Kemunited Specials: Shaukat Khanum Series (Part 1)

By Moeed Ahmed, Unsa Ather, Muhammad Mohsin Ali, Aneeqa Javed, Ammar Anwar and Ayesha Mushtaq

This is a special blog about the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) from students of King Edward Medical University. The blog has no conflicts of interest and is strictly related to healthcare with no political affiliations/conflicts. We thank the Management of Shaukat Khanum Hospital for allowing us to visit their facility and interviewing the CEO and the Chairman.

Our journey started in the month of Ramazan, 2017, when by special invitation, we got the opportunity to attend the Shaukat Khanum Memorial Cancer Hospital Annual Fundraiser in Lahore. The event was a wonderfully organized gala, held in the grounds of the Hospital's main building, with the Chairman and Founder of the Hospital Imran Khan gracing the ceremony with his presence. From small kids emptying their piggy banks to well established industrialists contributing lacs, the ceremony was a heartwarming display of charity to help patients suffering from cancer.

Team Kemunited with Imran Khan (from L to R): M. Mohsin, Moeed, Unsa, and Aneeqa

We followed this with a visit to the Hospital's main building; a visit gracefully arranged by Ms. Saima Khan of Media & Public Relations deparment. During our visit we were informed about the history of the hospital, from its inception till present age. We were also shown the various departments in the hospital; from the nuclear medicine ward to the profoundly equipped research laboratories.

A photo-walk through time: various celebrities came forward to contribute to the initial Shaukat Khanum Hospital cause

Now political arch-rivals, this picture shows Mian Nawz Sharif and Imran Khan at the inauguration ceremony of the first Shaukat Khanum Hospital; December 29, 1994

Ustaad Nusrat Fateh Ali Khan with Imran Khan during a fundraiser ceremony

Many famous performers have contributed to the Shaukat Khanum Hospital cause over time by performing at fundraisers, both locally and abroad.

The hospital has a large Out Patient Department, where patients who have already registered at the free Walk-in Clinics are dealt with. The whole system is well organized, with computerized tokens, a well ventilated sitting area, and various examination rooms with all the the equipment handy for a physical examination.

The Out Patient Department (OPD) of the Hospital recorded 236, 351 patient visits in 2016

Each Examination Room is well-equipped to facilitate patients as well as doctors performing physical examinations. Patient privacy is maintained in an effective manner.

At Shaukat Khanum Hospital, Financial Support is provided to all needy patients after a background check. Support depends on income, and as of 2016, almost 75% patients are supported financially at the hospital.

Our journey led us to the Pediatrics Oncology ward, where we saw state-of-the-art facilities being provided to the brave little souls fighting with cancer. The kids are provided with daily meals catered to their needs as well as entertainment, perchance to distract their minds as they continue their brave onslaught against cancer.

Despite the struggle they face at such a young age, these kids continue to smile, committed to beating cancer.

A kid battling cancer strikes up a stylish pose, resolving that he too, can and will achieve anything.

The hospital provides a learning room, a qualified teacher as well as books and computers so that the kids undergoing treatment do not fall behind on their studies as well.

The Pediatrics Ward has a soothing interior, aimed to ease the minds of the young kids who are admitted here 

The hospital boasts a well-equipped, state-of-the-art nuclear medicine department and a Pathology Laboratory certified from the American Board of Pathology.

Factoid: The walls and roof of this room are 7 feet thick, to prevent radiation leaks.

These protective masks and body-wear are customized for the patient and are non re-usable.

The Pathology Lab is equipped with the latest equipment. Around 400 different tests can be performed here, and 5,015,237 tests were performed in the year 2016.

We also learned about another very important aspect of the hospital: its electronic medical record system. SK boasts a self-engineered EMR system which emulates the system already in use in the United States. The system allows doctors to review all of the patients medical history and details, including drug dispensations. Uniquely, the system does not allow doctors to view the status of the patient with regards to financial support, thereby ensuring fair treatment without any undue bias or embarrassment for the patients.

Behind the Curtains: Interview of Dr Faisal Sultan

The highlight of our visit, however, was a meeting with Professor Dr. Faisal Sultan, the Chief Executive Officer and Administrative Head of the hospital. Below is reproduced our short interview with him, in which he highlights the qualities of good hospital management, and gives valuable advice to doctors finding their way within the community.

  

Q: When and how did you join Shaukat Khanum Memorial Cancer Hospital?

A: I joined in September ’95. It had been a few (8-9) months then since the hospital started. So my role here was in infectious diseases for cancer patients. With time I got a little bit of additional administrative responsibility. I was Medical Director in the year 2000. In 2002, the CEO left so I temporarily took over the job initially. Since then, I have been working in this capacity.

