4. In which ways is the initiative creative and innovative?
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This innovation combines the concept of home, healthcare, spatial management and technology altogether; a whole new way of services more than just a home visit more than a conventional home care.The municipality works together with a multidisciplinary team on the design based on the idea that patients with chronicle illness and bedridden elderly as well as their families or either of them should be involved in learning process of their problem, to think, decide and reflect on their own needs within the fifth dimensions; 1) Health 2) Activity 3) Society 4) Environment 5) Technology, to which direction they want to develop their health condition into. Thus, there is no fixed pattern of services for each household; depends on home condition, background, needs. Patients with chronicle illness and bedridden elderly is, therefore, the center of decisions on the matters require multidisciplinary team support and assistance to make a happy home. The freedom to choose is what makes innovation successful.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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1) A multidisciplinary team consists of physicians, nurses, psychologists, physiotherapists, social workers who have roles in assessing and providing services in all dimensions.
2) The support team consists of private entities, team of staff from TOT company limited supports for wireless phones and private sector has a role to support equipment to the necessity and sufficiency for nursing services such as first aid bags, sphygmomanometer, blood sugar meter, household remedy, wound dressing sets, cordless phones, and so on.
3) A committee of 24 communities; senior clubs, disable clubs, volunteers, together, searches for patients with chronicle illness and bedridden elderly. The team has roles in identifying patients and gives information to join the project.
4) Kao Prangammulnicile team supports/plans projects/activities and coordinates in all sectors as well as continuously builds a network of bedridden patients caring (Home Ward). This includes setting up systems and provides services for people of all age groups that rely, long term, on others as well as provides family doctors. And, the most important aspect of this project is
5) A team of patients’ families and communities whose roles are to jointly think, decide, witness and participate in problem solving and may contribute to the building of good health in patients’ home.
During 2015-2016, there are 5 households that are substantially affected by the project by successfully raise all five good health dimensions.They are
1.1 Mr. NoiPalawat, age87,a cerebral thrombosis patients
1.2 Mrs. NoiPadyon, age 78,vision impaired
1.3 Mr. Dam Dakrai, age88, Paralysis and BPH.
1.4 Sergeant Major SuthatJansuk, age59,paresis from an accident
1.5 Mr. PrayadGoytem, age69,lower body paresis
Currently, all 45 households participate in the project, five of which are healthy in all five dimensions; ten complete three dimensions and thirty reach two dimensions. However, the formality of the service varies according to the condition of the house and its family and community context. The prototype house which passes the health assessment will be certified and stickered with a logo in front of the house.
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6. How was the strategy implemented and what resources were mobilized?
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The main strategy used in this project is to be a flagship city of healthcare for patients with chronicle illness and bedridden elderly with the following processes.
1) January-March 2015, started to explore and study the situation before the implementation of the project as well as the impact on the families and communities of the patient prior to conception and design innovation.
2) April to June 2015, organized brainstorming and collaboration of relevant government agencies by selecting representatives from each group/club to took part in the meeting, including representatives of the elderly club, disabled club, the president of the community, representatives for the volunteers and community's representatives. So those, all sectors can jointly review and reflect on the issue.
3)October-November 2015, piloted the project by identify five households that are ready as prototype. Then, a team that composed of representatives from the municipality, elderly club, hospitals and volunteers was sent in to perform in-depth evaluation of the five dimensions and reflected on the health issues to the patients and families. Together, they decided to participate on a voluntary basis.During the end of 2015, the municipality worked with TOT Public Company Limited (PLC) to bring in technology for Excellent Happy Home Ward Innovation. When patients call Kao Prangam municipality, the officer will have patients' information, their place of stay and routing appear on screen. Emergency vehicle of the municipality will then take the patient to the hospital.
4)January-April 2016, assigned the same team participated in the assessment of the prototype house to plan a proactive workplan which includes preparing village health volunteers (VHV.) to receive training courses in taking care of patients with chronicle illness in the community, preparing action plan, home visit activity, health check, improving home surroundings to reduce the risk of falling items.
5)2016 to present, followed up and evaluated all prototype houses in every 6 months’ time to assess whether improvements or development is needed in any part of it.
Resources used are;
1 Social capital consists of 1) the elderly, about 30 people; takes part in the assessment of the appropriate environment for elderly home and provides information on the history of elderly or bedridden patients.2) Local personnel: considered a cornerstone in the management and coordination of appropriate resources used in respond to the needs. The Division of Public Health is the main player. They co-operate with the Welfare Division. Education Division and Division3) People in the community of 10 villages, 24 communities, with 2 representatives per community for a total of 48 people to help in providing, coordinating and mobilizing of resources.
