SPECIAL INITIATIVES Define Drivers for Engagement 1. Operating - - PDF document

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SPECIAL INITIATIVES Define Drivers for Engagement 1. Operating - - PDF document

Feb 16, 2024 130 likes •223 views

Everyone worked independently towards common objective!! Patients Clinician How long do I have to wait Reports of the patients are not to see the doctor available during the round Long lines at every counter Nurses are always

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SLIDE 1

1

Dr ASHOK V CHORDIYA

Director Fortis Hospital Noida

LEARNINGS OF A HOSPITAL CLINICIAN ADMINISTRATOR

Everyone blames the System

Everyone worked independently towards common objective!!

Clinician

  • Reports of the patients are not

available during the round

  • Nurses are always busy; not

enough time for the patients

  • Patients medication delayed
  • Beds not available
  • Equipments / Break-down
  • Infection Rates

Patients

  • How long do I have to wait

to see the doctor

  • Long lines at every counter
  • Waiting in ER for bed
  • Come again in the evening

to collect reports

  • Discharge time is very high
  • When will the surgery start
  • Very few nurses

Management

  • Patients are always complaining

about services

  • No budget for more man power

& equipments

  • Optimum utilization of services
  • How to prevent equipment

breakdown

  • Patient Satisfaction

y

Other staff

  • Everyone blames us
  • Lot of paper work
  • Pharmacy delays; medicine
  • ut of stock
  • Reports not available
  • Shortage of GDAs
  • Housekeeping not

responding

Hospital System

Define Drivers for Engagement

Enhanced

Clinician

Management & Administration Enhanced Patient satisfaction Nursing / Paramedical Staff

SPECIAL INITIATIVES

1. Operating System (FOS) 2. Clean Hospital Project (‘Sparkling’) 3. Patient Care Initiatives 4. Lean Sigma – ‘5 S’ Project

WHAT IS HOSPITAL OPERATING SYSTEM?

Standardizes all patient facing processes:

  • Patient-centric
  • Consistent
  • Efficient
  • Reliable
  • Repeatable
  • Replicable

Effective patient management

WHY A HOSPITAL OPERATING SYSTEM?

Capability management Enhanced patient experience Common platform management Optimum resource utilization Performance management Standardized Processes Operating System

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SLIDE 2

2

Fortis Operating System by looking at the overall hospital processes in 3 dimensions

Wards Beds

OT ER OPD

Diagn‐

  • stics
  • Hospital Performance management system

ICUs

  • Processes within

the department

  • Performance

management system – scorecard and review process

  • Patient flow processes

Admissions Discharge

OBJECTIVE

  • To ensure uniform high quality of

customer facing processes across Fortis hospitals

  • To

embed best practices in

  • perational

efficiency to yield

Enable Fortis to scale up its network faster and at the

  • perational

efficiency to yield bottom-line impact

  • To

facilitate performance management across all sites through use

  • f

a standardised cascade (scorecards at different levels)

  • f

metrics, tools and templates

right quality Analyze

WE USED DMAICFOR IMPLEMENTING FOS

–Define the process –Measure the problem

Define Improve Control

–Analyze and identify the gap –Identify and implement solutions –Track and review progress

D A I I C Measure M

9

  • In-depth understanding of the processes in the asset
  • Data collection and analysis enables identification of areas of waste and

variability

  • Ideas for improvement come backed with data ruling out scope for denial /

action by gut-feel

  • Enables out-of-the-box thinking as ideas can be substantiated by showing

improvement in areas of waste identified during the initiative Benefits of sticking to the rigor

OVER ALL PERFORMACNE REPORT CARD

Service

  • n time

Score 18/24 75 %

Every patient Delighted

42 / 51

82%

Asset Metric Unit Apr '09 May' 09 June' 09 Target OPD Patients waiting beyond 15 mins of appnt % 14% 14% 14% <5% PHC %age PHCs completed within defined TAT % 61% 72% 76% 90% ER Pts with LOS > 4 hrs in triage % 2% 1% 2% <5% ER Ambulance response outside 10 mins % 2% 3% 2% <10% Wards Discharges before 11 am % 46% 46% 45% 75% IPD ALOS Days 4 4 4 OT & Cath Lab Procedure / Surgeries starting within 30 mins

  • f scheduled time

% 91% 90% 93% 90% Lab Med Short lead test completed with in 1hour 30 mins % 87% 89% 90% 90% Radiology USG reports within 15 mins X-ray reports within 30 mins % 77% 78% 79% 90%

