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Hi Dr Suzy, I think selective hiring is still not a very much of a reality in Congo. Mostly people with the recommendations from influential personnels gets the job, even if they are not quite qualified for that specific role.
Question #1: Select one of the seven practices of ‘producing profit through people’ and provide an example of its implementation and outcome in your own context.
I think both selective hiring and employment security are both almost equally important. selective hiring helps the organization to hire the most suitable candidate, can prevent costly turnover of staff. I think candidates should also be selected based on the attitudes of the potential candidate, which can match with the organizations values and culture. for example, we had fixed rates for dropping patients especially if they came from the outskirts of Kinshasa or from nearby villages, which the patients directly pay at the counters before leaving the hospital. This was done so that the drivers will not ask the patients or their family to pay any amount. some old drivers did comply to this change while some who were recently hired based on their driving skills and on the recommendation of some influential people kept on pushing patients’ family to pay more or they used the vehicles for public transportation to earn money. To attain organizational objectives faster, to assure the quality of work it’s important for the employees to feel a sense of stability and job security.
I like the point which Dr Barry mentioned loyalty is more important than having most skilled candidate. skills can be taught or learned. workplace culture can sometime make employees feel less valued, it’s important to encourage healthy cohesion and interdependence.Question #2: Describe two lessons that may be learned from the COVID-19 pandemic and how this crisis may catalyze transformation.
covid created crisis that changed and transformed almost everything from political to healthcare system. I agree with Dr suzzy we all realized the importance of technology during pandemic. Telehealth care became the new normal for many countries. Even developing country like Congo began to develop the IT sector. multiple companies started providing WIFI connections, 4g began to bloom in Kinshasa. Companies like Africell and orange began to provide 3g and 4g at cheaper prices, Bank and supermarket started with digital and contactless payments. while this was huge positive change for Congo and benefited a few folks, on the flip side most of the people who are sellers in market, drivers… lost their daily income, which exacerbated already existing problems of poverty, sickness, communal violence, robbery. another lesson learned from pandemic is the importance of support from family and community, social isolation led to feelings of loneliness and rise in mental health concerns.As Dr Barry stated many false information was widely spread through social media platform, many took advantage of such false news and had huge financial gains, while it caused unwanted fear, confusion, riots, violence against Chinese nationals in Kinshasa. I really appreciate Dr Barry’s work in taking time to update people about pandemic, having real time conversation with people, answering their question, great work indeed as I have personally witnessed the chaos and violence and loss false information can cause.
Question #2: Describe two lessons that may be learned from the COVID-19 pandemic and how this crisis may catalyze transformation.
covid created crisis that changed and transformed almost everything from political to healthcare system. I agree with Dr suzzy we all realized the importance of technology during pandemic. Telehealth care became the new normal in many countries. Even developing country like Congo began to develop the IT sector. multiple companies started providing WIFI connections, 4g began to bloom in Kinshasa. Companies like Africell and orange began to provide 3g and 4g at cheaper prices, Bank and supermarket started with digital and contactless payments. While this was huge positive change for Congo and benefited a few folks, on the flip side most of the people who are sellers in market, drivers… lost their daily income, which exacerbated already existing problems of poverty, sickness, malnutrition, communal violence, robbery. another lesson learned from pandemic is the importance of support from family and community, social isolation led to feelings of loneliness and rise in mental health concerns.As Dr Barry stated many false information was widely spread through social media platform, many took advantage of such false news and had huge financial gains, while it caused unwanted fear, confusion, riots, violence against Chinese nationals in Kinshasa. I really appreciate Dr Barry’s work in taking time to update people about pandemic, having real time conversation with people, answering their question, great work indeed as I have personally witnessed the chaos and violence and loss false information can cause.
Question #1: What example can you provide of an early success story related to any ongoing change you are actively participating in?
