Award of the SERVICOM Index · Award of the SERVICOM Index Report of SERVICOM Compliance Evaluation...

February 24, 2009

The People’s Right to Be Served Right

Award of the SERVICOM Index

Report of

SERVICOM Compliance Evaluation of

National Hospital, Abuja

(General Out-Patient Department)

Office of the Secretary to the Government

of the Federation

SERVICOM Index compliance Evaluation Report

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EXECUTIVE

SUMMARY


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SUMMARY OF SERVICOM COMPLIANCE EVALUATION NATIONAL HOSPITAL,

ABUJA

Date of Evaluation: February 24, 2009

Score: 1.6 out of 4 (40%)

Ranking: Two Star (**) Service

Description: Fair

Findings

Strengths:

Customers confirmed that there are no hidden costs on charges

The use of Public Address Systems to disseminate information on service delivery

and other hospital activities

The hospital carries out customer satisfaction survey to determine customers’

satisfaction level

There are designated waiting areas with seats throughout the hospital where

customers seat while waiting to receive service

Weaknesses:

There are no clearly defined processes involved in monitoring performance against

set Standards, to show that the hospital adheres to its set standards in rendering

service to its customers For instance, the set standard on customer care in the

areas of promptness, speed of response and staff treatment of customers have no

process of monitoring as customers wait endlessly before services are accessed

The directional signs provided to direct customers to different service points in the

hospital are not enough e.g. there is no clear directional signs to the GOPD. This

makes access to service difficult for customers and visitors


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Customers and stakeholders of the hospital confirmed that costs and charges are

not set within the reach of the poor and the very poor especially with regards to

laboratory tests and costs of drugs. As a result poor citizens find it difficult to

access the services of the National hospital

Frontline staff are not trained on complaints handling, this affects the level of their

professionalism in the resolution and investigation of all complaints

Customers are not aware of how long it takes to receive service at the GOPD and

other service outlets of the hospital as they wait endlessly to be attended to from

one service point to another e.g. customers confirmed that it takes an average of

3- 4 hours before one receives service at the hospital

Customers complained that staff do not offer explanations for delays in service

delivery nor do they explain interruptions to services e.g. Doctors resume duties

between 10.00 am – 11.00 am while the patients are kept waiting without

explanations

Appointment procedures are not clearly detailed at all service outlets for the benefit

of both new and old customers. This gives room for preferential treatment as was

observed during our mystery shopping as also confirmed by customers

There is no evidence to show that the hospital has implemented the result of

consultation with all customer groups and adapted service accordingly e.g

costs/charges of service and issue of staff punctuality to work as contained in the

Report on Quality of Care Survey carried out by the hospital between September

– November, 2008

There exists the issue of some departments not duly represented at management

meeting. This excludes some staff from participation in the consultation process in

the service delivery system of the hospital

Frontline staff do not wear name tags, offices and desks are not clearly marked to

indicate names and functions of officers for easy identification by Customers

Performance targets are not set for individuals (staff) and departments, therefore

where there are variances in the overall targets of the hospital, it cannot be fully

explained

Frontline staff are not trained on Customer care, this affects the level of sensitivity

in the treatment of customers e.g. The majority of the customers interviewed

complained that most staff of the hospital at different service points are rude and


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arrogant; and are not friendly to customers. This was also confirmed in the Report

on Survey on Quality Care carried out by the hospital between September –

November, 2008

The Chief Legal Officer who is also the nominated Complaint Desk Officer is not

clearly identifiable to customers to ensure that customers have someone to talk to

when services fail

Recommendations:

There should be clearly defined processes involved in monitoring performance

against all set Standards. For example, a system should be put in place to check

how long patients take to access the services of the hospital. Such monitoring

system should take into account the movement from one service point to another.

