The recent news about delegation of powers of principals of GMC Srinagar and Jammu is making rounds and there is a buzz on social media wherein most of the concerned feel free to express their views in favor or against the decision with others feeling a need for reconsideration of the methodology of making the decision in itself. I had a detailed discussion with some faculty members and paramedical staff of SMHS hospital on this issue.
Before I make my observations public with an aim to present the grass root real scene for the higher authorities to take note of while taking any decision on this vital policy matter, I feel it a must to present a background of the issue which is sprouting out of fallow lands that too after a long dormant period.
Since inception of both Government Medical Colleges the position of Principal remained a position of authority on all administrative decisions. It is true that a Principal is in itself a doctor of high repute a techno-crate yet not fully aware of administrative know how on financial matters, over all administration on employees policy matters and same limits theirs influence on mainly academics or allied situation where crucial decision is needed in the interest of patient care.
But it must be kept in mind that in Medical Colleges and Associated Hospitals more than 70% decisions are involved with direct patient care and remaining decisions of administrative nature are again directly or indirectly linked with uplifting patient care, be it purchase of equipment’s or drugs or creation of infrastructure or manpower for any department.
With Principals working as authority there is always a harmony in associated hospitals headed by senior most faculty member designated as so called Heads of Department. Heads of departments work in liaison with Medical Superintendents (also doctors) and both work under the Principal. Being a professional character Principal as technocrat understands the technical language of Medical Superintendent and Head of Department and vice versa.
With this policy in practice I know of Government Medical College Srinagar used to be at very high ranking in fact at number 3rd in India in terms of quality education imparted at undergraduate and postgraduate level.
Government on sensing lack of full administrative know how of Principals on financial matters and various policy matters came up with the concept capacity building of Principals through augmenting their capability providing help from Administrators, Administrative Officer and Personal Officers. It is true that these administrative minds work with efficiency and have been delivering administrative help to Principal either by routine administrative flow chart or on demand.
As a professional, the Principal knows the importance of Injection Atropine, a life saving drug which costs not more than 3 rupees. Same is not expected of a bureaucrat who will give importance to things as per cost. To explain the importance of this drug to a bureaucrat may not be as easy as it seems. Result may be a serious confusion affecting the patient’s care.
What happened after disbanding the Rate Contract Committee of Colleges? All purchases went from college to JKMSCL. A huge gap got created between end-user and suppliers even on reporting on quality of drug or equipment. Many a time there is delay in purchase process and even with available funds departments fail to commission vital equipment in due time resulting in unwanted poor patient care. This may be because of lack of proper manpower with JKMSCL.
Initially, the Principal used to be Chairperson and Medical Superintendent used to be a Member Secretary of this purchase committee with Director Finance as expert and various Heads of Departments and Chief Accounts Officer as members. This practice would facilitate purchase of life saving equipment or drugs on the basis of quality rather than mere lowest rates. Same is not true as of now.
It is true that professionals are included as experts on creating specifications and remain involved in whole purchase process but the design of system is in hands of nontechnical personnel who are at the helm of affairs in various financial aspects of the bidding process that even the experienced hand fail to deliver the expected outcome fearing nonsense legal implications resulting in rejecting the worst quality because of lowest rates. This is a new phenomenon hampering provision of optimum patient care.
This is a mere cause that non-technical personnel fail to understand the difference between qualities versus lowest rate concept. As a result of this lack of knowledge institutions get drugs and equipment purchased on L1 basis but the same is not without a compromise on quality.
I am presently involved as an expert in the purchase of dual head gamma cameras for SMHS Hospital. I am trapped with finalizing a deal in favor of an un- reputed agency which has just one or two installations of less than a year’s period in India against an agency which has time tested equipment and best track record of service known to me in person. My opinion of selecting higher cost equipment will not be justified and I fear ending up with buying equipment without any secure future on performance or service backup.
Because of the uninterrupted availability of drugs, I could not offer morphine to cancer patients for at least a killing gap of two months. Thanks to the Honorable Prime Minister for providing free treatment through Ayushman Bharat Sehat Scheme which delivers instant and persistent supply of treatment to patients. A real solace for more than 90 percent patients and their treating doctors who would feel choked to offer costly treatment options to poor patients. All this confusion is the result of delegation of purchasing power of the Principal.
Many senior faculty members do also opine that putting the Chair of Principal out of other administrative powers is expected to create a mess of things. Even subordinate staff of principal like the Private Secretary/PA/ Sectional Officers / Accounts section and likes may not respect the honor and respect of the chair.
It is true that two minds are better than one. But the same is true if these minds are made to work together, in case these minds are planned to work in two directions a chaos and confusion is in making.
