“Emerging Management Practices in

Teaching Hospitals”.- My Experience as HR

Director of GHS, Former CEO, Board
Chairman, and Health Systems Consultant

PRESENTATION TO HO TEACHING HOSPITAL BOARD

SOGAKOPE, OCTOBER 13, 2022

DR KENNETH D. SAGOE
OUTLINE
• Brief History of Teaching Hospitals in Ghana and their Governance Arrangements/Systems
• Governance and Management Systems as enshrined in GHS & THs Act, 1996 (Act 525) –
My Experience as a CEO in Implementing the Act 525
• Benefits of Act 525 to the Teaching Hospital
• Challenges faced in implementing Act 525
• Setting of the Vision & Policy Direction from the Board
• Management/Organisational Structure and its impact on Performance and achievement of the Vision (How did the
Structure in Act 525 affect the performance as a CEO)
• Governance and Management Systems in GHS & THs Act, 1996 (Act 525) – My Experience
as a Board Chairman in Implementing Act 525
• Benefits of the Act to the Teaching Hospital
• Challenges faced in implementing Act 525
• Setting of the Vision & Policy Direction as the Board
• Management/Organisational Structure and its impact on Performance and achievement of the Vision (How did the
Structure in Act 525 affect the performance as a Board Chairman)
OUTLINE
• Key Recommendations to HTH to Design Organisational Structure that
can facilitate the Achievement of the Vision and Strategic Direction of
the Board based on your Previous Experience as CEO, Board
Chairman, and Health Systems Consultant who facilitated the
transition of Tamale Teaching Hospital, Cape Coast Teaching Hospital,
and Ho Teaching Hospital
• Explain the reasons behind the recommendation of the Current Organogram
of HTH and how it can facilitate rapid growth
 INTRODUCTION
• Teaching hospitals are interesting, and complex organizations and
are healthcare providers, dedicated to improving the quality of life
and reducing pain and suffering.
• Teaching Hospitals are institutions of higher education, offering
advanced training to Medical and Allied Health graduates.
• They are research centres of excellence, finding cures for
thousands of diseases, as well as helping in the discovery of new
medical devices, techniques, pharmaceuticals and practices (EBM).
• They are community pillars, providing service and well-being for
the total community in which they participate.
 INTRODUCTION
As part of the Health Sector Reforms in the 1970s,
Government gradually started a Decentralization system for
the Health Sector resulting in the enactment of :
The Hospitals Administration Law (PNDC Law 209, 1988)
provided the legal backing and also to give some level
“self governing” status to the 2 Teaching Hospitals at the
time.
The First Boards for the Teaching Hospitals was done in
August 1990 to grant some “autonomy” to the Hospital. A
“full autonomy” was proposed for 1st January, 1996.
 Brief History of Teaching Hospitals in Ghana and their
Governance Arrangements/Systems
• The PNDC Law 209 did not achieve Full Autonomy for the
Teaching Hospitals, in view of some constraints/restrictions
on the Boards from taking Key Decisions and Overall
Control was only vested in the MOH.
No laid down timetable for implementation,
No clear priorities/systematic operational guidelines in the Implementation
Phases,
No Common Vision, etc
To address the shortcomings in the Law 209, the
Act 525 of 1996 was enacted i.e. Ghana Health
Service and Teaching Hospitals Act, 1996.
 CURRENT MANAGEMENT ARRANGEMENTS IN
TEACHING HOSPITALS - I
• In Ghana, the Ghana Health Service and Teaching
Hospitals Act, 1996; Act 525 Part II established the
Teaching Hospital Board to:
• determine the policies of the Teaching Hospital which shall be
within the general policies of government on health;
• ensure sound financial management of the hospital's funds;
• monitor and improve the quality of care at the hospital;
• assess periodically the adequacy of the resources, including
personnel, physical facilities and finances of the hospital.
MANAGEMENT ARRANGEMENTS IN TEACHING
HOSPITALS - II
• ensure the implementation of the policies, plans and
programmes by the appropriate units at the Teaching
Hospital; **
• co-operate fully with the hospitals in the Service;
• subject to the approval of the Minister determine the
scale of fees to be paid by patients; and
• Appoint staff and determine their remuneration and
benefits subject to the law and policies for the time being
in force on social security and salaries.
• Boards represent the interest of the Stakeholders
 Governance and Management Systems as enshrined in
GHS & THs Act, 1996 (Act 525)
• Governance and Management Systems as enshrined in GHS & THs Act, 1996 (Act
525) – My Experience as a CEO/Board Chairman in Implementing the Act 525
• Benefits of Act 525 to the Teaching Hospital
More effective Policy Implementation within the broader MOH
Framework/Guidelines
Appointment and Promotion Guidelines were Modified within the Larger
MOH framework in Consultation with the Minister for Health (TTH specific
Promotion Guidelines along Deprived Area Incentives)
Effective and Shorter Decision-Making Process, Decisions are approved by
Board and are readily implemented.
All the Sub BMCs are within the same facility and vicinity - (Unlike GHS);
hence easier to Monitor activities and performance of key actors
Board exercising its role of holding the Management and Staff to account
(KATH)
Boards are also accountable for the Hospitals Organization and Performance
 Challenges faced in implementing Act 525 - I
• Setting of the Vision & Policy Direction from the Board.
• (Board Inertia)
• (Board pursuing Individual Self-Interest)
• Hospital Management must be allowed to deal with Management issues and
Board comes in when it is beyond the Management Committee.
• The role of CEO to provide Leadership and full participation in the
process is critical in the Development of the Strategic Plan and Policies
of the Teaching Hospital.
• Contracting out the Development of Strategic Plan entirely to External
Consultants without ‘Internal’ Staff involvement.
• Local participation of Significant Players contributes to high level of ownership of
the Strategic Plan
 Challenges faced in implementing Act 525 - II
• Management/Organizational Structure and its impact on Performance and achievement of the Vision (How
did the Structure in Act 525 affect my performance as a CEO/Board Chairman)

