The case of Maua Methodist Hospital
Short history of Maua Methodist Hospital
The idea to establish Maua Methodist Hospital was born when tragedy visited a family in England. The family had saved some money to take their son to medical school. However, when he died aged 25, they decided the best use of the money they had saved towards their son’s education was to gift the community with a hospital.
Maua Methodist Hospital was therefore established in 1928 and officially opened on July 15, 1930. At the time, the staffing consisted of one doctor, a nurse and a couple of patient attendants.
Medical bills were paid in kind and foodstuff and animals were accepted as payment for services. The hospital’s first surgery was a C-section done in 1942.
Today, Maua is a fully-fledged Level 5 facility. The ICU is under construction and upgrading of diagnostic services is on-going. The hospital boasts an ISO Certified Laboratory (ISO 15189:2012) and a total of 350 staff, including six full time specialists, five visiting consultants, six medical officers (Mos) 86 nurses, four chaplains, 65-unit attendants, eight college of health sciences tutors.
The six consultants are available on full time, either as missionaries, on secondment from the county or on payroll. The hospital enters into partnerships with consultants on a need basis through MOUs.
OPD registration and revenue collection points
Although outpatient visits were not at the hospital’s optimum, patients were still waiting too long to receive services due to poor flow. The poor patient flow was characterized by registration and pay points located in different parts of the hospital, limited waiting space and unclear signage. Patients had to do a lot of back forth movement, resulting in crowding.
With funding from AMH, one of the hospital’s biggest partners the outpatient has been refurbished. The registration and payment points, triage, clinicians’ rooms and pharmacy have been brought close together and are all in view as one waits to be served. It is now clear to patients where their next stop will be and the hospital can handle more outpatient numbers. The outpatient is spacious and airy, with proper signage and has become a safer environment for both patients and staff. A reception has also been included in the new design.
Many insurance companies wanted to work with Maua Methodist Hospital but utilization of inpatient services was low. A key contributing factor to low utilization of the female ward was poor aesthetics. The old ward had no ceiling and offered no privacy for patients. Lighting was poor and when patient numbers increased, the ward became quite congested. Upon renovation, the female ward now offers privacy, is well lit with good aesthetics and patient numbers have gone up.
Human resources for health
Human resources for health systems have been revamped to improve sustainability. Noteworthy is the introduction of a two-shift nursing schedule to replace the earlier three shifts, significantly cutting costs. However, on the down side, the two-shift system can be strenuous for the nursing staff. Before, the nurse in-charges ran the night shift, an arrangement that was quite strenuous for them. Currently, night managers are covering the hospital at night and on weekends, enabling the in-charges and their deputies to focus on their specific areas of responsibility.
There are fewer cases of nurses resigning abruptly. After discussions and reassurance, very few nurses are leaving without resignation or serving notice and their dues are promptly paid. For example, last year, only one nurse left without notice.
The hospital chaplaincy department is quite active and is led by the head of the Methodist Church. The four 4 chaplains play a central role, for example, in compassionate care and inculcation of culture. There is a social worker based in the Comprehensive Care Centre (CCC).
Solar energy production
The hospital installed solar energy production in November 2021 with a capacity of 36 kVA. Monthly power bills went down from average of Ksh650,000 to Ksh470,000, a saving of nearly Ksh200,000. The solar energy is used for peak period day time only as storage batteries are high maintenance and expensive. Installation of the solar panels was funded by the hospital’s partners abroad.
Caring for the environment
In partnership Equity Group Banking and long serving Missionary Dr Sarson, the hospital staff are taking care of the environment by planting trees. Equity Group donated tree seedlings which the staff planted and continue to nurture.
- Water: A major water development project is coming up. Friends of Maua have raised funds to do water re-piping in the hospital.
- Electricity upgrade is also being done.
- Oxygen plant: Through partnership with AMH, Maua is refurbishing its oxygen plant and will be able to sell the essential commodity to other health facilities.
- Proper security fencing of the 20 acres of land on which the hospital stands
Towards regional leadership in referral, training and research
- The hospital’s internship program takes in an average of 12 clinical and 10 medical officer interns per year.
- AMH has been running 4 – 12-week training courses since 2013. The courses cover palliative care, HIV and TB in HIV. The AMH programme also supports HIV activities in the community and neighbouring counties.
- The hospital has signed training MOUs with KEMU, KMTC Meru, AIC Kijabe Hospital Medical College, MUST as wells as Friends of Maua Hospital.
- Weekly intradepartmental and hospital CMEs ensure attraction and retention of the right caliber of health care workers to achieve sustainable staffing
- Scholarships are offered, for example in Critical Care Nursing, a month-long crash course aimed at helping nurses to understand how to deal with critical patients. The hospital has an intensivist consultant running the ICU and a clinical officer trained in critical care. The hospital also has an endowment fund towards training of medical doctors. The AMH is partnering with the hospital to support staff development.
- Methodist College of Health Sciences: The school began as a School of Nursing in 1974 but rebranded as a college of health sciences 2019. It is currently offering: Diploma in Nursing (KRCHN), Perioperative Theatre Technology, Community Health & HIV Management (Certificate and Diploma) and short courses. Scholarships awarded to very needy students and AMH sponsors some trainings.
Adopting global trends
COVID 19 has changed the way we work, including how governance is done in institutions. Maua is utilizing on-line meetings for its governance functions, with the advantage of cost control as travel expenses are reduced.
As a result, there are fewer apologies during meetings, conferences and even a new definition of the workplace.
Recognizing that its most valued resource is people, the hospital makes every effort to support its staff, develop leadership at senior and middle management and all other levels.
Continuous prayers are mobilized from staff, missionaries who served in the hospital in the past and partners such African Mission Healthcare, Friends of Maua Hospital, United Methodist Church in the USA, The Methodist Church in the UK, among others.
Role of the Board
Good governance at Board level is critical in creating the right culture, support and leadership
The Maua Methodist Hospital Board has been very helpful throughout the transformation process.
Board training is a key ingredient in ensuring proper governance. The hospital has a 14-member Board with varying experience. Board training helps to clarify roles, ensure effectiveness and minimize conflict of interest.