Kunle Thomas: When  Patients’ Voices Matter, Healthcare Becomes Safer, More Humane

The Chief Executive Officer of Patient Academy International, Kunle Thomas, is calling for stronger patient accountability mechanisms within Nigeria’s healthcare system, stressing that improving patient experience and transparency is critical to addressing persistent challenges in the sector. While also introducing ‘My Voice, My Health’, a new digital platform designed to enable Nigerians report and document their healthcare experiences, Thomas said the country must begin to prioritise patient feedback as a critical tool for reform. Sunday Ehigiator brings the excerpts:

What’s your take on the state of Nigeria’s health sector?

Nigeria’s health sector still has a lot that needs to be done. Yes, there is a lot being done already, and there are efforts on the part of the government to improve. We are aware, for example, of the body that was recently set up to look at clinical governance and examine what happens when things go wrong within the system. That is very welcome, but it is still very recent, particularly regarding issues of medical negligence. When you look at clinical governance as a whole, patient experience, and related issues, these developments are encouraging, but there is still a lot more that needs to be done. Listening to patients and members of the public, you get the sense that things are still very far from what they should be. I have spent about 25 years in the UK working within the health sector. I worked with the National Health Service, heading various departments across acute hospitals, general hospitals, mental health services, and ambulance services. When I compare what I am used to with what is available here, we still have a long way to go. That said, my expectation is not that Nigeria must replicate exactly what exists in the UK or other Western countries. What I expect is evidence that we are serious about moving things forward and fixing the obvious problems that exist. Recent events have drawn attention to the deficiencies in the system. For example, when someone is involved in a serious accident, the expectation is that an ambulance will attend to them immediately. There are critical interventions that should happen before the patient even reaches the hospital. Missing those steps can reduce the chances of survival and recovery. When international figures are involved in such incidents, people around the world take notice and begin to ask questions. They wonder why an ambulance was not involved and whether the emergency response system is functioning effectively. Those kinds of optics are not very good because they suggest that the country lacks a reliable emergency system.

Another case that drew attention was the tragic death of the son of writer, Chimamanda Ngozi Adichie. I understand that some doctors involved in the case were recently suspended. That suggests something may have gone wrong. There are still issues around facilities, equipment, and staffing. When I talk about staffing, I am not referring only to numbers, although the numbers are also a challenge. Many Nigerian doctors are leaving the country for opportunities abroad. Even those who remain often face poor welfare conditions. I speak regularly with doctors. One of my co-directors is a consultant anaesthetist with over 30 years of experience, and we also have board members who are physicians based in the United States and the UK. When Nigerian doctors travel abroad, they often excel because the systems there support them with good facilities, proper welfare, and fair remuneration. There are also strict rules regarding working hours. Until recently, some doctors here were expected to work up to 72 hours on call. Resident doctors had to push for reforms to reduce those hours. Imagine a doctor who has already worked 50 hours continuously and is then required to perform a major surgery. That doctor is already exhausted, and the chances of making mistakes increase significantly, no matter how skilled they are. These are some of the systemic problems that still need to be addressed.

Given your experience in the UK’s NHS, what is your organisation bringing to Nigeria?

Patient Academy International focuses on patient experience, clinical governance, patient and public engagement, and health communication. Our work looks at everything relating to how patients are treated within the healthcare system. For instance, if patients receive poor service, what happens? What is the complaint process? How is feedback gathered, and how is that feedback used to improve services? In advanced healthcare systems, the responsibility for improving healthcare does not lie solely with clinicians or hospital administrators. Patients and their families are also involved. For example, when a hospital wants to recruit a chief executive or a senior consultant, patient representatives sometimes sit on the interview panel. These individuals are not clinicians, but they bring the perspective of people who have used the service. International bodies such as the World Health Organisation identify three pillars that determine healthcare quality. The first is clinical outcomes. If someone comes to the hospital with a serious health problem, how effectively was that problem treated? The second is safety. Patients should not go into the hospital for one issue and leave with a new infection or complication. The third is patient experience, which concerns how patients are treated throughout the process.

