Professor Athasit Vejjajiva
Advance Diagnostic Imaging Center

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
In 1993, there were relatively enormous demands of advanced diagnostic imaging, especially, Magnetic Resonance Imaging (MRI) because there were only 12 MRI scanners in Thailand to serve nearly 60 million Thai people, i.e., merely 0.2 MRI scanner per 1 million people. Moreover, 8 scanners were operated by private imaging centers and hospitals while only 4 were owned by public hospitals. Thus the waiting time for a patient before getting MRI scanned could easily be a year or so in an advanced public hospital such as a university hospital. Furthermore, because an MRI scanner has been considered a very expensive diagnostic equipment and Thailand is not a rich country, very few public non-university hospitals can afford to acquire and operate those scanners. It was quite usual for underprivileged patients and those in rural areas ran into difficulties in order to receive much needed MRI diagnostic or follow-up examinations. In general, with a very long waiting time as mentioned earlier, an imaging center of a quaternary-care public university hospital can provide MRI and Computerized Tomography (CT) scanning for just only patients of its hospital since there are colossal numbers of patients from all over the country seeking healthcare services from such a hospital. Mahidol University Faculty of Medicine Ramathibodi Hospital, currently servicing nearly 2 million out-patients per year, has been one of the biggest quaternary-care hospitals of Thailand. With no exception, it used to have the typical long-waiting-time for MRI and CT examinations.

B. Strategic Approach

 2. What was the solution?
Mahidol University is a state-own university, thus Ramathibodi Hospital has been operated as a public hospital. Prof. Dr. Athasit Vejjajiva, the dean of Mahidol University Faculty of Medicine Ramathibodi Hospital at the time (1993), founded a diagnostic imaging center and acquired an MRI scanner without using government expenditure but a loan from donated money of Ramathibodi Foundation instead. Furthermore, Dr. Athasit’s strategies and plans for the center were as follows: (1) the management of the center had to be unlike that of conventional public sector; (2) it would be financially independent; (3) it should serve not only a huge university hospital but also patients from other hospitals and all over the country; (4) it had to be one of the most advanced diagnostic imaging centers in this region of the world. Fortunately, he got Dr. Jiraporn Laothamatas, a neuro-radiologist who had just moved back from the United States of America, to appreciate, carry on, and extend his vision. The challenges have driven the center for successes. In using no government expenditure, the imaging center could be opened to serve Thai patients of the quaternary-care public university hospital in a very short time. Since the center had to survive without government monetary support, it had to exploit the most out of its expensive medical diagnostic equipments, MRI and CT scanners. Currently, the waiting-time for MRI and CT examinations at the huge hospital has been as short as a couple of days and even less than an hour in an emergency case such as a stroke patient. The center has made profits for over the years and it always acquires the most advanced MRI and CT scanners to serve its valued patients. Academically, the center, regularly, not only has trained imaging personnel and students but also has arranged continuing education workshops and conferences, nationally and internationally. Finally, in advanced research, the center’s old-and-before-decommissioned 3-Tesla MRI scanner was used to scan dogs in a research on rabies, and it has housed big research projects such as Thai Brain Mapping, Studies on Child Boxers, In Vivo Iron Measurement with MRI.

 3. How did the initiative solve the problem and improve people’s lives?
The initiative of founding an advanced diagnostic imaging center as a private-like unit in a public hospital to serve patients was a revolution in public administration in Thailand. Unlike public servants in general, the center’s staff have become active in taking care of patients with service-mindedness. More and faster than conventional public-style services, patients have been examined by MRI / CT scanners. The government has no need to spend money on expensive diagnostic imaging equipments. Due to the efficiency and efficacy in utilizing high-cost medical equipments and its staff, even the center is not run for profit, it earns profits nearly every year. Lately, the center generates the profit of about 100-200 million Baht from its 4 MRI/CT scanners every year. Finally, the center has returned all loans with interests for all investments to Ramathibodi Foundation, and has given all profits to the foundation and its mother medical school. It has been known that Ramathibodi Foundation and Faculty of Medicine Ramathibodi Hospital have aided the poor in paying their hospital bills if they or their social health securities are unable to.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Carefully, Prof. Dr. Athasit Vejjajiva pointed out the need to have an advanced diagnostic imaging center in his medical school. However, the equipments to equip the imaging center were very expensive, thus they should be exploited as much as possible. The crucial strategy to success was to set the center to be managed as a private organization to support the public university hospital. The most important factor that he needed to have was to find a potential person who was very new to the conventional public service system. He got Dr. Jiraporn Laothamatas, a young passionate neuro-radiologist, who had just come back from the U.S.A. to carry on his vision. Dr. Athasit mitigated the sluggishness of the public administration system in establishing a new organization by getting a financial loan from Ramathibodi Foundation, a nonprofit organization to help underprivileged patients in medical issues. Dr. Jiraporn knew that to get the center to survive and to grow, she needed qualified and avid staff to run the center. She recruited nearly all of her staff from the outside of the public hospital. Most of them were young and just graduated. The most important thing was that she had to devotedly work hard for the young and new organization. That was the model for the new young staff. She managed to make sure that her staff would get monthly monetary compensations as high as those in private sectors, even the base salaries were not high. Those could be done with professional compensation and longer hours of work. Dr. Jiraporn implemented ‘24/7 working system’ to the center. Without office hours, the center has always opened to serve patients. Some sections can be closed at night to cut down the expenses, but patient servicing sections and the expensive equipments operate all the time, 24 hours a day, 365 days a year. This strategy has made the center be able to serve patients as if it is 4 times bigger in size. The additional working hours from the policy can increase the incomes of the center staff. Most importantly, the increased incomes of the center could pay back monetary investment in a short period of time as well as could make huge profits, and thus the typical long-waiting-time for MRI and CT scanners was solved. When a patient gets her needed MRI/CT examination fast, she or the country will indirectly pay less in the healthcare expenses for her disease!

