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Kasetsart University Veterinary Teaching Hospital
Thailand

The Problem

Early in the year 2000, the Kasetsart University Veterinary Teaching Hospital (KUVTH) took a full turn in improving the standard of hospital practice in the new 9-storey building named “Sixth Cycle Chalerm Pra Kiat Building” to commemorate the sixth cycle (72 years) of His Majesty the King’s Birthday. Consecutive to the rapid changes in economic, social, public health and environmental status, as well as new emerging disease and zoonoses in the last decade, the public psychological trends toward keeping house pets as companion increased continuously. Thus, the requirement of more knowledgeable health care and thorough medical services rose by 6 folds from 100 cases/day in the year 2000 to 600 cases/day this year (2010). The hospital opens for full service from 08:30 to 20:30 and a regular daily 24-hour service in the emergency and critical care unit (ER-CCU). The increase in case load and the expansion of service to fulfill public demand require not only a large number of highly trained employees including veterinarians and technicians but also the establishments of the structures and processes that contribute to desirable patient outcomes.
In the past five years the KUVTH has been faced with a shortage of veterinarians and a lack of advanced medical equipments. The small number of veterinarians and technicians in the KUVTH took a full responsibility in providing a large scale clinical service which leads to unnecessary prolonged wait time and unsatisfied rates of morbidity and mortality. At that time there was no surveillance system to reduce the medical error and to assure the patient safety. The awareness of patient safety seemed to be the most concerning issue. The competence of the veterinarians and technicians are also of great importance. The KUVTH staff development strategies had never been addressed raising the concerns of the quantity and quality of the veterinarians and technician in KUVTH in order to meet the organizational expectations and needs of public. One of the limitations of the KUVTH was the lack of modern medical equipment which prevented accurate disease diagnosis and effective treatment. The routine work in the past was restricted to the basic and general medical procedures while consumer needs have been moved toward specialty status. The continuous improvement of the quality of the animal health care is of great interest to many bodies including pet owners, veterinarian profession and animal welfare organizations. The essence of the initiative is to create the sustainable development in every dimension using both internal and external resources. Many projects and tools have been initiated and implemented to sustain and enhance continuous quality improvement of the KUVTH.

Solution and Key Benefits

 What is the initiative about? (the solution)
KUVTH took responsibility in taking care of the enormous risen of daily case load by extending service hour from 8 hour basis (8:30 am to 4:30 pm) to 12 hour basis (8:30 am to 8:30 pm). This extended service hour declined the crowded of clients in the early morning. Therefore clientele can choose their convenience time to come, consequently, leading to the less wait time, reduction of the risk of infection among the patients and increased the success rate because of the effective follow up. In addition to the 12 hour service in the out-patient department, KUVTH offer a regular daily 24 hour service in the emergency and critical care unit. This emergency and critical care has also given either the higher chance of survival or the better quality during the end stage of life.
In addition, the bond between owner and their pet become stronger nowadays , this leads to the expectation of high quality of animal health care comparable to the human medical health care. KUVTH serves that need by offering the expertise in 11 specialized areas of high incident diseases. They are Reproductive Disease Clinic, Oncological Clinic, Opthalmic Clinic, Feline Disease Clinic, Renal and Urological Clinic, Neurological Clinic, Cardiovascular and Respiratory Clinic, Dermatological Clinic, KU Exotic Pet Clinic, Endocrinological and Enteric Clinic (future prospect) and Center of Neurology, Orthopedics and Rehabilitation for Companion Animals. KUVTH also grants the best quality supporting units such as the imaging diagnosis and blood bank. These specialized services augment the quality of diagnosis, treatment plan and enhance the success rate of the treatment. For instance, of the 809 cases of severe acute or chronic anemia of different causes, our blood bank service has been able to save 76.5 percent through whole blood transfusion or blood components administration in the year 2009. Based on our direction to serve the comparable animal health care, KUVTH with the collaboration either from medical doctor or the foreign veterinarian, was the pioneer in many fields in Thailand. We have done the first successful case in surgical treatment of Left Atrial Mesothelioma (1996), surgical treatment of brain tumor (2003), and recently cementless total hip replacement (2009).
To solve the high expectation pressure as well as the crowded daily case load, KUVTH have to increase the numbers of veterinarian and veterinary technicians. Since KUVTH not only provide the animal health care service but is the educational institute, KUVTH staffs must be the archetype of small animal practitioner. It is therefore that the criteria in staff potential selection, training program and quality assurance has been proposed. Internship program and animal hospital accreditation was implemented to KUVTH early this year.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The role of veterinary medicine has become increasingly significant in the Thai community, resulting in rising awareness and needs for the veterinary profession. The faculty of Veterinary Medicine at Kasetsart University has a keen awareness of the need to increase the amount of highly qualified veterinary graduates to serve the community. This is necessary in order to satisfy the demands of various veterinary sectors: livestock animals, companion animals - including special and wild animals that have recently gained popularity. The Faculty, led by the Dean, has created policies to increase standards in teaching in order to produce highly qualified veterinary graduates that meet international standards. One of the policies implemented was to enhance the standards of the animal hospital so that it is accepted internationally. This is done by having on staff experts on various branches of veterinary medicine as well as state-of-the-art equipment in order to satisfy and produce increasing number of graduates.

