Concept of ‘Group of Hospitals’ run by JJ can bring quality in GMCs
   Date :03-Apr-2020

Dr Prakash Wakode_1 
 
 
Principal Correspondent :
 
What are the roles and responsibilities of medical colleges and what should be their aims and objectives are the issues which are unclear to many in this country. We need to understand healthcare system in this country. Dr Prakash Wakode, recently retired as Joint Director of Maharashtra’s Medical Education and Research Department, opened up while talking to ‘The Hitavada’ on the issue of how Government Medical Colleges and Hospitals should run? “Healthcare system is mainly divided into Government Health care system and Private health care. State Government provides Healthcare needs to its population through -- Public Health and Medical Education. Public Health Department should cater to the healthcare needs of people through its vast network of Primary Health Centers (PHC), Secondary Health Centres (SHCs), rural hospitals and District Hospitals. On the other hand main objective of Medical Education Department is ‘producing’ medical graduates.
 
Research in the field of Medicine is expected to be done by medical colleges,” pointed out Dr Prakash Wakode. Dr Wakode, a product of Government Medical College and Hospital (GMCH), Nagpur, has served his alma mater too. Before joining at Indira Gandhi Government Medical College and Hospital (IGGMCH) at Nagpur, Dr Wakode worked at Yavatmal, Nanded, B P Koirala Institute of Health Sciences, Dharan, Nepal, in various capacities.
 
He is known for this discipline as well as compassionate nature. “Due to overlapping of ‘healthcare’ issue, non-availability of good public health hospitals in cities and non-development of proper referral system in our country, there is siphoning of patient load to these tertiary care centers i.e., medical colleges., resulting into dilution of quality,” stated Dr Wakode. Anyone would say exposure to large number of patients would give wide experience to learning doctors. Why to object it. This is partial truth. These medical colleges have manpower as per norms of Medical Council of India (MCI). MCI has given the manpower needs as minimum required for 100, 150 or 200 student intake as the case may be. All these medical colleges have residency system, meaning by basic medical graduates, who want to do post-graduate courses like MS/MD have to undergo rigorous training for being available in the hospital 24x7 for patients needs.
 
 
Availability of residents 24x7 and specialist doctors to treat secondary and tertiary health care problems has made Medical colleges popular among masses. On the top of it negligible fees charged for the services by Government has made Medical colleges the Choice No. 1 for poor patients, added Dr Wakode. Pointing out the above factors have increased patient load on medical colleges, Dr Wakode explained, “Teaching undergraduates, post graduates, undertaking their theory and practical examinations, undertaking relevant research work are time consuming issues. And needs proportionate increase in the manpower, infrastructure and finances. Availability of land, shortage of medical teachers and other factors may not permit increase the infrastructure in given premises.
 
 
To overcome this problem we can make few changes in our present concept. Instead of having one large medical college with very large number of beds and specialties and subspecialties, which are difficult to manage from the administrative point of view, we can develop the concept of ‘Group of Hospitals’ being applied by JJ Group of Hospitals in Mumbai. There is one main Medical College and in the periphery of Metro or near by city there are small specialised hospitals like Eye Hospital, Children Hospital, Geriatric Hospital, Orthopedic hospital etc.”
 
 
“There should be one Medical Superintendent as Administrator to this hospital. The units in this hospital can be used to increase the PG seats, which is need of the time. The staff in these satellite hospitals can be mixed like teaching cadre and non- teaching cadre (doctors) This will reduce the need of already shortage of Medical teachers, but at the same time cater the needs of people and society. To get a specialist doctor is comparatively easier than getting a medical teacher,” suggested Dr Wakode. Resident doctors would be posted by rotation to these satellite hospitals which would definitely widen their experience in patient management. This can be achieved by collaboration with Public Health Department or Municipal Corporation hospitals, and thus reducing the cost in new construction.
 
‘Group of Hospitals’ would cater to the needs of people by rendering patient care, reducing the gap of bed-population ratio, (At present 10,000 : 9 – for India) increase the number of PG seats, and widen the experience of PG students, felt Dr Wakode. According to Dr Wakode, with the advent of science and newer concepts in technology, state of art Medical education should be given. “Quality of Medical education needs to be improved. One of the important factor is emphasis on hands on training to the post-graduate and undergraduate students. Dean is administrative and Academic head of these teaching Institution. But our present scenario daily adds new thing to his responsibility. Hence some of his responsibilities needs to be decanted to Medical Superintendent. However Medical Superintendent should be reporting to dean,” Dr Wakode made it clear.
 
“Aptitude test needs to be incorporated during selection process of Dean, and should not be merely on seniority. I think we have come close to Doctor-population ratio prescribed by WHO. We concentrate on quality of our products (doctors). For which we need: n Committed, dedicated and highly motivated manpower n Minimising the distracters like Private practice and sycophancy n Developing pre- MAT ( Grievances redressal forum ) before going to MAT n Transparent and on-line transfer and promotion policy n Outsourcing of Class-4 services( 50% only), outsourcing of laundry, kitchen, security, equipment, maintenance and legal services, which occupy medical administrator preventing him to concentrate on more important work n Creating center of excellence in different medical colleges zone wise. For example, one medical college in one zone, develops state of art services in a particular field like CVTS, or immune histochemistry or intervention radiology etc. And acting as referral center for other medical colleges in that geographical zone n Strengthening the curative services at Public Health Department n Developing star marking system for all Government Medical colleges n Municipal corporation hospitals should play vital role in infectious disease, and epidemics.