Transcript Slide 1

Republic of Serbia
MINISTRY OF HEALTH
Putting patient at the heart of changethe challenge in transitional countries
Katrava A,
Jekić I.M, Obrovački M, Milojković A, Andrejević V,
Đukić V*, Peško P*, Dmitrović T*, Drašković D** Dujmović F**, Trenkić S***,Pavlović R****
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EAR/EU SOFRECO Technical Assistance-TA Team, Belgrade
Clinical Centre of Serbia, Belgrade
Clinical Centre of Vojvodina, Novi Sad
Clincal Centre of Niš
Clinical Centre of Kragujevac
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
In ancient Greece,
Hippocrates taught medicine to his students
in the spreading shade of a great plane tree.
He taught that patients should be
the focus of care and that the
environment was important factor in healing.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
“Doctor knows best”
Back to Basics with IT and patient-centred care: Kaiser L.: Designer Healthcare for a Designer Nation: A New Paradigm
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Context
• The EU/EAR Project provided to the Ministry of
Health-MoH has been charged with
– reforming tertiary care services and
– implementing an EIB loan of EUR 200M in the
beneficiary institutions: the four Clinical Centres in
Belgrade, Novi Sad, Nis and Kragujevac
for their rehabilitation and strategic development.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Context
• The essence of the EU/EAR Project is to promote
the patient at the center of care.
• This has been accomplished at an institution level
by creating Business Planning Work Groups-WG
around main patient flows
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Emergency
Outpatient
Inpatient
Day Surgery/Care
Operating Rooms and ICUs
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Context
Corporate services
Health services
Management
(non-clinical services)
Quality
Shared services
(clinical support)
Clinical services
Lab.
Kitchen
Clinical
services
Inpatients
MED
OPD
Patient
centred
care
units
Imaging/Rad.
Finance
SURG
ICU
Laundry
OR’S
MIS/HIS
Purchasing
Med/Surg
supplies
Tech.
service
s
Pharmacy
ER
Medical
records
Sterilization
HR
Legal
Planning
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
DM /
DS
Background
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U.S. business invest in:
highly trained human beings
high technology processes
and
U.S. industry organizes itself around
informatics
just-in-time inventory control
Health care
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Team = Hospital + doctor
• Decisions making 24 hours a day (just-in-time)
• Reviewing the timetable of care (just-in-time)
• Healthcare organization reaches outside the hospital
Whitcomb,John E. and Shafa,Mehrdad, Physician executive,Sep/Oct2001,Vol. 27 Issue 5,p16
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Background - Leadership history
• Decision making
•Patient care
Centralized and Hierarchical
Direct nursing (in USA since 1966)
Decentralized
Patient-centered care
(in USA since 1990, in UK since 2000)
Clinical governance
Framework for improvements
through NHS
Moiden, Nadeen,Evolution of leadership in nursing,Nursing Management – UK,Nov2002,Vol.9,Issue7 p20
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Background – CCM vs. EBM
• CULTURAL COMPETENCE (CCM)
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STRONGER MULTICULTURAL ENVIROMENT
LEADS TO IMPROVED COMUNICATIONS
WITH PATIENTS MORE BASED ON
EVIDENCE BASED MEDICINE (EBM)
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MONOCULTURAL CLOSED ENVIRONMENT
HAS LESS FLEXIBLE COMUNICATIONS I.E.
LESS EBM
Hasnain-Wynia, Romana, Is Evidence –Based Medicine Patient Centered and Is Patient –centered Care Evidence-Based?
Health Service Research, Feb2006,vol.41,Issue 1
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Background
• In Southeastern Europe countries in transition, health
systems are mainly physician-centered and gradually
moving to patient-centered care.
• This is a long and cumbersome process mainly due to
– tradition that clearly sets the dividing line of patients and
professionals
– in many instances patients are not fully ready to be an active
partner in the process
• As market forces are introduced into health care services
– “choice and competition” will be the better answer than
– “command and control”
giving patients a right to decide where to be treated.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Methods
• The Clinical Centres have already embarked on the
Business Planning process.
