Response to Issues of Concern and Allegations made by the
Korle Bu Senior Staff Association [KOSSA] against the Chief Executive Officer and the Board Chairman of Korle Bu Teaching Hospital with respect to the management of the hospital
Korle Bu's Story from August 2014 to November 2015
The Chief Executive Officer [CEO], Dr. Gilbert Buckle, was appointed in August 2014 and assumed office in September the same year. The Board was also reconstituted in September 2014. The new CEO and Board met a situation characterized by an accumulated debt resulting in the acute and persistent shortages of medicines, non-drug consumables, and other critical inputs required to provide services. There was disunity and mis-trust between the central management and departmental management teams creating an environment of apathy and discontent among staff. In addition the hospital did not have a strategic plan that articulated the challenges it was facing and the needed interventions that would guide the growth and sustainable development of the hospital in a structured and progressive manner.
The first three months in office was spent understanding the depth of the situation. The next three months to embark on an organizational wide participatory process, involving all departmental heads and respective management teams, leadership of professional associations and Unions as well as respective senior and junior staff, in the design of interventions to address the current situation. This resulted in the development of the hospital Strategic Outcome Framework 2015 to 2017. This framework was Board approved in April and effective implementation across the hospital beginning in July 2015.
Over the past almost 16 months the focus of the central management team, led by the CEO, with the support of the Board has been primarily to improve leadership capacity in the hospital, create organizational alignment that will enable the management and administrative systems of the hospital to be strengthened. This was recognized as critical to the ability of the hospital to come out of the crises it was in and develop further. The current situation has improved significantly and reflects, effectively, five months of implementation of the strategic plan.
Sixteen months, though seemingly long, is a relatively short time in turning around an organization the size and complexity of the Korle Bu Teaching Hospital. It is appreciated that expectations for rapid improvement may exist, but the reality is that the transformation of Korle Bu Teaching Hospital will require patience, cooperation and the active participation of all stakeholders in the arduous and painful process of change that has began.
Chronology of Current Events Leading to this Publication
1. The CEO was informed on November 25th 2015, that KOSSA had placed notices in the hospital informing its members that a meeting would be held on Tuesday 1st December 2015. This was later postponed to Wednesday 9th.
2. The CEO contacted the KOSSA President on 26th November 2015, asking if there was any information or update on any issue concerning the hospital, which the CEO could support KOSSA with. The CEO additionally requested to be invited to the durbar to meet the KOSSA members and personally express his support for KOSSA. This was an opportunity to directly clarify matters of concern to KOSSA members. The President of KOSSA replied he would revert back.
3. On 30th November 2015, the CEO reminded the KOSSA President of the previous request, to which the KOSSA President responded that the meeting of Tuesday 1st December had been postponed to 9th December 2015. He also informed the CEO that it was a general meeting and not a durbar and that should the need arise KOSSA would not hesitate to invite the CEO. He further expressed his appreciation for the CEO's concern.
4. On Wednesday 9th December various media stations were reporting KOSSA was stating that the CEO, Dr. Gilbert Buckle and Board Chairman Prof. Anthony Mawuli Sallar were, in short, mismanaging Korle Bu Teaching Hospital in addition to other allegations against the CEO. The news account reported that KOSSA was meeting. Later news media reported that KOSSA had passed a vote of no confidence in the CEO and asked for his immediate resignation. Among other allegations made were the following; incurring a judgment debt of GHC 100 million, siphoning of funds, arrogance of the CEO. In addition the Board Chairman was accused of not taking action when he was presented with issues of concern in an Open Friendly Letter from KOSSA dated June 3rd 2015.
5. The hospital management met on Wednesday afternoon and discussed the allegations by KOSSA and its decision of vote of no confidence in the CEO and Board Chairman and request for the immediate resignation of the CEO.
6. The Board in a letter dated Thursday 10th December formally requested the President of KOSSA, to be accompanied by his executives, to meet the Board at an Emergency Board Meeting on Friday 12th December 2015 to formally present their allegations and issues of concern with the necessary evidence. The President of KOSSA replied in a letter on the same day that the Friday meeting was not convenient for the executives and they would find a more convenient day.
7. An Emergency Board meeting was held on Friday 12th December 2015, at which the CEO was asked to brief the Board on the situation as well as the allegations. This was done and the Board was satisfied and did not see any wrong doing as alleged. The Board decided that KOSSA should be asked to submit its issues and allegations with the necessary supporting evidence on Monday December 14th 2015 by 12noon to the Director of Administration, to enable the board act accordingly.