In the UK, for example, there were cases where hospital-acquired infections such as MRSA became widespread. That forced the government to invest heavily in infection control, including strict hand hygiene practices and empowering patients to question healthcare workers who did not sanitise their hands before treatment.

How will these ideas be applied in Nigeria?

One of the first initiatives we are launching is an online platform called My Voice, My Health. This platform allows any member of the public, healthcare worker, or regulator to provide feedback about their experience with any healthcare facility. Whether it is a general hospital, specialist hospital, diagnostic laboratory, or primary healthcare centre, users can submit their feedback. Many Nigerians experience problems in healthcare facilities but do not report them formally. Instead, they complain to friends or express their frustrations on social media, where the information disappears quickly. Our platform provides a centralised repository for these experiences so they can be analysed and used to improve healthcare services. The system includes analytics that allow us to identify patterns in the data. For example, we can determine the most common complaints within a certain period and identify the areas where hospitals are performing well. Policy makers, including officials at the Federal Ministry of Health, can then use this information to guide reforms and improve healthcare delivery. The platform also allows users to submit voice notes in local languages such as Yoruba or Igbo, which can be transcribed into English. This ensures that language barriers do not prevent people from sharing their experiences.

You emphasise co-production in healthcare. What does that mean?

When we say co-production, essentially, what we are saying in a very simple way, is making patients work hand-in-hand with hospital management, with clinicians, to make services better. But what you often have is not that. Even in advanced countries, they are beginning to perfect that as well. That is because the first thing that tends to happen in most departments is that they have an idea, the technical guys come in, the clinicians come in, and they say, okay, this is what we’re going to do, this is what we’re doing, right? We will bring in patient representatives who will sit around. So, you set up sub-committees that will work on any project you are trying to do. And we now bring patients and their carers who have been using that service that you are trying to reform. We bring those people who use those services to come and sit around the table. Even if you have a committee of, say, six, we can bring in just two patient representatives to join that six, making eight. And so they sit together, and the clinicians and the technical guys will start talking, and the patient will say, ah, okay, that sounds very nice, but have you thought of, because the last time my mother was here, or the last time I was here, this happened to me, this happened, and if we had had this, this would have been better. I say, “ Oh, thank you very much. And this is how that co-production works. So, it’s not that after everything is done, without patient involvement, you call the patient to come in. So, when you design and plan together with them, it becomes a true co-production, and that makes it so much better for everybody.

In 2023, you published the book ‘Dear Patients: A Medical Guide to Patient Experience,’ what inspired that?

So, ‘Dear Patients: A Medical Guide to Patient Experience,’ as you rightly said, was published in the UK in 2023. And the main purpose, of course, despite the advancement in the UK, I mean, you know, lessons have been learned every day, right? I mean, in the same Western world, you have seen nurses and doctors who become serial killers, and I’m sure you guys have had several cases, right? Where, I mean, you know, a recent one, well, not too recent, the nurse is in jail now, she’s a paediatric nurse, who basically was, you know, giving injections, giving medications to patients that would make them, you know, almost on the point of death, and she was rushing as they want to save them, and we all know that she’s the one that’s causing this. Because, you know, they have this mentality of they want to come in as a saviour, they want to come in as the one that will save the day, and all the rest of it. And in some cases, some of these patients die, you know. And so, it took a while for their colleagues and the system to say, because they are recording this, and say, okay, when this person is on shift, this seems to be happening whenever she’s on shift, what’s going on? So, it took a while. And when some colleagues were raising concerns to say, I’m going to manage, well, but they were being dismissed. Even in the UK, they were being dismissed that, no, no, no, no, no, it cannot be, you know. It was later on when it kept on happening, and then they felt that, look, we need to do something about this. And they started looking at all the data, they started looking at what was going on, and then they realised that actually, so much evidence just started pouring in, because you can’t accuse somebody of something very serious. They will sue you, sue the hospital, sue, and walk away with it. So, they gathered the evidence, they did all the research, and they realised that, yes, they have enough evidence to prosecute her. And she’s in jail now; she’s been in jail for a while. So, another one, a doctor in this instance, he didn’t clear my head at the moment, but he was a GP, a general practitioner. And they were highly, you know, these are people with what I call a professorial look, you know. Shipman, that’s it, Dr Shipman, you know.