This will ensure that the hospital adheres to its set standards in rendering service

to its customers

Adequate directional signs directing customers to different service points should be

put in place within the hospital especially that of the GOPD. This will make access

to service easy for customers and visitors

The issue of high costs and charges not set within the reach of the poor and the

very poor should be looked into by the management. Appropriate downward

review of price should be carried out in order to address the issue once-and-for-all

so that poor citizens can also access the service of the hospital

Frontline staff should be trained on complaints handling, this would enhance

effective resolution and redressal of all cases of service failures

Concerted efforts should be made by the management to reduce actual waiting

time of 3-4 hours in the hospital so that an average realistic waiting time could be

developed for the benefit of the customers

Staff should endeavour to give honest and substantial explanations for delays and

interruptions to service. This should be done as part of recovery of a breakdown to

service delivery and will reduce anxiety and anger of customers at service points

Appointment procedures should be clearly detailed at all service windows for the

benefit of both new and old customers. This will prevent incidence of preferential

treatment being given to some customers by staff and will ensure equal treatment of


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all customer groups

The hospital should endeavour to implement the results of consultation and adapt

service accordingly such implementation should be made public for all to know that

the hospital considers the views of its stakeholders in the service delivery process

Management should look into the re-occurring issue of some departmental heads not

being represented at management meetings. Adequate information on this should

be given to staff particularly Heads of Units for transparency purpose and for

improved service

All staff should wear name badges. Offices and desks should clearly indicate

functions and names of officers. This will ensure easy identification of staff at the

service points

Clear performance targets should be set for individuals(staff) and Departments in

order to monitor individual and department performance against set standards and

targets in the overall achievement of the hospital’s goal

Frontline staff should be trained on Customer Care, this would give staff the

mindset and capacity to always treat customers with respect and dignity during

service provision and delivery

The position of the hospital’s Complaints Desk Officer presently located at the legal

unit should be re-assigned to the SERVICOM unit for prompt resolution of cases

of service failures as directed by the Federal Executive Council

Full details of the Complaints Officer, Name, Room number and telephone number

should be clearly stated in the Charter

Conclusion

The SERVICOM Index awarded to the National Hospital, (GOPD) Abuja is 1.6 out of 4

(40%) which represents two star (**) and indicates ‘Fair’ service delivery. Although this is

still far from praiseworthy, it is our belief that the National Hospital, Abuja could ensure

continuous improvement on the quality of service delivered to members of the public if the

recommendations contained in this report are faithfully implemented.


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MAIN

REPORT


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1.0 Introduction

This is a report on the findings of a SERVICOM Compliance Evaluation of the National

Hospital, (GOPD) Abuja. Compliance has been measured against the SERVICOM Index,

a yardstick for measuring the quality of service as delivered by Government through its

various Ministries, Departments and Agencies.

The SERVICOM Index is predicated on the facts that:

The ultimate purpose of governance is to serve citizens

Citizens have the right to be served right

Service is well delivered only when citizens are satisfied; and

The Federal Government is committed to the provisions of SERVICOM (Service

Compact with All Nigerians) as a programme to improve service delivery throughout

the country

Customer satisfaction is the overriding consideration of service delivery. Extensive

research, consultations and surveys have shown that customer satisfaction is broadly

driven by several drivers, listed below. The selected service windows of the National

Hospital, Abuja has been evaluated for each of these drivers through customer

interviews, discussions with staff, discussions with partners, review of key documents and

observations. The Index score for National Hospital, Abuja has been calculated as a

weighted average of the composite scores evaluated for each driver. The weight of

importance attached to each driver is as follows:

Service Delivery – 30%

Timeliness – 24%

Information – 18%

Professionalism – 16%

Staff Attitude – 12%


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2.0 Acknowledgement

We acknowledge the co-operation of the following for their contributions in the course of

the evaluation exercise.

1. Alh. Yayale Ahmed Secretary to the Government of the Federation,

Office of the Secretary to the Government of the

Federation (OSGF)

2. Dr. Hakeem Baba-Ahmed Permanent Secretary, GSO, Office of the

Secretary to the Government of the Federation

(OSGF)

3. Dr. Z O Ajuwon, Chief Medical Director/Chief Executive Officer,

National Hospital, Abuja

4. Dr. I. L. Audu Director of Clinical Services/Chairman Medical

Advisory Committee (CMAC)

