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Yasthon Hospital
Yasothon Hospital
Thailand

The Problem

Yasothon General Hospital was established in 1965 initially as a 30 bed hospital. We now have 370 beds (with an average of 800 outpatient cases per day). Patient satisfaction levels were beginning to decline. The service had too many steps, each taking a long time, for example, 6-7 hours for some clients until the conclusion of the service process.. The service process depended on the patient’s condition. For example, the patient needed to complete a new registration card and OPD card during their first visit. Their vital signs were then recorded along with their chief complaint and other information at the screening unit before seeing a physician. If the physician needed more information about the patient’s illness, the patient needed to go to laboratory unit or X-ray unit and then come back to the physician’s unit after he or she received the X-ray or lab results. After the physician wrote his prescription, the patient handed in the prescription to the Pharmacy Unit before the pharmacist dispensed the drug and provided drug counseling. Then the patient could go back home. Survey studies found that the total waiting time was 5 hours 58 minutes per case. Patient satisfaction was 72.3 percent in 2004.
There were 2-3 complaint letters per day saying that “The hospital was a slaughter house.”, “The nurse should perform better service.”, “Poor service”, “Wishing the nurse would smile more.”, “The hospital has only a few doctors and they come rather late, making the patient spend a long time in the hospital”, “Patients need a quicker service. ”, “There is untidy and dirty environment and especially the toilets - smell bad.”, “The hospital should take better care at this stage.” and “The hospital should cooperate with other care providers and not rely on patient self-help alone”.
More and more, when people become ill, they like to buy medicine or see a doctor at a private hospital or private clinic. This increases patient expense unnecessarily and results in patients sometimes taking unnecessary drugs. People who take too much medicine have higher risk of getting sick from adverse drug reactions which can be life threatening.
Since 1976, we implemented a good front line system with multi-disciplinary care teams incorporating doctors, pharmacists, lab and X-ray staff, technicians, nurses, ward officials, psychologists, physical therapists and the others as required. All cooperate to develop continuous quality improvements and now we call this team Patient Care Team of OPD (PCT OPD).

Solution and Key Benefits

 What is the initiative about? (the solution)
The key performance indicators include patient satisfaction, patient complaints, and OPD service timing. We use the assessment of patient satisfaction by Dusit poll and Thailand Hospital accreditation questionnaires.
The data was collected by randomly sampling 20 patients per day every morning for 30 days. Every day the data were summarized and analyzed. The Patient Satisfaction results after developing and implementing turnaround strategies were as follows:

Jan 2005 87.45%
Jan 2006 88.3%
Jan 2007 89.4%
July 2007 92.3%



The collection data OPD service timing is fixed by form. Each unit writes down the Time. The forms are included with the patient’s history file. After one month each patient from the analyzed results found that the waiting time was only 56 minutes. (Standard waiting time is less than 1 hr 30 min.)
Patient comments included: “The hospital area environment is clean”, “The service is impressive”, “quick”, “excellent, “the providers are giving service by smiling heartily.”, “Nice talk”, “Good service indeed”. In 2004, the hospital received regional first prize for good quality public service.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The solution is relevant to government policy. The PCT OPD include doctors, pharmacists, lab and X-ray staff, technicians, nurses, ward officials, psychologists, physical therapists and other professionals. The achievement came about through brainstorming, teamwork, and cooperation among the participants. The executive promotes budgeting. The hospital lets the winning team attend seminars focusing on good organization, gives special bonuses and rewards the team by declaring a job well done.
There is a budget for cleaning, tidiness, and improving the environment. The hospital won the first prize for the cleanest toilets in the Public Health region.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
Strategies to solve the problem:
1. Using one stop service in every unit where possible.
2. Reducing overcrowded services by changing the service hours from 8 am to 16 pm to 7 am to 16 pm every day. Increase service times from 16 to 21 pm on weekdays. On Saturday, Sunday and holidays service hours are from 9 am to 13 pm.
3. Doing the aggressive change by creating two primary care units. (A health care team from the hospital goes to the care unit outside the hospital. This team is responsible for medication refill and check ups for patients with chronic diseases.). The primary care unit cooperates with health centers and community hospitals by a coordinated referral system. Since patients with chronic illnesses such as DM and HT have frequent medication refills and check ups, they come to primary care unit rather than to the hospital. Therefore, the number of patients in the hospital is reduced.
4. Now waiting at the hospital is more enjoyable, similar to an entertainment complex, with volunteers playing Thai music and overall improvement to the hospital areas. The hospital now looks like a good hotel. There are reading corners, herbal drinking counters, and peaceful areas for worshiping Buddha images, Hindu Gods, etc.
5. There is Thai massage, herbal saunas, karaoke, and a meditation room. Fitness clubs for health promotion for officials and others. The Thai traditional medicine unit and health educators are responsible for this section.
6. The public toilets situation has changed from having not enough toilets and unclean toilets with a bad smell. From our survey, we found toilets in Yasothon Hospital were used by 822 persons per day. We improved the toilets by using HAS (Health Accessibility and Safety) standards until we received the national first prize for the most excellent toilets from the Department of Health.
7. Personnel developed excellent behavior through team training by customer service experts from Thai Airlines to work with hospital personnel.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
The key development and implementation steps are Continuous Quality Improvement (CQI). Use of the PDCA cycle (plan, do, check, act) to develop a service system. Improving the service by reducing steps, therefore, saving time at each service point.
Reducing steps are done as listed below.
1. The patient care team OPD paid attention to making all patient care most satisfactory. Client care was emphasized through the multidisciplinary participation of every one at every level. These include doctors, dentists, pharmacists, nurses, technicians, physical therapists, health educators, psychologists, and social medicine practitioners.
2. Analyze the key performance index data by PCT OPD, reducing from seven steps to one stop service in the dental unit and specialization clinic. Clear steps are aimed at covering every dimension of patient care, including timing of service to ease the patient as needed. The clients are very happy. We monitor all data and take them to consult monthly with the other PCT teams, including Med PCT, Surg PCT, Ped PCT and ENV team.
3. Participation with local organizations, private sectors and other clubs can help us with activities such as campaigns for dengue fever, blood donations, and Heartfelt volunteers (Jit-asa).

