Iryna Lytovchenko: "Okhmatdyt needs a chief physician who will not only fight corruption, but also change the institution’s philosophy."

The tender commission of the Ministry of Health (MOH) will soon search for the second time the chief physician of the National Children’s Specialized Hospital (NDSL) "Okhmatdyt". A previous attempt by the Ministry of Health, dated March 2017, was unsuccessful. Oksana Melnyk ’s magazine and magazine told Oksana Melnyk about the specialist who is waiting for the chair of Okhmatdyt ’s chief physician, what corrupt practices he must overcome and what he can do to make Okhmatdyt a real children’s hospital. relations with the public and state bodies, co-founder of the Tabletochki Foundation Iryna Litovchenko. Iryna, at what stage is the procedure for holding the competition for the position of Chief Physician of NDSL "Okhmatdyt"?



Now the Ministry of Health is making a second attempt to find the chief doctor of Okhmatdyt. For the first time, on March 20, there were very few candidates. Only 4 candidates out of 9 who applied met the requirements of the Ministry of Health - others did not have the necessary experience and qualifications.
According to the legislation, the deadline for submitting documents by candidates for re-competition is 1 month. This term expired on April 27. At this stage, 10 candidates submitted their applications, but only 3 participants were able to submit all the necessary documents . The Commission decided to allow other participants to deliver those that were missing in their envelopes.

The public is saying that the competition is a game of democracy, but in fact there is already a winner determined in the political sphere.

Who is he? Let them sound then! (laughs).

In that case, which specialist do you think Okhmatdyt needs today?

Last time at a meeting of the competition committee, I asked the participants about a child-friendly hospital. In fact, Okhmatdyt is a very rich institution. Okhmatdyt does not have such equipment and sponsorship potential anywhere else in Ukraine. Every year, large corporations allocate millions from their budgets to NDSL Okhmatdyt. From a technical point of view, despite the large number of corruption schemes in the institution, everything there is quite powerful. However, this does not make the hospital truly a children’s home. Okhmatdyt needs a chief physician who will not only fight corruption, but also change the philosophy of the institution and make it child-friendly. We have a good one "Box", cool equipment, but here come managers and doctors who have the same philosophy.

What is it about in this context? How should this philosophy be changed?

Now there is nothing there for the work of doctors or for the stay of parents of children treated in "Ohmadit". Actually, for young patients there are 2-3 playrooms for the whole hospital, although they should be at least on each floor. If children are lying there, they simply have nothing to do…
While the children are being treated, the mothers sleep with them on the same beds together, both with very young children and teenagers. Even when the baby had surgery. The hospital management always referred to the lack of space. Like, there is no possibility to deliver beds, and there is no question of organizing dormitories. And in Okhmatdyt, mothers take turns washing the floor in the wards in an organized manner.

Still, the problem is money or staff?

It doesn’t take a lot of money to make Okhmatdyt a children’s hospital, you just need a desire. Usually the administration reduces everything to banal material support, and that’s it. They do not try to change the patient’s attitude from within. But it is very important for children! The Tabletochki team and I study a lot of world experience. In Europe and the United States, you can see that you have been admitted to a children’s hospital since the doorstep, and we have no normal toilets, no showers, sometimes even a fungus. it is to work in other conditions.
In other countries, children’s hospitals have a children’s table next to the reception desk, corridors are painted with colorful pictures, and staff wear uniforms with cartoon characters. When a child goes to the doctor’s office, she sits down at a low table to feel comfortable. This is not an expensive pleasure, which can be realized at the expense of sponsorship and with the help of volunteers.
In addition, what prevents management from inviting tutors, teachers and educators for children? What prevents you from allocating a small room for the learning process? Few people know, but Okhmatdyt still has a huge assembly hall. Why not hold something interesting for children? It’s not about money - the hospital needs to be redesigned from the inside.

In your opinion, is the team threatened by mass layoffs with the arrival of a new leader?