5. Barr. Judith I. Irabor Chief Legal Officer/Complaints Officer

6. Dr. J. A. Momoh HOD, Chemical Pathology

7. Alhaji Abdul Msheliza HOD, Pharmacy

8. Dr. Oche Ogbe HOD, Haematology

9. Dr. Ify Monye HOD, Family Medicine.

10. Mrs. A. Abubakar Health Records Department

11. Mallam Yahya Sadiq, Nodal Officer/Assistant Director Information

Services National Hospital, Abuja

12. Dr. K. O. Iregbu Medical Microbiology, National Hospital, Abuja

13. Mrs. Foluke Oni Nodal Officer, Office of Secretary to the

Government of the Federation (OSGF)

14. Mrs. Tola Tiamiyu MSU Staff, Office of the Secretary to the

Government of the Federation (OSGF)

3.0 Terms of Reference

National Hospital, Abuja was selected for evaluation following a Presidential directive that

all Government Ministries, Departments and Agencies (MDAs) be evaluated for

SERVICOM Compliance.


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The Mandate of the SERVICOM Compliance Evaluation team is to identify those areas of

action that can bring immediate or urgent improvement in services to citizens.

To ascertain the present state of service delivered to the Nigeria citizens

4.0 Methodology

National Hospital, Abuja is located at Central Business District in the Federal Capital

Territory (FCT) Abuja.

:

The Main Service Windows of the National Hospital are:

Accident and emergency

Intensive Care unit to cater for serious medical and surgical cases

Operating Theatre Units where a full range of minor and major operations are

performed including endoscopic procedures

Labour Ward/Theatres for deliveries and infant care facilities

Paediatric and neonatal care services for sick children

Radio Diagnostic services using ultra-modern X-Ray Machines such as

Mammography, CT Scan and Magnetic Resonance Imaging (MRI), etc

Haemodialysis services using a Linear Accelerator and other equipment

Cancer treatment services using a Linear Accelerator and other equipment

General and Private Wing Out-Patient Services

In-patient wards comprising private, semi private and open wards

Family Planning and Reproductive Health Services

Ear, Nose and Throat, Ophthalmology and Dental services

Laboratory services in microbiology, haematology, morbid anatomy/histopathology,

chemical pathology and immunology

Non-clinical services such as finance, administration, engineering, etc

Ambulance Services

Invitro-fertilization (IVF) services

Neurosurgical services

Urology services


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Psychiatry services

The General Out-Patient Department of the National Hospital, Abuja was justifiably

chosen for the following reasons:

It is the first point of call and reception (gateway) for every customer to the

Hospital.

It provides full range of services and has high volume of customers

It serves as referral clinic to the various specialist’s clinics and admissions for

patient whose illness needs further attention.

It runs 24 hours call services.

The result of the evaluation can be used to bring about improved services to all its

customers nationwide.

Therefore, the General Out-Patient Department was selected for evaluation based on

the process a customer is to follow in order to receive service. This process generally

touches on four main points of contact::

Registry: collection of cards, retrieval of existing folders/records

Consultation: medical examination/treatment

Pharmacy: drug services, drug costing and dispensary

Laboratory: conduct medical tests

The SERVICOM team for this evaluation consisted of two SERVICOM Officers, the Nodal

Officer of the Office of the Secretary to the Government of the Federation (OSGF), one

MSU Staff from the OSGF and the Nodal Officer of the National Hospital, Abuja.

Evidence was gathered at the service window through customer interviews, discussions

with staff, discussions with partners, review of key documents and general observations.

Given the particular nature of the services provided by the National Hospital, Abuja, it was

also important to evaluate further evidence by administering questionnaires, and

conducting interviews with its partners: the pharmaceutical companies and the external

surgeons. The website of SERVICOM office www.servenigeria.com and National Hospital

website www.nationalhospitalabuja.net were also used for research.

http://www.servenigeria.com/

http://www.nationalhospitalabuja.net/


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The key documents reviewed include:

Service Charter of the National Hospital

Operational Manual for the National hospital

Staff Handbook

National Hospital Customer Care Policy

Report on Quality of Care Survey (September – November, 2008) edition

2008 Annual Statistics/Performance Report

National Hospital for Women and Children , Abuja (Establishment , etc)Act

Minutes of Stakeholders’ Forum of 17th December, 2008

National Hospital, Abuja Newsletter (January 2009) edition

5.0 Findings

The findings presented in this section comprise of an Index score, observations on the

Service Charter and on the quality of service delivery found at the service windows.

