this case, the report presents detailed recommendations on how employees who have and who have not opted for University employment should be treated. It believes that employees who have not opted for University employment should be allowed to remain as civil servants and be considered as on lien to PIMS.
The report observes that ever since the establishment of SZABMU in March 2013, the organisation has failed to frame its service, clinical and operational rules, which would have clearly spelled out the duties of each functionary, delegation of authority to lower levels, and regulation of terms and condition for services. As such, the organisation has been operating in a legal void. However, on persuasion of the Ombudsman’s Office, SZABMU has prepared a draft of these rules and regulations which, the report stresses, must be validated within 90 days of the issue of the Committee’s report.
Taking note of the non-availability of surgical and medical specialists at PIMS even during regular hours, and their inclination to devote more time to private practice outside the hospital, the Committee has called for promoting institutional practice, as against private practice, or making it an integral part of the service contract to improve overall performance of PIMS.
The Committee also observed that 25 labs around PIMS have flourished on the referrals of doctors and lab staff of PIMS. As such, it has recommended that a beginning for institutional practice be made from the Pathology and Radiology departments within the next 180 days. “No professor or doctor should be allowed private practice outside the hospital during or after office hours. Institutional practice should be started incrementally from OPDs by refurbishing existing clinics within 180 days from the issuance of these findings. Those specialists not conforming shall, however, ensure their presence at PIMS during the full regular hours,” the report recommends. It is common knowledge that many specialists and consultants are available in their clinics only twice or thrice a week, and that too, for a couple of hours only.
With reference to the construction of the medical tower at PIMS, a PC-1 for which was approved in 2006, the Committee has proposed that the project may be revised on a modular basis after review by the Board of Governors under public-private partnership. The first medical tower should be ready by 2017 or by the first quarter of 2018, the report states.
Referring to the numerous security lapses that have occurred at PIMS in the past, such as thefts, abduction of newborn babies, murder and kidnapping, the Committee has called for undertaking a special security audit of PIMS in collaboration with the Ministry of Interior and induction of a reliable and efficient private security service on priority basis. The Committee has pointed out that the hospital’s boundary wall is not properly protected and should be raised to a height of 8 feet with razor wire and signposts to preempt such incidents in the future.
In order to reduce the existing patient load at PIMS, the Committee has recommended the establishment of four 500-bed general hospitals in ICT by 2018, revival of filter clinics within PIMS, upgrading of two of Polyclinic’s health clinics located in sectors G-6 and G-7, and expeditious implementation of the long-pending proposal for expansion of Polyclinic towards Argentina Park. It also recommended enforcement of daily rounds of wards by consultants for evaluation of the condition of their patients.
The Committee has also advocated in favour of an increase in the budgetary allocation for PIMS, and has recommended that PC-1s be prepared for upgrading of the three mortuaries at PIMS; for procurement of a new system for hospital waste disposal; and for upgrading the Department of Surgery, which is constrained by acute staff shortages, poor quality of equipment, and poor condition of OTs.
The report also contains detailed recommendations for improvement of nursing care and paramedical services. With reference to lack of career planning and poor promotion prospects for doctors and other personnel, the report recommends that promotions should not be linked to availability of posts but with time scale and seniority. It has stressed that all pending promotion cases should be finalized within 48 days from issuance of the report.
The Committee has also called upon the VC to conduct an inquiry to ascertain why the Liver Transplant Centre could not be made functional, why relevant appointments for the Centre were not made, and why the equipment purchased for it was left to rust or was stolen.
Even though the report is an eye-opener for any government that is truly interested in improving one of its largest tertiary care hospitals, there is little likelihood of its recommendations being implemented. Many reports of a similar nature have been prepared in the past as well, with no long-term improvements ever in sight.
According to one official of the government, the Prime Minister Secretariat is deeply concerned over the declining standard of the hospital, specifically poor service delivery and failure of its administration to manage the day-to-day affairs of the hospital. The official said that the government is providing Rs3 billion grant to PIMS, but service delivery remains poor with poor patients unable to get relief.
The official maintained that issues pertaining to employees retaining their civil servant status have been addressed through a notification issued by the Ministry of the CA&DD in 2014.