Placing ‘Doctor’ at the Centre of Transforming Public Health Sector in Odisha

Authors: Dr. Rahul S Reddy Kadarpeta, Health Systems Transformation Platform; Ms. Nidhi Prabha Tewari, Athulya Performance Facilitators

Dr. Somyakanta Das Pattnayak is a Medical Officer Incharge at the Community Health Centre (CHC) – Balugaon in Odisha. For the last 3 months he is making sure that people with mental health issues within his CHC coverage area, receive full treatment with a consultation at the CHC at least once every month. We see him busy in his consultation room, with at least 30 patients waiting for their turn. Accompanying him is a psychological counsellor, four community health officers (CHOs)and patient attendants doing their best to support him to achieve his goal of ensuring every patient gets the right attention and treatment. He is highly motivated to making mental health a priority and ensuring he follows up this motivation through necessary action is his coach Ms. Nidhi Prabha Tewari.

Dr. Pattnayak is enrolled in the physician leadership development program and is being coached to achieve his goal of ensuring treatment for 210 patients with mental illness in a period of 3 months using the Causing Incredible Performance Framework (CIP). The mental health patients in this area frequently travel to larger cities to receive a diagnosis and a prescription for their ailment or they attend a monthly camp at the CHC conducted by a senior doctor coming from district headquarters. There was no patient tracking, and occasionally the district level doctor missed his monthly visit.

Schizophrenia, depression, anxiety, Parkinson, and Alzheimer’s disease are a few of the conditions that are frequently identified. His primary concern is improving treatment adherence and follow-up in cases of mental illness. He was serving roughly 70 patients when he started working towards his goal. On 31 January 2023, at the end of the coaching period Dr. Pattnayak achieved treatment for 252 patients, which is beyond the goal he set for himself.

To make it simple for patients to contact Dr. Pattnayak, he ran out patient clinics at both the CHC and Primary Health Centre (PHC) levels. He had ASHAs and Community Health Officers follow up on and regularly care for people with mental health issues. For the first time, CHOs and ASHA are involved in the treatment of individuals with mental illnesses. He says, “it is for the first time in the CHC’s history that all 13 medicines prescribed for mental health are available at his CHC”. He organised these medicines, he learnt that medicines were available at the district store but he needed to invoice for them in a particular format. The provision of treatment and free medications is much appreciated by the family members of mental health patients.

Dr. Pattnayak participated in the physician leadership development program in Odisha supported by Health Systems Transformation Platform and State Institute of Health and Family Welfare, Government of Odisha, using the CIP framework developed by Athulya Performance Facilitators. CIP is a results-based program and focuses on individual and organizational goals that indicate performance. It comprises ten action principles, actions to apply each of these action principles, and some tools to aid taking these actions. After an introduction to the framework, participants set ‘goals’ they would like to achieve (In this context, participants set programmatic goals which may result in improved patient experience or health outcomes). Participants are then coached for three months to achieve these goals (weekly one hour of virtual calls with coaches) by internalizing the action principles.

In the Odisha program, between September 2022 and January 2023, 28 district and block level medical officers selected by the Department of Health and Family Welfare, Odisha took on goals and have produced results in the areas of anaemia, tuberculosis, mental health care, care for non-communicable diseases. Of these, 24 regularly attended their coaching and 18 of them achieved their incredible goals. More importantly, these individuals have been able to experience a personal transformation or a shift in their thought process, actions and feelings to achieve their goals. CIP alters something fundamental to the ‘Self’ of the individuals, through the focus on actions (what they do). Most describe this to be ‘life changing experience’, that has influenced their daily routine for the better. From the Odisha experience so far, doctors reported that it is now easier to achieve goals in a time frame and to overcome obstacles. Their planning and implementation are much better. And they have learnt to rally others for producing results. They have understood and experienced what does it mean to be a leader or a manager, managing the complexities of public systems, working in collaborative and team environment, communication, and people’s skills.

In the context of accelerated change in Indian health system that Ayushman Bharat and post-Covid scenario emphasises, leading and managing programs and people has become vital. Traditionally, medical leadership in India has been hierarchical where professionals assume leadership roles as they acquire higher positions either by virtue of their seniority or by rotation. Thus, leadership role for them is “accidental” or by chance^[1]. In such scenario, we understand that there are gaps due to perceived “existing competency” and “required competency” levels in leadership traits of health professionals in India. While the recently formulated Graduate Medical Education regulations by the National Medical Council (NMC) of India[2] have duly recognized the leadership role of Indian medical graduates in managing healthcare teams and health systems, in-service midcareer medical doctors working at various levels of the public health system need leadership programs to inculcate and improve their leadership competencies. There is a need for prospective leadership training with a focus on practicing leadership skills in a multidisciplinary team environment at a health centre or a medical institute. Since health systems often have both provider and system-level challenges, training may include improving problem-solving ability, risk tolerance and personal attitude or traits/emotional intelligence, motivation, communication, and people’s skills. Continuous improvements in these areas can have an impact on quality of services and patient outcomes.

CIP Framework could be one of the tools to build the skills required to achieve target-oriented improvements to solve complex health system problems. Transforming the ‘doctor’ who is central to the service delivery of health programs, impacts the staff working with him and within his sphere of influence, to contribute to achieving population-based health outcomes and transforming health systems that are responsive to India’s emerging health needs.

More recently, CIP has resulted in improving performance of government department officials in Odisha for various aspects of the Pradhan Mantri Ujjwala Yojana since 2019. Based on the extraordinary results produced in the state, CIP has since been used in eastern India as well states of western India.  The CIP Framework has been applied in over 770 “CIP Projects” in personal and professional life, and by a wide variety of people.  Incredible results have been produced in different kinds of organisations, in every conceivable function and in almost every aspect of interest to an organisation. To name a few CIP has been applied in corporate organisations, cooperatives, public sector units, government programmes/departments, NGOs, academic institutions and start-ups.  

[1]Jindal SK. Leadership in medicine. Indian J Chest Dis Allied Sci 2014; 56:69-70

[2] Graduate Medical Education Regulations, 1997 (amended up to 2018) | NMC. (n.d.). Graduate Medical Education Regulations, 1997 | NMC. https://www.nmc.org. in/rules-regulations/graduate-medical-education-regulations-1997/.