A novel way of providing comprehensive medical geriatric services
Ministry of health

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Bahrain is a small country in Arabian Peninsula of 1.381 million people. The health care in the island officially started in the late 50’s resembled in the opening of the main tertiary hospital which is Salmaniya Medical Complex. The geriatric population occupies a substantial percentage of the country’s residents. In addition, a significant amount of health budget was spent on them. Their health care in particular was to an extent given a less attention for a substantial period of time. The elderly population is around 10-15% of the whole country residents. The majority of them are dependant on others for general care such relatives or private caregivers. Nonetheless, a portion of them are neglected from different aspects which would later on reflect on their health. It was obvious that the rate of admission of this age sub-group was high with long hospital stay which reflected in higher rate of budget consumption, bed occupancy and hospital acquired infection. The life expectancy in Bahrain in the period from 2005-2010 increased from 70.5 to 75.8 years and it is projected to reach 81.4 years for the period 2045-2050. This is based on the United nations economic and social commission for western Asia. We were faced with a long list in the main hospital with a long hospital stay , as the health care workers are underestimating the needs of the geriatrics population and the family members are not educated or trained to take the patients earlier home , where the elderly usually prefer to be . Faced by this problem, Ministry of Health (MOH) presented by a group of physicians has noticed this problem. Therefore, the goal of improving their health status was set. The initiative’s goal is to search for the problem core and to be managed systematically and comprehensively from all its aspects. The main aim of this project was to create a multidisciplinary team with all the involved parties to provide the best care for this group of patients. As a result of this plan, there was a significant improvement in the health services provided with a great impact on their social and health outcome.

B. Strategic Approach

 2. What was the solution?
The initiative is about : 1. providing a comprehensive geriatric care for the geriatric community in the kingdom of bahrain and create a data base about it 2. putting a strategic plan for the geriatric service to cope with the estimated increase in the geriatric population based on the created data base 3. increase the quality of life of geriatric population , decrease morbidity and mortality and increase life expectancy In 2010, the Ministry of health with the support of the undersecretary and associated undersecretary for the hospital affairs started the initiative with the aim to improve the health care provided to geriatricians or the elderly population of the country. The project was supported by the higher authority in the ministry and a team was created and consisted of multiple components which are nursing care, physicians, physiotherapy, administration, nutrition and social workers. The end goal was not just concerned with their health but multi-factorial to boost their living standards. This program was part of the MOH 2030 vision of improving health services in the island. The team was mainly working in Salmaniya medical complex , the main secondary care hospital and in Muharraq geriatric hospital ( which is a geriatric hospital with a bed capacity of 104 beds and it is basically a long term facility) and ebrahim Khalil kanoo ( which is post acute and rehabilitation center ) and primary care The strategy consisted of multiple components: a) Surveying the key health problems of the elderly b) To evaluate the current preventive strategy for the elderly c) The current health services provided and how it can be improved d) The major obstacles encountered in their daily care e) The health personnel involved in their care and how their contribution to the plan can be adjusted to meet the elderly needs f) To collaborate with the other governmental and private hospital , as we are the main referral center for long term and geriatric facility g) To collaborate with the main rehabilitation center for geriatric , which has a capacity of around 44 beds. h) To give continuous education about the geriatric care for all the health care workers i) To participate and follow the recommendation of the national geriatric committee in the kingdom of Bahrain j) Our main target group are the geriatric services in secondary care in Bahrain which never been addressed before. Through this project, - we were able to establish a highly motivated team , which was involved in the evaluation of all the cases which were referred. - We created a database with a full geriatric assessment for all the patients - We were able to decrease the length of stay for these patients - We were able to put recommendations for a full plan for prevention and management of geriatrics health problems - We were able to cooperate with all the stakeholders in the country in order to improve the holistic approach to the geriatric care In order to ensure the success of this program, the team out a clear plan with a clear indicators to monitor during the process. We had to evaluate our action plan several times and modify it in order to make sure that at the end we can accomplishes the main objectives. The following strategy was followed: METHODOLOGY AND METRICS 1. A multidisciplinary team with enough knowledge and expertise to evaluate and monitor the process according to the internationals standards. These teams are covering primary care and secondary care and for preventive , acute , post acute and ling term care. 2. A well designed data collection form and recommendation forms 3. An innovative software for entering the data for the recommendations 4. A daily structured round on the cases for close monitoring 6. A passionate and well educated members 7. Regular meetings to discuss the progress and provide comments and plan for improvements 8. Regular feedback for the concerned and the end users MEASURING PERFORMANCE We used the following measuring performance indicators 1. the rate of recording all the geriatrics indicators including the dementia score, bed sores and physiotherapy score. 