Induction Speech of Dr. Sujatha Senaratne, President CMASL

7th April 2018

BMICH, Colombo, Sri Lanka

 

 

Dr. Tedros, Director General of WHO- Chief Guest, Dr. Poonam Singh, Regional Director WHO – South East Asian Region – Guest of Honour, Hon. Dr. Rajitha Senaratna, Minister of Health, Nutrition and Indigenous Medicine- Guest of Honour,Dr. (Mrs) Neelamanee Hewageegana, Immediate Past President of the College, Dr. (Mrs). Champika Wickaramasighe, Secretary of the College, All Past Presidents of the College, Members of the Council and Members, Former Ministers of Health, Secretaries of Health, Director Generals and other distinguished invitees, Ladies & Gentlemen,

 

It is indeed a pleasure & privilege to stand in front this august gathering as the 25th President of College of Medical Administrators of Sri Lanka, to deliver my Presidential address. Actually Medical Administration can be compared to rocket science. Rocket science focuses on the high risk levels of space travel resulting in a safe journey while health care aims for safe patient outcomes. However, in both instances, lapses and mistakes can be catastrophic. Our members throughout the history, combining the skills of medicine with the knowledge and training in management, had ensured the highest standards of medical care has been maintained, while at the same time developing a health system which is considered as a role model not only to this region but to the entire world. 

Today, 7th of April 2018 is a very significant day to the Sri Lankan Health System as today the World Health Day is celebrated in Sri Lanka. In deciding to hold the World Health Day in Sri Lanka, Dr. Tedros the DG of WHO said “ there is no other country suited for this than Sri Lanka with its high achievements in Health.”

            In addition other leading world organizations have expressed the following in relation to our health sector. The World Bank “Sri Lanka achieving pro-poor universal health coverage”. UNICEF “ US newborn survival rate nearly same as Sri Lanka”.

I think all of us who are gathered here, present and past, politicians to practitioners can be justifiably proud of these achievements. You all have contributed for this remarkable success to our health care delivery system.

However, we cannot forever live in the glory of the past.

In this era of Sustainable Development and Universal Health Coverage, bold new ideas and disruptive innovations must be respected, accepted, explored and executed thinking of the future. While learning from global experiences, the above have been implemented in a uniquely Sri Lankan style. We as Medical Administrators have to deliver results swiftly and quickly a rapidly changing environment making sure that no one is left behind. We have to build a health system which is future proof. This is the very reason why we chose the theme “Leading Healthcare in the Fourth Industrial Revolution”.

 

 

Revolution

 

Revolution can be defined as ”sudden permanent change”. There had been many revolutions in history and there will be more revolutions in the future. Among these revolutions, industrial revolution had a significant impact on mankind. 

The First Industrial Revolution in 1784, used water and steam power to mechanize production. All most 100 years later, the second was in 1870 and used electric power to create mass production. The Third in 1969 used electronics and information technology to automate production. Now the Fourth Industrial Revolution is bringing in, “Cyber Physical Systems” to the forefront.

Digital technologies are rapidly transforming daily life for people around the world, in ways never before thought possible. With new levels of mobility and connectivity, and emerging technologies such as artificial intelligence, Big Data analytics,  3D printing and nanotechnology, it is clear that the pace of change will only grow. This “Fourth Industrial Revolution”, where technology is fundamentally changing how we live, work and relate to others.

The dawn of the Fourth Industrial Revolution was recognized at the 2016 World Economic Forum in Davos, Switzerland.

Who is going to benefit most from this Fourth Industrial revolution?

According to the Economist Magazine, it is expected that the health sector will benefit most from the Fourth Industrial Revolution.

In the rest of my address, I  have planned to elaborate on how digital disruptions in Fourth Industrial Revolution is going to transform the health system in Sri Lanka and our plan to build a future-proof health system within the next 3-5 years.

First is human resource;

I am sure that you all will agree with me, that human resource is the most valuable and the least readily available resource in any healthcare setting. We have one of the best health work force in the world. A highly engaged health workforce, can perform miracles. However, sometimes we see that the basic needs of this work force are not sufficiently fulfilled. As the first step, I have initiated a project to provide better accommodation facilities. It is expected that this will help to ensure retention of staff at remote and underdeveloped areas in the country. This will strengthen universal health coverage and primary care services.

