| 4. In which ways is the initiative creative and innovative?
Tembisa Hospital is known as the centre for Benchmarking on case management for the whole of Gauteng Province also Cross Border Province-St.Ritas Limpopo Province
Promotes learning and exchange of knowledge and expertise on innovation and created a competitive edge amongst staff in the public sector
LIST THE IINOVATIVE
Reduced average length of stay: HIV/AIDS/TB from 27.50 days to 10 days
Preferences : there is a Paradigm shift, customers /patients enrolled on medical aid are now consulting at Tembisa Hospital outpatients/family medicine which is 24/7 with doctor and nurses on duty and had become the “thee’ Designated Service Provider (DSP network)
The Survey conducted showed that perception and staff attitude was modified
Collaboration with Billing displayed efficiency in Revenue generation and collection ensuring that expectations and targets are met e.g. Target set for Tembisa hospital 2014/2015 was: R19180103
Revenue collected by the end of March: R20444613.86
Over collected by R1, 127,000 which was beyond our expectation
Competitive Edge: Case Management project created a competitive edge amongst staff and stimulated internal motivation for staff to enter for different competitions to improve quality performance and raised a bar and efficiency in the standard of nursing care.
(195 word count)
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Case manager at Tembisa Tertiary hospital implemented the initiative.
Population of close to 3 million according to 2011 census not considering foreign nationals
(See attached map)
DESCRIPTION OF THE ORGANIZATION AND HOW MANY PEOPLE IT BENEFITED
• The hospital was established in 1972 is It is situated in the Ekurhuleni Metro
There are 840 approved and useable beds
• Catchment population of close to 3 million according to 2011 census not considering foreign nationals.
• Approved Personnel Establishment of 1865
• Provide both Generalised and Specialised Services
• Supported by 1 Community Health Centre and 1 Memorandum of Understanding and 22 local clinics with no extended hours of service, no referral district or regional hospital.
• Tembisa Hospital is overburdened with high BUR which is compounded by lack of primary health facilities like the district hospital.
• Social Challenges like substance abuse always lead to high incident of crime, stabs, gunshot etc. which overburdens service demands on the hospital.
• Other challenges of socio-economic nature like illegal connection of electricity, results in serious injuries like severe burns which further place strain on the hospital.
• The catchment area of the hospital spread across three Metros meaning that political interventions at community level cannot be uniform. Johannesburg, Tshwane and Ekurhuleni areas forms part of the hospital catchment area.
• Observed was an increase in trauma,
• increase in non-communicable disease(hypertension, diabetes complicating into diabetic leg ulcers
• Increase into communicable disease for example: (HIV/AIDS/TB) results in nosocomial infection.
• The non-existence of down referral facility prompted the idea of Out Patients Wound Management Clinic to address service delivery challenges in the work place.
The hospital plans to use proper referral system with aligned Protocols and procedures for management of wounds and burns post discharge.
• There need to be proper communication between hospital and the community clinics so as to enable for review of patients that need to dress at the clinics.
• Currently patients with diabetic leg ulcers, bedsores, stab wounds, burns are discharged via Outreach Programmes Teams for dressings.
• Children are referred and dressed back to the ward 21 paediatrics dept.
WHAT TO DO
• Financial support for infrastructure as outlined
• Sponsoring by companies of certain amounts towards the realisation of the project
• Companies to donate furniture, equipment and other things necessary to ensure wound clinic success
• A training program for nurses in wound care
• Partnership towards facilitating, and supporting a sub-cluster approach in wound within Ekurhuleni.
• Assistance with research programs on wound care
(399 WORD COUNT)
| 6. How was the strategy implemented and what resources were mobilized?