2. The number of patients seen for all services 3. The number of educational services given and the number of health care workers educated 4. The number of trained specialized personal 5. RECOGNITION The project has been acknowledged and highly supported by the 1. Acknowledged by the health care workers ( the end users) 2. The high authority in the Ministry of health 3. The Bahrain center for excellence In general : 1. The strategy was regularly monitored by statistical analysis of the number of admitted patients, duration of stay and the outcome. The data was collected by the admission bureau employee. The data is reviewed by the heads of the program to asses the efficiency of the steps taken. 2. In addition, a verbal communication is done with the physicians receiving geriatric population about their level of satisfaction of the provided services. 3. Weekly meeting to discuss the cases with the team members to discuss the cases and provide the best plan of action for them. 4. Monthly meeting to review the strategy and put the action plan and more educational sessions for the organization. 5. Daily walking rounds are conducted by the multidisciplinary team members to ensure that their recommendations are being followed up and to address any problem immediately. 6. A feedback reports are being submitted to the decision maker in the ministry in order to help in future planning for the geriatric services. The most important tool used was the comprehensive geriatric assessment As follow: The aim of this multifaceted intervention is the restoration of healthy function and independence, where possible, as well as the amelioration of disability and distress. The theoretical benefits of CGA have been described as improvements in diagnostic accuracy, optimization of medical treatment, improved prognosis, restored and maintained function, support for loss of autonomy and improved quality of life, ideally in a cost-effective model. Comprehensive geriatric assessment (CGA) A multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long-term follow-up. In-patient Geriatric Consultation Service (IGCS) team A multidisciplinary team which assesses, discusses and recommends a plan of treatment for frail older in-patients. Key to most trials is the role of a physician with experience in geriatric medicine, a coordinating or specialist nurse and a social worker. A variable number of additional team members reflect the complexity of these trials. Physiotherapists and occupational therapists form the next most frequent team members, and referral to these services was seen as necessary for teams that did not have dedicated therapy members. This always involved a coordinated multidisciplinary assessment process comprising the identification and documentation of medical, physical, social and psychological problems. Component Elements of the assessment: Medical Problem list Assessment Co morbid conditions and disease severity Medication review Nutritional status Assessment of Basic activities of daily living functioning Instrumental activities of daily living Activity/exercise status Gait and balance Psychological Mental status (cognitive) testing Assessment Mood/depression testing Social Informal support needs and assets Assessment Care resource eligibility/financial assessment Environmental Home safety Assessment Transportation

 3. How did the initiative solve the problem and improve people’s lives?
As the main part of this initiative is to do the comprehensive geriatric care and to cover all levels of services : prevention , acute, post acute and long term care , the Clinical Goals were : 1. To improve process of care: - Improve diagnostic accuracy - Improve medical treatment - Arrange for long-term case management 2. To improve outcomes of care: - Improve functional status - Better quality of life 3. To contain costs of care: - Reduce use of unnecessary formal services - Prolong tenure in the home/community 4. Nonclinical Goals: • Conduct research to determine patient baseline characteristics, natural history, or outcomes of treatment in addition to this : we were able to access a a large number of geriatric patients that are in need for the services : 1. we covered 1409 cases in the main hospital for acute care over 6 years, 4857 cases in psychiatry hospital over 5 years , and 1692cases in 2015 in primary care 2. we also have the mobile geriatric services which reach the geriatric population at home and provide for them services : in 2015 , 1443 case were visited and number of visits were around 19000. 3. We were part of national geriatric plan , as we put the medical part of the plan 4. A lot of educational services for health care workers : 22 workshops were 605 health care workers were trained 5. A lot of consultation services were given for patients and relatives : around 514 in health centers , 6. We established educational materials in English and Arabic languages about the care of different geriatrics problems at home 7. Clinics that provide care for this population : number of visits for geriatric in health centers reached 300,000 in 2015. 8. To design a vaccination plan for the same population in different health facility , reaching 100% in inpatient an even the geriatric homes in 2015 , 1272 were vaccinated 9. A comprehensive preventive plan for females : for breast and cervical center 10. A medical assessment were done to even who resides in nursing home: 415 were assessed 11. Training sessions for nursing students : 12. Coordination with other NGOs : to increase level of awareness about geriatric care 13. Provide diet services specialized for geriatric population in all sectors : around 885 visits in the health centers 14. The plan for another post acute care facility , in process 15. Provide occupational therapy and physiotherapy services for who needed it .

