Editorial | Transforming UHWI

The disclosure of the University Hospital of the West Indies’ (UHWI) J$18 billion debt to Jamaica’s tax authorities, adds another titillating bit to the tales of impunity and dysfunction the auditor general told in her recent report on the institution.

But the latest revelation, notwithstanding health minister Christopher Tufton’s deflective and amorphous statement about the institution’s culture, underlines the urgent need for deeply committed and transformational leadership at the institution, with a time-bound plan for its organisational overhaul. Our concern is that Dr Tufton seemingly downplayed the role of leaders in fixing problems, and how failed leadership can help in breeding dysfunctional cultures. The absence of clarity on this issue, thereby failing to address the matter frontally, could lead to merely offering palliatives to the UHWI, before its next bout of crisis.

In that context, the endgame for the UHWI must be leadership that insists upon, and inspires, cultural change with transparency and accountability, especially with respect to the expenditure of taxpayers’ money. High quality and efficient service count, too.

This programme can’t be about sticking fingers in holes in dykes, or using duct tape to paper over cracks – if that is the mandate of the acting CEO Eric Hosin, and the board led by Patrick Hylton. Then there is the parallel review body chaired by Howard Mitchell, established in the aftermath of the AuG’s report and seemingly given tasks that Mr Hylton’s board would be doing

LEADERSHIP CRISIS

Dr Tufton may not believe it, but whatever Mr Mitchell’s panel may recommend, the fundamental crisis faced by the UHWI is one of leadership. Fixing the problem starts with that.

In her report released in January, the Auditor General Pamela Monroe Ellis disclosed that UHWI officials couldn’t produce documentation for over half a billion worth of procurement contracts. They claimed that many files were destroyed when offices were flooded – which turned out not to be true, or not entirely so.

Additionally, in many instances the government’s procurement rules were either not followed, or supply requests were broken so that contract amounts wouldn’t meet the thresholds for competitive biddings.

There were also instances, too, of the hospital using its tax exempt status to allow private firms, including one owned by opposition parliamentarian Dennis Gordon, to avoid import duties by importing products on their behalf. Mr Gordon has since said that he has reimbursed UHWI J$10 million.

At a hearing by Parliament’s Public Accounts Committee into the AuG’s report, Mr Hosin, the acting CEO (he parachuted in the midst of the scandal after the incumbent went on leave) reported the J$18 billion tax debt, mainly for monies deducted from workers but not remitted to the authorities. The bill rises to J$40 billion when penalties and interests are added. These are not all the financial issues that afflict the UHWI, a teaching hospital of the UWI.

In comments to this newspaper a week ago, Health Minister Tufton suggested that there has been undue fixation on personalities at the UHWI, including its governors, rather than the “root issues”, which he identified as the hospital’s institutional culture.

“Even with successive boards that are well credentialed … even with those extremely well-credentialed individuals, there seems to have been a normalisation of that (dysfunctional) culture over time, which seems to have accepted some of these activities,” he said.

MISSED THE POINT

Dr Tufton either missed the point, or the plot entirely. True, that the dysfunctional culture, and its attendant crises, persist at UHWI despite the regular changing of governors. Each set was charged with addressing the problem. They failed either because they didn’t have the skills for the job, so were overwhelmed by the undertaking; they allowed themselves to be co-opted by managers, or others who had a stake in the dysfunction; or they were not allowed to fulfil their mandates by policymakers and or their pals.

The latter is the claim of Wayne Chai Chong, who had a short stint as chairman of the hospital board. Mr Chai Chong suggested that he was pressured into a resignation in 2023 when he started to make structural changes, including attempting to hire top quality management and insisted that the hospital collected outstanding debts. The counter argument was that Mr Chai Chong, and some members of his board, engendered personality conflicts.

Institutional cultures change with leaders and policymakers first accepting that there is a problem to be fixed and giving organisational leaders specific mandates, and the appropriate freedom to effect those changes, which must be executed with transparency and accountability, including of themselves.

Obviously, the mandate must be reasonable, its expected outcomes and timelines clearly articulated and understood across the organisation, and the penalties for under-performance or failure known. While the top bosses remain accountable for outcomes, they can’t outsource the responsibility for change to low-rung managers. It’s the bosses’ role to identify and eliminate mediocrity and other potential drags on transformation.

If they fail, that failure is theirs, unless there is compelling evidence they didn’t have the support of more potent, primarily external forces, to fulfil the mission.