Dr Lina Janulova, a public health consultant, has been the Acting/Medical Administrator at Mater Dei Hospital since January 2009.
Although she was born and grew up in India, Malta has been her home since she arrived here with her parents 32 years ago when she was a teenager. She attended the University of Malta and graduated as a doctor of medicine in 1985. She is married to a consultant ophthalmologist and they have a 20-year-old daughter and an 18-year-old son.
Dr Janulova joined the Department of Health in 1985 and has extensively covered many areas in the field. She has worked at Boffa, Mount Carmel and Gozo General hospitals and at St Luke’s Hospital, spending a couple of years at the Casualty department.
Her forte is Information Technology and in 1990 she joined the Health Information Department where she launched the National Obstetric Information System (NOIS) in all hospitals, including the private sector.
This was the first time that a National Hospital information system was set up and this system is still running.
She was Malta’s National Statistical Focal Point, for WHO/Europe Health For All 21 (HFA) from 2000 to 2004. “During this time I had the opportunity to work together with several local health and other professional partners from various organisations in Malta and Gozo, such as the National Statistics Office, the National Statistics Authority, Sedqa and public and private hospitals, for the compilation of Malta’s Health For All Data.
“I was also Malta’s focal point for the WHO Obstetric Quality Indicator and Data collection (OBSQID) project, which gave me the opportunity to introduce the concept of how important it is to have detailed national statistics also in the field of Obstetrics, at a local level,” she told me.
In 2004, she was asked to return to St Luke’s Hospital to set up the Data Management Unit with the objective of improving on very scanty clinical data available at the hospital.
“This unit was responsible for most of the clinical information, to mention a few examples – surgical operations, accident & emergency and In-Patient and Out-Patient data,” she told me.
Dr Janulova got a Masters degree in Public Health in 2007.
In late 2007 the unit further progressed into the Clinical Performance Unit at Mater Dei Hospital. She and her colleagues were successful in bringing valid hospital information to the clinical entities, thus transforming the information systems at the hospital into an effective management tool for assessing performance on clinical services offered.
“The clinical chairs of departments (the consultants) now have comprehensive clinical data – evidence based records and information, including details on surgical operation procedures – in their specialities,” said Dr Janulova.
I asked her about the problem Mater Dei has with beds and who has the final say on who gets a bed, or has to vacate it?
“Beds are pivotal to the efficient working of a hospital. It is not a question of ownership but problems are solved through teamwork. The patient is the focus and nobody can pass the buck,” she said.
But what can be done about so-called social cases like the elderly or people who still need rehabilitation and live on their own?
“You cannot put them on the street. One of the problems is that hospitals that have beds for rehabilitation or could accommodate elderly patients, for example, are not fully operational 24/7 like Mater Dei.
“However, despite certain problems there has never been a case of a patient waiting for 24 hours to be admitted to a ward. I am not saying we do not have our failings, but we have also been the butt of unfair criticism,” she told me.
But the problem of long waiting queues at the hospital is not unfair criticism, is it because there are not enough doctors or consultants. Is this going to improve in the near future?
“The result of long queues is multifactorial and not a question of more consultants or doctors in general. For example, waiting lists/times are inevitable regarding operations, because of time to focus on work undertaken.
“Waiting lists feature in all countries with a publicly funded health system. Despite countless well-meaning initiatives in all countries to eliminate them, their persistence continues to infuriate and frustrate governments.
“Several enterprising approaches have been addressed worldwide, the use of priority scoring, staff substitution, better management of theatre time, greater use of day care and pre-admission assessment clinics etc.
“All have contributed to increasing numbers and complexities of interventions carried out, but they have failed in eliminating waiting lists in total. The blunt truth is that waiting lists provide a constant demand for precious resources maximising efficiency theatre use, bed use, and staff.
“Significantly, it allows time for any natural or spontaneous recovery to occur rendering surgery unnecessary in some cases. It allows patients to consider or reconsider their decision to go for surgery and prepare psychologically and otherwise for an intervention.
“Furthermore, surgeons will provide new interventions as technology develops, and conditions, which were untreatable enter the realm of treatment; a patient demand is created while the process of cutting down on waiting time is ongoing, with the result of creating a longer queue.
“The success of public funded healthcare is best viewed from the number and satisfaction of patients treated. The more confidence the system generates in the public, the longer the queues and the wait to sample it.
“The quality/efficiency of health services is best judged by what is delivered, and the length of queues and waiting is in part a measure of the success of these services and the Maltese public’s confidence in them.
“Having said that, Mater Dei Hospital has not been in a position to realise its full potential as some operating theatres remain closed largely because of a lack of nurses.
“However, this situation is being reviewed and analysed by the new Director, Nursing Services at MDH,” said Dr Janulova.
I was curious as to whether human resources vis-à-vis doctors was within her remit?
“All Human Resources fall under the Director Human Resources (HR) at Mater Dei, so no, HR does not fall under my remit. I work with what is given to MDH.
“The clinical chairmen in the specialities make requests for their human resources to the HR Director, Andrew Xuereb and the Department of Health’s Director General Dr John Cachia.”
She believes the government should retain consultants who are over 60, since their experience is invaluable. “Age is the only limiting factor that keeps them from working in the National Health Service while they are still active and capable. Most countries in Europe set the retiring age at 65.
“For these professionals to only be available in the private sector would create a situation where not all can afford their services, which would be unfair to the group of patients that can only visit the public sector.
“I also believe they should still be employed in such a way that does not block any career prospects for the younger upcoming group of doctors.
“The National Health Service needs all qualified professionals still willing to provide a service,” she told me.
But what else, in her opinion, could be done to attract more doctors to the public service?
“Ensuring satisfaction and motivation and encouraging team achievement, making certain that while doctors provide a service they are also encouraged to pursue their own dreams in relation to the profession, lifestyles, hobbies, quality of family life and individual life etc.
“Doctors in the public service should be role models to other doctors. Working in the public hospital is extremely interesting from a medical perspective in terms of the wide range of case mix of disease that are presented to its doors.
“One is able to treat common conditions as well as a wide range of not so common conditions within a team. Life for a doctor in the public service is never lonely, boring or dull. There is an abundance of common goals, good energies, skill mix and case mix which money can never buy,” she responded. As someone who has never worked in private practice, I suppose she talks through experience.
There are bound to be different perspectives between the clinical and non-clinical staff and management. Where do you fit in? I asked her.
“I have a very good relationship with clinical chairs, mutual respect leads to a healthy rapport. There should always be understanding in negotiations in a consultant led practice. I see myself as a good will ambassador between the clinical and non clinical staff at Mater Dei,” said Dr Janulova.
I asked her whether she ever feels like giving up, when she comes across critical articles in the press and disgruntled patients or staff?
“Obviously, it is not pleasant to have to deal with shortcomings, which after all one would have to face up to in any job, but I see it as a gift to work in such wonderful surroundings and despite the setbacks, which are a challenge, Mater Dei is a place to be proud of.”