| 4. In which ways is the initiative creative and innovative?
Strategies used to achieve service development
The quality development of Songklanagarind Hospital places an emphasis on continuous cooperation, which enhances permanency as well as meets excellent standards, while, at the same time, satisfying customers, staff, and stakeholders. Hospital Accreditation (HA) and Thailand Quality Award (TQA) criteria have been the main impetus throughout the past 15 years.
In 2001, Songklanagarind Hospital was the first hospital in Thailand approved by the Healthcare Accreditation Institute (Public Organization) and has been continuously reaccredited till the present. In 2014, the hospital is a leading organization, implementing the higher criteria of Advanced Hospital Accreditation and Spiritual Hospital Accreditation (SHA) as we strive for higher objectives. At the same time, the TQA criteria are also used as a driving force toward a quality comparable to international levels.
The major implementation concepts are as follows:
1. Creating a cooperative environment to drive our values, vision, policy, and strategic objectives.
2. Recruitment and development of all hospital staff considering individual responsibilities, potential, and strategies. The main human resource development concepts include developing workforce competency, raising happiness levels, and wisdom and career progression.
3. Appointed two main groups responsible for quality of work development: 1) Functional teams, implementing annual development projects run by all Heads of Unit that align with the hospital action plan, 2) Cross-Functional teams led by the Patient Care Team (PCT) and various committees like Infectious Control Committee, Operating Room Administration Committee, Emergency Room Committee, etc., which have a major role in creating an effective plan (Plan) that drives the actions (Do). This follows the performance outcome review (Check), and Action Plan; thus, leading to further improvement (Act).
4. Developing quality assessment indicators that provide accurate results, continuous assessment and comparability with other national and international hospitals.
5.Organized knowledge-sharing forum to share and publicize best practices and create an environment for innovation.
6. Arranged external assessments from national institutes such as Healthcare Accreditation Institute (Public Organization), Thailand Productivity Institute and Office of the Higher Education Commission (OHEC). Their key concepts include a self-assessment report, an internal survey and further feedback.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Stakeholders and Participants
There are four levels of teams involved in implementation:
1. Organizational level
The Hospital Administrative Team and the Executive Board set up the development structure and relay strategies and policies to the Head of each unit and other staff.
2. Process level
Emergency Room Committee, Patient Care Team (Multidisciplinary Team), Infectious Control Committee, etc. work together as a cross-functional team to design the management process related to patient care.
3. Unit level
Each unit sets indicators that conform to the hospital’s action plan.
4.Individual level (Head and other work force)
Each level of staff employs the PDCA cycle in their practice. They plan and set supporting resources, management goal, (Plan), develop work processes (Do), evaluate their work using indicators (Check), and act as needed to ensure further improvement.
Key Stakeholders involved in the implementation are:
1.Patients and their relatives take part in the care process. Patient and their relatives are encouraged to voluntarily join self-help groups during their stay in the hospital.
2.Private and local government organizations: For example, the hospital has collaborated with Kohong Municipality to develop a Public Health Center in Kohong Municipality and the Rotary Club and Songklanagarind Foundation have established the Yensira Building, a shelter home for poor patients and relatives. Government agencies such as Social Security Fund, Universal Healthcare Fund provide some care guidelines and financial support.
3.Medical students, trained physicians and other healthcare workers are involved in patient care and support their families.
| 6. How was the strategy implemented and what resources were mobilized?
Besides the human-resource management mentioned earlier, the Financial-Resource Management is carried out as follows:
Songklanagarind Hospital is a state agency that raises and manages its own income, but it is also granted funding from the central government budget. At the present, all expenditures of the Faculty of Medicine account for more than 4,500 million Baht a year, while 2,932.53 million Baht come from the faculty’s revenue.
The faculty revenue is allocated according to the faculty’s strategic policies, which are under the regulations and supervision of the university. The allocation of the budget for service development can be categorized into the 3 main groups:
1.Staff development budget consists of 3 types:
1.1 Executive-level development budget covering the development of the institution’s vision, its leadership for change, and competence in the development of the quality of work.
1.2 Career development budget for medical instructors, physicians, and nurses covering short-term and long-term training both in Thailand and overseas. It focuses on individual competencies, based on job description, towards professional excellence and the treatment of severe and complex diseases.
1.3 Staff development strategy covering staff related to Information Technology, English language instruction, and usage of work development tools.
All staff involved in the above aspects are granted funding to attend training courses as per their personal interest, which is dispensed in the frame of an individual yearly budget. The HRD sets the overall development plan and evaluates outcomes.
2. Management of financial rewards for development projects:
2.1 Annual performance assessment awards for departments that achieve outstanding KPIs (with a 40%-70% ratio of the overall outcome of each department)
2.2 Management of annual promotion quota categorized into 3 levels of performance-based achievement – average, above average and below average. This result also impacts the management of advancement quota for individual staff members and heads of unit.
