In recent days, we have witnessed two open letters from employees of the National Cardiology Hospital. In them, they express their disagreement with the planned changes in the structure of the medical institution. What will happen and what is the financial condition of the hospital… The new director of the National Cardiology Hospital (NCH), Dr. Krasimir Jinsov, spoke to FACTI.
- Dr. Jinsov, what is happening at the National Cardiology Hospital from your point of view, after we see two open letters from hospital employees, in which they oppose the changes you plan to introduce…
- I found the National Cardiology Hospital in poor financial condition. The hospital has 10 million leva in arrears, generates losses, is decapitalized. If something does not change, we may soon see the end of the hospital. The end of an institution with traditions that in the past dictated the treatment of cardiovascular diseases in the country. In order to get out of the situation, in order to stabilize the hospital, change is necessary. If we continue on the same path - the rut in which the status quo has placed the hospital - will inevitably lead to its collapse. Is this what we want, is this what the supporters of the status quo want? In order to get out of the rut and lead the hospital on the path of innovation, the management has come up with a proposal to open new structures and activities. We live in a dynamic world, everything is changing, including healthcare in the country, and the National Cardiology Hospital must keep up with the times if it wants to survive.
- Let us clarify here that you are talking about a proposal for restructuring, because according to the doctors - no one has officially signed their name under these two letters so far, this is a decision…
- Our decision to change the structure leads to a proposal to the team. Nothing has been formalized at the moment. The official document regulating the hospital's activities is the medical activity permit from 2013, which has not been updated since then. We will take the legal path to update this activity permit. Only when we have approval from the Ministry of Health can these new structures that we are proposing become a fact. As colleagues have rightly said in their letters, in order for the new structures to work, it is necessary to clarify many administrative issues regarding their location and interaction in the hospital. This is a long process. We are just starting to talk and work on it. But it is certain that the goal of the new structures is to increase the capacity of the hospital, the quality of the medical care provided and meet the needs of patients. I cannot understand the colleagues who oppose this and I cannot understand why instead of talking through the media, we do not sit down to talk face to face and choose the best path for the hospital. The results so far categorically show - there must be a reform. If nothing changes, the hospital will perish. The management's proposal is an initial step for change. The management of the Cardiology Clinic has the most objections to this proposal. We have requested an analysis and a motivated proposal from the head of the Cardiology Clinic on how to improve the use of the bed fund, what measures he will take to provide the necessary medical staff. Instead of thinking about these issues, we communicate through open letters and interviews. This is not constructive, it is not constructive and it is causing chaos and tension in the hospital.
- Is there a ban on doctors speaking because we see these letters signed by the hospital staff?
- Reporting information in the media that undermines the hospital's prestige is contrary to work ethics and the labor code and can lead to administrative sanctions. According to an old order, the media appearances of hospital employees must be coordinated with the management. Whether this is the reason or they are simply afraid to stand behind what is written with their names, I don't know. But, look, we are looking for a solution. We need a constructive dialogue with ideas and suggestions, not speculations released into the public space. We need to sit down and write out a concept that is working, which will increase the hospital's capacity, guarantee the best care for patients and increase revenue. This way, the National Cardiology Hospital will pay off its creditors and provide its employees with the salaries they deserve.
- One of the other accusations against you is that all this comes a little unexpectedly. Almost overnight, and it wasn't discussed before…
- I have to go back to the beginning of the conversation and say again that what we are talking about right now is a proposal for new structures and activities. Let it be clear. In the first month of our management, we met with the heads of the clinics, reviewing the analyses of their activities presented by them. The financial situation of the medical institution and the risk of liquidation that it faces were explained to everyone. We gave them time to make their own proposals for optimizing the diagnostic and treatment process and improving the financial result of the structures they manage, with the available resources. In the meantime, we managed to defend four capital projects before the Ministry of Health, which are worth a total of about 10 million leva. Through them, we will renovate three clinics, as well as fully equip the central hospital sterilization. We put the hospital's new nuclear magnetic resonance into operation and completed a project started by the previous management. We have agreed on cooperation with several public health faculties and presented the hospital as an attractive employer and a place for career development to newly graduated healthcare professionals. We have organized a series of courses for medical and healthcare students so that they can get acquainted with the hospital and recognize it as a place for their career development. We have accredited the hospital as a training base for the specialty "Pediatric Healthcare", which is currently the subject of additional support under a project of the Ministry of Health and will provide an incentive for nurses to choose our hospital.
We have prepared and submitted the necessary documents to the Ministry of Health in order to apply for a state loan with which to pay off overdue debts.
We have held talks with the Sofia Municipality and the Ministry of Health and have launched a procedure for separating DCC-6 into its own building. The goal is to restore the integrity of the hospital in our main building, thus improving the patient journey and the healthcare service we offer. We have also done many other smaller things that I will not list now. However, during this time, we did not receive any specific proposals from the heads of clinics. At the meetings of the Board of Directors, we discussed how to increase the hospital's income, the possibilities for opening new activities. There were various ideas that we took into account the regulations and the capabilities of the hospital. This is how we came to this proposal for building new structures, but this process takes time and does not happen overnight. The fact that it is written in the internal regulations does not mean that colleagues will start working on the new structure tomorrow. This cannot happen. We expect a dialogue in order to improve the work of the hospital.
- How is the hospital dealing with the staffing problem?
- There is a shortage of healthcare specialists in the healthcare system throughout the country. What we do as management is to be in contact with all the faculties of public health in the country and actively promote the hospital. There are constant announcements for nurses. We offer good conditions. Last month, we increased the basic salaries of all healthcare professionals, so as to make the hospital a more attractive employer. The responsibility for recruiting nurses for specific clinics and departments falls on the management of these clinics and departments. Each clinic manager knows the specifics of the work in his unit and knows exactly what kind of people he needs. This is also assigned to them as an obligation in the job description - to propose the appointment and dismissal of staff in the clinic. They should actively seek medical specialists to fill their teams, and not pass the ball to the hospital director.
- How long have the hospital's debts been accumulating?
- The hospital has been in the red for a long time, but in the last five or six years, debts have been growing rapidly. The main expense is for employee salaries. Last year, the hospital was at a loss of more than 5 million leva, which also led to an increase in liabilities. So far this year, the hospital is at a loss again, but by about 2 million. If we compare the period of our management from July to November this year with the same period last year, we will see that we have managed to reduce the loss of the medical institution by 75% - from almost 2 million leva for this period of 2023, to under half a million for this year. But, still, the hospital is at a loss. Changes are needed to increase activity and thus increase revenue, because our main source of funding is the National Health Insurance Fund (NHIF). And the increase in activity and, accordingly, revenue, depends primarily on the medical teams. That is, the more patients pass through the hospital, the more revenue there will be. This is the reality and specificity of the healthcare system in Bulgaria at the moment and we must adapt to it.