To keep up with the rapidly changing environment, training is very important. We have planned many training programmes for staff members. The first one be for post intern medical officers.

 

According to  a WHO report , eLearning is  introduced into the curriculum used for the education of medical students and doctors in over 84% of countries. Universal Health Coverage needs staff with the right skills, and eLearning has the potential to play a significant part in addressing the skills & knowledge gap. Digital platforms such as Massive Open Online Courses, Learning Management Systems will be used for training. We are planning to develop and deploy Enterprise Social Networks for creation of knowledge. The digital transformation often demands not only technological change but also a re-imagination of roles, skills and culture.

As a first step we are planning to run a family medicine course for Medical officers working in Primary care using a e learning platform. In addition we will use the digital technology to improve the knowledge of our post intern medical officers awaiting to take up posts at various levels of responsibility

The effect of digital disruption, the transformation caused by the emergence of new technology and business models, are having a significant impact on the career trajectories of medical administrators. We need to develop leaders without silos. As the Economist magazine reports, the ability to manage across functions will become a more important leadership skill in the next three years, thanks to digital disruption, and  internal networking will be more important in the near future. Therefore as leaders, we have to corporate rather than compete with each other.

To our junior colleagues, I wish to state that as medical administrators, we are taking part in a relay, not a marathon.  Under no circumstances should we think of dropping the baton.  

As a new initiative, we have planned to conduct a series of workshops on operational research for Medical Administrators as a strategy to strengthen the health system. Prof Chanaka Edirisinghe, a world authority on operational research will be conducting these workshops. Also we are conducting monthly meetings to educate our membership with regard to new developments.

Primary care

Ladies and Gentlemen,

Let me share my ideas about future direction of health care, based on my experience. As a medical administrator I have served in both curative and preventive sectors. My experience as a the Regional Dental Surgeon- Colombo, Director of LRH,  D/ Director of NHSL and as the Additional Secretary – Public Health Services, helped me to realize the importance of primary health care.

During this year our college will support the Ministry of Health in the primary care strengthening / reform programs. As some of you may already be aware. The World Bank and the Asian Development Bank will fund programs to strengthen primary health care. The main focus will be on management of Non-Communicable Diseases at primary care level.

The college of Medical Administrators will be leading the primary health care re-organization. We will be assisting the Ministry of Health in piloting these reorganizations in two districts. In the pilot every citizen in the district will be issued with a personal Health number and will be assigned to a family care physician at primary care level. A Primary care institution will have a population of around 10,000-15,000. These Primary care Institutions will provide screening and treatment facilities for NCD, in addition to provision of out patient services. In addition these institutions will have facilities for provision of emergency care management. The supportive services will also get developed parellay so a person can get all services under one roof. Only the needy will be referred to a secondary or a tertiary care institution. We are sure the Ministry of Health  will consider strengthening of primary care as a priority and provide sufficient number of human resource as Medical officers and nursing officers to implement this all important change. We, the college of Medical Administrators will lead this change and also will  be the change agents to make this a real. There will be a strong  IT based information backbone to use digital health in this transformation. With use of technology  a patient visiting any institution will get continuation of care and the medical records will be available to all treating physicians at all time.  It is expected that by 2020 every citizen in the country will have an e-health card. 

Now from primary care to personalized medicine. As you all are aware, many drugs and treatments have been developed using a “one size fits all” approach, based on the characteristics of, and responses from, large groups of people. Now precision medicine offers the opportunity to tailor disease treatment to a specific person, by taking into account their genetic and biological makeup, the environment in which they live, and how they live their life. By taking a more tailored approach to health and healthcare – from screening to diagnostics, treatment and cure – we can improve outcomes and potentially lower the costs.

Personalized medicine can very well be used in preventive care. Having identified the mutations in the genome can reduce the impact and delay the onset of diseases like Alzheimer’s disease or cancers linked to genetic mutations. Also identifying genome can prevent occurrence of diseases like Thalassemia.

Fourth Industrial Revolution technologies, such as increased computational capacity, sophisticated digital information platforms and large amounts of genetic and biological data, are powering advances in precision medicine. Governments, industry, academics, civil society and patient groups need to collaborate to ensure that the whole of society is able to benefit from rapid advances in technology and precision medicine

Where do we stand?

