A committee of experts earlier constituted to assess improvement in medical facilities, in its report, has recommended reforms in health care, medical education in medical colleges and hospitals across Kashmir.
The committee was headed by Prof Y.K. Chawla, Former Director, PGI, Chandigarh. Prof Showkat Ali Zargar, Former Director, SKIMS, Srinagar, Prof Kaisar Ahmad, Former Principal, Government Medical College (GMC), Srinagar, Prof Ravi Gupta- Medical Superintendent, GMCH, Chandigarh (now retired) were the members of the committee.
In March and August, last year, the committee visited GMC Baramulla, GMC Srinagar and its associated hospitals, GMC Anantnag, Trauma Center Qazigund, SKIMS Medical College Bemina, Sher-i-Kashmir Institute of Medical Sciences Srinagar (SKIMS), Soura.
Initially, the heads of these institutions in a presentation highlighted the strengths and deficiencies in terms of human resources, infrastructure, and bio-medical equipment before the committee. It was followed by an interaction between faculty and the committee members and thereafter the committee members visited emergency services, laboratory facilities, intensive care units (ICUs), wards besides other facilities and areas. Based on this, the committee had given the following recommendations:
The committee said principals in Medical Colleges constitute the vital link between hospital, college, and government and is overall in charge to ensure the smooth and efficient running of the college and hospitals in terms of patient care, academics, and research.
The committee felt that several deficiencies hampered the smooth day-to-day functioning of college and hospital and observed that the rules for Principals which were framed decades back, seem to be outdated now.
Administrative & financial powers
At SKIMS Soura, the director has administrative and financial powers for efficient, speedy, and smooth functioning.
He works under the supervision of various High Powered Committees such as Junior and Senior Selection Committees (for recruitment of non-gazetted personnel), Apical Selection Committee (for recruitment of faculty), Academic Committee (to sort out academic issues) and Standing Finance Committee (for financial issues).
The committee observed that this system has proved highly successful and efficient for the smooth and efficient functioning of not only SKIMS Soura but also in all medical institutions of the National Importance in the country. The committee feels strongly such a system should be adopted in all the Medical Colleges of UT.
It has no financial implications but will bring a paradigm shift in the progress and functioning of these colleges and hospital. The principal should be given substantial financial powers that can be audited, so that small issues are not kept pending.
Tenure of principals
Currently, a principal of a medical college has no fixed tenure but continues till superannuation from the service. It has been observed that their stay is usually 1 to 2 years.
The principal needs adequate time to settle, review and set immediate and long-term goals. Therefore, the tenure of a principal should be 4-5 years as is prevalent in SKIMS, Soura and other institutions of national importance in the country.
Selection of principal
The expert committee observed that currently the principal of a medical college is selected based on seniority. However, the committee should select a principal not only on basis of seniority but also suitability.
Among eligible candidates (based on seniority), suitability should be assessed based on research, academic credentials, team leadership and vision.
This exercise should be carried out by High Powered Committee which should have members of eminence from the medical fraternity of J&K and from the country.
The selection should be from an open competition preferably from J&K UT, but if not available a person with best credentials should be chosen from the country.
The selection process should be initiated 4-6 months before the tenure of the sitting principal ends so that there remains no scope for ad-hoc arrangement.
Creation of hospital administration departments in all medical colleges
The committee observed that Medical and Deputy Superintendents are important administrators for ensuring the smooth running of patient care in the hospital.
It noted that all newly created Medical Colleges have Medical and Deputy Medical Superintendents who are Medical Officers with no training in Hospital Administration.
In view of the shortage of qualified Hospital Administration in the UT of J&K the post of MS should be filled through an open advertisement. Candidates should be from across the country so that the best candidates are selected.
SKIMS - only medical school having Hospital Administration Department, MD course in same
SKIMS Soura is the only medical school that has a Department of Hospital Administration and has MD course in Hospital Administration. Such a course should be immediately started in Government Medical College Srinagar to fulfill the needs of new medical colleges.
The posts of one Medical Superintendent and two Deputy Medical Superintendents in each newly created Medical College should be established.
The committee found that faculty in all institutions is well qualified, experienced and competent with great interest in patient care, academics and research.
It noted that the majority of departments are understaffed. The faculty positions are vacant for many years which should be filled immediately.
The committee found that one of the major causes of these vacancies was litigation due to seniority issues, qualification issues etc. which are all due to old improper rules.
This is also due to different entry-level into the faculty. Our suggestion is that the courts could expedite such litigations in any manner that they deem fit.
The infrastructure in the Associated Hospitals of Govt. Medical Colleges has expanded to a great extent. The expansion of healthcare facilities during the COVID pandemic is evidenced by addition of oxygen-supported beds, ICU beds and beds with ventilator support have been doubled within no time but the manpower has not increased proportionately, as a result thereof the quality of the work is suffering.
Increment in beds is taking place at a faster pace than the sanctioned manpower. The requirement of the manpower for ICUs is almost 2 to 3 times the requirement for a general bed.
