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Improved Patient care and Cost Reduction
Loei Hospital
Thailand

The Problem

A volume of patients were coming to the Loei General Hospital with non communicable diseases and other non emergency health care needs. Treating this non emergency population reduced the available time for the professional staff to care for the real time sensitive emergences. They also strained the available hospital facilities. Many of these non emergency patients are economically challenged, coming from the surrounding villages necessitating there loss of work time, the expense of travel, having to arrange for child/elderly care, and the cost of food and lodging. These patient issues prevented many from completing there needed follow up care. It became a high priority of the hospital to seek ways to improve the delivery of patient care, decrease patient inconvenience in seeking health care, and accomplish these goals in a cost effective manner

Solution and Key Benefits

 What is the initiative about? (the solution)
An initiative was designed to meet more of the non emergency patients needs, create more available time for the professional hospital staff to treat diseased/emergency patients and reduce the burdens on the hospital facilities. This new initiative opened seven satellite PCU, (Primary Care Units), in the districts surrounding the Loei Hospital. These PCU’s, have been able to deliver more patient services primarily to diabetic, hypertension, and the other minor health care needs than previously handled by the hospital

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The hospital assembled a team of Doctors, Pharmacists, Nurses, and administrators to define the needs to be addressed with new initiatives relieving some of the burdens on the hospital, improved patient care, and do so in a cost effective manner. When opened, the satellite PCU’s saw an immediate volume of patients coming for treatment for their health care needs. The establishment of these PCU’s enabled rural patients to secure quality care without the burdens previously endured coming to the hospital. Manny of these patients have been able to come more often for care dealing with diabetes, hypertension and other chronic medical problems. There has been marked improvement in a volume of patients which resulted in better control of their diabetes, reduced hypertension and numerous other conditions. Many of the side effects from chronic conditions have been able to be identified and treated in earlier stages than in the past. This benefit is a direct result of the convenient PCU locations in the surrounding areas. These convenient locations enabled the PCU staff more frequent patient contact, treatment and the moderating of their various conditions. There were fewer hardships on the patients needing health care which allowed them to avail themselves of the PCU offered services more often.

(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.
New inititaves were developed by hospital staff from many different disciplines. The administration of the Loei Hospital, challenged this team to find ways to reduce the use of hospital facilities by patients with non-emergency conditions, improve patient care for these non-emergency patients and do so in a cost effective manner. The team recommended the installation and operation of 8 scattered site PCU’s to address these issues. For these initiatives, application was made to the National Health Organization (NSHO), requesting funds for implementation. Loei Hospital, opened sites in the district serviced by the hospital and the areas located out of their service district were contracted to various providers. Administration and monitoring of the PCU’s is being done by the Social Medicine Department, at Loei Hospital

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
The hospital administration defined resource limitations being experienced in the delivery of medical care. A energetic team of of medical professionals was assembled to study the problems. The final draft of the study was completed, tested, reviewed and ultimately approved for impimentation by the administration. The funding for the program was secured by applying to the Thai National Health

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
The outline of problems to be addressed was initially overwelming. The each area needing to be improved had to be examened further to comprehend the depth and underlining issues. The development team disected the results found looking for areas that could be linked together and give releif to the over taxed facilities of the hospital. When the final draft was completed there was concern by the development team that their recomendations would not be able implimented for lack of funding. Funding was found as a result of the application filed with the Thai National Health Organization.

(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
Statistical information was presented by the I T department of the hospital. The development team was assembled from the existing staff of the hospital. There were patient focus groups that volunteered there time to give input as to their problems and needs related to receiving health care. There was no new expense incurred by the hospital in development process. Hospital staff also prepared the application to the Thai National Health Organization for funding. No additional expenses were incurred in the application process.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
All staff members of the PCU's have come from the existing employees of the hospital. The exception is the PCU's that are contracted to other providers. Hospital Doctors provide limited onsite medical services on a limited part time basis augmenting the PCU staff. Again, not additional payroll cost to the hospital.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
The implementation and operation of the PCU's have been a win-win for all parties. Several of the PCU staff requested to be assigned there as it was closer to their homes. Patients had access to medical services near their homes reducing many of the burdens they previously experienced. All staffing was accomplished by reassigning existing hospital employees which did not expand the payroll expenses of the hospital. New funding for the PCU facilities was secured from an outside source.

Contact Information

Institution Name:   Loei Hospital
Institution Type:   Government Agency  
Contact Person:   Mrs.Sutthiwan Preecha
Title:   Nurse Superviser  
Telephone/ Fax:   042-862123
Institution's / Project's Website:   042-862147
E-mail:   sutthiwanpreecha@hotmail.com  
Address:   32/1 Maliwan rd.,Kudpong
Postal Code:   42000
City:   Muang
State/Province:   Loei
Country:   Thailand

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