As some of you may already be aware, Sri Lankan scientists are leading this field of precision medicine. We had the privilege of meeting some of them and they all agreed to help us in this regard.

Are we talking about a distant future?

Definitely not. The bed rock for personalized medicine is the electronic health records. I am happy to state that our medical administrators are playing lead roles in implementing electronic health records in the country. If all goes well, all institutions will be using electronic health records by the year 2020. We can leapfrog to the future. Also, future medical diagnostic images will all be in digital formats and filmless. This transition from photos to pixles will address the triple bottom line ;ie. People, Planet and Profits.

The success of this will depend on the collective efforts of different individuals led by medical administrators.

Where do the medical administrators fit in the Fourth Industrial Revolution to lead in healthcare?

Promoting innovation & Research

 

We all have to accept that all industrial revolutions were brought about by innovations. It has been said that the previous industrial revolution favored those who were “privileged”. i.e those who had labor and capital. But the fourth industrial revolution is completely different from this. To reap the benefits and not be left behind in this era of rapid change, we have to promote innovations both conceptual & experimental.

During this year, the College will establish a Healthcare Management Research and Innovation Centre. This will foster and promote multidisciplinary collaboration in research.

We also will promote, collaborative research and development with the indigenous medicine sector.

As you all know, King Ravana was a great physician. He is credited with the introduction of chemical extraction from plants to prepare medicines and use of heavy metals such as gold for treatment. Even today this practice is continued as “Rankiri kata gama”

The ancient wisdom such as these, can be researched in depth with the technologies brought about by the Fourth Industrial Revolution. 

We are also planning to support research in personalized medicine, gene therapy and stem cell research.  This may sound ambitious and high tech but all are within our reach.

Power of computing will enable big data analytics where n=all. We will be always in beta mode as there will continuous evolution.

To promote research and innovation, I would like to recommend to you to read “Originals”, a book by Adam Grant. This describes how non conformities are changing the world. This is very true for this era of revolution and innovation.   

Fourth industrial revolution & Sustainable Development Goal (SDG)

Achievement of SDG need to be carefully monitored. Quality data will be the key. Use of Artificial intelligence will have a real benefit.

 

Policy impacts

While new products and services are routinely rolled out, governments try to keep pace with these new technologies. This requires regular overhauling all aspects of health care. While governments are trying to carefully measure and mitigate their impacts, citizens are eager to reap benefits.

What is needed is a new era of agile governance. A  policymaking that is adaptive, human-centered, inclusive and sustainable. Policy development is no longer limited to governments but rather is an increasingly multi-stakeholder effort. Therefore policy making need to be;

  • Focused on achieving policy goals rather than check-the-box regulatory compliance;
  • Open to new information and drawing on elements like data-driven government and pilot programmes, and willing to change if goals are not met;
  • Open to input from a wider group of stakeholders and grounded in transparency.

Management challenges

The Fourth Industrial Revolution will bring many challenges to healthcare leaders.  The important ones would be;

  1. Adapting to the ongoing digitization of healthcare industry
  1. Dealing with digitally empowered customers (both internal & external)
  1. Provision of superior service to those with sufficient knowledge and alternatives.
  1. Managing digital disruptions
  1. Making strategic decisions on digital technologies
  1. Promoting and managing innovation both conceptual and experimental
  1. Making necessary changes across the health system

Finally, I have a lot of people to thank for nurturing and caring for making me the person today. First I would like to thank my parents. My mother and my brothers and sisters looked after me very well and always were with me and guided me since my father left us when I was small.

Then my teachers in school and in university of Peradeniya and Postgraduate Institute of Medicine taught me well and in addition to knowledge in subject matters, they taught me life skills and how to live in a society with people of different ideas and views.

Then I met my husband Dr. Rajitha Senaratne and He was beside me all my life supporting and encouraging me. As experienced by all of us there were many ups and downs in our lives. We faced them together and we both helped and encouraged each other. My two sons Chathura, and Sesath and my daughters in law,  I have no words to thank you. There were times you have rarely seen me. When I worked as a Hospital Director. I stayed in the quarters and worked  the whole time.  You all understood me and encouraged me to work for the people. Thank you very much.

Then I would like to thank my council for organizing this event and I am confident that with your support we could achieve what we have planned.

Thank you.