8. KOSSA rather than respond to the issues, decided in a letter dated December 11th 2015 and received at 11:35am on Monday 14th December that "because the issues concern the Board Chairman and CEO it will be wrong, unfair and unjust for them [Board Chairman and CEO] to be arbiters in the same allegations made against them. The Executives have therefore petitioned the Minister for Health to investigate into the allegations".
9. On Wednesday 16th December it was announced on Class FM 6 am news that Ghana Registered Nurses and Midwives Association, Korle Bu District, had written a petition to the Hon. Minister of Health raising similar concerns as KOSSA.
10. The Minister of Health, on 17th December 2015 has been sent an official update on the situation in the hospital resulting from the allegations made by KOSSA.
ALLEGATION OF INACTION OF BOARD CHAIRMAN TO LETTER HEADED 'FRIENDLY OPEN LETTER' FROM KOSSA
The Board Chairman responded to the letter, dated 3rd June 2015, by calling a meeting of the CEO and the KOSSA executives in his office at GIMPA to discuss the issues raised. It was explained that it was the position of the Board and management that as much as possible we should desist from paper communications if face-to-face discussions would address issues. This was to ensure corporate harmony and conducive working environment. He reiterated that only after verbal explanations have not been convincing then we could resort to paper correspondence in such matters.
The following were points raised in KOSSA's friendly letter and the responses emanating from the meeting.
1. KOSSA alleged illegal Increment in Management allowances:
KOSSA was made aware that the conditions of employment to the positions of Director and Deputy Director and management grades includes allowances as a percentage of their basic salaries. However in other categories of senior staff with management responsibilities, for example, Heads of departments, departmental accountants and administrators their compensation is a fixed allowance, which is not tied to their basic pay. This arrangement has been in place at KBTH prior to the coming of the CEO and the Board and there has been no change in the percentages.
2. Fund allocation to sub BMC's:
The 60%/40% fund allocation formula utilized by the hospital [60% revenue retained by departments and 40% by the central administration] has been found to be fundamentally flawed in that the allocation is done on gross revenue not the balance after expenditure on revenue.
In addition, the current prices of services rendered do not recover full cost of services provided. In general all sub BMCs are not breaking even creating funding gaps across the hospital. The hospital's debt portfolio is exceptionally high and needs, as a matter of priority, to be reduced as it is affecting the hospital's ability to secure supplies from vendors who we are indebted to. This situation accounts for the erratic minimal amounts of funds disbursed to the sub BMCs.
3. Financing the CEO, Directors and Deputy Directors and their family's health care
KOSSA indicated that at present current benefits for the CEO, Directors and Deputy Directors included health benefits for themselves their spouse and 4 dependents under 18years and the staff had nothing. KOSSA was informed that the new Board since coming into office had insisted on having medical benefits for all workers as well as Provident Fund and the Board has put the processes into motion that this benefit is rolled out. KOSSA was further informed that similar conditions of service benefits for all workers have been in discussion at both the National level (at the Ministry of Health) and hospital level. The national discussions have been concluded resulting in the document Framework for conditions of service for Public Service health workers. The hospital is also concluding how it is going to implement these benefits (including health care) detailed in the Sector conditions of service.
KOSSA was further informed that it is erroneous to conclude that because staff of Korle Bu currently pays for their cost of health care services they access in the hospital, it is that money that is used to pay for health care for the CEO, Directors and Deputy Directors and their families.
4. Policy on staff health refunds
KOSSA was informed that this benefit was directly related to conditions of service, in particular to health benefits. Until discussions on the conditions of service are concluded, there has been no policy on this. The previous discretionary approach approving staff refunds for health expenses has been suspended till the benefit package was defined. The current administration prefers a policy framework under which all workers are treated rather than the discretionary approval method that might not be uniform across the board. It is important to note that work on general conditions of service and health benefits in particular has been a priority of management and the Board and it's pace has been determined by the national pace of development of the sector conditions of service.
KOSSA in discussion mentioned that one director's son, after medical assessment in Korle Bu, was requested to send his ward abroad for care. KOSSA was informed that, care for his ward was part of the Director's condition of service and the Hospital has no choice but honor it. Similarly the same benefit was extended to a staff that sustained an injury in the line of duty and required care abroad. This staff was sent to South Africa for care, with all costs borne by the hospital. The care abroad was informed by similar request by Korle Bu doctors.
5. CEO's Conditions of Service
KOSSA was informed that the conditions of service of the new CEO are informed by his fixed term, negotiated service contract of 2 years duration. Due process was followed with the Public Service Commission [PSC] interviewing him, and the Board confirming his appointment in consultation with the PSC.