2.3 Management of rewards for office heads, who successfully complete the annual development project approved by the Service Quality Development Committee. About 200 heads of office each year are awarded up to 6,000 Baht monthly depending on the individual project. A yearly report on its performance progress is required.
3. Investment in modern medical devices and technologies to enhance the overall level of our institution’s treatment capability. The actual plan is set up by the hospital administration team in collaboration with the relevant hospital departments, and is considered and approved by the faculty Steering Committee. The submitted plans (performance plan, staff-development plan and medical-device-investment plan) must not overlap and/or duplicate current devices, must reflect the existing institutional readiness. Environment was renovated as appropriate to support patient care and healing.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Success outputs and examples are shown below:
1. Performance based on the guiding principal philosophy, “Our soul is for the benefit of mankind”
- Best patient safety in Thailand, e.g., Ventilator-Associated Pneumonia (VAP) rate in ICU.
- Highest Case Mix Index (CMI) in the country
- Creation of innovations such as A-Knife (a Scalpel for Percutaneous Trigger Finger Release), and Latex Polymer Head Pad (for intra operative pressure sore prevention)
2.Organizational culture resulting in continuous enhancement of work quality and being a best-practice institution in many aspects of patient care.
- First medical school in the country to have its quality certified by HA –the 4th time in April, 2014
- Receiving the Thailand Quality Class (TQC) Award in 2007 and LEAN Award in 2010
- Starting to use of visual control for medication safety in 2005 (Figure II), which is applied worldwide and nationwide by pharmaceutical companies.
3. Self-developed Hospital Information Technology system connecting every hospital service unit.
- A user-friendly and economical system and being a role model for other institutions nationwide.
- Considered as the best paperless healthcare IT systems in Thailand.
- Capable of monitoring daily hospital operations such as physician prescriptions and laboratory results.
4. Strong cooperation networks for the benefit of both patients and relatives.
- Establishment of networks such as the Rotary Club, Local Administrative Organizations, and foundations helping the poor as well as those affected by the unrest situation in the South.
- All network hospitals in Songkhla Province have been quality certified through the Southern Hospital Accreditation Collaboration Center.
- Enhancing service accessibility for all patients through the established referral system.
5. Dedicated workforce with a high professional capability in spite of working in a situation of unrest
- Numerous innovations and awards related to patient care.
- An Emo-meter reading indicating that 74% of employees are engaged with the organization, which is higher than the national average of 50% (surveyed by National Institute of Development Administration (NIDA), 2013).
| 8. What were the most successful outputs and why was the initiative effective?
The major concepts applied in monitoring are:
1.All levels of workforce are encouraged to use the data related to patient needs and/or complaints in order to improve our service quality.
2.The hospital makes quality outcome the basis for its institutional management.
3.The hospital also participates in the benchmarking system hosted by the Thailand Hospital Indicator Project(THIP)in order to evaluate its quality and learn from other best-practice organizations. Quality frameworks such as TQA and HA guide our improvement plan.
The hospital’s service tracking and assessment system as well as the hospital-wide information technology system help the hospital collect, analyze and evaluated daily service data led to hospital improvements as per the following level.
1.Executive Board reviews hospital KPIs, action plans progress reports every month.
2.Hospital Morning Briefing monitors and improve action plan every week.
3.Quality Team agenda include quality development report, Incidence report, Risk management, Complaint management results which reviews every month.
4.Work systems was reviewed and improved the performance by various committees e.g. or committee.
5.Patient Care Teams take action for patient care improvement.
6.Songklanagarind Foundation provide budget for the poor people and for support Yensira building.
| 9. What were the main obstacles encountered and how were they overcome?
Problems, obstacles and management
A) Imbalance between number of patients and accessibility to healthcare
1. Increased system efficiency by reducing the patient length of stay, which allowed for a better patient admission management and flexible hospital bed management. In addition, after-hours services were offered.
2.Enhanced healthcare efficiency of hospitals nearby through trainings, teleconsultations as well as providing clinical data and treatment plans to all patients discharged from our hospital.
B) High resignation rate and work overload
1. Implemented the Lean administrative concept to reduce the“7 wastes”
2. Increased the use of information technology and other supporting outsourced services.
3. Improved workforce benefits to help decrease the number of nurse and other health professional resignations.
C) Deficiency in the capital budget
1. Using utilization management to enhance productivity in all work units
2.The expenditure control and loss reduction was made possible by procurement development, material quality analysis, price comparison, stock management, reasonable medication use, systemic drug control, and the use of approved locally-made drugs replacing imported ones. These measures have resulted in Songklanagarind Hospital’s medication criteria becoming a national model.
3. Strategic investment via a collective leadership system
4. National and international financial resource management through government budgeting, private company collaboration, and donations
As historically excellent contributors to the Songklanagarind Hospital Foundation, they have resulted in the continuous increase of our fund-raising efforts (From 80,000,000 Bath in 2007 to 180,000,000 bath in 2013)