Ademola Dada: The surgeon driving rare efficiency in Nigeria’s public health

Nigeria’s healthcare system’s shortcomings are readily apparent, confronting anyone seeking care with a flurry of problems.

A few like Ademola Dada have however put their best foot forward to prove that achieving the efficiency of our dream is not rocket science, particularly in the public health sector.

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The shrewd orthopedic and trauma surgeon knew there was more to providing refined health outcomes on a large scale than confining his career to clinical practice alone.

While he excelled as a consultant treating bones, joints, and ligaments, Dada also pursued training in healthcare administration and hospital management. He believed that the quality of leadership is crucial to transforming any system.

So he grabbed a postgraduate fellowship at the West African College of Surgeons and another fellowship at the National Postgraduate Medical College to start with.

His quest for knowledge extended beyond Nigeria’s borders. He proceeded abroad to acquire more training at the Anthony Berkeley Teaching Hospital in Clermont, France. He had further stints at the University Hospital of Basel, Basel, one of the five university hospitals of Switzerland. He also practiced at the Sancheti Institute for Orthopedics and Rehabilitation College of Physiotherapy in Pune, India. 6. Not only did he hone his medical skills, but he also deepened his grasp of finance. He enrolled in a business school in Hensley, Fontainebleau France to deepen his grasp of finance.

The wide travels and exposure left him with a zest to localise what he had gleaned within the fore walls of the hospitals where their systems ran effectively and efficiently. Specifically, he was invested in how they sustained their system and ensured that it delivered good healthcare services to people.

When former President Muhammadu Buhari appointed him the chief medical director of the Federal Medical Centre, Ebute-Metta in 2017, the opportunity met a man pruned for the job.

Over seven years, he and a dedicated strategic team have transformed the Lagos hospital, generating about N450 million monthly.

Once a scene cluttered with decrepit equipment, edgy workers, and sluggish procedures, it’s now a rallying point for advanced medical excellence in Nigeria’s commercial capital.

From two theatre suits and 120 beds, the hospital now operates with 11 theatre suits and 420 beds, all furnished and functional.

It runs decentralised intensive care units of 16 beds. One of them holds 10 beds: each bed equipped with a monitor that streams patients’ vital signs to a central monitor in the ICU corridor. It is also detailed with a ventilator, and an oxygen outlet for each patient. A functional elevator strictly for patients is installed on the ground floor to convey patients directly into the ICU, making emergency transit easy. Another three-bed ICU is dedicated to emergencies that arise from operating theatres. It also runs a decentralised pharmacy operational in multiple key departments.

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Digitised system

The hospital sees about 40,000 new patients monthly through a digitised system that tracks patients’ journey from triage to treatment. One such digitisation is deploying Global Care’s hospital management system software in all departments of the hospital.

The electronic medical records (EMR) solution effectively tracks and monitors health records, quick diagnosis, financials, inventory, and other administrative information.

This simplifies the navigation of workflows and processes which are key to the normal working of any hospital.

A typical patient seeking care at FMC Ebute Meta is registered into a database and issued a smart card. The card features a wallet that can be funded, easing payments required within the hospital premises.

Also with the EMR system, the hospital can effectively track the number of patients seen by each doctor at any given time, ensuring transparency and accountability.

This is uncommon in public healthcare but helps maintain efficiency and discourages absenteeism.

At the level of diagnosis, patient samples are also registered on the database and unique barcodes are generated to distinguish each one, creating an authentic footprint for tracking.

“My patients don’t touch money. Money goes to the remitter, who transfers it to our Treasury Single Account in real time. We have the card that is both the financial and the clinical history of the patient. with the two married together, there is no room for anybody to undercut or undermine the system,” Dada explained.

Clinical workforce

Dada’s vision for an efficient public healthcare system is further empowered by a well-distributed clinical and non-clinical workforce.

It currently has about 300 nurses, 80 consultant specialists, over 100 doctors, and 26 pharmacists manning its operations. Its non-clinical workforce numbers about 700.

Among the hospital’s expertise are cardiothoracic surgery, orthopaedics, general surgery, neurosurgery, urology, pediatrics, spine surgery, and arthroscopy. It also performs laparoscopic surgery techniques like appendectomy and colorectal procedures.

In internal medicine specialties, it works with a broad range of specialists to serve patients in endocrinology, gastroenterology, respiratory medicine, dermatology, and cardiology.