Service for all Predicta ble service

Score – 12/12 100% Score – 12/15 80% Score

= 1 = 2 = 3 X ray reports within 30 mins Asset Metric Apr '09 May' 09 June' 09 Target OPD Calls Dropped % 4% 3% 3% <5% ER Ambulance calls turned back % 1% 1% 0% <5% IPD Admissions denied % 0% 0% 0% 0% OT & Cath Lab Surgeries rescheduled % 4% 4% 3% <5% Asset Metric Apr '09 May' 09 June' 09 Target ICUs % Step downs planned % 77% 78% 81% 80 Billing Patients with final bill more than 5% of estimate % 12% 11% 10% <5% Wards % discharges planned % 76% 81% 80% 80% Wards Length of discharge process Mins 132 132 147 120 House keeping TAT for room cleaning post discharge Mins 25 25 24 30 76% 78% 82%

Project ‘Cleanest Hospital’

Highlights of Project “Cleanest Hospital”

What is ‘CLEAN’?

Re‐define? ‘Patient Safety’

Only Sparkling or Infection free?

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SLIDE 3

3

ZONING OF THE HOSPITAL

ZONE 9 - OT ZONE 6 – 5th FLOOR ZONE 5 – 4th FLOOR ZONE 4 – 3rd FLOOR ZONE 3 – ICU ZONE 1 – G/FLOOR ZONE 12 PUBLIC AREA ZONE 11 BASEMENT ZONE 10 - ATRIUM ZONE 9 OT ZONE 8 – OPD 1st FLOOR ZONE 7 – OPD G/FLOOR ZONE 3 ICU ZONE 2 – 1stFLOOR

ACCOUNTABILITY OF HK SUPERVISORS TO BE ENSURED

STAFF DEPLOYMENT

G M E G M E G M E

GENERAL (0900 TO 1730 H)

  • 02

MORNING (0700 TO 1530 H)

  • 35

EVENING (1300 TO 2100 H)

  • 30

NIGHT (2100 TO 0700 H)

  • 18
  • 1

3 3 3 3 3 3 3 3 3 2 N 2 2 2 2 N 1 N

PRO INTERACTIVE (3 + 46) DYNAMIC (2 + 31) ARNA (1 + 8)

  • 1
  • G 1

3 3 3 M 18 6 2 3 3 3 M 9 3 2 3 E 17 2 4 2 3 2 E 7 G 1 NIL M 8 E 6 2 2 1 N 11 1 5 N 6

  • 1

N 1 P 1

GRAND TOTAL - 85

CLEAN PATIENT ROOM CHECK LIST DATE:‐ FLOOR:‐ SUP:‐

Area to check Points to be checked

Room Room Remarks Main door Polish/Paint/Chipping/Door handle/Door closer/Hinges/ Locks Walls and ceiling Corner/Dust and stain free Patient bed Dust free‐bed wiping/Clean linen/Paint/Mattress Wiping Water tray Flask‐clean/Glass cleaning/Tray cleaning Phone Dust free/Telephone sticker/Wire dust free/Disinfectant used Almirah Polish/Paint/Door hinges and Knob/Lock And keyHangers/Pt. Dress clean/ Rod clean/Inside clean/Attendant Linen clean Food trolley Clean‐Stain and Dust free Foot stool Clean‐Stain and Dust free B d id l k Cl St i d D t f Bed side locker Clean‐Stain and Dust free Patient bell Clean‐Stain and Dust free Room window blind‐working/Blind clean/Ledges/ Lock‐in place/Window sealed/Glass smugge and streak free Attendant couch Upholstery‐condition/ No sagging TV Working with all Channels/Dust free/ Wire Clipped/Height for Viewing Room Curtain Track smooth move/ All hook Intact/Curtain Clean Lights and switches Working Wall clock Working Waste bins Garbage bag liner/Clean‐Inside and outside AC Thermostat‐on when Occupied/Grills‐Clean and Dust free Floor Clean/shining/No Spots/Clean Skirting

INFECTION FREE PATIENT ROOM CHECK LIST DATE:‐ FLOOR:‐ SUP:‐

Area to check Points to be checked

Room Infection check Remarks

Main door Polish/Paint/Chipping/Door handle/Door closer/Hinges/ Locks

Random sampling to be done

Walls and ceiling Corner/Dust and stain free

Random sampling to be done

Patient bed Dust free-bed wiping/Clean linen/Paint/Mattress Wiping

Random sampling to be done

Water tray Flask-clean/Glass cleaning/Tray cleaning

Random sampling to be done

Phone Dust free/Telephone sticker/Wire dust free/Disinfectant used

Random sampling to be done

Almirah Polish/Paint/Door hinges and Knob/Lock And key Hangers/Pt. Dress clean/ Rod clean/Inside clean/Attendant Linen clean