Almost three years back, our hospital in Kinshasa, decided to start two small clinics at two different locations, almost 36 km and 52 km from the main city and hired local nurses and other staffs to run the clinics. The majority of problems we were facing at the time was mainly due to lack of communication, getting the correct information and getting the information on time. One of the reasons why this was happening is because most staffs at the clinic were not using android/smartphones. Most of the information was conveyed over phone calls. Poor reception, airtime cost, traffic and bad roads was another set of challenges. A person needed to take a bus/motorbike to get to the main hospital to order the supplies and needed to come at another time to collect the supplies. Managing the quality and effectiveness of these two clinics were proving to be difficult both cost and energy wise. we came up with the plan to install sat Wi-Fi and get the head nurses of these two clinics android phones so that we all can communicate online, created a WhatsApp group, which made a lot of things easy and quick to coordinate. now orders can be supervised and tracked. orders now can be made directly to the pharmacy; transportation can be arranged before time to deliver medical supplies or for transporting patients. What used to take several days eventually, we were able to get it done in the span of two to three days. This change caused cost reduction, increased efficiency, nurses became more confident in using online platform to communicate, on a personal level we all started to connect and understand each other’s positions better and overall quality of patient care improved.Question #1: Provide one example from your professional or personal context of a reward system conflicting with expected outcomes. How might these be better aligned?
Our university’s foreign administration department wanted to reward, students who have passed HSK level 5 (which is a Chinese proficiency exam), teachers mostly recommended students who can speak Chinese well, but have not necessarily passed the HSK exam which includes speaking, writing and reading. I think it might have been better if the university rewards the students based either on the two criteria’s, students who have passed HSK with high scores, who can read write and speak Chinese or students who can speak Chinese well.I agree with Dr Abanda, at the end of the day its patients who suffers and pays the cost, I remember in our NGO, management wanted us to prescribe an antibiotic which was launched by a new pharmaceutical company, quarterly bonus was promised to doctors who would prescribe these antibiotics and other products of this company. This quickly led to unnecessary prescription of drugs.
Question #2: What does a fee-for-service payment system reward? Describe one initiative of the 2010 ACA or 2015 MACRA legislation intended to transform payment models to increase value.
fee for service payment system rewards hospitals, physicians, other medical care givers. in Kinshasa FFS is the dominant method of payment for privately financed healthcare. in India both government hospitals as well as in private hospitals FFS is the still the method of payment, only that government hospitals are little less expensive than private hospitals. I agree with Dr.Abanda that “a fee is required for everything” which is so true in the context of healthcare systems in Kinshasa. payment must be done upfront, doctors are incentivized to see more patients, order unnecessary tests (which can also encourage defensive medicine), to prescribe medications of certain pharmaceutical company, doctors are not incentivized for preventive care. I think in the context of healthcare in Congo, it would be great if government of Congo would create an organization similar to ACO and fund it, which will reduce the cost and more people will be able to get affordable healthcare.Question #1: When was the last time you were overwhelmed with too many options? How did you make the decision easier and overcome uncertainty?
As a master student last month, I had to make a choice between Dalian first hospital or Dalian second hospital for my internship. The problem is the daily commute and cost. To reach first hospital, either I need to hire a cab or get on a bus, bus station is just outside the main gate, but it will take more than 2 hours to get to the hospital. To commute to second hospital, its faster as its near to a metro station but three times expensive compared to the bus. I had to make a choice between time, money and energy. I decided to choose second hospital of Dalian, as time is more precious and valuable, also I didn’t want to lose my energy on daily more than 4 hours of commute.I agree with Dr Barry and Dr Suzy getting the facts is important, as it can influence visions and decision making. people sometimes find it difficult to make a difference between a fact and opinion and formulating a clear compelling vision for the change is necessary for achieving individual goals/organizational goals.
Question #1: Describe a current problem you are facing and discuss two of the ten key evidence-based principles in the context of a change to your situation.
