INTERNAL MANAGEMENT OF HOSPITALS IN THE GHANA HEALTH SERVICE (GHS)

Question 1

Introduction

Answer 1

The Ghana Health Service was established by the Ghana Health
Service And Teaching Hospitals Act 1996 (Act 525)
• Divided into levels • National
• Regional
• District
• Sub-district
• All these levels have different category of professionals managing them
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• s 1. Establishment of the Health Service
⎯ In accordance with article 190 of the Constitution there is
established the Health Service. • s 55. Scope of the Service
• The Health Service established by clause (1) of article 190 of the Constitution, shall not include persons employed by
v(a) teaching hospitals,
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v(b) hospitals, health stations, centres or clinics of
⎯ (i) the Security Services,
⎯ (ii) religious bodies or any other charitable institutions,
⎯ (iii) companies,
⎯ (iv) statutory corporations, and
⎯ (v) private organisations or individuals or a group of individuals

Question 2

GHS organogram of a district hospital

Answer 2

Slides

Question 3

CHAG ORGANOGRAM

Answer 3

CHAG ORGANOGRAM
• For CHAG, especially Catholic hospitals, the Medical Director, Nurse Manager and Administrator are at the same level (Tripartite system at the top of management)
• For Catholic hospitals, the admnistrator is often a Catholic Brother or Sister.

Question 4

CORE MANAGEMENT TEAM OF A TYPICAL DISTRICT HOSPITAL IN GHANA

Answer 4

CORE MANAGEMENT TEAM OF A TYPICAL DISTRICT HOSPITAL IN GHANA
1. Medical superintendent (director)—chairperson 2. Hospital administrator
3. Nurse manager
4. Head of pharmacy
5. Head of finance

Question 5

CORE MANAGEMENT TEAM OF A TYPICAL DISTRICT HOSPITAL IN GHANA
1. Medical superintendent (director)—chairperson 2. Hospital administrator
3. Nurse manager
4. Head of pharmacy
5. Head of finance

Answer 5

Medical superintendent (director)
• Usually a clinician, who should have both clinical and management skills • Head of the facility
• Spending officer
• Signitory to all hospital accounts
• Chairs management meetings, and many others
• Ultimately responsible for everything in the hospital
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• s 29. Medical superintendent of hospitals in the Service
⎯ (1) There shall be appointed for each hospital within the Service, a medical superintendent as the public officer in charge of the hospital with responsibility for ensuring the execution and implementation of the decisions of the Council in the hospital.
⎯ (3) In the temporary absence of a medical superintendent, the regional director may authorise a senior health personnel at the hospital to perform the functions of the medical superintendent.
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Nurse manager
• A nurse or midwife
• Responsible to the medical superintendent • Head of all aspects relating to nurses
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Hospital administrator
• Usually not a clinician
• Has qualification in health service administration • Responsible to the medical superintendent
• Head of all non-clinical aspects of the hospital
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• s 30. Hospital administrator
⎯ (1) There shall be appointed for each hospital within the
Service, a hospital administrator.
⎯ (2) A hospital administrator is responsible for the day to day administration of the hospital and is in the performance of functions, answerable to the medical superintendent.
⎯ (3) A hospital administrator shall hold office on the terms and conditions specified in the letter of appointment.
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Head of pharmacy
• Usually a pharmacist
• Responsible to the medical superintendent • Head of pharmacy
Head of finance
• Usually an accountant
• Responsible to the medical superintendent
• Heads the finance/accounts and everything relating to money in the hospital

Question 6

HOSPITAL HOUSE MANAGEMENT COMMITTEE ESTABLISHED BY ACT 525

Answer 6

HOSPITAL HOUSE MANAGEMENT COMMITTEE ESTABLISHED BY ACT 525
• s 31. Hospital house management committees
• (1) There shall be appointed in each hospital within the Service a
hospital house management committee.
• (2) A hospital management committee shall consist of
⎯ (a) the medical superintendent in charge of the hospital as the chairman,
⎯ (b) the hospital administrator,
⎯ (c) the heads of clinical units where applicable,
⎯ (d) the head of nursing services,
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⎯ (e) the head of pharmacy,
⎯ (f) the head of finance, and
⎯ (g) two representatives of the Health Workers’ Union who shall hold office for a period of three years subject to renewal.
• (3) A hospital management committee shall
⎯ (a) explain policies and directives of the Council to the employees of the hospital;
⎯ (b) develop measures to promote the co-ordination of activities of the units, of the hospital; and
⎯ (c) assist with the administration and management of the hospital

