Holistic School in Hospital Initiative (HSH)
Queen Sirikit National Institute of Child Health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Queen Sirikit National Institute of Child Health (QSNICH) was found as “Children’s Hospital”. It is the public hospital works under Department of Medical Service (DMS), Ministry of Public Health (MOPH), Thailand, uniquely providing medical care for young-patients (0-18 year). The patients who need tertiary care are transferred from across the country with complicated health conditions. QSNICH takes care of the patients physically, mentally and socially. In educational perspective, QSNICH also provides training and research in pediatrics medical science to healthcare personnel including developing service model and national policy advocacy in child healthcare. In 2003, WHO declared that over 15 percent of youth population is suffering from chronic diseases including cancers, diabetes and congenital heart diseases. In Thailand, more than 3,000 new cases of youth with chronic diseases are found and hospitalized that makes over 36,000 accumulated cases of school-age patients each year. QSNICH caters over 10,000 cases annually, they need long-term hospitalized and inevitably absent from schools, so they were deprived of academic opportunity and failed to catch up with their proper classes. It resulted in delayed graduation or worse, failure to graduate. This leads to other social problems those are stemmed from inadequate education, which was identified as the main factor that increase social inequality. They will live their lives in the vicious cycle: lack of education, poverty and unhealthiness and burden on society. Besides that, Thailand is identified as one of top 15 countries with the highest number of children absent from education system, (UNICEF 2011), this group of young chronically-ill patients must play a role in the problem. The problem was initially identified in 1983 by multidisciplinary health team in hospitals, who understood the suffering of young chronically-ill patients being absence from school for long. The teachers were brought in, to teach the missing lessons in the hospitals. However, there were four main problems with the initial program. First, there were limited numbers of teachers, even though existed but still lack of capability to teach all major subjects of the curriculum. Consequently, the problem of substandard education prevailed and patients were unable to return their current classes. Second, the program lacked nation-wide integration and scalable platform. The program was developed on an ad-hoc basis and each hospital developed the program separately, so it was neither applicable nor replicable to each other. It was difficult for the hospital to reach out for collaboration from different government agencies e.g. Ministry of Education (MOE); therefore, the program was ineffective and insufficient resources. Third, the program was only available in well-established hospitals. Young-patients in other hospitals were not provided with such support. Fourth, young-patients and families are often excluded from participating in decision making and tailoring the academic courses provided in the hospital. The programs were not effectively and efficiently catering to the patient’s needs. As a result, young chronically-ill patients were still deprived of several academic requirements and they were unable to resume normal education. A new initiative was needed to effectively address the situation.

B. Strategic Approach

 2. What was the solution?
The initiative “Holistic School in Hospital (HSH)” was set to facilitate and foster learning environment for young-patients with chronic illness and long-term hospitalization to provide holistic care (physical, mental, social and spiritual) by using Information Technology (IT) and infrastructure. In1995, the initiative was first founded by QSNICH, MOPH, which transformed normal teaching in hospital into IT class, using e-Learning program including Computer Assisted Instruction (CAI) and Electronic Distance Learning Television (eDLTV) supported in sequence by Ministry of Science and Technology (MOST) and Distance Learning Foundation (DLF) which is initiated by His Majesty King Bhumibol Adulyadej. HSH initiative has been under Patronage of H.R.H. Princess Maha Chakri Sirindhorn since then. In 2005, according to the policy of MOPH, HSH started replication. It became effectively executed and sustained by the collaboration of MOE, MOST and MOPH as the inter-government-agencies MOU, in 2009. HSH aims to 1) provide an adequate education for chronically-ill youth who have been hospitalized and deprived from school for long. 2) create a standardized program that are tangible and scalable through a collaboration of three involved government ministries in education 3) improve overall education system by integrating IT into teaching methods and practices 4) promote a tailored courses and class-on-demand for remote users. There were three imperative steps for the project. First, the