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
This initiative of elderly care is the first in the gulf in its components. Initially, there was reference to international standards of geriatric care as we have a lack of them in our institute. However, these standards were adjusted and reformed in a way to suit the eastern conservative background and culture. After a lengthy review of the existing systems in the area and internationally , we did not find any other experience that we can replicate to help us in achieving our goals . So we worked on the international standards and created a full geriatric assessment booklet. This booklet has several sections for all the needed subspecialties including : physician, nurse , physiotherapy, dietitian , and social workers. Each section has to be filled by the same subspecialty for each patient. Then we created software where we can enter all the data collected in order to create a database. This database was analyzed and helped in producing the necessary information for further planning for decision makers. There is continuous update for these protocols to acclimate the dynamic changes and advancement in their care. The specific elements of the program consisted of the following: a) A multidisciplinary team specialized for geriatric care b) Developed a booklet to record all information concerned with their care and follow up c) The main tertiary hospital and other peripheral centers were combined in a way to provide a systematic and organized care to the patient. d) Continuous education of all the involved personnel about the geriatric care e) Very motivated team ‘, we invested in the human factor f) Getting all services available and all stakeholders together to create the best picture of geriatric services

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The project is implemented by 1. multidsciplianry teams in primary and secondary care and post acute and long term facility services 2. the mobile geriatric units 3. team in psychiatry hospital 4. it involved personal with different specialites : geriatric physicians , psychiatry, nurses, dietetion , physiotherapy, occupational therapy , social workers and allies health the population affected by this program : 1. all the geriatric population and resident in the kingdom of Bahrain 2. who are in acute care, pot acute care in secondary care hospitals 3. who are attending local health centers 4. who are attending psychiatry hospital 5. who are living in nursing homes and day care facilities
 6. How was the strategy implemented and what resources were mobilized?
The strategy of improving geriatric care was implemented according to the clear mission and objectives defined in the Kingdom of Bahrain MOH 2030 vision. At all times, our central goal was to improve all services provided to the elderly population of the country. The initiative was conducted according to two phases: a) Planning: October 2010- June2011 a group of meetings took place between the head of the initiative Dr. Jameela and the officials of the MOH. The plan, mission, vision and goals were discussed. The deficiencies in the field were clarified and set according to priorities. The personnel involved in the program, each was given a specific task to carry out to bring out a final plan and vision. The agreement on the strategy logo was done too. Part of the planning was to sit educational preparations to be part of the strategy. A communication was done with Ministry of Development and Social Affairs to mingle them in the strategy as they already have contributions to the geriatric population in more of social aspect. We started by recruiting health care workers who has experience in the geriatric care and we created the main team which covered Salmaniaya medical complex, Muharraq geriatric hospital and the rehabilitation center . b) Scaling: June 2011-June 2012 those involved in the program were given a month period to achieve their assigned duties and a regular follow up was done by the head of the program to check the feasibility, accuracy and efficiency of the program. The program was started in Salmaniya medical complex for evaluating all the inpatients in the geriatric age group who needed a geriatric care . they were evaluated to provide the full care , improve their length of stay , prepare them and the caregiver for going back home or plan for their stay in the rehabilitation center or if not possible to the long term facility. Then we started applying to more inpatients by decreasing the referral age to all above 60 years as our team was more capable of running the service . Then we applied the same process to all patients in the geriatric hospital with the long term stay. Then we expanded our services and had meetings and education to the personnel form ministry of social affairs who are involved in geriatric care. Now it is covering all secotrs of services c) Monitoring and Refinement: - Since June 2012: the program was