Situated in the northern city of Mekelle, Ethiopia, Ayder Referral Hospital not only serves patients from three regions, it also serves as a teaching hospital for students attending Mekelle University’s College of Health Sciences. This means that many physicians, in addition to their clinical duties, are responsible for teaching medical students.
“Most people thought that it was somebody else’s business to run this hospital, and that they (health workers) are just here to earn a salary, their heart is not here…” reflects Dr. Amanuel Haile, the Chief Clinical Director in charge of Ayder Referral Hospital, “but the training made them feel as though they are working for eachother.”
The training that Dr. Amanuel referenced was the “LMG Program,” an adapted Leadership Development Program Plus (LDP+), a team-based training that helps managers and health workers identify and overcome everyday challenges. The main challenge that teams at Ayder Referral Hospital identified was patients’ long average waiting time, which was in excess of two hours by early 2016.
“I read, personally, books on leadership, management, and governance, but I never had the opportunity to sit down with my team, with my own colleagues, to talk about what leadership is.” The LMG Program provided this opportunity. The teams soon recognized that a contributing barrier to decreasing the average patient waiting time was that physicians scheduled their morning clinical audits from 8:00am to 10:00am, which meant that they could not also examine patients.
Dr. Amanuel says that a good leader, “understands the situation very well, and knows where they want to go… and they know how to bring people together to fulfill the vision… and more than anything, should be an example.”
Although training health workers on leadership, management, and governance may not appear to be a direct investment in stronger health systems, Dr. Amanuel believes that leadership is the “single most important investment… that we should make.”
At Ayder Referral Hospital,the LMG Program helped physicians realize that they could reschedule their morning audit to instead prioritize examining patients. That meant patients started to be seen by physicians at 8:00am, instead of waiting until 10:00am.
In leadership, as in health systems, “creating trust is something very difficult… it requires only a few mistakes to lose this trust, but it takes years to build trust, and we really need this.” Although the teams have only completed two sessions of the LMG Program training, they have already started to see patients and other staff who are benefitting from the schedule change.