SUNDAY BYTES: ALL ABOUT SKIMS – From Policy to People -Part – 2

Leadership, Governance, and the Imperative of Institutional Renewal

Dr. Fiaz Maqbool Fazili

Large public healthcare institutions are shaped less by episodic decisions than by the leadership systems that translate policy into daily clinical and academic practice. The Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Jammu and Kashmir’s apex tertiary-care and academic institution, offers an instructive case study of how leadership styles influence institutional continuity, credibility, and public trust. This reflection is written in the spirit of institutional strengthening; this reflection recognises the administrative and political constraints under which public healthcare operates. Beyond symbolism, it applies structured gap analysis and outcome-based review using public-domain data. Authored by a healthcare-standards professional, former alumnus, and concerned citizen, it avoids personal attribution. In the absence of NABH accreditation, it remains a gap analysis, intent is constructive feedback open to validation, scrutiny and institutional review.

Leadership and Institutional Memory: Institutions remember leaders not for titles or tenure but for the systems they build, the standards they institutionalise, and the results they sustain. In healthcare, governance shortcomings rarely arise from lack of expertise; they more often occur when optics overshadow patient-centred outcomes.

At SKIMS, sustainable governance required/s a careful balance between autonomy and transparent accountability to patients, professionals, policymakers, and the public. This is not an appraisal of individual tenures but a reflection on institutional continuity. Experience across public institutions affirms a simple truth: systems outlast personalities. Ethical, policy-literate, vison, mission oriented and patient-centred leadership produces durable gains, while person-centric or politicised authority weakens institutions over time. This piece does not reflect on individuals or names, or assign scores on care leadership at SKIMS: Who Led, How, and What We Learned.

It may reasonably be assumed that successive CEOs and Directors assumed office with sincere intent to strengthen SKIMS, and many are rightly acknowledged for their contributions. The contextual and policy constraints of different periods are neither fully documented nor there is any frank avowal in public domain this piece is not the subject of retrospective judgment. Yet institutional evolution suggests the absence of a consistently pursued long-term master plan supported by robust strategic and operational frameworks.

Without such institutionalisation, continuity in long term planning weakened, effectiveness suffered, and direction fragmented. The present challenges therefore reflect accumulated systemic limitations rather than isolated decisions or individual failings.

From National Vision to Constrained Reality
SKIMS was conceived as a nationally comparable tertiary care referral academic medical institution—not merely a high-volume (overcrowded, overburdened) hospital. Given its early reputation, monopoly tertiary role in J&K, and sustained public investment, expectations that it would rank among India’s leading institutions were realistic. That trajectory, however, was gradually faded, or lost or not fully realised. Over time, SKIMS drifted into a service-heavy, academia-light model. Its absence from top 100 /1000 major national and global rankings reflects unmet performance markers: research output, academic visibility, outcome reporting, defined KPIs, NABH accreditation, future-oriented planning, and community outreach innovation. Failure to evolve into a deemed medical university constrained academic autonomy and interdisciplinary growth. Weak enforcement of rational referral pathways contributed to chronic overcrowding and dilution of tertiary expertise.

Several critical super specialties—paediatric cardiac care, comprehensive oncology, transplantation, advanced neuro-spinal services, advanced genetics and a dedicated children’s hospital—remain underdeveloped, compelling patients to seek care outside the state. Patient dissatisfaction narratives, whether factual or amplified, largely arise from systemic overload rather than professional apathy. This article does not attempt to assign causality—whether mission drift, governance weaknesses, leadership limitations, strained institutional relationships, or misplaced priorities. Those questions merit separate, deeper examination.

What matters now is the revival of trust—institutional, professional, and public. This requires not reinvention but restoration: clarity and authority in leadership roles, a credible long-term academic and research vision, protected academic time, optimal resource allocation, focused centres of excellence, regulated referrals, patient-first governance, and an organisational culture that values constructive criticism as a catalyst for improvement rather than a threat.

Quest for Revival – An Audit Lens: As SKIMS approaches 2026, midway through the current leadership’s tenure, the central question is not whether “all is well,” but whether efforts are being assessed professionally, objectively, and honestly, in a patient- and institution-first spirit. This assessment is observational, neither diagnostic nor judgmental, and seeks to convert identified gaps into a coherent reform pathway. Revival demands restoration of unified team spirit through clarity of vision, continuity of strategic planning (a master plan), and structural accountability—principles that once defined SKIMS and can be deliberately re-institutionalised.

SKIMS Soura’s 43rd Annual Day and Festival Week, concluded in December 2025 and attended by the highest governing authorities, highlighted research activity, staff recognition, acknowledged shortcomings, and institutional resilience. Recent public communications by the Hon’ble Director—on Gulistan TV and during the Annual Day address—openly acknowledged systemic challenges through a SWOT lens and articulated intent toward reform and revival, marking a departure from defensive narratives. Policy analysis, however, demands outcomes rather than rhetoric.
Service Load and Structural Stress; Reported figures—around 1.5 million OPD visits, over 100,000 admissions, nearly 50,000 emergency registrations, and more than 20,000 surgeries annually—illustrate an extraordinary tertiary-care burden. With daily footfall approaching 50,000, stress is structural, not episodic. These numbers reflect both public dependence on SKIMS and long-standing capacity gaps in peripheral systems. Addressing this demand requires sustained policy interventions—capacity expansion, workforce planning, rational referral policy, and decentralisation—rather than episodic administrative fixes.