In Medical Colleges and Associated Hospitals we have Heads of Departments and under them work Heads of Units. Every Head of Department and Head of Unit looks after work and conduct of some faculty members and paramedical staff.
Being professionals, junior faculty respect and adhere to guidelines of Head of Department or Head of Unit and till date the same is true about paramedical staff.
Now that paramedical staff will be under Administrators and their transfer/promotions etc. will not be handled by principals who would deal with individual cases after taking Head of Department into confidence and taking account of his/her comments.
Delegation of powers of principal is in reality delegation of powers of Heads of Departments and Heads of Units. Lacking full control on paramedical staff will definitely lead to a routine crisis where patient care will get affected to the worst.
It is true that Head of Department and Head of Units create a family-like team of faculty and paramedics and that is the reason that 90% of employees whether paramedics or faculty never go for even due leaves. Sensing administrative apathy of Principal/Head of Department/Head of Unit a minimum of 10% paramedical staff will take undue advantage and it will be administratively very difficult to handle them sensing division of fixing responsibility.
Fixing of responsibility would lead to better outcomes in an educated society but this arrangement is expected to fail in a setup where work culture is suffering because of ours being an uneducated society. Giving power to the educated will pave a way for his/her better performance and giving power to the un- educated is apt to derail the delinquent in a crisis.
Tomorrow I enter the theater or ward to see my technician is transferred, and another technician from another department is joining. Not to talk of me, my Principal may not be able to stop any undesired transfer. A bureaucrat may not understand the importance of taking into account the expertise of a particular employee. It will lead to two types of crises.
Number one is that inter departmental discipline will get detailed and subordinate staff will not fully comply with Head of Department, seeing that even Principal will not be able to transfer him or her not to talk of Head of Department, definitely this will harm patient care to dismal outcome.
The second outcome of this unwanted transfer of my technician will be suffering of patient care through losing the expertise of my trained staff that too unexpectedly. Means that confusion is expected in routine work. When a head of Department tackles a staff member it is always a heart to heart affair and that is the reason that more than 90 percent employees never avail even the due leaves and gazetted holidays not to talk of unauthorized absence.
Administrative officers will not be taking ward rounds and can’t enter the ICCU and Theater hence can’t understand the pain of the patient. In these areas and even outside these areas maintenance of cleanliness needs a routine check by the Head of Department and Medical Superintendent who can reprimand an employee for dereliction of duty. Same is not expected now, as the subordinate staff knows limitations of powers of Head of Department/Principal etc.
Taking a routine round of twenty wards of SMHS hospital, super specialty and various departments of GMC alone may not be possible for the administrators not to talk of taking round of all associated hospitals. This will lead to a dismal outcome on work culture presently maintained by Heads of Departments and Medical Superintendent on their own. I’m sure this decision will put both the Head of Department as well as the Medical Superintendent in a compromised administrative situation. Result will be the worst patient care.
With so called delegation of powers which in actuality is decreasing the administrative authority of principal the very concept of deputing administrative officers as help will get lost and will backfire. I suggest working with both Principal and Administrators in such a cohesive manner that interests of institutions and patient care cum academics are not played with. It is good to define powers of both chairs but the same must not be divided. It is true that accountability can be fixed when responsibilities are defined but not divided.
Working in union for betterment of institutions must be the goal of every Principal and Administrators. Principals being technocrats are always expected to focus on patient care and academics and help from bureaucracy in administrative matters will continue to play a pivotal role in uplifting the level of care provided, whereas working as separate powers will lead to contrary results not welcome by any conscious heart.
So as to frame a policy on this vital issue I request for taking into account views of at least Heads of Departments and Heads of Units and Medical Superintendents who are at the helm of affairs. As discussed with many faculty members and paramedical staff I have reached to a conclusion as presented below:
Government must follow the recommendations of Dr. Y K Chawla committee constituted by Hon’ble High Court. This committee has already provided detailed recommendations for improving medical facilities in UT.
In case same is not financially possible as of now then:
1. Frame committees for separate functions like purchase committee headed by principal but must have administrator as member secretary and chief accounts officer as executive expert with various heads of departments as members on demand.
2. Frame selection committee for house surgeons and registrars with Principal as chairperson and registrar academics as member secretary and administrator as executive expert on various legal implications etc. and concerned head of department as member.
3. Departmental promotion committee must have both Administrator and Principal as equal weight age with Personal Officer and Administrative Officer and Senior Head of Department as members.
Same way many committee can be formed to care for all aspects of administrative work of institution so as better outcome in terms of inter and intra departmental discipline, better patient care and best academic goals are achieved with ease.
This will be a real constructive step in the direction of augmenting technocracy and beurocracy.
The author is Head of Department, Radiation Oncology, GMC Srinagar.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.