Since the inception of the hospital, under the management of various deans, directors of KUVTH hospital and administrative team at Kasetsart University, policies are constantly adapted to keep up with the changing times. The rules and regulations are in place and used in hospital management to ensure the highest standards of quality and services. The staff, administration, faculty and students of the Department of Veterinary Medicine at Kasetsart University all strive towards a common goal, that of not only becoming the lead educational institute of veterinary medicine in Thailand and Asia, but also being recognized as a world class veterinary institute. We are extremely proud of our progress and accomplishments thus far which have left profound and positive impact on the communities we serve.

In conclusion, the rigorous creation and implementation of policies to improve teaching standards have resulted in continuous, steady and measurable advancement in veterinary medicine.

(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.
In the year 2007, Dean. Thawatchai Sakpuaram. give faculty vision to be the best five faculty of Veterinary Medicine in Asian country with 5 strategic directions:
1. To develop qualified veterinarian
2. To strengthen research work
3. To efficacy of public service
4. To continue improvement of administration
5. To achieve in teamwork

In responding to the faculty policy, Professor Dr. Apinun Suprasert, Director of KUVTH, all KUVTH staff and the public have brainstormed the Vision, Objective and Strategy of the KUVTH :

Vision
Since 2008 the goal of KUVTH is to become the best Veterinary Teaching Hospital in Asia within 5 years.

Objectives
KUVTH emphasizes in ameliorating knowledge and skills of veterinary students through clinical practice, providing quality veterinary services and knowledgeable information to the public, and assisting in research, innovative development and transfer of modern veterinary medical knowledge and technology among Faculty staff members, students and to the public.
Strategic Directions
1. To achieve a good system of Animal Hospital Accreditation
2. To make Good Value and Profile of KUVTH
3. To produce qualified Veterinarian by Internship Program
4. To strengthen Research and Development
5. To provide Good Administration and Network
Prof. Dr.Apinun Suprasert and administrative team also reorganized the functions of KUVTH comprise of 6 divisions and 1 Center:
1. The Administration Division
2. The Clinical Division
3. The Research and Veterinary Science knowledge Division
4. The Hospital Standard Quality Development Division
5. The Royal Canine Health Care Division (RCHCD)
6. The Division of Interactive Activity for the Public
7. Center of Neurology, Orthopedics and Rehabilitation for Companion Animals

His Majesty King Bhumibol Adulyadej has at all times reigned with great responsibilities for his subjects from all around the country. His Majesty has graciously given his royal idea to overcome the fatal zoonotic disease and also to handle all kind of animal with kindheartedness. His Majesty the King and His Royal Highness the Crown Prince have also bestowed upon the KUVTH with 6 important medical instruments for diagnoses and treatments, Suvarnachad hydrotherapy swimming pool, and an underwater treadmill including initiating the Animal Treatment Fund for the Needy and several Royal initiated projects, all for learning and researching to improve the high standard of Veterinarian in Thiland and for public service to high standard of living for both animal and human. During the last 10 years, the implementation of Royal Initiatives in combination with clear Vision and Strategic Directions have moved KUVTH forward successfully.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
KUVTH proposed 5 key developments which are
1. Implementation of the new service.
Kasetsart Pet Blood Bank
Kasetsart pet blood bank, the first blood bank for pets in Thailand as well as in Asia, was established at KUVTH in 2000 with the major commitment is to supply a good quality of blood products for patients under life-threatening situations.
Like human, pet blood transfusion is one of the essential emergency procedures which can enhance survival rate of the patients. Of the 809 cases of severe acute or chronic anemia of different causes, we have been able to save 76.5 percent through whole blood transfusion or blood components administration.
Exotic pet sanctuary center
The recent problem of exotic pet occurred in Thailand is the poor quality of life. It is the result from the mal-husbandry and mis-understanding of animal biology. KUVTH staffs in exotic pet play a crucial role in reviving the animal health condition. Such a dedicate work in improving the animal quality of life leading to the fabulous project is supported by KU president. At present, our exotic team is working hard in the exotic pet sanctuary center; the first complete center in exotic pet health care.

