Transcript MALAMULELE HOSPITAL PRESENTATION

MALAMULELE HOSPITAL
PRESENTATION
VHEMBE DISTRICT : THULAMELA
MUNICIPALITY
DATE:
7 APRIL 2006
TABLE OF CONTENTS
KEY MESSAGE
SITUATION ANALYSIS
CHALLENGES
RESOLUTIONS/RECOMMENDATIONS
KEY MESSAGE
 Malamulele hospital is an effectively managed hospital with the staff
establishment of 626 (398 filled posts), serving a population of
approximately 314 029 with 17 feeder clinics, 1 health centre and 3
mobile clinics.
 There are 272 patient beds, however, the total utilization of beds is 256
(94%).
Doctor: patient ratio is 1:20: female ward
Doctor: patient ratio is 1:47: male ward
 In spite of the efficiency of the hospital, limited working space was
identified as one of their major challenges.
Malamulele hospital grounds
Inside the private ward – promoting the hotel services concept
KEY MESSAGE
SITUATION ANALYSIS
PROCESS AND
PHYSICAL
ORGANIZATION
DESIGN
PEOPLE
MANAGEMENT
FINANCIAL AND
PROCUREMENT
oSmall hospital with
small volume of patients
oThe span of control for
Deputy Managers is too
high.
 Good Managementunion relationship
Unicare system less
prone to manipulation.
Good staff morale
(rating of 3 out of 5).
Debt recovery
procedures not clearly
defined / writing off.
oHigh standards of
cleanliness
oAcceptable OPD but
there is room for
improvement
oIn-patient occupancy
rate of 78%.
oThe hospital has good
infrastructure
oLack of space for
maintenance and clinical
support services
oJob grades of health
professional noncompetitive
oShortage of office
space impacting on
filling of posts at
administrative level
oThe vacancy rate of
37%.
Effective
implementation of
Performance
Management System
which is modeled
around the National
framework.
Good interpersonal
relations between
stakeholders.
Revenue collection
relatively good due to
the private patient
wards.
80% of the budget is
utilized by personnel,
despite 37% vacancy
rate
SITUATION ANALYSIS
PROCESS AND
PHYSICAL
ORGANIZATIONAL
DESIGN
PEOPLE
MANAGEMENT
FINANCIAL AND
PROCUREMENT
oTheatre arrangement
combined (major and
minor)
oNon-integration
between the hospital and
clinics (PHC)
Poor supervision,
doctors and nurses.
Insufficient budget
allocations
Very low fraud and
corruption
occurrences.
 Direct
procurement and
contracting of
service providers by
provincial office
hampers service
delivery and
management of
service level
agreements.
oLack of facilities for
staff.
oLack of space for some
services (Reproductive
Health Services)
oPatients happy with the
treatment – however,
oVery unhappy with long
waiting times at OPD and
pharmacy.
oHRD manager
appointed in February
2006 to attend to critical
skills identified in
Finance, IT and the
effective
implementation of
ABET program.
Service excellence
awards held on the
14 December 2005
Staff Morale
4
3.7
3.67
3.5
3.23
3.07
3
2.9
2.37
2.5
2.37
2.27
5 Very Good
4 Good
2
3 Acceptable
2 Poor
1 Very Poor
1.5
1
0.5
0
Train avail.
Career
progress.
Com.w ith
mgmt
Facility qual. Service quality
Pms
effectiveness
Mgmt quality
Budget Usage
Client Satisfaction
4
3.7
3.6
3.6
3.4
3.5
3.3
3.4
3.2
3
2.7
2.5
Very Good
Good
2
Acceptable
Poor
Very Poor
1.5
1
0.5
0
Vis time
Staff help
Clean
Toilets
Treatment
Medicine
Money val
Staff skills
BEST PRACTICES
•Good OPD process map
•Excellent record keeping
•Excellent Hotel services
• program
•Minimal fraud and
corruption occurrences
•High standard of
cleanliness
•The implementation of
UNICARE system iro financial
management minimizes
Fraud and corruption
•Excellent help desk and patient
screening
CHALLENGES
•Limited office space
•Lack of space for
maintenance and clinical
support services
oLack of facilities for staff.
Poor supervision, doctors and
nurses leading to long
Queues in OPD and pharmacy
•Shortage of office
space impacting on filling
of posts at administrative level
•Non-integration between
the hospital and clinics (PHC)
o
•Debt recovery procedures
not clearly defined / writing off.
•Insufficient budget allocations
•Direct contracting by
provincial Office hampers
service delivery and
management of SLAs.
OUT-PATIENT PROCESS MAP
10 - 15 mins
Help Desk
gives
Queue
number
10 - 15
mins
Second
visit
Registry
Clerk
Present
collect
File
Yes
Yes
Register in
First OPD counter
No
No
Register and
and
Register
nd OPD
pay at
at 22 nd
pay
OPD
counter
counter
Emer gency ?
Yes
No
Gate way clinic
Registration Functions in
In one OPD to avoid
duplication
Chronic patients
collect medication
PHC
Vital data
collected
23hour
Screening to start
as patient come
Given slip &
referred to on
site poly - clinic
and casualty
Outreach program
Queue for
screening
PHC
problem?
Yes
Consulted by
Professional
nurse
No
Queue to
23hou
r
Dedicated Doctor
at OPD
strengthen
supervision
Consult with
Dr
Go to
admission
Yes
Admission
required?
No
Go to Pharm
& hand in
script
2 - 3hour
Receive
medication
Patient
leaves
1
Queue for Screening
Queues at doctors’ rooms
Furniture at clinics
Furniture
at clinics
The Pharmacy Dispensing process Malamulele Hospital
Need for waiting area
in pharmacy
Enters
Pharmacy
through
the door
Knowledge
Of where
file placed
Yes
Put file on
the window
Is the
Pharmacist
busy Yes
Leaves file in
pharmacy counter
Sits on the bench
No
No
Patients
to be
given
direction
s where
the file
should
be
Placed
Ask other
patients on the
benches
Patient
leaves
the Hosp
Sign medicine
chart and place
file on the
counter
One
pharmacist
can assist
the patient
up to the
end of the
procedure to
ensure that
two patients
are assisted
at a time
File box needed to
keep files which have
been completed rather
than keeping files on
the counter as it
causes confusion
Gives patient
Medicines and
gives instructions
Pharmacist takes
the file from the
counter
Reads file and fill
packets with
medicines
Label medicine
packets
Second
pharmacist
Calls patient and
record in stat
form
Push the file to
the second
pharmacist
Put medicines
packets in the file16
RECOMMENDATIONS
•Implementation of the
Revitalization Program
•Integration between clinic
and hospital
• Effective monitoring and
evaluation of employee
performance at senior level
•Clearly defined debt
recovery plan
•Strengthening monitoring
in the management of
Service Level Agreement
•Sensitization of provincial
office to the impact of
conservative budget
allocations
THANK YOU