With the new developments, Dada said the hospital has seen a staggering increase in demand for its services. ICU care has skyrocketed by over 1,000 percent. The number of babies treated in incubators has also risen dramatically by 600 percent. Dialysis sessions have seen the highest growth, surging by over 2,000 percent. This surge applies to virtually all areas, from the number of babies delivered to patient outcomes.

Dada’s sights are set on ruffling feathers with the biggest private hospitals in Lagos and the staff monitoring system is part of an effort to improve efficiency and service quality to rival private institutions.

According to Dada, judicious financial management is crucial. He believes that regardless of budget size, getting value for money is crucial and remains committed to following regulations to ensure efficient use of funds from government budgets or other sources.

A vision for transformation

Dada’s long-held vision for how hospitals should function was fleshed out in a strategic plan based on five key pillars.

The first he identified is human resources development, a pillar focused on investing in staff’s training and skills to ensure they provide the best possible care.

Improved quality of care and services is a second pillar he has leveraged to deliver top-notch care to Nigerians, focusing on patient well-being and positive outcomes.

The third is financial transparency systems aimed to ensure the responsible use of funds to maximise their impact.

The fourth is the rehabilitation of infrastructure and expansion of services to meet the growing demand for healthcare. The fifth is the use of technology to enhance care and improve efficiency and the overall patient experience.

“To achieve this transformation, I first discussed the plan with the leadership team and management. They enthusiastically embraced the vision and helped communicate it to the staff. With everyone on board, we began implementing the strategic plan. As you can see from the results, these five pillars have been the foundation for all our advancements,” Dada told BusinessDay.

“If you had come in 2017, it’s virtually like we tore down the entire hospital, replaced the roof, replaced the ceiling, replaced the floor, replaced the wall. Even the things inside the wall, like the electrical wiring system and the water pipes and all the rest of them, have been replaced. You will find out that all our floors are v9 floors. That is the element of the pillar of improving the infrastructure and expanding services. Of course, we brought in financial transparency and that brought about nobody collecting cash in this hospital.”

Concept of double

In a hospital setting, downtime with equipment can be critical. Imagine coming in for treatment and being told a machine is unavailable. To prevent this, Dada adopted a strategy of having redundant equipment for essential functions. You’ll see this throughout the hospital. For instance, we have two central sterile supply units, which act as a central hub for ensuring a steady supply of sterile equipment and supplies, crucial for maintaining hygiene and preventing infections during medical procedures.

Used medical instruments and supplies are collected from different hospital departments. The CSSD team cleans and disinfects them to remove visible dirt, debris, and microorganisms. For backup, the hospital has a functional spare.

In its laundry, there are two industrial washing machines and two industrial ironing machines. Most clinical testing machines have digital and manual versions. It has two power-generating sets.

“This ensures we have backups to keep operations running smoothly, even if a primary machine malfunctions. It’s a concept practiced in laboratories worldwide – having both main and backup equipment is essential,” Dada said.

Future developments

The Dada-led management plans to establish an IVF centre to make the procedure more affordable for Nigerians. Additionally, it aims to offer cancer care with reduced costs through acquired equipment. Cardiac care and advanced laparoscopic surgeries are also on the agenda, allowing for same-day procedures with minimal recovery time.

“We are looking at the opportunity of selecting categories of patients that doctors can see remotely. They don’t have to come to the hospital because we are also trying to reduce the kind of crowd that we have in the hospital,” Dada explains.

“We are also going into cancer care. We have contracted the equipment. We are expecting it to be delivered very soon. You see that the cost of radiotherapy care in Lagos is quite high. We are going to find out the cost. We have also done calculations. The objective is also to crash down the price so that healthcare can be made affordable and readily available to Nigerians.”

In the long haul, Dada expresses hope that these improvements will reduce medical tourism and contribute to the national healthcare goals. He believes this will align with the federal health ministry’s objectives of value enhancement within the healthcare system.

Continuous improvement

Dada acknowledged that while perfection is not achievable, he and his team continuously strive to improve based on patient experiences and feedback. They view quality improvement as an ongoing journey to provide Nigerians with service standards comparable to anywhere else.

“We’re not perfect. But we are making efforts to ensure that because in any case, quality care is a journey. It’s never a destination. So we are improving every day,” Dada said.