Question 7

HEALTH STATION MANAGEMENT COMMITTEE

Answer 7

HEALTH STATION MANAGEMENT COMMITTEE
• s 32. Health station management committees
• (1) There shall be appointed in each health station within the Service a health station management committee composed of
⎯ (a) the head of the health station as the chairman,
⎯ (b) two other health personnel of the Service in the area of the
health station,
⎯ (c) another employee of the Service at the station who is not a health personnel, and
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⎯ (d) two representatives from the communities in the subdistrict area in which the health station is situated nominated by the District Assembly of the area.
• (2) A health station management committee shall
⎯ (a) explain the policies of the Council to the other employees of the station; and
⎯ (b) assist the head of the health station in the effective performance of functions.
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• s 57 defines the following: • “health station”—
⎯ means a central or local government-funded health post, health centre, health clinic or any other central or local government- funded medical station other than a hospital
• “hospital”—
⎯ includes a Government-funded hospital within the Service and a specialised institution
• “specialised institution”—
⎯ means health care facilities that manage specific diseases or health conditions such as a psychiatric hospital, leprosarium and cardio thoracic unit

Question 8

CLERICAL ACTIVITIES NORMALLY PERFORMED BY HEAD OF THE FACILITY

Answer 8

CLERICAL ACTIVITIES NORMALLY PERFORMED BY HEAD OF THE FACILITY
1. Dealing with correspondence—
• Paper correspondence should be properly sorted out
⎯ Incoming
⎯ Outgoing
⎯ Pending
⎯ Minuting on paper correspondence (documents)
2. Signing the minutes of meetings as chair
3. Approving and authorising payments to any body or organisation • Endorsement of PVs and cheques

Question 9

Minuting on paper documents

Answer 9

Slides

Minuting on paper documents
• Minuting on documents—
⎯ is the act of writing numbered notations on the face of a document that addressed to-dos to individuals within an organisation, and their responses until – ultimately – the document is “retired” to central records for retention/storage.

Question 10

MEETINGS

Answer 10

Slides

Core management meetings
• Called by Med. Sup
• Chaired by the Med. Sup
• Quorum— ?
• Voting— ?
• Attendance— Involves only core management members
• Frequency— ideally weekly, but may be held 2-weekly or monthly. There can be emergency meetings
• Content— everything concerning the hospital
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Extended management meetings
• Called by Med. Sup
• Chaired by the Med. Sup
• Quorum— ?
• Voting— ?
• Attendance— Involves core management members + others (unit heads, internal auditor, clinical coordinator )
• Frequency— regular meetings can be held quarterly, except in emergencies
• Content— usually things that concern and affect clinical practice, including management of the wards and units

Question 11

Entity tender committee meetings
(Public Procurement Act 2003 as amended)

Answer 11

Entity tender committee meetings
(Public Procurement Act 2003 as amended)
• Called and chaired by Med. Sup
• Quorum— chair + 3 others
• Voting— ?
• Attendance— Med. Sup, administrator, head of finance, clinical coordinator, Attorney-General’s representative, District Coordinating Council representative, head of procurement unit [secretary]
• Frequency— [s18: The tender committee shall meet at least once every quarter and notice of the meetings shall be given at least two weeks prior to the scheduled date of the meeting]
• Content— procurement matters

Question 12

Quality assurance (QA) committee meetings

Answer 12

Quality assurance (QA) committee meetings
• Called by QA head
• Chaired by QA head
• Quorum— ?
• Voting— ?
• Attendance— members of committee
• Frequency— regular meetings can be held monthly or quarterly, except in emergencies
• Content— usually things that concern and affect clinical practice