6. Disrespect and lack of consideration of staff
KOSSA has been requested to clearly explain and offer incidents that are informing its opinion that the CEO in particular and management in general are disrespectful and inconsiderate of staff.
KOSSA further intimated that there was 'High Tempers and Tensions' in the hospital. They were asked to provide management with information as to what was informing this opinion. KOSSA could not concretize anything in particular
7. CEO taking leave and being absent from the implementation of "major events"
KOSSA was informed that the procedure for the CEO taking entitled leave or being absent from the hospital for official reasons does not include putting notices around or informing all staff of the hospital directly. The procedure is that the CEO seeks approval from the Board with the Minister of Health in copy. In addition the CEO notifies the various Directors and Heads of Departments. The CEO has done this anytime he has to travel. The CEO is not expected to be present at all times but rather make provision for the effective and smooth operations of the hospital in his absence. This was done.
RESPONSE TO PETITION ON HEALTH STATUS OF A STAFF
On 8th September the CEO received a copy of letter dated the same day addressed to the Board Chairman. The content of the letter was with respect to a staff of the hospital, suffering from a chronic health condition. The cost of the staff's health care was being partly borne by the hospital, upon instructions of previous Chief Executives. On assumption of office, the current CEO noted that there were many claims for the re-imbursement of health cost by staff. Further inquiries into the situation brought to the fore that there was no policy or guideline in the hospital supporting these re-imbursements. The CEO instructed that all such re-imbursements be stopped till the entire issue of staff health benefits was resolved.
This decision was without prejudice to the individual. This person had, on previous occasions, approached the CEO and the Director of Administration. Difficult as it was, it was explained to her the hospital's position, making it clear that the decision was not an action taken against her personally.
It is important to note that KOSSA did not present this petition to management but directly to the Board and copied it widely. The petition also included threats by KOSSA to embark upon repeated demonstrations in the hospital, until their request was granted. The Board instructed the CEO to meet with KOSSA, address the situation and report back. KOSSA was unable to make itself available as requested and did not indicate an intention to do so. The hospital management then had to inform the District Police Office of the threat made to the peace of the hospital and requested them to remain vigilant. A meeting with KOSSA was eventually held, after this, at which the circumstances surrounding the staff were explained.
RESPONSE TO RECENT ALLEGATIONS PRESENTED IN THE MEDIA
There have been various media reports from 9th to 18th December 2015. These reports have been on interviews granted by the President of KOSSA and some of the members as well as on a petition from the Ghana Registered Nurses and Midwives Association [GRNMA], Korle Bu District to the Minister of Health.
The following allegations have been gleaned from these reports, since KOSSA and GRNMA have not made a formal submission of their concerns and allegations to management or the Board.
1. Payment of Judgment Debts amounting to GHC 100,000,000.00
There has been no judgment debt accrued to the hospital due to acts, commissions or decisions of the CEO or the new Board since coming into office, in September 2014. A judgment debt of GHC 875,809.53 had been incurred by the hospital from August 2011 to June 2014. Out of this mount GHC 250,304.16 has been paid in 2015 as at August 2015.
2. Hospital funding of travels of the CEO
There has been no personal travel of the CEO funded by the hospital. Since coming into office the CEO has embarked on four approved official travels as follows:
a. Travel to Chicago November 2014 at the invitation of General Electric [GE] to attend the RSNA Conference. GE funded this and travel allowances due to the CEO were paid for by the hospital.
b. Travel to Atlanta May 2015 at the invitation of the Ghana Physician and Surgeons Foundation USA. The opportunity was also used to visit USAID in Washington and JSI Deliver head offices as well since a partnership was being developed for JSI Deliver to support KBTH in the improvement of its Supply Chain Management Systems. This was jointly funded by the Foundation and USAID and travel allowances due the CEO were paid for by the hospital.
c. Travel to India November 2015 on the invitation of the Indian High Commission. The Indian Government funded this and travel allowances due the CEO were paid for by the hospital.
d. Travel to Taiwan November 2015 at the invitation of Taichung Hospital and the Ministry of Health and Social Welfare of Taiwan. The Taichung Hospital and the Ministry of Health and Social Welfare of Taiwan funded this, travel allowances due the CEO was paid for by the hospital.
For all these travels of the CEO, Board permission was secured and the Minister of Health informed as required.
3. Two cars given to directors
Upon assumption of office of the CEO and the Board, we inherited a situation in which the hospital had procured an Audi A6 as the official vehicle of the Chief Executive Officer and nine [9] VW Passat's as the official vehicles for the use of Directors and Deputy Directors at the central administration.