5.1 Charter Evaluation

The evaluated score for the Service Charter of the National Hospital, Abuja is

Two (2) out of three (3).

Description: Suitable

5.1.1 Findings on Service Charter

Standards guiding the service provision and delivery are not stated in the Charter

The existing grievance redress mechanism stated in the Charter has no time

frame stated for complaints resolution and redressal

Details of the Chief Legal Officer, who is the Hospital’s Complaints Officer are not

clearly stated e.g. The Name, Office telephone and Room number are not stated

in the Charter

Prototype Charter of service outlets are displayed at some service points of the

hospital


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5.1.2 Recommendations for improving Service Charter

Service standards of the hospital should be reflected in the Charter

Specific time frame to resolve complaints should be stated in the Charter

The position of the hospital’s Complaints Desk Officer presently located at the

legal unit should be re-assigned to the SERVICOM unit for prompt resolution of

cases of service failures as directed by the Federal Executive Council

Full details of the Complaints Officer, Name, Room number and telephone

number should be clearly stated in the Charter

Prototype Charter of the service outlets should be displayed at the various

service points of the hospital

5.2 Index Score

The table below summarises the result of the evaluation of the service window. Based on

these, we have calculated a score for the National Hospital

The overall Index score awarded for the National Hospital (General Out-patient

Department) is 1.6 out of 4 (40%)

Description: Fair


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Score for National Hospital, Abuja (General Out-

Patient Department)

Overall Index score 1.6

Service Delivery 1.7

1 - Standards and

practices / performance 1.1

2 – Reception

experience 2.4

3 - Complaints and

grievance redress 1.6

Timeliness 1.3

1 – Standards and

practice / performance 1.3

2 – Customer

friendliness 1.3

Information 1.9

1 – Information 1.8

2 – Customer feedback 2.0

Professionalism 1.3

1 – Transparency 0.8

2 – Efficiency 1.9

Staff Attitude 1.7

* Scores are rounded to one (1) decimal place.


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5.3 Key Findings

The following observations have been made on the quality of service delivery provided by

the National Hospital, Abuja which we feel need to be addressed as a matter of urgency

5.3.1 Service Delivery

There are no clearly defined processes involved in monitoring performance against

set Standards, to show that the hospital adheres to its set standards in rendering

service to its customers For instance, the set standard on customer care in the

areas of promptness, speed of response and staff treatment of customers have no

process of monitoring as customers wait endlessly before services are accessed

The directional signs provided to direct customers to different service points within

the hospital are not enough e.g. there is no clear directional signs to the GOPD.

This makes access to service difficult for customers and visitors

Customers and stakeholders of the hospital complained that costs and charges

are not set within the reach of the poor and the very poor especially with regards to

laboratory tests and costs of drugs. As a result poor citizens find it difficult to

access the services of the National hospital

Frontline staff are not trained on complaints handling, this affects the level of their

professionalism in the resolution and investigation of all complaints

It was observed that the toilet facilities at the Emergency Unit are kept under lock

and key. Customers are therefore at a loss as to where to go for toilet purposes

5.3.2 Timeliness

Customers are not aware of how long it takes to obtain services at the GOPD and

other service outlets in the hospital as they wait endlessly to be attended to from

one service point to another e.g. customers confirmed that it takes an average of

3- 4 hours before one receives service at the hospital

Customers complained that staff do not offer explanations for delays in service

delivery nor do they explain interruptions to services e.g. Doctors resume duties

between 10.00 am – 11.00 am while the patients are kept waiting without

explanations


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5.3.1 Information

Details of the actions taken to remedy poor performance are not published for the

customers to know the possible outcomes and in turn develop confidence in the

service delivery system

There is no evidence to show that the hospital has implemented the result of

consultation with all customer groups and adapted service accordingly e.g

costs/charges of service and issue of staff punctuality to work as contained in the