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Prof. Dr. Athasit Vejjajiva and the administrative board of Mahidol University Faculty of Medicine Ramathibodi Hospital in 1993 initiated the challenging policy. Ramathibodi Foundation gave investment loans to found the advanced imaging center. Dr. Jiraporn Laothamatas has managed the center as if she has been the mother of the center.
 6. How was the strategy implemented and what resources were mobilized?
Ramathibodi Foundation, a nonprofit organization to help underprivileged patients, gave the first loan of 66 million Baht to found the advanced imaging center, while Mahidol University Faculty of Medicine Ramathibodi Hospital rented out a place for the center in its university hospital. Most of the loaned money was spent on acquiring an MRI scanner, while some was used in building the center office. Later when the center expanded to the present size (4 MRI/CT scanners), the foundation also gave a new loan for the center. All loans and interests have been paid back to the foundation.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The center’s most proud success is that it can serve a lot of patients of a very large university hospital to have diagnostic and following-up examinations in a very short waiting time with a few expensive equipments. Indirectly, this will save the country’s expenditures on health care. Moreover, the center can extend its advanced medical diagnostic services to patients from all over the country. The center has just received ‘Excellent Agency of the Nation Award’, given by the office of prime minister. The picture of the center director receiving the award from Her Royal Highness Princess Sirindhorn is at the center’s website:

 8. What were the most successful outputs and why was the initiative effective?
Continuously, the center has arranged trimester meetings. The reports on waiting-time-to-be-MRI-and-CT-scanned, financial situation, human resource, and risk management are presented by the center staff. Then they will be discussed and suggested by the center administrative board. Anyhow, there is monthly meeting of section heads with the center director.

 9. What were the main obstacles encountered and how were they overcome?
Because of the 24/7 patient servicing without the hospital boundary policy, there are too many MRI/CT imaging data of patients to be served by sub-specialty radiologists of Mahidol University Faculty of Medicine Ramathibodi Hospital. The center director came up with the solution of hiring sub-specialty radiologists from other medical schools and private hospitals to help. Their monetary compensations are nearly as high as those in private imaging centers and hospitals. Thanks to the internet and information technology era, those sub-specialists can work from their homes and offices. Of course, the hardest obstacle was to have a private-like patient servicing organization in a public hospital. Laws and regulations must have been adjusted with transparency. Human resources and sufficient financial compensations for the center staff are crucial. Even being associated with a public university and hospital, the center has been able to keep imaging center staff including highly-sought technologists by supporting them to get higher education and continuing education, setting up professional compensations, and giving them chances to work extra hours to earn more incomes.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The most important benefit of founding this private-like imaging center is that the country can save expenditures on healthcare costs and expensive medical equipments. The 24/7 patient servicing strategy helps reducing the cost per examination of using expensive medical equipments. With the flexibility in management, the center can foster innovations and creativities. Indirectly, the center can financially help a restricted-budget public organization.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This innovative private-like imaging center in a public medical school can survive for 20 years and make hundreds-million-Baht-per-year profits while servicing patients from all over the country. Only some transparent changes in laws and regulations in any public service organization as well as strong motivations in helping the country and the people are needed to set up this kind of health care servicing organization.

 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 financially-independent organization is possible in a health care public service hospital. Indirectly, the initiative can reduce health care expenditures of the country.

Contact Information

Institution Name:   Advance Diagnostic Imaging Center
Institution Type:   Government Agency  
Contact Person:   Patsara Treerattanaprayoon
Title:   Ms  
Telephone/ Fax:   +(66) 2201-125
Institution's / Project's Website:  
Address:   270 Rama VI Road
Postal Code:   10400
City:   Rajataewe
State/Province:   Bangkok

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