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Action Learning Pilot Programme

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Action Learning Pilot Programme Project Khaedu - Addington Hospital report-back 20 May 2005 Agenda Key messages Agenda Current situation what we ve seen and ... – PowerPoint PPT presentation

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Title: Action Learning Pilot Programme


1
Action Learning Pilot Programme
  • Project Khaedu - Addington Hospital report-back

20 May 2005
2
Agenda
  • Executive Summary
  • Current situation
  • Some best practices identified
  • Some remaining challenges

3
Key messages
Addington is a well-run hospital within the
constraints in which it exists, with a capable,
tightly-knit management team
Best practices
Challenges
OPD process
HR Management
Macro
Micro
  • Patient information
  • Patient screening
  • Medical records
  • Recruitment and retention strategy
  • Motivation and awards
  • Training and development
  • Multi-skilling
  • Provincial Health Department overhead structure
  • Uncertainty around future location and role of
    Addington
  • Pharmacy wait times
  • Staff communication

Out of the direct control of hospital management
team
4
Agenda
  • Executive Summary
  • Current situation
  • Some best practices identified
  • Some remaining challenges

5
Current situation what weve seen and heard
Process and physical
Organisation design
People management
Financial and procurement
  • Large hospital with high volumes of patients
  • Over 1200 per day outpatients
  • Very good OPD process
  • High inpatient occupancy rates (average of 91
    last year)
  • Relatively good level of infrastructure and
    maintenance
  • Geographically very spread-out, with resulting
    fragmentation of some processes
  • Patients happy with the service and treatment,
    but
  • very unhappy with long wait times at the pharmacy
  • Relatively high level of delegation down to the
    hospital
  • Mixture of regional and district services
  • Causes some confusion with patients, and
    complicates management and communication
  • Provincial Health Department overhead structure
  • Potential duplication and unclear roles between
    district and region
  • Vacancies are lower than provincial average
  • No vacancies at senior and middle management
    level
  • Capable experienced management with clear
    strategy and good execution
  • Majority of staff appear positive
  • 83.6 in employee satisfaction survey
  • Relatively good relationship with unions which
    has improved over time
  • Relatively good basic supervisory and management
    skills on the ground
  • Very good human resource management
  • Regular, clear communication may improve
    relationship with staff further
  • Good training and development programmes
  • Apparent high cost per patient, but difficult to
    benchmark accurately with current information
  • Some delays in procurement of supplies due to
    Provincial Stores
  • Difficulty in controlling budget allocation due
    to top-down process and limited overall resources

6
Addington has a very high volume of outpatients
on a daily basis, and this appears to be growing
2005 average
14 increase
7
Patients are happy with the service and
treatment, but very unhappy with wait times
Very happy
Happy
Very unhappy
8
There is a capable, experienced management with a
clear strategy and good execution
5 Strategic Objectives
9
Addington appears to have a relatively high cost
per patient day
But difficult to do like-for-like comparison due
to significant factors e.g. training college and
increased maintenance being on the beach front
10
Agenda
  • Executive Summary
  • Current situation
  • Some best practices identified
  • OPD
  • Human resource management
  • Some remaining challenges

11
Despite the very high volumes of outpatients,
Addington has instituted a number of measures to
manage this
  • Good information regarding
  • Status of the hospital and services available
  • Where to go
  • Rigorous and efficient screening process
  • Separates PHC patients from appointment and
    emergency patients
  • Very efficient medical records process

12
The outpatients process
10-15 mins
Patient arrives
Given slip referred to on-site poly-clinic
Gate clinic for screening
Appoint-ment?
Emer-gency?
No
No
Yes
Yes
See prof. nurse
PHC problem?
Yes
Register and pay at OPD counter
AE
10-15 mins
No
Directed to relevant clinic (file already there)
See Doctor
Consult with Dr
Medication required?
Yes
Go to Pharm hand in script
Receive medication
Medication required?
No
Yes
Patient leaves
No
13
e.g. patients receive information in their own
language
The voice of the voiceless a walk-about
sister ensures that all patients know where to go
and why they are waiting
Knowledgeable security guards at all entrances to
direct patients
14
e.g. patients receive information in their own
language
15
Medical records has developed a number of best
practices
  • All O/patients have to have an appointment before
    they are seen at Outpatients
  • All files logged out on the computer as soon as
    they are drawn
  • All appointment patient files drawn 2 days prior
    to appointment
  • Moved to respective clinics 1 day prior to
    appointment
  • Colour coding system to prevent mis-filing
  • Repeat prescriptions separated out and filed in
    separate area for rapid retrieval

16
All files are logged out out on the computer as
soon as they are drawn
17
All appointment patient files drawn 2 days prior
to appointment
Photo taken on 18/5/05 Files ready to go to
Medical Outpatients clinic
18
All files are colour coded
to enable quick identification of misplaced files
Mis-placed files
19
Repeat prescriptions are separated out and filed
in separate area for rapid retrieval
20
Agenda
  • Executive Summary
  • Current situation
  • Some best practices identified
  • OPD
  • Human resource management
  • Some remaining challenges