strategic plan was created by three ministries’ committee having QSNICH as one of secretariat team. The target was identified as young chronically-ill patients and families. They were included into the discussion regarding the academic requirement of each patient. The program is able to create the Individual Education Plan (IEP). QSNICH multidisciplinary team shared the knowledge of caring with National Science and Technology Development Agency (NSTDA), which is under MOST, to create the special learning programs for children with learning disability (LD-children) and Autistic children. Second, each lesson must be executed by the experienced teachers from Bureau of Special Education (BSE), which is under MOE, who specialize in teaching with e-learning program. As a result, patients could access teaching records via televisions or computers, which also integrates both online and offline platform, thus provide a great flexibility for them to tailor on-demand lessons as well as time schedule. Third, it was critical to install programs and the supportive infrastructure which was done by MOST. The great IT and infrastructure provided HSH the ability to transfer and sustain. Moreover, given the interconnectedness to its local administrative offices, each HSH can introduce the program to teach local knowhow and traditions. HSH has solved previous concerns for in-hospital classes: a) Provision of customized education for youth with chronic diseases and creation of holistic care for patients by using multidisciplinary e-Learning program that can lower the teacher demanded and standardize the educational program in hospital. b) The standard best practice of HSH is well established and the collaboration of the whole-of-government service ensured greater scale of resources and sustainability to solve the previous issue of inability to scale. HSH can now be transferred to 23 hospitals around country. c) The current project is catering to over 47,000 patients annually. Continuous replication, the program would be able to cater all young chronically-ill patients nationwide. d) Flexibility of e-learning in informative age has provided patients and families the ability to select and tailored-made their own lesson plan. Moreover, experienced teachers are available to teach and records can be made and keep in data storage for patients to study anytime. As a result, patients with chronic illness are no longer deprived from proper education, be able to return to their classes even after a long absence, and continue their childhood life as normal children.

 3. How did the initiative solve the problem and improve people’s lives?
1) Tight integration of three government ministries: MOPH, MOE and MOST, are formed to solve insufficient education problems and promote social inclusiveness of chronically-ill youth. 2) The integration of programs including CAI, eDLTV, special learning program for LD children (LDP) and “Social Story Program (SSP)” for Autistic children, perfectly supplements traditional teaching style by adding up gimmicks to promote learning willingness of young patients. 3) Moreover, these programs allow users to customize educational program by using IEP and access from nationwide. This creates greater equality for young patients both in genders and social statuses. The use of ‘edutainment’ concept (70 education: 30 entertainment) introduces the real holistic care that enhances physical and mental health together with proper education during hospitalization. 4) Using same infrastructure, staff of each network can teleconference as scheduled to ensure the standard and equality of network. 5) Families and community can share ideas via social media (Facebook) for improvement of the initiative including adding vocational education, teaching young-patients and families to produce various kinds of commodities those are community wisdom. 6) Last but not least HSH created the first certified examination center in hospital. As a result, they would no longer be deprived of academic opportunities.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
There were four important steps in implementation of this HSH initiative. First step: Transformation step started in 1995 by introducing the information technology to the ordinary classroom in QSNICH e.g. Computer Assistant Instruction program(CAI) and eDLTV using offline technology, operated by NSTDA, MOST which was authorized by DFL. Families and patients were included in decision making to create a suitable IEP for them and also the local administrators and private sectors to share their suggestion and resources. The HSH initiative has been under the Patronage of H.R.H. Princess Maha Chakri Sirindhorn, and gained informal collaboration form BSE, sending two teachers to work fulltime in HSH. Second step was Transfer step. HSH model was continuously developed to create the qualified best practice of school in hospitals in the information age using ICT, therefore in 2005 QSNICH which is responsible for national child healthcare policy