So, he was a doctor for many of his patients, mostly elderly patients, right? And what happened, many of them were basically being essentially killed, you know, by the person they trusted that was there to save them, that they trusted so much. So, he was a highly regarded man in society, a doctor of so many years’ experience, highly regarded and loved in the community. But because he was working, he moved away from a big practice where he was working, and he was working as a lone practitioner. So, that’s why it took some time before the authorities were able to really get him. It would have been easier if he were working in a big practice; other people would have, you know, identified the problem. But anyway, he was eventually not, and he actually died in jail, committed suicide in jail, you know. So, these are some cases to show that even in the West, you have cases that are very serious. But the difference between the West and here, from my experience now, is that we don’t keep quiet. People don’t keep quiet in the West. Accountability. And the accountability doesn’t just come from the management, it comes from patients, it comes from the public, and it comes from even staff, right? If you read some of the articles I’ve recently written, the whole concept of whistleblowing is very strong in the UK, and I’m sure in most countries in the West. Whistleblowing is a policy, a policy in hospital management that allows staff, that gives staff the liberty to, you know, privately and publicly come to report their colleagues that they have seen that are doing things that can harm patients or that are, you know, unethical or any other misconduct, right? That’s what all this is about. So, yeah, the book looks at different things. It looks at what patient experience is all about, and how we can use the data that we gather in patient experience, in surveys, and in tool complaints. There are many data systems and datasets available, not only from complaints or compliments but also from regular surveys. So, you actually have to go out deliberately and survey.

The government does its own survey annually on so many things. There is a separate survey for maternity services, a separate survey for inpatients, and a separate survey for outpatients in the UK. So, there are so many different surveys nationally done, right?

But hospitals now have, and other health facilities now do their own local surveys. So, you have a lot of data. And that data, obviously, is not just data for the sake of data. It’s data to be able to analyse that data and say, how do we use this data to continue to, you know, improve services. And that is the bottom line.

What legal backing exists for your new platform?

Well, the platform provides support in several ways. Firstly, it helps patients navigate the healthcare system by directing them to the appropriate regulatory bodies. So, if you are not sure who to report to or what your rights are, we guide you through that. Secondly, we offer advisory services where experienced clinicians review complaints and suggest possible solutions. That way, patients can understand the clinical aspects of their complaints and what realistic outcomes might be. Thirdly, we can provide advocacy by acting as intermediaries between patients and healthcare providers to help resolve disputes. We don’t take sides, we’re not here to sue anybody, we’re here to broker solutions. Our role is really to broker resolutions where possible rather than encourage litigation. But if a case cannot be resolved, the patient may choose to pursue legal action independently. That’s entirely up to them.

 How is the project funded?

Currently, the project is funded entirely by Patient Academy International and our technology partner, iPhonenova. We have invested significant resources in developing the technology, staffing, and promotional materials. As the project expands, we hope to attract partnerships with international organisations, NGOs, and private sector stakeholders who share our vision of improving healthcare accountability.

Looking ahead, what impact do you hope your work will have?

My vision is to help promote a culture of transparency, accountability, and patient involvement in Nigeria’s healthcare system. We want to shift the mindset so that patients feel empowered to speak up about their experiences, and healthcare institutions are willing and prepared to listen and act. No healthcare system is perfect, and mistakes or failures will happen—but what really matters is how the system responds when problems occur. If hospitals and clinics take patient feedback seriously, investigate issues thoroughly, and make necessary improvements, the overall quality of care improves. When patients feel that their voices matter and that reporting concerns can lead to real change, healthcare delivery becomes safer, more effective, and more humane. That is the culture we hope to encourage, not just in Nigeria, but eventually in other developing healthcare systems where patient engagement and accountability are still evolving. Ultimately, it’s about creating a system where transparency, responsiveness, and continuous improvement are the norm, not the exception.