Need of manpower audit
It said that an urgent need of manpower audit in light of increase in various activities and infrastructure in the Govt. Medical Colleges and healthcare institutions and vacancies identified. This needs to be compared with the actual requirement as per the State/National MCI recommendation.
Faculty issues in new medical colleges:
In newly created Medical Colleges such as GMC Baramulla and Anantnag, the faculty has been drawn from respective District Hospitals and Medical Education Department with different pay structures and inappropriate qualifications.
The faculty drawn from erstwhile hospitals are underpaid and uncertain of their future and it has resulted in a lot of heartburn between faculties.
The government has to take the final decision about their amalgamation into the college on a regular basis or otherwise.
It was found that some super specialists were posted in hospitals without their specialty. In PHCs specialties like surgeons and Anesthetists were posted where no facilities for their work existed (e.g. OT table/light).
At present, faculty recruitment for colleges is done through the Public Service Commission (PSC) which because of the huge burden of work cannot make timely recruitments.
The committee strongly recommends that recruitment of faculty in medical colleges should be outside the preview of the PSC and the High-Level Selection Committee should be authorized to make selections.
Such a practice exists in various other states and UTs including SKIMS Soura (by Apical Selection Committee). Each of the colleges should have its own Selection Committee. This system will ensure timely and speedy recruitment. The recruitment process is also slow and vacancies have piled up over the years.
Pay scale, other incentives
The committee said that the salary scale of the faculty of the college is not adequate at all. It should be at par with the salary scale of the faculty of PGI Chandigarh/AIIMS Delhi. Low pay scale affects patient care and forces them to resort to private practice. The committee recommended:
1. Additional incentives in the form of monetary benefits should be given to faculty working in the Medical Colleges of Anantnag and Baramulla to attract talented faculty.
2. To stimulate the interest of faculty in academics, research and patient care, the following additional incentives must be considered.
o Academic allowances to cover the cost of books, computers, journal subscriptions, and subscriptions to academic societies.
o Academic leave and conference allowance to attend 2 National and 1 International conference per year if they have to present their research paper or for attending the workshop.
o Sabbatical leave for higher learning and experience in good hospitals abroad- which would help the faculty economically.
The committee observed that the present system of promotional avenues for the faculty has resulted in stagnation and the same doctor stagnates for a longer time on the same post. The situation is worse for the post of Medical Superintendent in Associated Hospitals of colleges.
The present system is responsible for unrest and a high degree of dissatisfaction in the faculty and in Hospital Administration personnel.
The committee suggests the implementation of the Assured Merit Promotion (AMP) scheme as is done in SKIMS Soura, PGI Chandigarh/AIIMS Delhi and other national institutes. This system prevents stagnation and unrest in faculty.
It also addresses the recognition issues of the MCI. This time-bound promotion scheme is based on an interview by the selection committee looking into eligibility, suitability and due credence is given to participation in academics and published research.
Skill development programs
Faculty should be encouraged to participate in workshops to enhance their interventional and surgical skills. Also, experts from National Institutes should be regularly invited to enhance the academic, research, and patient care activities of the faculty. The faculty should also be sent to INI to develop and upgrade knowledge of their specialty.
ALS, BLS certificate courses
Certification courses for Basic and Advanced Life Support courses should be made mandatory for all doctors. Even BLS courses should be undertaken for all nurses, nursing aides and other non-gazetted staff within 3 months of joining.
It will enable to carry out Cardiopulmonary Resuscitation (CPR) at a community level or even at their home in case of emergency to save precious lives. Increments in pay should be based on the CPR training done. It also raises the self-worth of all trained individuals.
Faculty training in research methodology and faculty development
Faculty should be trained in Research Methodology and Faculty Development. The post of lecturers should be abolished and the entry post should be Assistant Professor as is present in SKIMS Soura, PGI Chandigarh and AIIMS Delhi, and other National Institutes. There is a 3 tier promotion system as prescribed by MCI in all institutes and colleges of the country and 4 tier system as in INI.
The present working hours between 10 a.m. to 4 p.m. is quite inadequate and all medical schools of the UT should adopt working hours of 8 a.m. to 5 p.m. with half working day on Saturday as is in PGI Chandigarh/AIIMS Delhi and other National Institutes.
The committee said that this can be achieved if the Jammu and Kashmir Government agrees in principle to revise the pay structure and academic incentives for the faculty.
Connect GMCs with national institutes
All medical colleges should be connected with national institutes of importance via telemedicine for academic activities. This will allow valuable mentorship between colleges and national institutes. Similarly, SKIMS and GMC Srinagar should provide mentorship to new GMCs in Kashmir division.
The committee said that a mortality audit should be done by all departments to find out the deficiencies in management in each patient's death. This is a great learning exercise so mistakes are not repeated and patient management is improved in the hospitals.
Security system in hospitals in mess
The committee observed that the security system of all hospitals is in a mess. This results in a high risk of attendants and visitors creating chaos and vulnerability of the staff to physical manhandling. An efficient and well-trained force needs to be created for the security of hospital equipment, infrastructure and personnel.