continuously monitored. - Daily walking rounds on the cases refereed - Regular weekly meeting in both salmaniya medical center and Muharraq geriatric hospital to discuss the cases and make sure that the program is going smoothly - The data were collected on a timely manner and entered in the software for analysis - Different leaflets/ brochures were created and distributed in the hospital and other periphery centers to define the team goals and encourage others to be part of it. - In addition, multiple lecture and teaching sessions were done for different departments who encounter elderly patients to introduce them to the program and clarify to them the challenges faced by this population. - Along the way, any deficiency or defect was re-adjusted to suit the goals of the program. - Meeting with provides of services in primary care The improvement of geriatric health care strategy was fully supported by the MOH. It was a great challenge to convince the authorities to support this program. The strategy was a new vision with long term goals and significant results on medical and social understanding on geriatric care. Recourses involved in the program: 1) Human: all human resources were mainly from Salmaniya Hospital and the periphery geriatric hospitals including Muahrraq Geriatric Hospital and Ebrahim Khalil Kanoo Long Term Rehabilitation Center. This involved all the needed subspecialties form these centers including : physician, physiotherapy , nurses , dietitian and social workers . the manpower in primary care and psychiatry hospitals 2) Technical: a. the brochures, leaflets and all lectures which were provided to the hospital personnel were arranged by the heads of the program and financially supported by the MOH. b. The creation of the software was done by the team c. The analysis of the data was done by the members of the team 3) Financial: the MOH fully supported the program. However, there was no separate budget for the strategy. It was included in the financial plan of the internal medical department. A main point which makes our program to stand out as an innovative project , is that it was done with no extra budget. On the other hand, we were able to save a lot of budget by providing this service whch facilitate the discharge of the patients and decreasing the length of stay.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The main stakeholders were three multidisciplinary teams, each team was in one facility ( the main hospital, the rehabilitation center and the long term facility ) The team in each center involved a group of: 1) Physicians: a group of geriatricians and other medical residents who are interested in the field. Physicians from other departments within the hospital who come across elderly patients were involved s part of the teaching lectures which were held at different timings. They were involved in daily rounds and taking care of the patients. They were involved in completing the geriatric assessment and entering the data and analyzing it. 2) 2) Nurses: nurses from Salmaniya Hospital and geriatric centers were involved in establishing the initiative. They were major component of the program as they were involved directly in the elderly patient care. They were regularly updating physicians about the health status of the patient and whether any further intervention was needed to fulfill the goal of the initiative. They were doing the daily rounds on the patients , evaluating them and proving the needed care. There were involved in completing the geriatric assessment and entering the data 3) Nutrition: nutritionists were part of it too. Regular visits done to the patients in the wards. The feeding requirements were calculated according to a specific scale. They also helped in teaching care givers of the best method of delivering he food to the patients in the safest way e.g. oral, nasogastric feed. 4) Physiotherapist: in Salmaniya Hospital and peripheral geriatric hospitals and a group of physiotherapists were trained to asses all elderly patient and plan a program that suits their general status taking into consideration their co morbidities. In one center, an occupational therapist is available too. He is involved in creating re-creational activities to enhance their mental and behavioral capabilities. 5) Social workers: their main role was to deal with the in patient group particularly who had problems with their caregivers. Some elderly were socially neglected by their families or they belonged to poor families who had troublesome in providing the basic necessities to their elderly. The social workers helped in understanding the social circumstances of each patient and to try as much to overcome any obstacles that would put the patient at risk of negligence. 6) Administrators; they were involved in the initial creation of the team and in regular follow up of the progress of the team and gave all the support needed for all the functions. 7) Same stakeholders in primary care