Q: So what is your job description and the division of labor at your hospital?

A: CEO is primarily responsible for administrative side but is also the overall head. Then there is Chief Medical Officer (formerly Medical Director), looking after medical side. Both of them report to the Board of Governors. Primary responsibility of CEO is of course program delivery. The Board questions us about the treatment, number of patients, number of those patients undergoing free treatment, the quality of treatment etc.

Then comes the planning aspect; general planning for the future including yearly (budgeting) and also long term planning, i.e. the goals for say 3 years or 5 years. You have to plan in order to achieve; so all this planning is the job of the Chief Executive Officer as well as the branding, marketing, genuine image-building, quality assurance within and outside, financial transparency via 3^rd party auditing. We also have an internal audit process to reduce risks and provide an additional insight to the Board, other than the CEO. There is also a Medical Quality Assurance Wing alng with  other 3^rd party reviews like Punjab Health Commission to ensure quality. Apart from this, there are other day to day matters like management information flow, information flow between professionals, supply of materials, in short every little thing that goes in to making the organization work. Medical side like QA, recruitment, complaint handling is done by CMO. 

"You have to plan in order to achieve."

Hospitals are complex in that they involve a lot of public dealing. People come here when they are unwell; outcomes are not determined 100%, sometimes bad things happen. It might be like any other hospitality industry; but it is a riskier environment with a different set of expectations. There are also conflicts; as they are inevitable whenever there is a bunch of people together. You need to ensure you listen to all parties, make a logical and fair decision, and resolve conflicts. Contrary to what people think, this is not a job of ordering people. Modern organizations do not work on ordering people. You can only pass orders 2 times out of 100; 98% percent of the time, you have to sell your position, tell them why exactly you want a certain thing done. Logic makes more sense and then people accept it more. A lot of what somebody needs to do in my position is not ordering, but selling and communicating.

"Modern organizations do not order people."

Q: We would like to know about the research being carried out here in SKMCH&RC.

A: We have clinical trials here as well as basic science research. Basic Science Research is primarily being conducted on BRCA (gene involved in breast cancer). Clinical trials are also being conducted; pharmaceutically funded as well as institutional. Dozens of trials of one kind or the other have been conducted here and are being conducted even now. Some are on a small scale, others are large international collaborations which are being participated in by many hospitals globally and we also contribute a small proportion of patients to them. There is a Clinical Research Office to help you with the ethical approval and scientific review of your projects as well as to find the funds for that. Basic Science projects also follow pretty much the same course; only difference being that they focus on biomedical and biologic specific issues.

Q: How do you manage patient privacy?

A: We train people and orient our medical staff and nurses about our hospital management system and expectations on privacy. Unfortunately mostly people come from a background where privacy violation is no big deal. For example if an actress comes to me today and gets a mole removal, I would go and announce it all over. People do this all the time. We have seen situations where privacy has been breached. But we do train our people to respect the patients' privacy.

Q: We attended your fundraising dinner recently and witnessed how people give huge donations. How have you managed to build that trust of people in your organization and how difficult is the entire process of managing funds?

A: It takes time; we have done it by consistently delivering, by being transparent, and showing that we are doing what we are saying. Like I said before, program delivery is the key here. If you don’t do program delivery, nobody gives you money. You can ask Imran (Khan). To raise the first lac or the first crore was the hardest. After that, once you start delivering, then obviously people do give. Brand image and then protection of that image is important. People are giving you their money because they trust you; if they won’t trust you, they won’t give you.

Q: So approximately how many years did it take you to come on a smooth track?

A: The hospital started operating in 1994 so I think it took, maybe until the year 2000 or 2001, when people started thinking that yes they are working. So we weathered that storm and since then we have not had a gap in our credibility.

Q: How do you keep the hospital free from politics?

A: We try to keep it free from politics by keeping the political side away. You would have noticed that barring a few occasions, Khan Sb does not speak about politics on our functions and even if he does, we stop him. He also thinks that politics is everyone’s right; but if we talk about politics with him, then it becomes PTI politics, which we don’t want. We don’t want Shaukat Khanum Hospital to be politically aligned. With the association of the Chairman both ways, it can be hard at times but by and large we manage to do it. We have supporters and donors from every party known to this country.

Q: How do you keep the transparency in induction of the staff?