Report on Quality of Care Survey carried out by the hospital between September –

November, 2008

Costs and payment procedures are not clearly displayed at all service windows, for

the benefit of the customers and to forestall hidden costs

5.3.4 Professionalism

Appointment procedures are not clearly detailed at all service outlets for the benefit of

both new and old customers. This gives room for preferential treatment as was

observed during our mystery shopping as also confirmed by customers

There exists the issue of some departments not duly represented at management

meetings. This excludes some staff from participation in the consultation process in

the service delivery system of the hospital

Staff complained of not being motivated, this is due to the fact that good work is

neither commended nor rewarded whereas staff are promptly disciplined when their

performance is unsatisfactory.

Most frontline staff do not wear name tags and offices / desks are not clearly

marked to indicate names and functions of officers for easy identification of staff

by Customers

Organisational charts are not displayed at all service points so that the hierarchy of

the organisation is known to customers to enable them know where to go when

services fail

Performance targets are not set for individuals (staff) and departments, therefore

where there are variances in the overall targets of the hospital, these cannot be

fully explained


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5.3.5 Staff Attitude

Customers complained that the presence of Interns Doctors in the consultation

rooms without explanation or prior information to the patient does not give room for

privacy

Customers complained that services are rendered on preferential treatment basis

and not on first come first served

Frontline staff are not trained on treatment of customers, this affects the level of

sensitivity in the treatment of customers e.g. it was observed that some frontline

staff in the Medical Records Unit and at various service points of the hospital are

arrogant and not friendly to customers

The hospital’s Chief Legal Officer who is also the nominated Complaint Desk

Officer is not clearly identifiable to customers to enable them channel their

complaints when services fail

5.4 Additional Findings


The existing system of dispensing drugs based on product needs without adequate

pharmaceutical care makes the hospital not to be patient oriented in its treatment

of customers

Customers waiting to be bled for the Oral Glucose Tolerance Test (OGTT) in the

lab have no adequate place for privacy and to rest after the test


Customers complained that essential drugs are not available on a regular basis for

the prompt treatment of customers

The majority of the customers interviewed complained that continuous payment of

consultation fee at every instance at the hospital when seeing a doctor is

unaffordable and should be looked into by the management

Staff and customers of the hospital complained that there are not enough

professionals to attend to the teeming patients (doctors, consultants, pharmacists)

who visit the hospital. This results in delay at service points

The retrieval of folders and cards allocation systems causes delay in the Records

unit


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Customers complained that frontline staff at GOPD devote much time discussing

private matters rather than being committed to their duties and at the expense of

giving timely service to customers

6.0 Recommendations

The following recommendations are provided in order to suggest actions that can be

taken which could directly lead to improvements in service delivery. In this report, we are

unable to comment on general constraints relating to physical or human resources, or

structural and systemic issues, which may impinge on effective service delivery of

services to the public

6.1 Key Recommendations


There should be clearly defined processes involved in monitoring performance

against all set Standards. For example, a system should be put in place to check

how long patients take to access the services of the hospital. Such monitoring

system should take into account the movement from one service point to another

This will ensure that the hospital adheres to its set standards in rendering service

to its customers.

Adequate directional signs directing customers to different service points should be

put in place within the hospital especially that of the GOPD. This will make access

to service easy for customers and visitors

The issue of high costs and charges not set within the reach of the poor and the

very poor should be looked into by the management. Appropriate downward

review of price should be carried out in order to address the issue once-and-for-all

so that poor citizens can also access the service of the hospital

Frontline staff should be trained on complaints handling, this would enhance

effective resolution and redressal of all cases of service failures

Toilet facilities should be well kept maintained and opened for use by the

customers. This will show that the hospital is sensitive in the treatment of

customers and for improved reception experience of all customers


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6.1.2 Timeliness

Concerted efforts should be made by the management to reduce actual waiting

time of 3-4 hours in the hospital so that an average realistic waiting time could be

developed for the benefit of the customers

Staff should endeavour to give honest and substantial explanations for delays and

interruptions to service. This should be done as part of recovery of a breakdown to

service delivery and will reduce anxiety and anger of customers at service points