Question 13

Staff durbars

Answer 13

Staff durbars
• Called by administrator
• Chaired by med. Sup
• Quorum— ?
• Voting— ?
• Attendance— management and all staff
• Frequency— regular meetings can be held quarterly, except in emergencies
• Content— matters affecting all staff; welfare matters, etc

Question 14

Peer reviews

Answer 14

Peer reviews
• Conducted by peers from other hhospitals
• Intended to assess the the hospital’s facilities and clinical care • Marks are usually given to each hospital
• Performance is ranked
• May be held half yearly or yearly

Question 15

Performance reviews

Answer 15

Performance reviews
• Usually whole hospital clinical staff
• Chaired by med. Sup
• Reviews the perfomance of the hospital over a period, and profer solutions and remedies going forward
• Content—usually include review of indicators, morbidities, mortalities, etc

Question 16

CONDUCT OF MEETINGS

Answer 16

CONDUCT OF MEETINGS
A. Notice of meeting—published ahead of time
valid a notice must:
1.State the date, time and place of meeting.
2.State with sufficient fullness the purpose of the meeting.
3.Give notice of any special business to be conducted at the meeting.
4.Comply with any statutory and legal obligations.
5.Be clear, honest, unambiguous and definite.
6.Be issued on good authority.
7.Be given in the prescribed manner (hand, post, advertisement or other means).
8.Allow the appropriate length of time between service and the date of the meeting.
9.Be sent to every person entitled to receive it.
10.Comply in all respects with the regulations, rules or byelaws of the body issuing it.
• To be
⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯
⎯
⎯ ⎯
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B. Agendaofameeting
• The traditional order of business is on the following lines: • 1.Introduction of new members.
• 2.Apologies for absence.
• 3.Minutes of the previous meeting.
• 4.Correspondence.
• 5.Reports.
• 6.Important items of business of a non-recurring nature. • 7.Date of next meeting.
• 8.Any other business.
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C. Constitution of the Meeting
• A meeting will be properly constituted when, at an adequate venue, sufficient members are present to form a quorum and someone to control the meeting (i.e. a chair) has been duly appointed
D. Quorum
⎯ The word quorum denotes the number of members of any body of persons whose presence at a meeting is requisite in order that business may be validly transacted.
⎯ Where no number is specified, ??? Majority of members present 4-Feb-2022 34

E. Voting— a way of taking decisions at a meeting
F. Adjournment— is the act of postponing a meeting of any private or public body, or any business until another time, or indefinitely, in which case it is an adjournment sine die
⎯ in law, the adjourned meeting will form part of the originally convened meeting
G. Closing and signing of minutes by chair and the person who wrote the minutes
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Question 17

Drug and therapeutics committee (DTC) meetings

Answer 17

Drug and therapeutics committee (DTC) meetings
• Committee formed in the hospital to oversee clinical use of drugs and related matters
• Composition
⎯ Med. Sup or another appointed clinician— chairman ⎯ Physicians/clinician members
⎯ Pharmacy members—pharmacist as secretary
⎯ Nursing members
⎯ Administration representative ⎯ Other health professionals
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Role
• The DTC’s role is to make rational use of medicines more efficient
by:
⎯ evaluating the clinical use of pharmaceuticals,
⎯ developing the policies for managing medicine use and
administration, and
⎯ managing the formulary system
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• The main functions are—
1. Advisingmedical,administrative,andpharmacydepartmentson pharmaceutical related issues
2. Developing pharmaceutical policies and procedures
3. Evaluating and selecting medicines for the formulary and providing for its periodic revision
4. Identifying medicine use problems
5. Promoting and conducting effective interventions to improve medicine use (including educational, managerial, and regulatory methods)
6. ManagingADRsandmedicationerrors
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CONCLUSION
• The Ghana Health Service was established by the Ghana Health
Service And Teaching Hospitals Act 1996 (Act 525)
• The service is divided into four (4) levels, with each level having different composition of management members
• In a typical health facility in Ghana, different type of meetings are often held as part of the day-to-day menegement of the facility
• The conduct of meetings should follow a recognised format. Decisions of meetings may have relevant evidential value.
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