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
Even though the personnel already provide a highly efficient service and are admired by patients, the client’s desire for endless quality service creates what appears to be a gap between patient and service system. To reduce this gap, PCT OPD is developing risk management strategies that recognize and assess risk, and develop strategies to protect and manage the risks that may be harmful. All of the service units are working on innovative ideas to increase patient satisfaction. They are setting strategies for achievement as follows.
1. Realizing service.
2. Defining service behavior to meet the client’s need.
3. Categorizing the problems and obstacles.
4. Patient hearing.
5. Knowledge management and competency of Personnel Promoting continuous quality improvement.
6. Admiring and giving rewards to the personnel who do the best.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Computer used by Hos-XP program is adapted for use in the hospital by having cards record the time in queue automatically at both the card room and pharmaceutical room. The cost for this program was over 300,000 baht and was subsidized by local organizations and the public health ministry.
Human Resources: Volunteers come from the general population and retired persons who wish to help the patients without any wages. Heartfelt volunteers (Jit-ASA) is a group of retired people and patients with chronic disease who volunteer to help patients and service providers understand about the service system and even respond in some parts of service delivery. It seems that they enjoy helping the patients and the personnel

Sustainability and Transferability

  Is the initiative sustainable and transferable?
There is a meeting held every month to monitor quality of service, including any problems, and then take the problems entering PDCA cycle. There will be continuous quality improvement. The Yasothon Hospital OPD can serve as a model which can adapted in the other hospitals in Thailand and even for Cambodia and Vietnam in 2003-2005.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
We developed a good front liner system with multi-disciplinary care teams that received awards. It took us a long time for us to brainstorm with all of the concerned units. It is clear that we must work as a team with heartfelt attention to provide satisfactory service to the patient. That has meant holding frequent meetings to evaluate all problems from patients who entered the PDCA cycle. CQI standards are established in order to develop service behavior standards leading to an improved system that reduces steps and waiting time for patient well-being and ease. Building a positive environment with Thai music, karaoke, and a meditation room, along with having a health club promotion has also contributed to our success. An equally important part of our success is the clear policies set by the higher executives as well as the budget motivations and continuous control. Most important however, is the service provider, and the continuous dedication and concern among themselves as well as the networking among communities and private sectors.

Contact Information

Institution Name:   Yasothon Hospital
Institution Type:   Government Department  
Contact Person:   Dr.Manas Kanoksil
Title:   Director  
Telephone/ Fax:   +(66)45712580
Institution's / Project's Website:   +(66)45712373
E-mail:   saewongz@hotmail.com  
Address:   Yasothon Hospital Jangsanit Rd.
Postal Code:   35000
City:   Yasothon
State/Province:   Yasothon
Country:   Thailand

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