Dismissals should be, but only at the discretion of the new chief physician. There is now a mismatch between the number of junior staff and the number of doctors: there is a shortage of junior staff due to low salaries, and the staff is even inflated. In addition, even in this bloated state, work is not controlled. For example, in the surgical department, out of ten surgeons, only three perform the operation, and all the others fill in the medical history. Older, experienced people who have been working in the institution for a long time do not allow young professionals to use a scalpel to receive more material gratitude from their parents.
Doctors can be understood from the point of view that they were put in such a position. They may not want to take this money, they are internally uncomfortable talking about these prices for operations, but otherwise they will not survive. But, again, many experts do not agree to move to the official field. They now have the opportunity to take thousands of hryvnias for one operation without taxes and fixation. They are unlikely to want to switch even to a salary of 25 thousand hryvnias.

In your opinion, what aspects of the work of Okhmatdyt’s top management may raise questions during the audit?

Here is an example. Two weeks ago, Okhmatdyt found an order to destroy all distribution journals, all acts and invoices for used medicines for the last 13 years. The chief accountant came to the chief doctor with such a document, saying, "sign, we’ve done this often." This, in my opinion , was the reason. I can’t imagine what would have happened after that if the board of trustees hadn’t found out… And in this case, it’s not who signed it that matters, but who initiated the move. If the team so wants to destroy the documents, then there is something to look for.
In addition, the distribution of the fund needs to be checkedEisenhower investments. There’s crazy money that is being used inefficiently. Now Okhmatdyt has bought a very good and expensive X-ray, and the traumatology department has undergone repairs. What was the purpose of directing sponsorship funds for this? In autumn, a brand new trauma department with X-rays opens here. Why was it not possible to take a balanced approach to the distribution of funds? For example, ask the sponsor to wait with an X-ray and solve some other urgent problems of Okhmatdyt. As an option - to build a mini-hotel for parents.

And there is an interesting practice with pharmaceutical companies that donate the device and "plant" the whole hospital for consumables for it. And they seem to have made a gift, but at the same time forced to pay a lot of money in the future. For example, in the oncology department there are two different drips on the floors, the maintenance of which costs about 10 and 50 thousand hryvnias. Every month is a crazy difference. We offered to buy them a new one, because the consumables are bought at the expense of philanthropists. However, the hospital cannot just take and write off expensive maintenance equipment, because it works.

By the way, when exactly will the new building of "Ohmadit" be opened?

The question is rhetorical. 2 start-up complexes will be opened, which are almost the same in area as the whole hospital now. In fact, another new Okhmatdyt is opening. The first part, which contains diagnostic departments, will be opened in 2017, and next year a surgical department, oncology, etc.

Should Okhmatdyt’s chief physician also be the director of the institution, or should these positions be divided?

According to the Charter, there is now only the chief physician, who has authority exclusively in administration. There is nothing about medicine there, he is in fact a director. We argued with the Ministry about this. Why should the chief doctor of Okhmatdyt receive medical education if he is engaged only in economic activities? To do this, you need to reorganize the hospital. The director must perform his functions, and the doctor must perform his.

How can it be reorganized in the current legal field?

Now the president has signed a law on the autonomy of medical institutions . This will change the hospital’s charter and make it a non-profit organization. Thus, the hospital is released from the classifiers of the Ministry of Health and has no restrictions on salaries and staffing. This is an opportunity for the institution to form salaries even according to the rating of doctors. The head who will come according to the results of the competition will be able to move to adequate hospital management.
We at the Ministry of Health even joked that under the current system, doctors will stop taking bribes only when their pockets are cut off in medical form. But, returning to the topic of personnel cleansing, before the decisiondismissals of the chief physician must conduct an audit. Currently, the State Financial Inspection works in the institution, but only checks the presence of certain documented facts. They are not doctors, and will not analyze from a medical point of view. The Ministry of Health should set up a joint commission with auditors and doctors to deal with this in more depth.