Random sampling to be done

Food trolley Clean-Stain and Dust free

Random sampling to be done

Foot stool Clean-Stain and Dust free

Random sampling to be done

Bed side locker Clean-Stain and Dust free

Random sampling to be done p g

Patient bell Clean-Stain and Dust free

Random sampling to be done

Room window blind-working/Blind clean/Ledges/ Lock-in place/Window sealed/Glass smugge and streak free

Random sampling to be done

Attendant couch Upholstery-condition/ No sagging

Random sampling to be done

TV Working with all Channels/Dust free/ Wire Clipped/Height for Viewing

Random sampling to be done

Room Curtain Track smooth move/ All hook Intact/Curtain Clean

Random sampling to be done

Lights and switches Working

Random sampling to be done

Wall clock Working

Random sampling to be done

Waste bins Garbage bag liner/Clean-Inside and outside

Random sampling to be done

AC Thermostat-on when Occupied/Grills-Clean and Dust free

Random sampling to be done

Floor Clean/shining/No Spots/Clean Skirting

Random sampling to be done

Fire sprinkler Working/No paint marks

Random sampling to be done

Untidy Store Tidy Store OPD Chamber of Doctors

INFECTION CONTROL COMMITTEE

  • S. N.

Name Designation Title 01.

  • Dr. Mrinal Sircar

HOD & Sr. Consultant‐Critical Care Chairman 02.

  • Dr. Ravneet Kaur

Consultant‐Microbiologist Convener 03.

  • Dr. Ashok V Chordiya

Facility Director Member 04.

  • Dr. Adarsh Koppula

HOD & Sr. Consultant‐CTVS Member 05.

  • Dr. Dushyant Nadar

Consultant Urology Member 06.

  • Dr. Manoj Singhal

HOD & Sr. Consultant‐ Nephrology Member 07.

  • Dr. Mary Abraham

HOD & Sr. Consultant‐Anesthesia Member 08.

  • Dr. Usha Gupta

Consultant Clinical Pharmacologist Member 09.

  • Ms. Neena Yadav

Deputy Nursing Superintendent Member 10.

  • Ms. Kuttyamma

Infection control Nurse Member 11.

  • Mr. Ravi Adhlakha

Chief Engineer Member 12. HOD Housekeeping HOD Housekeeping Member

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SLIDE 4

4

ACENITOBACTER ACTION GROUP

  • S. N.

Name Designation Title 01.

  • Dr. Mrinal Sircar

HOD & Sr. Consultant‐Critical Care Chairman 02.

  • Dr. Ravneet Kaur

Consultant‐Microbiologist Convener 03 Dr Ashok V Chordiya Facility Director Member 03.

  • Dr. Ashok V Chordiya

Facility Director Member 04.

  • Dr. Adarsh Koppula

HOD & Sr. Consultant‐CTVS Member 05.

  • Dr. Akash Sud

Deputy Medical Superintendent Member 06.

  • Mr. Satish Kumar

Quality Manager Member

Academic training Bedside teaching Critical Care Update for Nurses

HAND HYGIENE CAMPAIGN IN ICUs

“Impact

  • f

short term focused education intervention on ICU nurses´ awareness of infection control measures, ICU hand washing practices and nosocomial infections.”

Authors: Critical Care Microbiology and Infection control Nursing Authors: Critical Care, Microbiology and Infection control Nursing Teams Paper accepted for oral presentation at the annual conference of European Society of Intensive Care Medicine (Vienna, Oct 2009)

ENGAGEMENT WITH CLINICIANS

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SLIDE 5

5 MONTHLY MEDICAL FORUM

Infection Rates & Control Measures Pathology & Radiology Related Issues and/or Concerns Medical Statistics & Audits Mortality Data – Issues & Discussions Medication & Prescription Error Data Academics & Research Update Mapping Clinical Out‐Comes Criteria for Clinical Indicators Recognition of Articles, CMEs, Conferences et al Training Workshop / Advanced Course Updates Any Other Clinical Issue(s)

Vi i i E i Visioning Exercise @ Fortis Hospital Noida

MID TERM PLANNING ‐ TEAMS

Team 1 Team 2 Team 3

FHN

  • Col. Harinder Chahal
  • Dr. Rajesh Ahlawat
  • Dr. Rajesh Gupta
  • Dr. Yogesh Agarwala
  • Dr. Sanjeev Dua
  • Dr. Anand Pandey
  • Dr Manoj Singhal
  • Mr. Jasbir Grewal
  • Dr. A.K. Singh
  • Dr. Vijay Kher
  • Dr. Sudhir Sharma
  • Dr. Madhu Shrivastav
  • Dr. Girish Vaishnava
  • Dr Vikas Gupta (Ort )
  • Dr. Manoj Rai Mehta
  • Dr. Ashok Rajgopal
  • Dr. Ajay Bhalla
  • Dr. Adarsh Koppula
  • Dr. Vikas Gupta
  • Dr. Dushyant Nadar
  • Dr I PS Kochhar

