Transcript UZ GENT - Hospital Authority

IHF University Hospital Chapter
May 16th, 2001 - 14:00 - 15:30
Hong Kong
“ View on the situation
of the university hospitals ”
Presentation by
Prof. Eric ENGELBRECHT
Chief Executive Officer Ghent University Hospital
1.
MY ENVIRONMENT
2.
COMPARATIVE STUDY
UNIVERSITY HOSPITALS
IN 5 EUROPEAN COUNTRIES
3.
PROPOSAL FOR THE FUTURE
4.
THEMES FOR THIS AFTERNOON
SESSION
1. GHENT UNIVERSITY HOSPITAL
DIA 3
Mission of a University Hospital
Providing high quality :
1. Health care
2. Education & Training
3. Scientific research
4. Service
DIA 4
Main figures : input
 1.059 beds
(35 wards)
 Budget 01 : 270 million $
 Number of employees :
3.212,47 BFTE
4.101 people
 Number of buildings : 16
(288.000m2)
DIA 5
 Medical equipment :
 3 CT scans
 4 CAT labs
 2 angiographyrooms
 1 MRI (1.5 tesla) & 1
MRI (1 tesla)
 3 linear
accelerators
 1 PET
 1 cyclotron
Medical department :
48 medical services in the following disciplines

Internal medicine : endocrinology, gastro-enterology,
haematology, geriatrics, cardiovascular diseases, medical
oncology, pneumology, enz

Surgery : general thoracal & cardiovascular surgery, cardial
surgery, urology, neurosurgery, ophtalmology,
otorhinolaryngology, plastic surgery


Pediatrics
Dental surgery : fixed protheses & paradontology,
preserving dental surgery & orthodontics, mouth - teeth & jaw
diseases


Radiotherapy & nuclear medicine
Psychiatry
DIA 6
Medical department :
48 medical services in the following disciplines
(continuation) :

Medical logistical services: clinical biology lab UZ
Gent, anaesthetics, radiography & radiology

Maternity & women diseases

Emergency unit

Intensive care

Special services : burns unit, medical genetics,
neonatal intensive care, fertility unit, ...
DIA 7
Number of beds
Psychiatry
Surgery
Medicine
Pediatrics
Geriatrics
Maternity
Neonatal IC
Total beds =
DIA 8
86
428
380
72
30
31
32
1.059
Staff
 Number
of functionary doctors 180
 Number
of employee doctors
80
 Number
of junior doctors
330
Total medical staff
 Number
 Other
of nurses
personnel
Total staff
DIA 9
590
1.750
1.760
4. 100
Main figures (output)
 Hospitalisation in 2000
 admissions
32.000
 average bed occupation rate 82%
 inpatient days
300.000
 operations
18.000
 Outpatient activities in 2000
 consultations
 day case admissions
 outpatient attendances
DIA 10
172.000
42.000
400.000
Main figures ‘92-’00
1992
1993
1994
1995
1996
1997
1998
1999
2000
Sales $
(million)
148
160
172
181
188
190
205
233
240
Admissi
ons
26.800
27.700
27.900
28.200
29.000
30.000
30.600
30.900
32.000
Amb.
Cons
Operati
ons *
154.000 155.000 159.000 161.000 162.000
11.500
* general anaesthesia
DIA 11
11.800
12.300
13.900
15.000
164.000 170.000 173.000 172.000
15.300
16.200
17.500
18.000
Length of stay ‘75-’00
17
16
15
14
13
Length of stay
12
11
10
DIA 12
99
96
93
90
87
84
81
78
75
9
Transplantation services
YEAR
91
92
93
94
95
96
97
98
99
00
KIDNEY
24
23
25
40
36
39
41
41
62
79
LIVER
21
34
35
34
36
41
42
28
46
45
PANCREAS
0
0
0
1
0
1
2
7
12
12
HEART
1
5
7
9
12
7
10
10
8
6
65
60
55
50
45
40
35
30
25
20
15
10
5
0
DIA 13
Kidney
Liver
Heart
91 92 93 94 95 96 97 98 99
0
Organisation chart
BOARD OF DIRECTORS
CHIEF EXECUTIVE OFFICER
MANAGEMENT COMMITTEE
MEDICAL DEPARTMENT
DIA 14
GENERAL STAFF
GENERAL SECRETARIAL
OFFICES
ADVISORY BOARDS
GENERAL SERVICES
BUILDING & TECHNICAL SERVICES
Support function
HOTEL SERVICES
Support function
NURSING DEPARTMENT
PHARMACY & CARE
LOGISTICS DEPARTMENT
ADMINISTRATION &
FINANCIAL DEPARTMENT
2. COMPARATIVE STUDY
CONCERNING
UNIVERSITY HOSPITALS
IN 5 EUROPEAN COUNTRIES
Comparative study : framework

Sept 1998 :
Foundation of the Council of
University hospitals in Belgium

Jan 2000 :
paper : “Which future for the
University Hospitals?”