 Directors could gang-up and Counter or Subvert the CEO at Board Meetings.

 The Directors of the Hospital could also come together to push their parochial interests

 The Directors within the Hospital could oppose an issue proposed by the External Directors and win if

put to the vote.

 Some crucial Departments could not participate directly in Hospital Management Meetings including

Expanded Hospital Management Meetings. (HR, Research and Development, PPME, Diagnostics,

Audit, etc

 Willingness of the Executive Members to sign Performance Contract with the Boards and to be held

accountable.

 The development and implementation of Succession Plan for the major positions of the Hospital.
Challenges faced in implementing Act 525 - III
Implementation of certain policies they seem not to be in
favour of. For example the implementation of certain
policies such as electronic medical records management,
on-site banking and installation of electronic attendance
management systems are sometimes kicked against by
some of the Executive Members on the Board.
Holding the Executive Members to be accountable since
they are all Members of the Board that delegates
responsibility; if they fail to perform, it is difficult to hold
them accountable, more especially when their numbers
are almost double the Non-Executive Members of the
Board.
PREPARATIONS TOWARD THE TEACHING HOSPITAL
STATUS FOR HTH
• Conducted Organizational Assessment to determine
readiness of the Volta Regional Hospital.
• Assessments include:
• Organizational Efficiency and Culture Assessment
• Human Resources Audit
• Infrastructure Audit
• Equipment Audit
• Accreditation Assessments by:
• Nursing & Midwifery Council
• Allied Health Professional Council
• Pharmacy Council
• Medical & Dental Council
ESTABLISHING COLLABORATIVE RELATIONSHIPS -I

• There is the need for a

Memorandum of Understanding (MOU)
• This needs to be officially signed to seal the Relationship
between the Schools/University and the Hospital Board &
Mgt.
• Medical School
• Physician Assistants Programme,
• School of Nursing and Midwifery,
• Allied Health School,
• School of Pharmacy, etc.
 ESTABLISHING COLLABORATIVE RELATIONSHIPS -II

• To implement the MOU, there is the need for

Joint Standing Committees for managing
Critical issues in the MOU such as:
• Human Resource Mgt. esp. for Medical, Allied H,
• Use of Consumables,
• Infrastructure, Plant and Equipment and other
resources at HTH and make appropriate
recommendations for the consideration of the
Governing Boards and Managements of both
Parties.
ESTABLISHING COLLABORATIVE RELATIONSHIPS
• There is the need for Job Plans between the Medical Director, Heads of
Departments and the Consultants.
• All Consultants shall:
• sign a Job Plan by the beginning of the Year or Academic Calendar
• Submit timely, their Job Plan to facilitate the work of those planning service
developments, application renewals, and approval of annual leaves for the
Consultants.
• Copies of the Job Plans must be with the Director of Medical Affairs, Head
of Department, Lead Clinician and the Consultant to ensure adequate
monitoring and for the discussion of any review.
• Adequate sanctions must be available and applied to all defaulters to
ensure a positive work culture thereby assuring highest quality of service
to clients and students
• Promotion issues, especially to Consultant positions
Way Forward
• In addressing our Management issues let us learn from others,
but also know their shortfalls and avoid them but above all look
to Innovate, Learn from Experience and apply Evidence of Best
Practice to create a “Model” Teaching Hospital Management
System which can be a Pace Setter for the rest to emulate.