2. Implementation of the innovated service method
Emergency and Critical Care Unit (ER & CCU)

The ER & CCU of KUVTH, the most complete unit for companion animal in Thailand, has been serving the public 24 hours every day since 2004. The major concern is animal welfare and public satisfaction.

3. Encouragement of the establishment of specialized clinics
At present, KUVTH specialized clinical unit comprises of 11 specialized clinics relating to the most important diseases in Thailand such as Oncological Clinic, Opthalmic Clinic, Urological Clinic, Cardiovascular Clinic, Dermatological Clinic, Gastrointestinal Clinic (future prospect) and Center of Neurology, Orthopedics and Rehabilitation for Companion Animals, etc.

4. Internship program
Internship program is the one year intensive program for newly graduate in opportunity of small animal practitioner experience. Internships are seen as potentially valuable tools to explore general career avenues. Such arrangements in three mains area; medical unit, surgery unit and critical unit, can provide them with valuable work experience both practical and for résumé enhancement. 20-24 newly DVM graduates are enrolled in this program each year. The reasonable salary of 8 hour working period rotating all 24 hour assisted KUVTH to overcome our man-power problem.

5. Animal hospital accreditation

KUVTH dedicate themselves to be the pioneer in introduction KU animal hospital accreditation which proposed to be the guidance of the Thailand Animal Hospital Accreditation in the future. This accreditation is of its dedication to professional development, for its hospital accreditation standards, and for the excellence of its education programs. KU animal hospital accreditation vision is to

Enhance the abilities of our veterinarians to provide the excellence quality animal medical health care
Enable veterinarians to successfully conduct their practices and maintain their facilities with high standards of excellence
Be the idol of veterinary education in Thailand

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
As mention earlier, KUVTH offer a regular the 12 hour service in the out-patient department and daily 24 hour service in the emergency and critical care unit. This extended service hour declined the crowded of clients in the early morning. Therefore clientele can choose their convenience time to come, consequently, leading to the less waiting time, reduce the risk of infection among the patients and enhance the survival rate because of the continuously treatment. On another word, the extended service hour leads to the less quality of life of our KUVTH staff unless the more staffs are hired. In order to achieve our goal in excellence animal healthcare service, KUVTH has to dramatically increase veterinarians and veterinary technicians during the service hour. Before 2009, the veterinary positions and veterinary technician positions have to be approved from Faculty committee before getting hired, however, the increasing rate of daily clients made us never overcome this need. Furthermore the more staff we increase, the less potential they are. The obstacles lead to the new implement in the more sustainable staff hiring system, the excellence staff training policy and the last the excellence animal healthcare service. It is recognized as veterinary internship program and KU animal hospital accreditation.
Internship program help KUVTH save the salary cost of 3,155,040 Baths per year. Moreover all interns that work under supervision of mentor rapidly improve their skills in animal practice. In addition to the advantages of internship program in the academic improvement, KU animal hospital accreditation will help all staffs work in the same qualified guidance, consequently, reduced safety risk but increased more service pleasure.