The current problem which I and others from my batch is facing is that of a language barrier. 1.Assess the Opportunity or Problem Motivating
the Change: Here a study involving the students is necessary to understand the problem which is motivating or is demanding a change. some students have been in China and knows the language to some extent, while others are new here. Department of foreign student sending all the students directly to the hospital, without arranging for the language classes is difficult for the newcomers. It would also be better to have some of the Chinese students, who can speak English to be mixed in with the foreign student’s group, which makes language learning and other communications/work easier and efficient, rather than totally and absolutely depending on the professor, who already has many other responsibilities and is clearly overworking. 2.Mobilize Energy for Change: to change this situation, foreign student department, administration department in the university, department for internship in the hospital needs to get ready to make the necessary changes, coordinate and implement the changes required.Question #2: Provide a ‘Miss Harris’ example from your own experience. How might they have benefited from consistently higher-quality, lower-cost, and more patient-focused care?
To provide higher quality lower cost patient focused care in countries like DRC is almost impossible, with no organized health systems, infrastructures, health insurance and so on. most people manage to get by on a daily basis. Hospitals equipped with scans and other facilities are few and are expensive, the hospital where I was working for one MRI costs 500 USD, in a country where most people earn 1 to 5 USD per day. most of the drugs are imported from India, Dubai and other countries which increases their cost, consultation fees, blood and other test are not only expensive but difficult to access, since most hospitals and labs with such facilities are located in the city and not one hospital or lab has all the test facilities. lack of transportations adds another dimension of difficulty for patients from rural areas or who does not have their own vehicles. personally, I knew a 35-year-old lady, who was diagnosed with breast cancer, she could not afford the treatment and surgery, and took the option of going to a traditional doctor to get healed since it was much cheaper, eventually she passed away within a year.I agree with Dr.Barry and Dr.Suzy, regarding the struggles of homeless people. Almost three years back our organization in Kinshasa started a weekly (Monday, Wednesday and Saturday) feeding program for orphan children and decided to hire young women to cook traditional food, some of them were homeless, some grew up in the orphanages while some were living with their distant relatives. my thought was if they get a job, it can solve their problem, bring some sort of financial independence to their life. in reality it was more complicated than that, most of them could not keep up to the task as stability and routine were a new concept to many of them. many struggled with their prior addictions. some thought complying to new standards and demands of the job means they are losing their freedom. I believe educating their minds and showing love and kindness to them is also important as it can improve their chances of keeping a job and can improve their life.
Question #1: What problem are you currently facing that appears to be a people problem but may actually be related to the situation they (or you) are in?
Currently I am facing a situational problem, language barrier. The inability to understand medical Chinese and to write Chinese characters can sometimes become overwhelming (in my own opinion speaking mandarin is easier than writing). Patients case files are handwritten, so google translator mostly can’t translate. linguistic differences are causing inadequate comprehension, miscommunications, not to mention lack of communications and connection to the peers and patients. I believe it must have been good if our university could arrange some classes or training sessions for us foreign students to learn medical Chinese and to gain cultural competency.Hello everyone, my name is Thomas Juby, I got my bachelor’s degree in medicine from Jilin university China, after which I moved to DRC, where I was working with a non-governmental organization in Kinshasa, for past five years. In December of 2022, I moved to Dalian China, to finish my master’s degree in surgery, which was discontinued due to pandemic. While in DRC due to lack of staffing and proper infrastructure, I eventually started working both in the clinical and the administrative departments where I realized the importance of management and decision-making skills. I am talking this course as a part of MIH elective course and to expand and deepen my knowledge regarding effective management and leadership, which I believe can be tailored and implemented in low-income countries. I believe that good leadership can help to reduce the social economical and health gap present in the communities.
Question #2: If Hashem was not granted refugee status in Sweden, what might have become of him?
If Hashem was not granted refugee status in Sweden, then he must have been forced to find ways to cross border again most probably illegally since without the refugee status he can’t bring his family and be reunited with his wife and three children. or he had to stay in Sweden without proper documentation and without the hope of reuniting with his family until or hoping the law would change in his favor. He would again be thrown mentally into the storm of continuous fear and anxiety regarding the authorities, arrest, deportation and the unknown future of him and his family.