Study ordered by the government :
 analysis of the problems
 structural solutions

May 2000 :
presentation first draft of
the report to the belgian
Minister of Social Affairs
Comparative study : contents

5 countries :
France
Netherlands
United Kingdom
Germany
Belgium
Comparative study : contents

4 fields :
 Mission and Legislation
 Patient care
 Education and training
 Clinical research
Comparative study : main figures
Hospital beds (H)
F
N
UK
G
B
734
305
420
658
560
49
?
57
72
/100.000 inhabitants
“University” beds (U) 142
/100.000 inhabitants
Percentage (U/H )
19% 16% ?
9 % 13%
Comparative study : findings
Mission and
legislation
F
N
UK
G
B
+
+
+
+
+
-
+
+
+
+
Mission :
F : education and training, research
N: health care, scientific medical education, research
G: health care, education and research
B: health care, education and scientific research
Legal frame :
F : since 1958 - public sector
N: in 1994 - positionning towards university
G: in 1999 - gaining of independence - public character
B: in 1978 - recognition - not applied
Comparative study : findings
Primary care
Secundary care
Tertiary care
F
N
UK
G
B
++
+
+
++
++
+
++
+
++
+
Specialised services =
Referral from an external specialist to our medical
staff
Comparative study : findings
Doctors revenu
salary
fee for service
F
N
UK
G
B
+
-
+
-
+
-
+
-
+
-
Comparative study : findings
F
N
UK
G
B
Education and training
Excess funding
13% 23% 20% 25% 3.55%
Clinical research funding
public
+
+
private
+
+
+
+
+
+
+
+
Comparative study : health care
expenditure
Health care in GNP
F
N
UK
G
B
9.9
8.5
6.7
10.5 7.6
45
52
42
35
41
450
250
390
340
%
Hospitals in Health
care cost (%)
expenditure hospital 440
care per inhabitant ($)
3. PROPOSAL FOR THE
UNIVERSITY HOSPITALS
IN BELGIUM
Proposal

Towards programming & concentration

A clear legal definition on
the legal frame
the mission
for the university hospitals
Proposal

Global budget no longer acceptable :
 Patient care :
funding related to
care programs
 Training & research : funding in relation
to a patient related assignment
Proposal : programming
 financing of patient care related to care
programs :
special care programs such as pediatric
oncology, burns unit, neonatal care
incentive for integration of physicians in
hospital structures (multidisciplinary)
sufficient exta funding for
patient care
complexity of care
severity (APR DRG, SAPI)
second opinion and revisions
Proposal : concentration
 patient related mission financing for
teaching and research
excess
% on the budget (European
comparison)
evaluation
by objective criteria
Proposal : concentration
evaluation by objective criteria :
 education :
number of students,
number of junior doctors
number of trainers

research :
publications
 citations
impact factors
cfr. NHS R&D budget (1 % of NHS global budget) AME proposal
Conclusion
Donna Shalala, Ph.D. on the AMC in the U.S.
Secretary of Health & Human Services, Washington DC
“If we lose our academic health centers we
won’t just be cutting costs, we’ll be cutting
our best chance for a healthier America”
(Acad. Med. 74,8; Aug 1999)
4. THEMES FOR THIS
AFTERNOON SESSION
4. Program
14.15 Sten Lindahl
- Prof. Karolinska Hospital
“How to integrate Health Care, research and
teaching in a learning organisation?”
14.30 Lauri Laitinen - CEO University Hospital Helsinki
“Rebirth of University Hospitals. Finnish strategies”
14.45 M. Jacques Grisoni - Deputy Chief Executive
Teaching hospital group of Lyon
“Organisation of research activities”
15.00 Hendrik Borchgrevink - Management consultant
Norway
“From performance to transformance (transforming)”