Funded by Tembisa Hospital CEO
ACTIVITY START DATE EDD DATE BY WHO Status Comments
Background of the facility and abstract Makwela M
Identify (people)key individuals and competent staff
Review minimum requirements for the position
Identify a purpose/goals
Recruitment and Selection
Develop the hierarchical structure Makwela M
Develop training programme for the staff
Identify all task required Makwela M
Identify documents ,policies and standards for training Makwela M
Identify the Target audience Makwela M
Hardware: Arrange and purchase hardware, equipment and computers/or use old repaired ones to save cost Makwela M
Identify original operating systems for effective usage and develop other systems Makwela M
Identify Tools means to generate and augment revenue Makwela M
Develop a protocol to effect mitigation as an advocacy to protect patients from unnecessary cost being imposed on them and not having access to care in line with National Core Standard Makwela M
Develop a Marketing Strategy Makwela M
Identify means to control average length of hospital stay, save cost and per day equivalent
Community Empowerment: Health education for the family/patients respectively to reduce ALOS and Patient Day Equivalent Makwela M
Attach attended register
Provide alternative means of hospitalisation for example: Rehab, Step-down 24/7,Hospice for terminally ill patients and pain control Palliative care Makwela M
Referral means to OUTREACH programmes to reduce ALOS and overcrowding Makwela M
Evidence monthly statistics of all referred patients
Mention ways to sustain the project for example: ongoing training and development Makwela M Attach attended register
Mention challenges and set solutions to solve them Makwela M
Define the replicability and its outcome
Launch the project and its programs Makwela M
Develop processes steps for the project Makwela M
Interview personnel and draw hierarchical structure as per organization Makwela M
Conduct orientation and induction for new staff on the project Makwela M Attach attended register
Educate and provide practical training for healthcare providers Makwela M Attach attended register
Involve Private Public Partnership agents to provide in-house training for the staff to enhance the skill, in capturing of pertinent date and ICD 10 CODING Makwela M Attach attended register
Meetings, in-service, demonstrations conferences Makwela M Attach attended register
Embark on Client satisfaction survey Makwela M Submit survey report to the CEO and Executive
Develop Mission, Vision and Objectives in line with the Six Quality Priorities and of the organization To signed by the CEO of the organization
Admissions: in-patients and all externally funded patients Makwela M
Daily, Weekly ,monthly statistics Makwela M
Discharged patients Makwela M
Health Information for data collection Makwela M Monthly report
Monthly revenue collection from BAS Makwela M Monthly revenue report from BAS central office
Estimated Target set for the department year financial end March 31 2015/2016 indicate if over collected or under collected the revenue Makwela M
Indicate total number of staff underwent training Makwela M Attach attended register
It may take 3-6month to see the return on marketing efforts Makwela M
PUSH AND PULL STRATEGY Makwela M
Promote the concept of case management and for Executive ,staff to buy-in Makwela M
Ensure organizational Leadership understand if it takes time to build the right foundation
MONITORING AND EVALUATION
Checking of results monthly
Track the key performance areas
Embark on customer/employee satisfaction survey Makwela M
Interview customers on service delivery Makwela M Submit report to the CEO
Monitor monthly revenue generation Makwela M Evidence report if reached set target met
Create a momentum , Celebrate success and reward the team Makwela M
(WORD COUNT 576)
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Gauteng Department of Health: Revenue Management unit proposed the establishment of case management units in 2011. It was the revenue enhancement strategy by the department.
Tembisa Hospital was the first Regional hospital to establish this unit and it now upgraded to Tertiary hospital offering specialised services to patients.
The unit was composed of one registered nurse, one enrolled nurse and a 1 administration clerk.
The implementation of the project was initiated by case management unit at Tembisa hospital. Trained staff: Doctors, nurses, administration clerks, on the concept of case management in the Public sector and for them to buy-in.
Tembisa case management unit went an extra mile and involved the Community in understanding access to care and benefit of medical aid for example Prescribed Minimum Benefit .Advocacy: case managers mitigated against cost being imposed on patients unnecessary and gained customer loyalty and satisfaction. (See attached letter)
Private Public Partnership involved especially in ongoing training on capturing of pertinent data relating to medical aid members, authorizations, process of claims and payments for example: GEMS ,Transmed and Medikredit company
Non-Governmental Organizations were invited from Ekurhuleni Metro for smooth referral post discharge to their facilities for continuation of care namely:
Palliative pain control facility for cancer patients Arebaokeng Centre, Edenvale Hospice/Rehab centre for HIV/AIDS/TB (See attached letter)
Ekurhuleni Metro: CEO Dr Pekane invited them to be involved in the process of implementation for referrals of post discharge patients diagnosed as having strokes, wounds and bedsores for Homebased care (244 WORD COUNT)
| 8. What were the most successful outputs and why was the initiative effective?