advocacy, proposed the HSH initiative to Department of Medical Service (DMS), MOPH to set the policy of transferring this model across the country, thus hospitals up country were included into HSH network. The bigger the networks, the more partners, the better whole-of-government service approaches in fostering the vulnerable human resources are. MOPH created six networks according to the strategic plan during this period. The third step was Inter-government agencies MOU. In 2009, the official MOUs between MOE, MOPH and MOST were done to ensure the transferable and sustainable of the initiative, thus accelerated the growth of HSH networks and coming together with sufficient resources e.g. MOE’s policy of having three teachers each HSH. Scheduled meetings were set to strengthen collaboration among all stakeholders and to share learning experiences. Together they set the clear vision and political will to promote the whole-of-government approaches in education service of the young chronically-ill patients for ease of access. Many new ICT technologies were added on to foster the holistic medical care, education and social inclusiveness of young patients in hospital both from the public and private sectors including citizens who volunteer. Continuous development is final step which has been done to ensure the better service in providing sufficient education for young patients meanwhile hospitalization or even at home in some cases, who could not go back to normal school, then the teachers from the Office of non-formal and informal education (ONIE), MOE provided them the non-formal and informal education. Evolution were as followings: In 2009 notebooks were introduced to support the bedside teaching which started in 2006 with simple teaching documents, Special Examination center in hospital was first started in 2011 thus patients could then study and be tested on their lessons without the need to re-take the exams after they are discharged from the hospital to answer all needs of patients, special program for children with learning disability (LDP) was launched in 2012 and also the completed online technology of eDLTV and infrastructure. Tablets were substituted notebook to suit the small young patients which have succeeded in increasing their willingness to learn. Last in 2013 the special program for autistic children named “Social Story Program (SSP)” was first distributed in HSH networks for testing its ability to increase autistic children focus and social inclusiveness. Inclusion of all stakeholders was the main goal, thus Social media: Facebook account named “IT for young patients in hospitals” was created in 2012 by NSTDA, MOST to promote the initiative and bolster communication of all users and workers allow them to feedback and share about all activities of the initiative to improve overall perspective. Moreover, in 2012 teleconferences were used to enhance communication among networks in sharing of suggestion, opportunity for improvement, and resources.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
HSH initiative is executed mainly by the committee of three ministries: MOE, MOST and MOPH according to the MOU, together with many stakeholders e.g. DLF, private NGOs, local administration office and 23 network hospitals nationwide including patients and families . 1) MOPH by QSNICH provides the HSH model development, medical and paramedical personals as the consultants and resource persons and budget to transfer HSH model nationwide and arrange the evaluation and monitoring of network performance by the three ministries monitoring team. 2) MOST by NSTDA provide the IT infrastructure (PC and Tablets), installation of e-Learning programs e.g. CAI, eDLTV, creation of LDP and SSP, training teachers to ensure teaching skill by using e-learning. 3) MOE by BSE provides teachers, assistant teachers who manage edutainment for patients at bedside, and teaching materials. Office of the non-formal and informal education (ONIE) provides vocational classes as scheduled for both patients and families and supports the establishment of an examination center in HSH. 4) DLF contributes a full range of eDLTV programs at no cost, not only accession online at http://edltv.dlf.ac.th/ and http://edltv.vec.go.th and authorized NSTDA to store the whole data to digital storage for all HSH can access offline anytime. 5) Some private NGOs and Local administration office can involve in HSH located in their geographical area to do edutainment and vocational education and community wisdom as appropriated. 6) Last the youth patients and families have opportunity to take part in designing or even teaching the children by themselves. The whole stakeholders cooperate to create the real holistic school in hospitals and foster the education of chronically-ill youth all over country thus they can live their childhood life with better physical and psychology health, and proper education together with sufficient social inclusiveness and become the qualified human resource of country in the future.