6.1.3 Information

Details of the actions taken to remedy poor performance not only in terms of

structural defect but in service failure should be published for the customers to

know the possible outcomes and build confidence in the service delivery system of

the hospital

The hospital management should endeavour to implement the results of

consultation and adapt service accordingly such implementation should be made

public for all to know that the hospital considers the views of its stakeholders in the

service delivery process

Costs and payment procedures should be clearly displayed at all service points for

the benefit of the customers and to forestall hidden costs


Appointment procedures should be clearly detailed at all service windows for the

benefit of both new and old customers. This will prevent incidence of preferential

treatment being given to some customers by staff and will ensure equal treatment of

all customer groups

Management should look into the re-occurring issue of some departmental heads not

being represented at management meetings. Adequate information on this should

be given to staff particularly Heads of Units for transparency purpose and for

improved service

Staff who are performing well should be motivated to continue to put in their best.

This could be done by way of commendation or reward. Staff could also be motivated

in terms of welfare packages in order to get their optimal input in service delivery at

the hospital


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All staff should be made to wear name badges, and offices/desks should clearly

indicate functions and names of officers. This will ensure easy identification of staff

by customers at the service points

Organisational charts should be displayed at all service points so that the hierarchy

of the hospital is known at a glance and all customers would know where to go for

service as the need arises

Clear performance targets should be set for individuals(staff) and Departments in

order to monitor individual and department performance in the overall achievement

of the hospital’s goal


The need for respect and privacy should be not be overlooked by the hospital

management. In as much as the hospital employs interns doctors, room for privacy

should be created for patient who might not feel comfortable with the presence of

two or more doctors

An appointment procedure in order to serve customers on first come first served

should be worked out by the hospital

Frontline staff especially Nurses and Records staff should be trained on Customer

care. This would give staff the mindset and capacity to always treat customers with

respect and dignity during service provision and delivery

The position of Complaints Desk Officer should be re-assigned to the Complaints

Desk Officer in the SERVICOM unit, whom the customers can easily reach to

lodge complaints when services fail

6.2 Additional Recommendations


Drugs dispensary should be done with adequate pharmaceutical care based on

the patient needs rather than the product for improved customer sensitivity in the

service delivery of the hospital e.g. there should be interaction with the pharmacist

and patients to determine their response to the prescribed drugs

Provision of private /separate areas should be made for patients waiting to be bled

for the Oral Glucose Tolerance Test (OGTT) for improved service delivery


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Professionalism

Essential drugs should be made available at all times in the hospital on a regular

basis to enable those on emergency be attended to promptly and in case of an

outburst of disease at any given time

The issue of continuous payment of consultation fee at every instance at the

hospital when seeing a doctor should be looked into or such a fee reviewed

downwards

Management should look into divert ways of bringing in more professionals and

experienced staff to assist the existing staff in the hospital for better performance

and for service improvement e.g. experienced doctors, pharmacist, consultants

should be used rather than interns doctors

The Health Records system of retrieval of folders and cards allocation should be

well managed and computerised in order to reduce delay at the Records unit of the

hospital

Staff Attitude

Staff should devote more time to service delivery rather than chatting away at

service points. Training of staff on work ethics should be carried out in order to

eliminate attitude of rudeness and arrogance

1.2 Service Improvement Planning

Although the question of how these recommendations might best be implemented is a

management issue for the National Hospital, Abuja the SERVICOM Office, through the

SERVICOM Institute will work with the management of National Hospital, Abuja and its

SERVICOM Unit to develop and guide the implementation of appropriate Service

Improvement Plans.

Conclusion

The SERVICOM Index awarded to the National Hospital, (GOPD) Abuja is 1.6 out of 4

(40%) which represents two star (**) and indicates ‘Fair’ service delivery. Although this is

still far from praiseworthy, it is our belief that the National Hospital, Abuja could ensure

continuous improvement on the quality of service delivered to members of the public if the

recommendations contained in this report are faithfully implemented.

Award of the SERVICOM Index · Award of the SERVICOM Index Report of SERVICOM Compliance Evaluation...

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