Corp

  • Dr. Manoj Singhal
  • Dr. Pradeep Jaisingh
  • Dr. Akash Sud
  • Mr. Pankaj Dhingra
  • Mr. Srinagesh
  • Dr. Vasudha

Rajasekar

  • Mr. Venkat I yer
  • Dr. Sudhanshu

Bankata

Facilitator: Mr. Daljit Singh

  • Dr. Vikas Gupta (Ort.)
  • Dr. Ashwini Sengar
  • Dr. Mary Abraham
  • Mr. Malyawant Passi
  • Ms. Anila Agrawal
  • Dr. I PS Kochhar
  • Dr. Neerja Johar
  • Dr. Sanjay Saxena
  • Mr. Alok Khanna
  • Ms. Neena Yadav
  • Dr. Narottam Puri
  • Mr. Capri Jalota

Dimensions Inputs Hospital Positioning Medical programs Medical mix – between medical programs

Thought Tinkers

People & practices Pricing Marketing & branding Patient channels Patient care services

Medical Programs Growth

Medical Programs Year 1 Year 2 Year 3

Cardiology

  • EP program
  • Heart failure clinic

Gastroenterology

  • EUS
  • Enteroscope

PATIENT CARE INITIATIVES

Floor Patient Welfare Officers

Buddy Program In-patient Facilitator Patient Mania Delight Cards ‘SAARTHAK’ Cancer Survivors’ Program ‘Friends of Fortis’ Initiative

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SLIDE 6

6

The aim is to have one Patient Welfare Officer on each floor to attend to issues, in addition to their regular duties.

FLOOR PATIENT WELFARE OFFICERS

In this program, as soon as a patients is admitted to twin sharing room category and above, they are assigned a ‘Buddy’.

BUDDY PROGRAM

The role of Patient Welfare Officers has been enhanced to take on certain

  • ther managerial functions
  • n the floors, so that they

are a one point contact for all issues

  • n

respective floor. They visit these rooms daily, interact with the patients and their attendants and resolve any issues that have arisen. They also attend the buddy meeting every Friday and give their feedback.

PATIENT MANIA

With a view to involve personnel at all levels, Patient Mania program was evolved which is an euphoric

campaign to reiterate FORTIS behavior and service excellence

  • Activities to become Patient Maniac
  • Patient Service Case Studies
  • Letter to Myself
  • Self Learning Techniques
  • Learning FORTIS Way

INTERACTIVE SESSION WITH CLINICIANS PATIENTS’ PARTICIPATION IN THE PROGRAM

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SLIDE 7

7

DOCTORS ADDRESSING PARTICIPANTS

PATIENTS’ PARTICIPATION IN THE PROGRAM

Implementing 5s Project

for

Lean Healthcare

Well known facts….

  • For every dollar spent on healthcare over 75% is spent
  • n the non-patient care activities of communicating,

scheduling, coordinating, supervising, and documenting care.

  • Preventable medical errors kills as many as 98000

patients annually.

  • Errors cost approx. $ 17 bn to $ 29 bn per year

nationwide.

  • Nurses spend a third of their time in patient care & rest
  • f their time in hunting, documenting, clarifying.

Source: Institute Of Medicine

Waste as it Exists in Healthcare

To be a world-class provider you need to be operating at a level of above 40% of value-added activity

5S for Healthcare includes…

Sort ‐‐ "When in doubt, move it out.“ Set‐In‐Order ‐‐ "A place for everything, and everything

in its place."

Shine ‐‐ "T

  • be Lean, you must be clean."

Standardize ‐‐ "What you don't know, you can't

improve."

Sustain ‐‐ "Maintain the gain and forget the blame."

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The Good, Bad and the Ugly

First the Bad and the Ugly - Life Without 5S

The Good

Typical Lean Healthcare Results

Reduced Inventory by 20% or more Increased patient satisfaction Optimum Utilization of Resources Improved staff satisfaction Reduced stress Reduced costs

CHALLENGES AHEAD

  • Clinicians involvement in driving Quality &

Safety programs

  • Medical Audits
  • Events / Errors reporting
  • Clinical Records Completion
  • Antibiotic Usage
  • Good Clinical Practices