 6. How was the strategy implemented and what resources were mobilized?
Human resources: Medical teams in hospitals under MOPH take care of the young patients’ physical and psychological health, and create their in–hospital education plan as IEP together with teachers and patients’ families. Three teachers from BSE, MOE, are fulltime staff in HSH, taking care of young patients’ education, and also edutainment both in class and bedside. These teachers need special skills: using IT equipment and e-Learning programs to aid their teaching. Teachers from ONIE, MOE, are part-time instructors, when the young patients need vocational education and special examination in hospital. IT teams from NSTDA, MOST, take care of implementation of infrastructure, program installation, special programs development, including Facebook development and maintenance, and operation to maintain and ensure that access ability to e- Learning is possible anytime anywhere. They also nurture teachers to ensure their teaching ability in information age. Last the volunteers and NGO groups, who willing to contribute to these vulnerable youths, visit HSH occasionally or as scheduled to arrange the varieties of activities and recreation for young patients in HSH thus nurture their mental health and promote social inclusiveness. Some local administration offices, where HSH located, may involve as local HSH committee or MOU in teaching the local culture and wisdom. Budget: Mainly from MOE for the salary of three teachers in HSH, in 2014 MOE provide one more conference added on the one that MOPH arranged annually for sharing and monitoring, evaluation and promote the hospitals and local administration offices to transfer HSH initiative, thus contribute more than 30 million baht. MOPH by QSNICH contribute the over one million baht each year since 2005, for transferring of HSH model to the hospitals nationwide according to the strategic plan including monitoring and evaluation of this initiative. At hospital level, the administrators grant the area and renovation cost to suit a classroom and teachers office. Budget from NSTDA may not substantial compare to their technology and man-days. It is over 100,000 baht using mainly to travel among HSH networks to finish their tasks mentioned above. Materials and Technology: The eDLTV is the intellectual property of DLF initiated by His Majesty King Bhumibol Adulyadej. The program provides education at primary, secondary and vocational levels which are compatible with the curriculum of MOE. It was first transmitted via satellite but now using modern information technology, the programs provides students at distance schools with a virtual learning environment. DLF authorized NSTDA to distribute and install the program to schools in needed across countries including HSH networks to educate all vulnerable groups. All e-Learning programs, CIA and special programs e.g. LDP and SSP are installed by NSTDA staff. Most of the PCs and tablets are the used computers being donated to NSTDA who distribute to those in need as HSH networks. The tablets, be introduced for bedside teaching because of some medical situations, patients cannot be moved. Together, all government agencies and citizens work together in contributing to the learning of young patients, who are the future of country.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Tight communication and interaction among government agencies and citizens together with clear vision, strong willing and recognition of powerful IT, three ministries introduced a unique idea and new policy to promote the whole-of-government approaches in education and social inclusiveness of the vulnerable group thus created public high value. The most potential output is the percentage of patients, those can resume their normal education, has increased from 65% in 1994 to currently 99.4% after implementation. The number of students increased from 5,215 in 2004, to 34,592, 36,558 and 47,630 in 2011, 2012 and 2013 respectively and satisfaction is 93%, 95% and 98%. Replication of HSH is effectively executed thus HSH networks have increased in number 17 places during 2005–2014 compared to 4 places during 1995–2004, that is more than 4 times growth in the 10 year interval. Also, teachers have increases from 2 before 2009 to currently 3 in each HSH according to the policy of MOE that is 50% increasing in human resources. Beside e- Learning education, social inclusiveness was gained by using social media: Facebook account “IT for young patients in Hospital” and Skype account to a)contact and share with friends in social societies, b)communicate between teachers, patients and families c)interactive homework assist, d)data storage of learning history of patients which will be transfer to their current school after they can leave the hospitals, e)gather the recommendation from all stakeholders, f)distribute the merchandises made by patients and families. Thus FB followers have increased 66.6%, 72% and 86% in last three years. This initiative made the transformation within a large framework rather than incremental expansion. Using e-learning program making HSH achieved academic standard certified by MOE as patients can pass the examination of ONIE 100% consecutively since 2011. This also enhances the teachers’ capability to fulfill their ability in teaching various subjects that are needed for the patients. HSH was authorized by ONIE to be the first examination center outside regular schools. It is also the first start of the community to be involved in providing education to the youth, thus there are diversity among HSH network to fit the context of each community, such as the terrorist situation in the south of Thailand that schools often be attacked so they expanded the HSH to help the illiterates to study via e-learning in rural hospitals not only in provincial hospital.

