Nadeem Mustafa Khan - First National Director General and CEO of University Hospital

Nadeem Mustafa Khan is the first Pakistani Director General and CEO of Aga Khan University Hospital in Karachi.

He graduated from Peshawar University, where he secured a first position (Gold Medal), followed by a three-year BSc (Econ.) Honours from the London School of Economics. Having completed his training in chartered accountancy from Price Waterhouse and Company, he joined Aga Khan Hospitaland Medical College Foundation in 1981, as Assistant Manager, Finance and Administration. He rose to become the Director, Finance and Information Systems in 1987, moving two years later, to hospital operations as the Director, Professional Services. In 1997 he was appointed the Chief Operating Officer.

You are often referred to as a "quality guru" in Pakistan, do tell us about your quality journey.
Our rewarding journey of continuous quality improvement began in 1993. It involves focusing on the processes of work, using both internal and external customer focus, looking at data and improving continuously.  All groups of faculty and staff  have participated in improvement through teams, collaborating groups, quality circles and task forces.  It has continuously helped us in improving our standards. We obtained a certification under ISO 9002 for six areas in 1999 and for the entire Hospital in June 2000. 

What are the challenges in trying to maintain internationally accepted standards of patient and medical care?
We face a number of  challenges  in  staffing,  quality  and  cost. As the world becomes a global village, there is massive attrition in our trained manpower, particularly nurses, who are attracted to centres in the developed world. Similarly, technicians are in short supply in our country as they succumb to similar attractions in the Middle East. Retaining faculty is also difficult. Thus, maintaining a well-qualified and well-trained group of individuals to perform regularly over an extended period of time is a major challenge.  Health care is a service and providing this service imbued with all the ingredients of compassion, proper communication and teamwork is a definite challenge.  The health providers, whether consultants, resident staff, nurses, technical and support staff, have to work together as a team - bringing all these "knowledge workers" together to provide the best possible care. 

Regularity and consistency in standards is essential and reducing variation in the quality of care and services also remains a major challenge. 

Other resources such as availability of equipment and supplies are still further challenges. Health care is expensive and a major challenge is to ensure that costs are contained.

Is the Hospital accessible - physically as well as financially,  to  the  general  public?
The question of costs is central in the equation for access.  We continue to monitor our costs and keep them under control. Our users come from all sections of society - our continuous surveys show that 70% of our patients are drawn from the middle and lower socio-economic groups. The Hospital has also tried to make itself physically accessible by moving out into the community. We are operating 12 Laboratory Specimen Collections Units dotted throughout Karachi and 17 in other major cities of Pakistan. 

We are collaborating with the Aga Khan Health Service, Pakistan (AKHS,P) in  running  clinics and  performing day surgery at Karimabad, running clinics in Garden and Kharadar as well as Family Health Clinics in five centres in Karachi.  We have also started a joint Family Clinic, Laboratory Specimen Collection Unit and Pharmacy in Malir, a low middle-income area. These efforts are aimed at making our Hospital accessible to the community at large, both physically and financially, which is our institutional mission.

Do tell us about future plans for maintaining high standards of health care and meeting the needs of patients.
The Institution is constantly raising its bar on quality and standards.  The Hospital is currently preparing itself for the US Joint Commission International Accreditation (JCI) standards and in this regard the JCIA team of consultants has also carried out a pre-assessment.  We intend to focus on the areas of improvement in our patient care delivery and service, which will be to the ultimate benefit of patients.  The focus continues to be on the needs of the patients - we have to continually update ourselves in knowing their needs through various surveys carried out on a biannual basis.  We have started a home-based physiotherapy service to assist patients in providing care in their homes and are about to launch into a pilot home health programme, whereby general wound and dressing care, catheter care, intravenous antibiotics and fluid therapy  can be administered in the homes of patients who have been discharged from the Hospital.  This is an ongoing process of meeting the needs of our patients.