(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
The huge changes in case load and the determination to maintain the standard of veterinary medical practice have pushed the Kasetsart University Veterinary Teaching Hospital (KUVTH) to find new approaches and solutions to accomplish its goals, to deliver the best quality of service and teaching. The availability of government funding to support the KUVTH is limited. The internal and external sources of finance have been utilized for productive investment. The internal source of funding for development plan is spared from the income generated by the hospital itself. Some parts of the funding are from individual contribution or group donation. Many medical equipments and facilities of the KUVTH are conferred by His Majesty the King of Thailand and His Royal Highness Crown Prince of Thailand.
The vision to become the best veterinary teaching Hospital in Asia has directed the policies for technology transfer and staff development plan. The KUVTH try to create a framework that will provide effective staff training to improve their competency through engaged training and the integration of technology by collaborations with experts and national organization bodies. The technology is transferred from other biomedical fields including human medicine and biomedical engineering in the form of research and clinical collaborations, and partnership for innovation. The collaborations did not limit to the national level, our potential veterinary staffs were sent on training abroad under the collaborative project in the preparation of veterinary specialists with others universities worldwide. Many staff exchange programs have been established under memorandum of understanding between the Faculty of Veterinary Medicine, Kasetsart University and other institutes. The scholarships for staff development program are contributed from federal agencies, the Kasetsart University and international sources of funding. Many faculty members received scholarships from the Anandamahidol Foundation under the Royal Patronage. After completion, these faculty members returned to their homeland and became role models who dedicated their time and efforts to foster the best clinical practice and teaching in the KUVTH.
The initiative is mobilized under the faculty of Veterinary Medicine umbrella that has the comprehensive and ambitious policies to foster the best quality of veterinary education in Thailand. The policies have been consistently implemented for a decade to nurture the growth of the KUVTH’s infrastructure. The most powerful engine to drive the initiative is the KUVTH staff. Their skills, experiences, passions, capacities and willingness to contribute to their KUVTH are the keys of success that pave the road to our achievement.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
The knowledge and team working with best effort servicing to help animals without discrimination is our keys mission, beyond the benefit of helping sick animal, on the other hand, it is capable of relieving the animal owner worried at the same time. Furthermore, we state our mission to be the best Veterinary Teaching Hospital in Asia. We are a team of specialist in veterinary medicine with broaden mind of innovative thinking and implementing new technologies for our best service in veterinary profession. Since we invest lots of budget in capacity building for our veterinarian and staff both national and international levels, set up new diagnostic tools, implemented alternative treatments and so forth. A profit is not only factor for our hospital since the cost of service is certainly reasonable compared to other sectors. This has been proven by the drastic increasing number of cases per days, which rather strongly indication of the reliability of public toward our Hospital. So far, it can be claimed as the number one loaded animal cases per days among the Veterinary Teaching Hospital in Bangkok and in Thailand.
In accessing the quality of hospital improvement, KUVTH utilizes 5 main strategies, two of which include animal hospital accreditation and internship program. In hospital accreditation, it is crucial that all hospital team members understand the common purpose and adhere to the established standards and guidelines to achieve maximum efficiency. The administrative team at KUVTH trusts that the insistent on high and consistent standards and work ethics will form a solid foundation that eventually translates into the organization culture. This culture is instrumental in the sustainable progress of the hospital. We also plan to expand our internship program to encompass all practicing veterinarians and not simply those who graduated from Kasetsart University. Our ultimate goal is become the center of reference for veterinarians and consequently establish a Thai veterinary network. The network will be strategic in ensuring continuous and sustainable progress in the field of veterinary medicine.
Additionally, we not only support our own staffs and our veterinary students to adopt our advanced finding techniques which has already been accepted into real practice , but this advanced technique is also transferred to veterinarians of the other sectors without boundaries. By all means, in compatible with the invaluable supports from the Royal family both budgets and medical equipments donated to help animals via our hospital’s work. Therefore, the public cases can receive this donation through the beneficial use of the facilities as similar standard as our treatments that gave to royal pets. Besides, the knowledge has long been communicated to other sectors several times, which can be acknowledged by counting of the annual number of events of open seminar and work shop in domestic and international meeting which organized by our hospital. Thus, we strongly believe that we are the organization benevolence our best effort to the public in fulfillment of all aspects of initiative sustainable and transferable into veterinary profession and the Thai society.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
In order to strengthen KUVTH vision to become the best Veterinary Teaching Hospital (VTH) in Asia, the networking for nationwide medical service exchange and international collaborations have been fulfilled through time and efforts dedicated to deliver a high quality service for the patients, for teaching veterinary students, and for providing opportunities for life long learning of the veterinarians in Thailand as a clinical training center (post graduate level) in many fields of companion animal medicine and surgery. The KUVTH has been known among professional society as an institute that contributes its expertise in clinical service to support the local Veterinary Hospitals. Several cases has been referred from veterinarians in local or remote areas of Thailand as well as from neighboring countries such as Malaysia and Brunei to KUVTH for further diagnosis and advanced treatment e.g. total hip replacement, eye surgery or blood transfusion. The collaborations between KUVTH and other renowned institutes in Asia, Europe and North America in terms of clinical staff exchange and training abroad have extended our clinical competency that eventually will benefit our patients as well as Thai veterinary education.
In summary, what we have learned so far that our five main strategies will give us the correct direction to become the best Veterinary Teaching Hospital. As proved on December 16, 2010, KUVTH and KU pet blood bank received two best quality award-winning public services; type of service innovation award from Office of the Public Sector Development commission Thailand.

Contact Information

Institution Name:   Kasetsart University Veterinary Teaching Hospital
Institution Type:   Government Agency  
Contact Person:   Prof. Dr. Apinun Suprasert
Title:   Director of KUVTH  
Telephone/ Fax:   +(66)2-9428756-59 ext 2323
Institution's / Project's Website:   +(66)2-579-7541
E-mail:   fvetais@ku.ac.th  
Address:   50 Pahonyothin Road, Lardyao
Postal Code:   10900
City:   Chatuchak
State/Province:   Bangkok
Country:   Thailand

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