• Continuing to develop excellence and set the standard
for patient-centered care in Serbia will require further
evolution along four dimensions;
– Measurement
• Identify and manage against performance-based measures of
service and outcome
– Interdepartmental Cooperation
• Eliminate barriers between departments that hinder the delivery of
care and services; enhance statistical process control skills to
identify significant opportunities
– Management Skills
• Reward “taking risks” to improve service/outcomes
– Reporting
• Develop status reports and information systems to support the
management of quality improvement
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
• At a system level, Project is facilitating
collaboration
– vertically between network partners
• in primary health care (including first aid)
• secondary and tertiary care (other providers)
– horizontally with all key stakeholders including
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Ministry of Health - MoH
the Institute for Public Health - IPH
National Health Insurance Fund - HIF
Govt’ Agencies
between Clinical Centres.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
• At institutional level, four Clinical Centres
– due to their central regional/national role and
magnitude
– could provide a forum for practical application
and implementation of a patient-centered care
model.
– Pilot projects with primary HC, HIF and patient
associations are underway.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
• The Work Groups-WG consistently supported CC’
service focus on the needs of the patient and
family.
• Seven (out of 28) strategic recommendations
emerged in CC’s 5-year Business Plan:
• Patients and their families need to participate actively in the care
process (1-3)
• Each patient's care will be coordinated, in Clinical Center and
across the network (4-5)
• The setting will foster the well-being of the patient and family
(6-7)
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
Seven (out of 28) strategic recommendations emerged in
CC’s 5-year Business Plan:
To ensure that patients and their families are able to participate actively in the care process, WE RECOMMEND THAT:
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(1) The Clinical Centers should adapt its services to the individual patient's and family's situation. In particular, services should:
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ensure that all staff develop approaches and interventions that respond to the needs and situation of the patient and family
ensure that dedicated resources are available to support the psycho-social and ethical needs of the patient and family
disrupt as little as possible the patient's normal work, school or other activities by offering flexible, extended hours and providing care closer to patients at
satellite clinics, whenever possible
respect patients' their spiritual, religious needs and cultural traditions
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(2) The Clinical Centers should establish procedures that ensure that patients are provided with appropriate information about their care, and that
they receive every opportunity to take an active part in decision-making related to their care. The Clinical Centers should give patients, in their
homes, access to information related to their treatment as soon as possible, using currently available technology.
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(3) The Clinical Centers should ensure that each patient has a personal care plan, developed by a team that includes the patient and family, and,
when appropriate, shared with other health care providers involved in the treatment of the patient across the network, using Information
Technology, where available.
To ensure that each patient's care is coordinated, both within the Clinical Centers and across the network, WE RECOMMEND THAT:
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(4) The Clinical Centers should further define, develop, and emphasize patient care coordination across all programs of care, including:
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educating patients, Clinical Center staff, and the community about how patient care coordination works for them
providing training for the patient care coordination function
establishing mechanisms to evaluate the impact of care coordination on patient care
(5) The Clinical Centers should further develop and enhance information systems that support and improve coordination of care, including:
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scheduling systems
complete electronic health records
internal electronic communications systems
telecommunications links with community-based professionals
To ensure that the setting of the Clinical Centers will foster the well-being of the patient and family, WE RECOMMEND THAT:
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(6) The design of the (re-)developed Clinical Centers should create a healing environment that is flexible in conception, based on the most recent research into
the positive effects of lighting, ventilation, sounds, natural elements, textures and finishes, and other architectural and design features on patient care outcomes.
The environment should be planned to alleviate stress in patients and their families, staff, and others who work in the facility.
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(7) Patient rooms in the Clinical Centers should be designed to accommodate the presence of family members, where appropriate. Adequate space for families
should be provided, including a common meeting room that can be also used for other meeting purposes.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Results
• Flows
– for Emergency
– for Inpatient
– for Outpatients
have been developed by responsible WG in all CC’s
• data survey results
• Jointly, both represent basis to make operational
improvements in particular patient flow areas
putting them at the centre of care.
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction
Conclusions
• Patient centered care culture in transitional
country could be introduced and developed by
– Observing cultural competence – CCM
– Promoting evidence-based medicine – EBM
To link
Natural tendency of careers to care
and
Knowledge of how that should be done in
contemporary medicine / health care
TA for Capacity Building for Tertiary Care Services
An EU-funded project managed by the European Agency for Reconstruction