2. Capital in the form of institutional supports in funding and equipment consists of 1) government agencies including PraNarai hospital, Provincial Social Development and Human Security, Army Aviation Center, Artillery Battalion, Wing 2 Royal Thai Air Force and Army Aircraft Maintenance Division. 2) Local government includes Kao Prangam municipality3) Private sector consists of TOT Public Company Limited, Osotspa Company Limited 4) Public sector includes community health volunteers, elderly club, disabled club, children and youth council 5) Community consists of families of the elderly and people in the community.
3. Intellectual capital to be used in innovative home is the knowledge of appropriate environment management for bedridden patients as well as knowledge in adjusting the condition of the house. It also integrates with the resources used to create innovative prototypes home which are 1) natural resources, and 2) man-made resources, sometimes from nature, such as supporting tools patients and their families made themselves from natural materials such as wood. Moreover, there are also a modification of garden area or build coconut shell ground so that patients can practice walking and the use of natural stone in the treatment of patients at home.
4. Financial capital: budget used to support this innovation comes from three major sources; 1) main financial supports to provide or create good health in each dimension are from Kao Prangam municipality 2) secondary financial recouse comes from the patient's family. In some cases, families are financially capable of supplying or supporting the creation of home innovation to elavate health condition such as leveling the ground, home cleaning, vegetable garden etc., and 3) TOT, together with Kao Prangam municipality fund communication equipment to connect to a computer system inistalled in all participating households.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The design was born from a joint meeting to brainstorm and discuss the problems in the area among municipality council members, president of elderly club, representatives from the municipality, volunteers, representatives of elderly from senior school and academics from ThammasatUniversity. At that time, this innovation happened after an informal discussion that we have to come together to think of and create something new in order to solve the problems of increasing number of patients and disabled people and we want to see the changes taking place in all area. All parties were brainstorming. The first phase aims to make a breakthrough, House of Joy. From then on, there was a trial and error process untill Excellent Happy Home Ward Innovation happens today.
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8. What were the most successful outputs and why was the initiative effective?
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1. Five prototype houses to care for bedridden patients with five health dimensions raised and guarantee from the municipality that this is a kind of home patients with chronicle illness and bedridden elderly can live happily and has been providing comprehensive service that responds to the needs. The five homes are truly prototype of healthy home. In all prototypes, there are services that cover all five health dimension, but the service may vary according to the condition of the home and the context of family and community. The prototype house passed evaluation will be certified using a sticker as a sign in front of the house.
2. Better standard of patient caring system in Kao Prangam community, a system that is tangible and can be shared with interested areas for a trial. The system was set in a clear process. There are five dimensions health indicators and evaluation framework by indicators.
3. Clear working network that works with the integration of entities in every sector including 1) organizations in both public sector consists of PraNarai hospitals, Provincial Social Development and Human Security 2) local government includes Kao Prangam municipality 3) private sector consists of TOT Public Company Limited OsotspaCo.Ltd. 4) public sector includes community health volunteers, elderly club disabled club, children and youth council 5) community consists of families of the elderly and the community working together in bringing innovation into practice.
4. Distribution of wireless phones into every home that has bedridden patients, total 45 phones in 45 households.
5. Volunteers to care for bedridden patients equipped with knowledge and certified training courses. There are 40volunteers who passed the training from PraNaraiManaraj Hospital and 6 passed the training of specialized volunteers.
This innovation is effective because the objectives are well assigned to raise the health status of patients with chronicle illness and bedridden elderly to be better than a mere dimension of health, according to the strategy to make the city a flagship on health of patients and elderly. When put into practice, the innovation achieves the objective of enhancing health although not all the dimensions in every household, but the main requirement to have the access on voluntary basis helps in making the use of resources worthwide which is to integrate resources from all sectors resource allocation.
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9. What were the main obstacles encountered and how were they overcome?
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The main obstacles are not being able to intervene or manage the space of patients with chronicle illness or elderly. The indicator of this innovation related to the fifth dimension. All dimensions are interrelated and connected, especially environmental dimension which is the most difficult and challenging because a worker may be required to deal with the environmental conditions of the patient, as the patient requests or as the assessment team presents the solution to the patient such as inadequate lighting, confined and non-ventilated. The condition leads to adjustment of the room to have more light and must be cleaned and the need to throw away some of the items. The aforementioned issues affect patient private space, especially when some of them got accustomed to it and would like to know what could be touch or some cases valued highly the belongings inside the house, thus changing the lives of patients to improve the environment is a great deal that depends on readiness and voluntary.
In making this innovation, this problem can be overcome by a multidisciplinary team. Community committee team went in to talk to the patients and the elderly to see the advantages and disadvantages that will occur and gave them time to make a decision as well as explain to the family to get their help to convince the patient, especially the issue of adjusting home environment. This must be agreed by the family and based on understanding of the situation.
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