 8. What were the most successful outputs and why was the initiative effective?
The initiative is evaluated mainly using the indicators those are set in strategic plan and operational plan each year. The measures focus on all parameters: the achievement of patients and families, human resources, IT accountability, social media using, HSH networks capacity and ability, and the accountability of e-Learning program including the achievement of the HSH model replication. The measurements are the number of young patients involved by each HSH and total number each year, number of young patients that can resume their proper educational class, number of young patient that go to the non-formal and informal education system and those who pass the examination of ONIE. These measures evidence whether the HSH network is qualified as the standard school. Moreover the program monitors the performance of teachers by online testing to ensure their potential in teaching by using e-Learning program, the number of Facebook account users and followers, number of e-Learning classes viewed, customer satisfaction to HSH, number of teachers working in each HSH, number of new HSH and total number each year, so far we can ensure that the initiative is on track meeting the target set in strategic plan. The result of all indicators from 23 HSHs will be sent online to the representatives of all involved ministries. 2) Network meeting will be hosted annually by QSNICH (MOPH representative), the delegates are from three involved ministries, all HSH networks and also customers and stakeholders representatives. Since 2014, MOE by BSE hosted one more meeting thus now there is twice meeting a year. 3) Multidisciplinary Supervision team, consisted of QSNICH, BSE and ONIE (MOE representatives) and NSTDA (MOST representative), will visit HSH across the country six times each year. They aim to help the hospitals to start the HSH model efficiently and help existed HSH to solve their onsite problems. 4) Annually, the HSH project committee from involved three ministries will report to H.R.H. Princess Maha Chakri Sirindhorn, who is very interesting in helping all of the underprivileged citizens, and always encourage the involved government agencies to focus on this initiative. Each year the representatives from three ministries will together analyze the data collected from all networks and stakeholders including problems and suggestions and SWOT analysis in order to organize the operation plan for further development of the initiative.

 9. What were the main obstacles encountered and how were they overcome?
The obstacles mainly are 1) Teachers turnover rate is high, only 48% of them worked longer than three years because HSH can’t provide them the suitable career path as working in real school, so they need to move out to pursue their career as teachers in schools. The solution is MOE now creating the career path for teachers in HSH networks that they can get promotion without moving out. 2) Budget, the more patients HSH catered, the more budget needed for all kinds of resources and management. Solution is increasing the government budget and HSH networks raise fund from local private sector for materials and management. 3) Place, HSH is only one in many tasks of hospitals, also space in some hospitals are very limited that HSH in those hospitals are not match the ultimate place for foster the holistic care and education for young patients. The solution is HSH inter-government-agencies committee set the criteria for hospitals to be recruited as one of the HSH networks, in which the proper space is one of the criteria. 4) The infrastructure, it is the shortage of PC or tablet, but the bedside learning is limited without high speed hotspot available in hospital especially in the ward that patients had been admitted. This solution is difficult but the inter-government-agencies committee is focusing on it. One of the permanent solutions is 3G+ telecommunication service for mobile equipment but it needs the collaboration of private companies, owners of 3G+ technology and takes time to become a reality. The transient solution is that the assistant teachers upload the programs or subjects into mobile equipments, covered the patients’ need according to their schedule each day, and redo it every day. This is not ultimate because it increases workload of the teachers, but it is currently the best.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Improvement and expansion of the whole-of-government delivery in holistic care and education service to the vulnerable: young chronically-ill youth, is achieved with the HSH initiative using IT in the information age, evidenced by 23 HSH networks and 47,630 young patients involved in 2013. HSH project has exhilarated the well-being of youth in hospitals, significantly alleviated the exclusion of young-patient from education system. The strong collaboration of three ministries and Distance Learning Foundation (DLF) that provided eDLTV, has led to the creation of a powerful and extensive long-lasting network nationwide. Two main benefits arose from the formation of network. A) Once the collaboration has been set coupling with the rise of standardized practices, the project was ready for expansion. As a result, it was no longer impractical for the project to be successfully expanded. The extension of the network to 23 hospitals