21
In the absence of PMDS, management have
instituted individual and team service excellence
awards
Service excellence awards are hand-made teak
plaques made from a part of Addington
Employee satisfaction at 83.6 in last employee
satisfaction survey (2004).
22
Good training and development programmes,
  • 80 of training and development money allocated
    to unskilled categories e.g. general assistants
    and handymen
  • ABET for 53 students last year
  • Developing tradesman aid to handyman to artisan
    (plan submitted by line manager to HRD training
    coordinated by HRD)
  • Remaining 20 pooled and coordinated at Head
    Office level

structured attraction and retention strategies,
  • Recognised the fact that the sale of Addington
    has an impact on attracting and retaining staff
  • Set up committee to address these issues and find
    other ways to attract and retain the best staff

Appears to be having an effect lower vacancy
rates than other hospitals
23
Addington has a 13 vacancy rate, which is lower
than many of its peers
Provincial average
Addington
Add avg
24
multi-skilling in the team
A, B, C consultant
D, E, F consultant
G, H, I consultant
J,K,L consultant
  • Leave
  • Appointments
  • Orientation
  • Persal issues
  • Other human relation issues
  • Leave
  • Appointments
  • Orientation
  • Persal issues
  • Other human relation issues
  • Leave
  • Appointments
  • Orientation
  • Persal issues
  • Other human relation issues
  • Leave
  • Appointments
  • Orientation
  • Persal issues
  • Other human relation issues

Multi-skilling, with each consultant with a set
of clients
25
Addington is struggling with absenteesim
  • Numerous employee awareness programmes attempt to
    address the absenteeism challenge
  • Employee assistance programme
  • Life-style diseases management programme and
    health awareness days
  • IOD and needle-stick injury management programme
  • TB/AIDS surveillance programme

26
Agenda
  • Executive Summary
  • Current situation
  • Some best practices identified
  • OPD
  • Human resource management
  • Some remaining challenges

27
The pharmacy has instituted a number of measures
to improve the process of dispensing medication
  • Allocating numbers to patients as they arrive
  • Separate counter for critical/emergency patients
  • Opening satellite pharmacy at Addington
    Childrens hospitals (value to whole system open
    for debate)
  • Planning further satellite clinics for MOPD and
    Polyclinic (value to whole system open for
    debate)
  • Separate process for old-age homes in bulk
  • 1 representative collects for whole home

28
However, nearly all patients interviewed
complained about wait times at the pharmacy
We wait very long to receive medicines often
more than 4 hours
It is not an acceptable waiting time I am
going to miss the taxi back home because I have
waited so long
I waited nearly the whole day at the Polyclinic
and then had to come back the next day
The dispensary is too slow
29
There appears to be a bottleneck at the
pharmacist part of the process
30
Addington has a high vacancy rate amongst
pharmacists
Provincial average
Addington
Add avg
31
and it is unlikely that we will be able to
recruit significantly more pharmacists (and we
have budget constraints)
WHO norm for industrialised countries
SA average
SA average
Source Equity and the Provision of
Pharmaceutical Services, Andy Gray,
Pharmaceutical Policy Practice Group, University
of Durban-Westville Initiative for Sub-District
Support, HST
32
and we are losing them quicker than we can
replace them
Facing the recruitment and retention crisis in
pharmacy looking abroad
Pharmacy in Britain is facing one of its biggest
ever recruitment crises. The lack of newly
qualified pharmacists, the result of the fallow
year, has left employers looking for other
sources of pharmacists to fill the gap. One of
the answers has been to look abroad.
The Boots experience Boots The Chemists started
recruiting pharmacists from abroad about 18
months ago. The company has been on several
recruitment visits to both Spain and South
Africa. It is planning to return to both
countries later this year.
The Pharmaceutical Journal Vol 267 No 7156 p45-46
33
The use of flat trays means medication slides
around and also causes disruption of numbering
process
Top tray scripts came in later than bottom tray,
but will be dispensed first
Bottom tray scripts came in first, but will be
dispensed later
34
Batching of more than 30 scripts at a time means
that patients wait much longer than is necessary
35
Some preliminary ideas to ease the bottleneck at
Addington
Physical
Systems
Times
People
  • Improve layout to match the process
  • Categorize and separate out complex
    prescriptions
  • E.g. Schedule 5s
  • Change flat trays to shallow, rounded box
    containers to prevent sliding of drugs from one
    patient to another
  • Also assists in stacking
  • Eliminate batching
  • Motivate for the implementation of the pharmacy
    module of MediTech
  • Automatic printing of labels
  • Limited checking of patient name etc
  • In the interim, ensure certification of
    post-basic PAs to do writing of labels for
    Pharmacists
  • Synchronise opening times of pharmacy and pink
    card section, e.g.
  • Open pharmacy at 6am, but do not start handing
    out medication until 7.15 (to prevent
    time-creep earlier and earlier
  • Potentially spread the opening time of the pink
    card section over a longer period
  • Careful implementation of the PMDS for
    pharmacists as well as assistants
  • Hold pharmacists and PAs to accepted norms
  • Potential for teaming between e.g. 3 pharmacists
    and 3 PAs
  • Institute league tables for best team

36
Improve the layout to match the process
37
Remaining Macro challenges
  • Inability to recruit and retain staff due to
    impending sale of Addington
  • Moratorium in filling of posts even if there are
    funded vacancies
  • Very hierarchical provincial overhead structure

38
The overhead structure in Health appears very
hierarchical leading to delays in decision-making
MEC
HOD
DDG (Health Services Cluster)
DDG (Health Services Cluster)
15
DDG (Health Services Cluster)
14
District Health Development
What is the difference in the roles and job
description of these two posts?
13
eThekwini District Officer
CEO (Hospital Manager)
13
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