The Audi A6 was valued at the time, to enable a decision to be made if it was cost effective to sell it to purchase a less expensive and more operationally economic vehicle to replace. The State Transport Corporation and the vendor, Stallion Motors were requested to re-value the vehicle. Both valuation reports indicated that the vehicle had depreciated and a forced sale would value would further reduce the value of the Audi A6 if sold. The Board upon review of the respective reports decided that selling of the Audi A6 would cause additional financial loss to the hospital. In consultation with the Ministry of Health and with the approval of the Board it was decided not to sell the Audi A6.
The Ministry of Health directed that since the hospital did not secure permission to use its IGF to purchase the Passats, all the beneficiaries were to either pay for it themselves or return it to the Ministry of Health. All the beneficiaries opted to purchase the vehicles and a have done so. This covered seven of the vehicles. The remaining two vehicles were assigned to the two new Directors of Finance and Medical Affairs respectively as their duty posts vehicles. The amounts paid against the vehicles by the hospital are being recovered.
4. Financial mis-management and siphoning of hospital funds
The hospital has traditionally not been recovering costs. In 2014, immediately on assuming office, the CEO with Board approval, requested for and secured parliamentary approval to increase the hospital's fees and charges by an average of approximately 150% for the year 2015. The approved rates were introduced in June 2015.
The introduction of prudent fiscal measures, which included the streamlining of revenue collection and blocking revenue leakages, has led to the realization of GHC 1.1 million. In addition to the introduction of the new fees and charges in June 2015 the debt profile has significantly reduced as illustrated in the table below:
Debtors
Amounts due as at July 2015
Amount paid as at November 2015
% Debt reduction
1
Suppliers
6,275,202.83
5,394,210.00
86%
2
Staff Allowance [fuel and vehicle maintenance]
2,413,590.00
594,447.00
25%
5. Shortages of laboratory reagents, consumables and medicines
At the beginning of the year the hospital was experiencing acute severe shortages in medicines and non-drug consumables due to the inability of the hospital to pay its suppliers. Medicines availability was less than 40% in the hospital and practically every month there was one or the other non-drug consumables out of stock requiring emergency purchases. As at November ending 2015 medicine availability was between 60% and 70% and the frequency of stock outs of non-drug consumables has significantly reduced.
6. Payment of bonuses to CEO and Board Chairman
There has been no payment of bonuses to the CEO or Board Chairman.
7. Staff Medicare
A committee has been established to finalize proposals to start a hospital Medicare scheme for staff in 2016. This is in line with the effective date of commencement of the health sector conditions of service. The committee has completed its work and submitted its proposal in November 2015 to management for onward submission to the Board for approval. In the meantime all employees have been asked to provide a list of up to four dependants less than 18 years of age, plus a spouse, in preparation for the implementation of the staff health scheme in early 2016. This scheme is in addition to staff registration with the NHIA. The President of KOSSA is a member of this committee.
8. GHC 100.00 as 2015 Christmas Bonus
The hospital is not paying out Christmas bonus to staff. It is rather the maximum to be spent per staff in lieu of a Christmas party for staff [approximately 5500 staff]. It was agreed that this amount may be used in various ways including:
a. Use it all to have a party for staff
b. Give the total amount as cash to staff
c. Use it to purchase items to be given to staff to take home
d. Or a mix of b, and c
The total financial commitment for this, discussed with and approved by the Board, is approximately GHC 560, 000.00.
9. Bias towards Audit Reports
KOSSA has requested for copies of Audit reports of the hospital. At time of these requests the reports were draft reports. In line with professional audit practice, draft audit reports are not public documents since the auditee has not been given the chance to respond to the draft findings. Until they are finalized and issued by the appropriate authority it would be inappropriate and prejudicial to release draft audit reports to the public, KOSSA including. In the case of the hospital's audit reports, this would be the Audit Service of Ghana.
10. Victimization
The Executives of KOSSA were requested, in line with due process, to formally present their concerns and allegations, with the necessary evidence to the Board to enable the Board initiate the appropriate process to investigate and act accordingly. KOSSA has declined on two different occasions to meet the Board and present its concerns with the necessary supporting evidence.
This adherence to due process has been described by KOSSA as victimization
11. Other allegations.
Many other allegations are still being reported on the airwaves and other media platforms. These are being listed and will be responded to, if and when appropriate. It is important to note that in all this KOSSA has not made a formal submission of their concerns and allegations and continue to decline to meet the Board.
The Board and Management of Korle Bu Teaching Hospital wish to assure the Government and people of Ghana and all our esteemed clients [national and international] that the provision continuous quality services in a sustainable manner remain the primary focus of the Board and Management.
Issued by Board and Management
of Korle Bu Teaching Hospital
21st December 2015
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