LEADERSHIP & MANAGEMENT IN HEALTH

The Hospital Administrator

Dr. Douglas Lungu, Malawi

My name is Douglas Lungu. I work for the Daeyang Luke Hospital. I’m a doctor. I specialize in
general surgery.

One of the major resources that we deal with in Malawi, especially in the health sector, is
human resources, which is in very short supply. We don’t have enough nurses; we don’t have
enough doctors.

We just started a hospital three years ago and we had to recruit everyone from...you know,
whoever was there. We were looking for very good people, because we wanted a very good
hospital. But our idea of what a good hospital should be and what the people that we found
were quite different, and that was partly of experience, they haven’t experienced anything
different and also the way they have been trained. The training in Malawi in terms of medical
education, medicine, or nursing, is super, it’s quite good, it’s better than a lot of countries.
Might be better than the United States.

But it’s the ability to take that and use it that has been the problem, because there hasn’t been
much opportunity to use that information, to use that knowledge and so on. The hospital I work
with, we have a lot of people from abroad. We have some Koreans and some Americans, and
there was always the impression, we need to be perfect, we need to make it perfect, we need
to get it done properly. Basically, it meant that if the people couldn’t do it, these are not the
right people; we need to go and find other people.

It was quite a struggle to...actually, there’s no other people out there, and it’s quite difficult to
explain that. But also, they were comparing us, they were comparing the hospital that has only
been in existence for three years with hospitals that have been in existence for years and years.
Sometimes a hundred years or something like that. And they had a chance to train their people.
They have just to create a culture to have a chance of an environment that is consistent and the
people have been there long enough. To try and persuade everybody to say, listen, it’s our job
to train the people that we have in the best possible way and to make sure that they come
through at the other end and to be able to accept that some people will learn faster than
others.

But it also meant that you are all the time having some degree of frustration as to...you know
what you can do and you are not there yet. Also, sometimes you may find that people that you
know for sure, that they are going completely off of course and you afterwards say, no, these
people you have to let go.

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In our organization it became quite clear that every time that we have to ask someone to leave,
which wasn’t many times, it was because we as the leaders, we are the people that are running
the place have actually failed to teach these people to be what we would like them to be.
Because each one of the people that came to work for us had a genuine desire to do well.

As a young person I was quite an idealist. I knew we could do this, and everything was possible,
everything in the shortest time possible. I think, over the years you realize that all things are
possible but maybe in the time scale that you are looking at. Also, that there are other ideas out
there that other people can contribute. One of the things that I came to realize was that if you
know what you want to do, usually it is not always that you know how. If you present that to
other people, they may want to do it in a different way and it is better for you to let go and say,
I’ll allow this. This is something that can be quite traumatic.

Commitment is very important. You have to be committed to what you are doing. Commitment
also means that people know that this is important, and I always emphasize that if it is
important then everybody has to know that it is important, and you have to treat it as
important. I always tell people that 70% of what we do is a show, you know that we’ll make
30% work.

I always take an example of theatre, if you go to theatre everything changes. I’m a surgeon so it
may be difficult to understand, but as a surgeon you go into theatre and you have to change
your clothes, you change your dressing. Your language changes, and then you do things...half of
the things actually don’t make much difference to what you are doing. It just increases
what...that futuristic atmosphere that you have created, but it reminds everybody that this is
not the same as outside and therefore they treat...they behave differently, and they
concentrate differently and things like that.

And since I was the Director of Clinical Services, I’ve always been wearing a tie. I actually didn’t
like ties very much. As a manager, I always try very hard every morning to dress up neatly and
go to work as neatly, because that to me, you know, expresses how important my workplace is.
I think what I’m going to say now, and my wife would disagree with me completely, but I...yeah,
I think I’m probably one of the few people that would consider myself in danger of actually
burning out in the sense that when I do my work, I start very early, I end late, and sometimes I
have to go back in the middle of the night and so on. Commitment and overworking I would
think they are two different things. The way I look at it, is to have a single mind to a particular
task. How you go about doing it, is where the burning out comes in.

So, if you are committed to a particular task, you have a single mind to that task, this is a task
that I’ve been put here to do. Having done that, you have expressed your commitment. Now
you need to demonstrate that commitment and some people demonstrate that by
continuously just doing that thing. I think that is just a manifestation of that commitment, and
that may not be the best manifestation of the particular commitment. Because if you burn out,
then that thing that you are committed to is not going to continue. You’re gonna lose that.

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And also, if you consider that one of the things that I try and say, is that, in that commitment
you should never be necessary. If you become necessary, something has gone wrong. I don’t
know whether that makes sense, but if you are committed to something, then you need to
recruit as many people to that commitment as you can, because that thing has to continue, that
thing must be bigger than you. And if it’s bigger than you, you will not find yourself in this burn
out situation. You’re not going to find yourself being the very same one holding everything just
to keep it going.

So, commitment would require that you recruit other people to that commitment. You make
other people committed too. Our hospital that is now going for three years...but two years
down the line we did an audit. Somebody came and did an audit. We didn’t come out very well.
The accounts were not so particularly great, and not because we had defrauded the accounts, I
would say that of course, but because our accounting system just didn’t work very well. Some
of the processes...or the standard operating procedures were not fully placed. And that was
very discouraging to the whole management, especially me, it was my responsibility to look at
that. It was quite a point when I felt, maybe this is not a place I need to be, if we can mess up
like this. But, the way I tended to look at it was to say, what else have we done? Have we done
something good in this process? And is that completely at grips by what the failure is?

And therefore to be able to say, ok, I need to concentrate on what the good we’ve done and
then in that way, let’s see how we can correct this. Because if we have done something good,
that means there’s some good in us that can also correct the problem that we had. So, we were
able to look at the accounts. We were able to see what the problems were and we were able to
say, listen, we have a bigger job to do. This is a means to an end, and the end still exists. So, we
need to deal with the problem.

If there is a failure, I acknowledge it. Many people that have visited our hospital say, oh, but
you don’t have this, you don’t have that, and I say, yes, that’s my responsibility and I haven’t
done it. I need to do it. And they’ll take that. Therefore, I try not to blame someone else for it.
People might be responsible for certain bits and pieces of it, and of course I need to correct
that.

But the ultimate responsibility is mine and having accepted that this hasn’t gone very well, it is
my responsibility to correct it. But taking responsibility and then feeling guilty about it, are two
different things, I would think. And if it came to the point of them saying, listen Dr Lungu, you
are responsible for this and for this, I’ll have to take that consequence. But for me to be
despondent about it and frustrated and feel guilty, that’s not something that I would dwell on
for too long.

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