An Employee Gone Bad: Why Strong Management Is Important

The nurses knew something was wrong. They were working the nightshift on Tuesday, August 28, when one of the male staff members quietly moved a young girl from the room where she was being treated to another room within the hospital. She had been brought in earlier that day after being kidnapped and assaulted by two boda boda (motorcycle taxi) operators. The men had raped her in turns, tied her up, and left her. She was eventually found by her parents and rushed to the Kisii Level Five Hospital in Nyanza, Kenya.

According to the news story, the clinical officer caring for her was a newcomer to the hospital, and no one was quite sure why he had moved the patient. The nurses grew suspicious when he turned off the lights in the girl’s room.

One of the nurses opened the door to investigate. There, she alleges, she saw the clinical officer raping the 12-year-old girl.

The nurse shouted. Several others came running. They expressed their horror and outrage by descending on him en masse, beating and kicking him mercilessly until the police arrived.

It was an upsetting, dangerous situation for the hospital staff members, one they should never have had to encounter. Health workers want to be safe. And they want their patients to be safe. But an employee gone bad is one of the dangers that many patients and staff members in health facilities in Kenya—and around the world—face every day.

Managing the problem

We at IntraHealth champion health workers—we advocate for them in every way we can. We hate to hear stories like this. They are real, though, and not to be ignored.

What happened at the Nyanza hospital is, of course, an extreme case. Most health workers would never dream of harming a patient this way. But the fact is that when a health facility does not run smoothly—especially when managers don’t know how to deal with hostile or ineffective personnel—it can quickly become a place where bad things happen. It’s a problem in many countries, including Kenya.

Under poor management, employees grow miserable. Good work goes unrecognized. Bad behavior has no consequences. Some workers begin to skip shifts or even leave in the middle of medical procedures. In extreme situations, other workers may take out their frustrations on the patients through violence or extortion.

IntraHealth is working to train clinicians-turned-managers in Kenya to make sure they know how to recognize problematic behavior in employees before it turns dangerous, and how to navigate the processes and paperwork that go along with disciplining unscrupulous employees.

“Generally managers in the public sector don’t want to fire anyone,” says Achim Chiaji, an organizational capacity development specialist for IntraHealth in Kenya. “There’s a strange sense of camaraderie. And so somebody might recommend suspension very quickly but not follow it up with the due process that leads to firing. In some cases it’s because they don’t know how to do it. In other cases, it’s an ethics issue, a manager thinking, ‘I don’t want to be the one who causes this person to be out of a job.’”

IntraHealth’s new eLearning training program in Kenya includes a module on standard government procedures for personnel issues, which have been a point of confusion for managers in the past.

Data management is another problematic issue. The accused clinical officer arrived at the Kisii Level Five Hospital after he was removed from the Nyamache District Hospital because of similar allegations. He should never have been allowed to get another job working with patients, but records from other hospitals aren’t always available (or checked by hiring authorities). IntraHealth’s Capacity Kenya project is working to address human resources data issues such as this. Health leaders in a dozen countries have begun using IntraHealth-developed human resources software to track some 475,000 health workers, including their training, licensure, and other key personnel info.

Our hope is that by making the right training available to health facility managers, we can help create the pool of skilled health workforce managers Kenya needs. Under trained management, the country’s health workers are more likely to be present, ready, connected, and safe. That means patients will be in more capable hands than ever before.

Litigation is ongoing against the suspect in the Kisii Level Five Hospital case, and his guilt or innocence has not yet been proven. His hearing is scheduled for October 25, 2012.

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