Emergency services rational redesign, which needed long awaited strict and structured triage, segregated pathways, a five-suite operating complex, round-the-clock laboratory support, CT imaging, Ayushman facilitation, and expanded radiology were highlight of Director’s speeches. From a governance perspective, these are patient-centric measures. Proposed additions—a 100-bed emergency block and a dedicated trauma centre—are policy necessities; their impact will depend on timelines, staffing models, and protected funding.

Installation of portable ultrasound and X-ray units on each floor integrated with PACS represents meaningful workflow improvement. Planned laboratory modernisation and capital investment nearing ₹100 crore signal intent to align infrastructure with demand. Audit principles, however, require evaluation against outcomes—waiting times, throughput, clinical indicators, and patient satisfaction—not expenditure alone.

Cancer care, a major regional burden, is receiving focused attention through expansion of day-care services, preventive oncology initiatives, and acquisition of advanced technology, including a linear accelerator, 3-Tesla MRI, and high-end CT. The ONCONET hub-and-spoke model is strategically sound; its success will hinge on district readiness, referral discipline, and digital integration. Upgrading the Cancer Institute to a Zonal Centre remains a critical milestone requiring defined timelines and sustained governmental support. Subsidy for high-cost chemotherapy remains a pressing gap, as public appeals for financial assistance persist.

Human-resource measures addressing delayed promotions and recruitments reflect attempts to correct historical inertia. The assumption of recruitment processes by the PSC has generated cautious optimism, with movement on long-pending vacancies, paramedical posts, and proposed faculty recruitment. Issuance of PSC notifications for faculty posts is a positive step that requires sustained follow-through to ensure merit-based, time-bound recruitment aligned with service expansion.

Community outreach, including camps and engagement with civil, social, and religious groups, must extend beyond central facilities to remote areas. While the flurry of CMEs and academic updates suggests revival, the true test lies in translation into clinical innovation, teaching quality, and public-health impact.

Claims, Confidence, and Evidence: Institutional health cannot be declared through loyalty or optics alone sycophancy of all is well is not patriotism. Critique or constructive feedback is oxygen to improvement. Just as clinical auditors assess improvement through objective data, healthcare quality professionalism relies on transparent KPIs. Recent inaugurations, academic initiatives, seminars, workshops, and CMEs reflect positive momentum and intent to revitalise SKIMS. For this progress to be meaningful and durable, it has to translate into measurable gains in patient satisfaction and public trust. Cultural change, once initiated through visionary planning, must be sustained and demonstrated via accessible data on patient experience and staff morale. Strengthening accountability through credible, transparent morbidity–mortality reviews (including RCA of recent two three years) and an approachable grievance-redressal mechanism will further anchor reforms in institutional trust. Assertions that patients no longer need to seek care outside the region are aspirational. Policy prudence requires validation through real-time data, outcome benchmarking, and independent audits to ensure confidence is evidence-based. Frequent leadership changes—nine Directors in a short span, as acknowledged by the current —have affected strategic policy planning continuity. Understanding how institutional autonomy is essential, not to assign blame, but to identify systemic gaps and work on measures, channels and communications to rebuild confidence toward reclaiming SKIMS past stature.

Governance Signals and Expectations: Public acknowledgment by the Hon’ble LG and CM underscores SKIMS’ relevance and resilience. Such recognition raises expectations that future-oriented strategic and operational plans will be matched by sustained policy support, rigorous accountability, optimal resource allocation, and outcome-based evaluation. All initiatives must converge on a shared ethos—patient and institution first. While it may be early to judge the depth of leadership-driven cultural change, 2026 offers renewed hope aligned with patient and public expectations.

Major Pickups: SKIMS’ enduring strength has always rested on dedicated professionals who unite competence with conscience. Sustainable progress now depends on outcome-driven, system-based leadership rather than symbolism, with accountability shared across government, regulators, professionals, patients, civil society, and the media. Early signs of revival are encouraging, but lasting renewal will hinge on governance structures that outlive individuals and withstand pressure. Constructive criticism must be recognised as a civic duty and catalyst for growth—not as disloyalty. Institutions grow stronger through scrutiny, evidence-based evaluation, and transparent public communication, not by ritual repetition of “all is well.”
(To be continued – PART 3. STRAIGHT TALK COMMUNICATIONS EXCLUSIVE. The author is a Clinical auditor, ex Alumni of SKIMS, National and Certified professional in Healthcare policy analysis , planning and Quality reforms can be reached at drfiazfazili@gmail.com)