nationwide rapidly enhances the reach and effectively increases the opportunity for higher education for young patients. More than 47,000 patients are catered to with HSH program. The program quickly increases the success rate of young patients in education from 65% in 1994 to currently 99.4% those are reintegrated in schools and pass the exam. In the future, once resources are in place and sufficiently allocated, the program will be able to expand its capacity and cater more patients. B) The extensive network and resources of on-demand classes can also be used to educate the other vulnerable groups of citizen those are deprived of education opportunity e.g. disabilities, prisoners who deprived from education opportunity. eDLTV can be replicated and extended to other schools and academic institutions in rural area those are facing shortages in teachers and certain resources. It is found that more than 30,000 additional schools have benefited from eDLTV. Apart from serving the education in Thailand, DLF under Royal Patronage also links with school in neighbouring countries, such as Laos, Cambodia, Myanmar, Vietnam and Southern China, with educational broadcasts in English and Chinese. The program cultivates positive environment within the hospital. Social inclusiveness of young patients rises as they felt more cared-for. 98%-satisfaction rate indicates that patients are engaged and their morale is uplifted. As classes evolve from the concept of ‘Edutainment’, they were both educated and entertained concurrently. The use of technology alters boredom to excitement as they were allowed to participate along with leveraging eDLTV to enhance learning. Raising level of gratification in young chronically-ill patients is an invaluable achievement that is not quantifiable. The joy of care in young patients strategically equips them with hope and will to battle the chronic diseases. The main objective of the initiative is to improve quality of life and provide a standardized educational program for young chronically-ill patients. The program has a great success as it significantly improves their educational inequality. Moreover, with education during HSH program, young patients were provided with another chance, that was taken away by their illness, to fulfill their life goals either pursuing further education or entering a way of livelihood. It is a program that cannot be replaced and definitely install both tangible and intangible impacts to patients. A case study is the story of 13-years-old boy pseudo-named ‘John’ form sportsman: famous football player of school to chronically-ill cancer patients who need to be hospitalized since grade 7. Treatment result was he lost his leg, hospitalized, got depression and scared of medical team. John was deprived of the mobility and further education. He was a great hardworking student who always wanted to continue his education. Teacher from HSH initiative was brought to him to gain his attention and willingness to overcome his illness, thus he studied happily in HSH. Upon the time of 3 years, John condition deteriorated. Unfortunately, he passed away few days after his last examination to finish grade 9. The family received his graduation certificate during the funeral, handed by teacher from HSH, which was the light of their day. They explained that it was his ultimate goal to graduate from school and it was extremely meaningful and heart-warming for them to watch his succession with joy. The program is not only long generated impact on patients but the impact is also extended to other stakeholders as well.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Under the inter-government-agencies MOU, enhancing performance by integration of three government services across three different ministries are possible and efficiently executed and encourage use of shared e-Learning system for seamless integration. Under the HSH initiative, the whole-of- government service can reach out to provide the integrated service of holistic care and education using IT tools for chronically-ill youth and families with sufficient resources allocation and administrative support. The initiative sustains upon the horizon integration and collaboration of three government ministries executed by the aligned agencies to support the program management, and Distance Learning Foundation which contributed eDLTV regarding the most concern of H.M. the King who initiated eDLTV. Patients and families highly satisfied because they are involved into creation of the young patient education and most of patients are inspired to live their life cheerfully with targets and can resume their normal education after leaving hospitals. Local administration office, community leaders, volunteers and private NGOs are incorporated into the local HSH networks’ operation and then gain a long-running ownership of HSH. These factors ensure sustainability because it is the win-win situation for all stakeholders who have achieved their shared goals and outcomes in providing services and sharing including having self-esteem in contributing and co-creating public value. Finally HSH will be sustainable because it creates public high value and serve its objective to solve the educational problem of young patients in hospital from being deprived of education system and burden on society. Being the best practice of holistic care of young patients with