8.1 COMMUNITY EMPOWERMENT
Empowering the community about their chronic conditions, care how to prevent complications by being compliant to treatment thus reduced cyclical patterns of short term readmissions to the acute facility.
Life expectancy of the community enhanced up to 75 years
Women in their reproductive age and young girls were given health talk about the prevention of HIV/aids and use of condoms and abstinence
Thus reduce average length of hospital stay thus saved cost and per day equivalent
Minimized nosocomial infections
HIV/AIDS/TB patients ALOS from 27.5 days to 10 days (see Medikredit report attached)
New cases of HIV/AIDS reduced to only 13 in 2016 from April to December
8.2 REVENUE GENERATION: the inception of the unit resulted in an increased revenue generation for example: target set for Tembisa 2015/2016 was R19, 180,103, revenue collected was R20444613. The hospital surpassed the set target beyond expectation.
8.3 Prescribed Minimum Benefit (PMB) Patients transferred in from Private sector/clinic to Public hospital because funds are exhausted or depleted denying them access to care , case managers are able to advocate for the patients ,obtain authorisation under a PMB condition and may also qualify for surgical operations to specialised hospital e.g. Steve Biko Academic for heart operations
Tembisa Provincial Tertiary Hospital is known as the center for Benchmarking on Case management for the whole of Gauteng Province, even Cross Border namely: St.Ritas Regional Hospital in Limpopo ensuring that the concept of case management is known and acknowledged.
8.5 COMPETITIVE EDGE
Case Management project created a competitive edge amongst staff and stimulated internal motivation for staff to enter for different competitions to improve quality performance and raised a bar and efficiency in the standard of nursing care.
Case management unit entered for competitions and won the following:
• Dinaledi Service Excellence Awards 2013-Face of Government and Best National Core Standards in Case Management
• Khanyisa Awards won first prize in National Core standards 2014
• Central Public Service Innovation Award-First Prize 31 /10/2014 awarded a gold/silver plated trophy and a R10,000 from sponsor DATA CENTRICS
• Dinaledi Service Excellence Awards 2013-Face of Government
• CMASA NATIONAL Awards at Cape Town 15th May 2013 (case study)
• CMASA NATIONAL Awards at Indaba Hotel 18th April 2012 (case study)
• Khanyisa Awards the best in Case Management July 2012
(377 word count)
| 9. What were the main obstacles encountered and how were they overcome?
On case management concept and computer literacy to nursing staff
IT Department was involved in on going in-house training on computers and their skill was enhanced
ERRONEOUS CLASSIFICATION of patients and application of Foreign Policy for foreigners in South Africa
Case managers conducted ward rounds daily identified the gaps and spot teaching done with ward clerks, efficiency and competency enhanced
PRESCRIBED MINIMUM BENEFIT
lack of knowledge and procedures to access benefits funds Case managers conducted orientation and induction of staff to highlight them on case management concept ,processes and procedure on medical aid how to identify chronic disease list and be able to classify patients as private patients as per Uniform Patient Fee Schedule Tariff Rates thus generates revenue
Patients enrolled on medical aid do not disclose in time, hide cards and disclose on discharge in need of fit for duty letters or when they sign Refusal Hospital Treatment to be admitted at private clinics
Ward Clerks are now probing questions, any patients that signed Refusal hospital treatment are followed-up, traced and obtain authorizations from their fund.
Shortage of Hardware resources for example: individual computers in each department for nursing staff and ward clerk.
Case managers entered into Central Public Service Innovation competitions and won first prize R10, 000 sponsored by DATA CNTRIX and was able to buy Computer, Fax, copier scanner printer machine color and black and white printer
Overcrowding and non-traceable of foreigners
Tembisa community has grown up to Midrand/ Diepsloot. Daily consultations at Out-patient =2000 and average admissions per day 700.
The community and foreigner’s by-pass the referral system and patients cannot be turned back to the clinics once inside the hospital.
Perception and staff attitude was the main obstacle due to resistant to change
(292 word count)