During mid-year review on February 7, Lhab Dorji, the president of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), requested prime minister to drop the hospital’s annual performance agreement target of constructing a new mortuary by this month.

Lhab Dorji said the proposal to construct the mortuary was as per the cabinet’s directives. “The activity cannot be implemented because the budget has not been approved.”

Prime Minister Tshering Tobgay said he would take the responsibility and would discuss with the Cabinet members. “If we don’t get the budget within a month’s time, the hospital can drop the success indicator from its APA.”

Prime minister said the success indicator was included in the hospital’s APA because of international convention.

Lhab Dorji also requested prime minister to reconsider four more success indicators that are at risk.

The hospital has a target of achieving 65 percent progress in construction of an additional hospital wing by June this year.

Lhab Dorji said the construction of the additional wing could not be started because of delayed approval from Thimphu Thromde and inadequate experienced technical personnel to handle the project.

“We are yet to get a response from the health ministry about our request for technical assistance,” he said. “However, the work has been tendered.”

Lhab Dorji said that only about 25 percent of the work could be completed by the end of this fiscal year since the approved budget of Nu 40 million (M) is only about 25 percent of the total estimate.

Prime Minister urged the hospital to achieve as much target as possible in the fiscal year instead of reducing the target to 25 percent. “This is a priority success indicator.”

The hospital is not likely to achieve its ambitious target of completing 75 percent of the construction of the Bio Medical and Procurement office by the end of the fiscal year.

Lhab Dorji said that only about 65 percent of the work could be completed within the project duration of two years.

“If 65 percent can be achieved, then it’s very good. So there is no reason to bring down the target,” prime minister said.

One of the targets of JDWNRH is to discharge all patients before 11am. The hospital has 18 inpatient units catering to over 17,000 patients in a year.

Prime minister said the same hospital and the same staff catering to 17,000 is a huge success.

Quarterly report of July-September and October-December 2017 saw patient discharge before 11am at 61 and 73 percent. On an average, 67 percent of the patients were discharged before 11am.

Lhab Dorji said 100 percent target could not be achieved because patients have to be discharged after 11am to free the beds. “Given the limited number of specialists who has to visit all wards, it is difficult to finish the ward round before 11am.”

Some patients prefer to leave after 11am due to social issues.

The target revision of 70 percent from 100 percent was proposed. Prime minister approved the proposal.

The recent OPD (out-patient department) waiting time survey conducted in October last year registered 9,401 patients in a week. The average waiting time was one hour nine minutes against the target of less than 45 minutes. It was found that only 58 percent of the total patients were seen before 45 minutes.

Lhab Dorji proposed that 60 percent of the total patients to be seen before 45 minutes.

Prime minister said 60 percent appears too low. “Maybe the target can be revised to 65 percent.” He urged the president to talk with the office of the government performance management system (GPMS).

The hospital has 13 OPDs, providing services to nearly 500,000 patients a year.

Of the 30 targets, JDWNRH has achieved 11 and 14 are on track.

Lhab Dorji said if full autonomy is granted to JDWNRH, the hospital could address issues of staff retention and incentives, clinical quality improvement, consultation time and diagnosis, and introduction of 19 new services proposed in the 12th Plan.

Prime minister said currently the hospital is an autonomous agency just like Gross National Happiness Commission and National Environment Commission. “How can we give more autonomy than that?”

JDWNRH has, however, no authority in terms of human resources and finance, Lhab Dorji said.

Prime minister said that if the hospital is to have authority in human resources and finance, then it has to be done through corporatisation.

Some thought that the hospital would charge for the health services, prime minister said. “But none of us stood up to say no. I tried my best that it’s not the intention, but nobody is standing up to say this is what we want and that nobody is going to charge money for the health care services.”

He added: “It’s too late now. I feel we have lost some time on this. Anyway, it will be up to the new government. I feel that the hospital should be given more autonomy and this is what I have been pushing for.”

To enhance diagnostic and curative health care services along with improved access to all healthcare facilities, the hospital targeted to have indoor physiotherapy room complete and develop assistive device workshop by this month. Both the targets were achieved.

Lhab Dorji said that the target to set up urine testing and diagnostic facility in Community Health Department Laboratory, establishment of a separate burn unit and procurement of Therapeutic Drug Analyzer, and Reagent by this month were also achieved.

The hospital also met its target to train four staff for repair and maintenance of medical equipment, remodeling the ICU room, and enhancing biometric facility.

With the establishment of radiotherapy unit and providing services to cancer patients, Lhab Dorji said the hospital has achieved its target to develop, introduce and set up amenities for new specialised tertiary health care and diagnostic services.

The hospital targeted to finalise and operate the hospital disaster management strategic plan together with mass simulation exercise to enhance disaster preparedness in the hospital.

Lhab Dorji said JDWNRH Contingency Plan for emergencies and disasters has been developed and a mass casualty management drill was conducted in September last year.

Prime minister applauded the achievements.

“But, we need to aspire for better,” he said.

Of the hospital’s revised budget of Nu 1130.29M, it had so far spent Nu 515.17M or 45.5 percent.

Dechen Tshomo