Planning a turnaround strategy
TOWER Psychiatric Hospital has been in the news for all the wrong reasons lately, with allegations of inhumane treatment of patients and poor management. Health Reporter caught up with newly appointed acting CEO Dr Luvuyo Bayeni about how he, in just thr
ST: What are the challenges faced by Tower Hospital?
LB:
The hospital is inundated with more media queries now than ever before, which at the time had indicated irregularities and challenges that showed up internal processes inadequacies. Apart from the genuineness of a number of the issues raised, there was an element of exaggeration which resulted in an added burden to the staff – and the department at large. However, we have since prioritised issues of infrastructure, patient care, patients’ rights and leadership.
ST: The health ombudsman has spent time in the Eastern Cape and Tower talking about problems faced by the institution. Are you in a position to share what the ombudsman uncovered during his visit as he had feared Tower could be another Life Esidimeni waiting to happen?
LB:
Yes, the ombudsman is attending to mental healthcare provision in the EC – not only at Tower. There are still supporting documents and statements being sought from both institutions and individuals who participated in the hearings. There is no report issued as yet.
ST: What can be done to prevent Tower from degenerating into another Life Esidimeni situation? LB:
The department has already acknowledged challenges and areas of intervention within Tower. My appointment here as acting CEO is but one of the interventions to address gaps with a commitment/ intention to avoid a “Life Esidimeni” replica.
ST: What is the capacity of the hospital and does your current staff complement meet the numbers stipulated in the organogram?
LB:
Currently, Tower is gazetted as a 400-bed hospital for long-term rehabilitation. The hospital now has 329 in-patients with 102 on leave of absence (LoA). There is a challenge in the staffing numbers across different categories, especially the clinical component. There are various contributing factors to this, ranging from funding to recruitment to being a rural hospital. Clinical staff do weigh up their options when choosing posts.
We then capitalise on the outreach and in-reach programmes that exists within the department, with an example of Fort England outreach.
ST: What is your turnaround plan for the hospital?
LB:
Mine is to enhance the current management systems and committees but with the introduction of better transparency, accountability, honesty, teamwork and optimism. The hospital has potential and my plan is to remind the staff and patients of that potential through a culture change of inclusivity and innovation. Tower Hospital is a true demonstration of a communal health system which needs to be understood and embraced by society. [I] will be prioritising stakeholder engagements and health education within Amathole and throughout the Eastern Cape. All of us have a role and responsibility in rendering quality care to mental healthcare Users. This starts with changing the mindset and language of everyone for them to know that we do not have “mad” patients, but mental health care users. Asinawo amageza, sinabantu abakhubazekileyo ngokwengqondo.
ST: What was wrong with the isolation wards?
LB:
There were no ablution facilities as the building was built way before the current regulations entailed in the Mental Healthcare Act (MHCA). The distance from the ongoing nursing activities was also noted as a concern. However, that has always been mitigated by the duty allocation of staff with routine rounds to the wards.
ST: During the renovations, where are the patients who ought to be there in isolation wards?
LB:
We have involved the clinical team to be part of the project as they are the ones who are responsible for issuing the orders on which patients should be isolated. Where there is an indication from them to isolate patients, a single room is identified. Where an isolation room does exist, a modified routine for nursing care is applied to ensure that patient ablution and safety needs are attended to.
ST: In which areas is the department excelling at Tower Hospital and how?
LB:
The rehabilitation programme does meet the expected standards. We have adult education and training (AET) programme, which has five teachers appointed to it by the department of education – as a collaborative effort. The programme includes computer literacy and participation in external examinations with good performance. We have a range of activities from gardening, car wash, carpentry, sewing and entrepreneurship through kiosk/ tuck shop management. The hospital has been embraced for staff development and extramural activities such as sport and entertainment.
ST: In which areas is the hospital failing?
LB:
We have experienced challenges with the discharges whereby the system had gaps, in a form of social readiness for some of the families. This has resulted in readmission of patients that were declared fit for discharge. There has been incidents of lack of implementation on standard operation procedures by staff which are immediately attended to by management on reporting.
ST: What is the situation with infrastructure?
LB:
The current building design and compliance are not in line with the current requirements. Alterations are constantly made to accommodate this, especially patients’ safety and rights with an example being security features of burglar gates and CCTV cameras. Courtyards spaces tend to limit the mobility of the patients in-between rehabilitation programmes.
WHO concerns are valid and in keeping with the revolving care that is being offered to mental healthcare patients. However, the department does make every effort to ensure that patients are safe at all times.
ST: When was Tower built and opened?
LB:
[The] hospital was established in 1894 but the current buildings were build 1981 with relocation completed in 1985. There still exists monumental structures from 1894 within the hospital premises.
ST: How old are the youngest and oldest patients and what is the longest stay?
LB:
The youngest is 19 years old and the oldest 92 years. The longest patient duration is from 1976 though not the eldest patient.
ST: Is there a need for another hospital like Tower in Eastern Cape?
LB:
There is no disputing the population size of the Eastern Cape and the need for a supplementary hospital.
In the same token though, there is an even serious need for educating the communities on how to handle mental health care users. The more the society still has a stigma and rejects these patients, the more they remain a state burden even though they have been fully rehabilitated.
ST: How many clinical staff members are there at Tower? LB:
There are three medical doctors, including the clinical manager. Currently, we are waiting for a medical officer and a fulltime psychiatrist. There are 12 allied healthcare workers consisting of pharmacists, pharmacy assistants, social workers, clinical psychologist and occupational therapists. Our clinical component is concluded by 187 nurses of all categories.