certified curriculum, being assigned as the responsible agencies to transfer this model across country and being a first prize winner of Public Quality Service Award, Thailand in 2014. This initiative has proven its ability to transfer with 23 networks nationwide. There are many international visits e.g. Malaysia, Nepal, Laos and USA, those enhance the opportunity to be transferred worldwide. One of QSNICH mission is training the pediatricians who once have been involved into this initiative during training, they all would like to create one of their own, thus increase the transferable ability. Using eDLTV with IT both offline and online access has broaden the replication within a larger framework thus can serve all group of citizens, not only young patients but other vulnerable population e.g. the poor, the disabilities, the illiterate and the indigenous regardless of their physical status, gender, age, culture, religious and area of residence. Social media and teleconference are the strategic tools to increase the communication and interaction among government agencies and reach out to all stakeholders with the objective of sharing and improving services. Besides being the best practice in its unique holistic-care model, the HSH initiative is also the ultimate integrated model of the whole-of-government service to harmonize the program and improve government functions including enhance human resources capacity by using IT tools and techniques in substitution of the original services in order to achieve the collaborative outcome that increase public value in the information age. This is a model to be transferred.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The important lessons learnt may help those who want to replicate the model in the future. To be the government agency that responsible for policy advocacy in child healthcare, it was the QSNICH strategic goal to develop the best practice in holistic care of young patients in many perspectives. 1) The best holistic care needed to be developed on the basis of clear vision and focus on the vulnerable population: young chronically-ill patients. Because Child Right is the most concern of all government agencies, who responsible for child caring, that their right to be educated must be provided regardless of their physical status. 2) The best holistic care cannot be done as one function approach. It needs multidisciplinary approach which may involve variety of government services across different agencies. 3) AS the inter-government-agencies strategy, the MOU should be created on the Win-Win situation for all involved agencies. It should identify the function of all partner, declare their shared clear vision, goals and outcome including well defined framework for project governance and the efficient operational team to improve and integrate performance harmoniously. Thus collaboration and maximizing synergies between different agencies in order to promote the shared outcomes that increase public value is possible. 4) The inclusion of all stakeholders drives success in the program. a) It is imperative to identify the needs of the patients and to include them in the decision making process. The inclusion of parents eases the understanding and increase corporation. The tailored program offer a unique learning experience for all patients. The program only became more effective once classes are made on-demand as parents and patients were involved in selecting courses for the student. b) Inviting local administrators, private sectors and volunteer to join the committee which conducts the local HSH network, is the strategy to gain their ownership in HSH initiative that they will try their best to provide resources and ensure longevity of HSH. 5) Using information technology bridges social gaps for marginalized citizens. In the informative age, ICT tools and techniques play the major role in solving many problems arise from the original teaching style e.g. on-demand classes as IEP, standardized the curriculum, become more attractive to young patients, ease transferring of the model, enhance social inclusiveness of young patients to the social world, ease sharing and lesson learn among workers and provide service to all regardless of their gender, age, social status, physical status, economical status, religious, culture and race, thus increase equality in access the service. 6) The holistic care provider team who work hardly with passion and strongly attitude as the teamwork across the government agencies with a will to increase value for underprivileged youth. Once the managements are aware of the program and its impact, they provide support and network to improve the program everlastingly. Further on, transfer of the HSH initiative will be done to cover all 76 provinces of Thailand and working further with no boundaries in ASEAN country which facing the same problem.

Contact Information

Institution Name:   Queen Sirikit National Institute of Child Health
Institution Type:   Government Department  
Contact Person:   Parichart Kumjim
Title:   Assistant Director in Strategic Management  
Telephone/ Fax:   + (66) 2 354-8323/ +(66)2 354 8326
Institution's / Project's Website:  
E-mail:   drparichart@gmail.com  
Address:   420/8 Rachawithi Road
Postal Code:   10400
City:   Rachathewi district
State/Province:   Bangkok

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