A: We try to do it by keeping people accountable. For instance if we have a weak candidate who gets selected people can ask us afterwards regarding it. We have 4 people in a room who are independent and from different backgrounds, and obviously sometimes they may have differences. I believe that a fair process starts from the initial induction: you select honest people and they in turn select honest people as well. And it is equally important to weed out the people who do not believe in fairness and merit; I think they do not reflect the culture of this place. So no matter how intelligent they might be, if they interrupt the merit or transparency then we cannot accept them by any means.

Q: What are your future plans for Shaukat Khanum Hospital?

A: Our future plans are enhancing capacity here by constructing a new clinical tower in Lahor, building the hospital in Karachi and solidification of our presence in Peshawar. 

Q: Your Hospital has come a long way compared to Public Hospitals. So how do you think Public Hospitals can ever compare to it?

A: Look, there are 10 or 50 Public Hospitals run  under one Health Department. How can you do that? It takes me all my energy to manage one hospital, how can you expect one department with dearth of resources to manage all the Public Hospitals? They have to be delegated and autonomous and not to be political, but this is what they are trying to implement in KP by making independent boards. It involves a lot of struggle, litigation and challenges, but allow me to explain it: you make a board of 4 or 5 people, and give them authority and manpower to deal with problems, and they will perform better. When they made a governing board over here, it had honest, hardworking and committed people like Dr. Parvez Hassan, Razak Dawood, Imran Khan himself, and his sisters; they were much focused. They made mistakes, of course, being humans, but they tried to make decisions that set the main agenda for the board. When you set the main agenda for yourself, you set the same for the management as well. And the hire people accordingly as well; even if you hire someone wrong you try to weed them out sooner or later. So Public Hospitals will improve too, provided they are not run remotely and by one Secretary Health. This is a misconception that one department can run like 20 public sector hospitals. In UK, the NHS has various trusts which run separately. They get funding from the center and generate some funding on their own, but all their administrative matters are done by each NHS Trust. So you know, they have smaller managing units. It is a pretty complex business, so you can wonder how one person or department can manage it all.

Q: SKMCH&RC caters to a specialty of patients. How can the CEO of a hospital like Mayo Hospital, which gets hundreds of doctors each year from all over Punjab, ensure that they follow the ideology of the place, especially when there is such a need for doctors?

A:   You have to look at the full picture. Yes, these hospitals do have a large volume, they should be more adequately resourced. But if the CEO is empowered to make the right decisions, sooner or later, he or she will start getting better people. Even if induction is central, they should be consequences based on whether you do or don’t work. So that is why this aggressive politicking by young doctors at times is counter-productive, because the administration, in a bid to not get their hands dirty, will then take no decision at all. I don’t really know much about that system but I can tell you that with better and more hands on governance, they can improve. For instance, if Mayo has a governing board, it will raise a hue and cry with the secretary health when it doesn’t receive adequate funds for a teaching hospital. And after they get that money, we should hold the management accountable as well. We should ask the CEO or Chief Director regarding the utilization of funds in achieving set targets. Obviously the public sector has complex issues. The system at times is so complicatd and rigid that it doesn’t allow you to get the best people and the best resources. In private sector, you serve at the pleasure of the management. 

"If we don’t measure things, we cannot have accountability."

In government sector, once people are employed they act like it is for a lifetime regardless of whether they work or not. Those things also need to change, and they are changing with time. Basically you just need to make organizations more accountable. We don’t expect things to change within a day. For instance, Mayo is a large hospital having a huge load of patients. Considering the incidence of surgical site infections, if we say its 20 percent, we just ask them if they can bring it down a notch to 18 percent. And often times they can do that because it is a minute, not a drastic change. Then we will give them provisions and ask about outcome indicators, whether the incidence did go down to 18 percent. And if it did, that means the battle has already been won. Next year the incidence will fall to 16 and the next year to 5 percent. Why? Because now we have a measure of things. We have accountability. If we don’t measure things, we cannot have accountability. The challenges Public Sector hospitals face are massive, and unfortunately they have not been managed and funded the way they should have been. If you just correct these two things, you will see that these same hospitals become state-of-the-art health centers. 

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With that, our interview with Dr. Faisal Sultan came to an end. He gracefully acceded to a group photo, and exited, leaving us with much to ponder over.

The interview also marked the end of our visit to the hospital. All things considered, it was a hugely productive afternoon in one of the topmost hospitals in Pakistan. Shaukat Khanum Memorial Cancer Hospital and Research Centre, without a doubt, has managed to achieve more than anyone would have imagined in such a short duration of time. It is no longer just a hospital; it is an institution representing hope and quality health care for patients from all walks of life. 

This brings us to an end to this blog. Do stay tuned for the second part, featuring the exclusive interview of Imran Khan, Chairman, Shaukat Khanum Memorial Cancer Hospital.