 8. What were the most successful outputs and why was the initiative effective?
The most successful outputs of the is project is to provide a high level of quality and an accessible services to this group of population that is usually was underserved. The result was an efficient experience entirely oriented to make sure that the elderly patients, their relatives and their caregiver are not left alone and they have a high quality services developed to them. The most successful outcomes were as follow : a) Increase in the number of discharged patients. As a group, all worked to fasten the recovery of admitted patients. One of the major points which helped in achieving this point was to involve the relatives in their care in the sense of having a detailed discussion about their underlying health problems and how it can be managed post discharge (e.g. bed sore care and nasogastric feed administration). The program has assessed almost 60 cases in Salmaniya Hospital and 7o cases in the geriatric hospital plus long term care hospital. b) Improvement in the awareness of non-medical department of how to approach and address elderly population. Through a number of lectures and teaching sessions which were held throughout the year and involved doctors plus nurses, the key points of elderly care and when and how to investigate any existing or newly emerging problem. Total so far more than 400 people were involved in the teaching sessions with around of 15 workshops held. The plan is to extend these educational activities to include schools and universities. c) Improve in the family communication with the assigned team. Such contact made it easy for all components to contribute to the patient’s long term care. Any concerns raised by the relatives were answered and as much addressed before the discharge. d) We were able to decrease the length of stay for a lot of geriatric patients in the hospital , as most of them get admitted under different subspecialty and they received treatment for the admission diagnosis . On the other hand the primary care team , overlook the other aspects of geriatric care which leads to increase in the length of stay and increase morbidity and mortality related to hospital stay. e) We had worked efficiently with the geriatric mobile unit in order to make this service available for all our patients who are in need for it. Collaboration with the geriatrics mobile team from the local health centers: the mobile unit had scheduled periodic visits to the patient at home once discharged. These visits were arranged by the social worker with the agreement of the caregivers. The unit assessed the patient fully including the vital signs and a quick general examination. Any queries were answered and the patient was advised to approach a primary or secondary care facility as needed. f) A short term care was provided for a temporarily period in periphery centers such as Kanoo Rehabilitations Center. Patients were admitted there as a transition period between the hospital and going back home. During their stay, daily medical assessment is done and continuous nursing care. Along with that physiotherapy and occupation therapy is done to the patients as tolerated by them. we were able to access a a large number of geriatric patients that are in need for the services : 1. we covered 1409 cases in the main hospital for acute care over 6 years, 4857 cases in psychiatry hospital over 5 years , and 1692cases in 2015 in primary care 2. we also have the mobile geriatric services which reach the geriatric population at home and provide for them services : in 2015 , 1443 case were visited and number of visits were around 19000. 3. We were part of national geriatric plan , as we put the medical part of the plan 4. A lot of educational services for health care workers : 22 workshops were 605 health care workers were trained 5. A lot of consultation services were given for patients and relatives : around 514 in health centers , 6. We established educational materials in English and Arabic languages about the care of different geriatrics problems at home 7. Clinics that provide care for this population : number of visits for geriatric in health centers reached 300,000 in 2015. 8. To design a vaccination plan for the same population in different health facility , reaching 100% in inpatient an even the geriatric homes in 2015 , 1272 were vaccinated 9. A comprehensive preventive plan for females : for breast and cervical center 10. A medical assessment were done to even who resides in nursing home: 415 were assessed 11. Training sessions for nursing students : 12. Coordination with other NGOs : to increase level of awareness about geriatric care 13. Provide diet services specialized for geriatric population in all sectors : around 885 visits in the health centers 14. The plan for another post acute care facility , in process 15. Provide occupational therapy and physiotherapy services for who needed it .

 9. What were the main obstacles encountered and how were they overcome?
Each step had its own challenge. 1. At first, it was getting the MOH agreement to approve the strategy which was later on eased by convincing them with real statistics about the problems being faced by the treating physicians and nursing staff. 2- No available database: Challenge: The main obstacles we found at beginning of the strategy, that there was no available data of any kind that we can start with or to compare our results with. The other major point that it was difficult for us as when we started there was a lot of paper work, and it was difficult to retrieve data. Solution: - we created the booklet for the comprehensive geriatric assessment for data collection - We established an electronic database. - We analyze the data and give summary report to all stakeholders and to the decision making authority Outcome: - better and easier access for the data - Facilitate data analysis, and daily updated data. - Created a Database for future studies 2- Shortage of well trained staff in the best geriatric care Challenge: Another problem was a shortage of man power. As the geriatric population is considered huge and they constitute a significant percentage of the admission, to get enough staff to cover all the time could be a dilemma. - shortage of well trained staff, including geriatricians , nurses , physiotherapists , social workers and dietitian who are trained to care of the geriatric population . Solution: - A serial of educational lectures to all the health care workers and the stakeholders - we started the program by limitation of the number of cases we can review - more staff were recruited and trained mainly junior residents to ensure the sustainability of the project, more efficient data collection and analysis. Outcome: - more well trained health care workers are available to maintain the sustainability 3- No communication between all the stakeholders: Challenge -there was no communication between the stakeholders who are taking care of the geriatric patients so the work was fragmented which makes it very difficult to deliver a quality service. Solution: - Regular meetings between involved specialties with a high degree of transparency - Availability of the forms with the recommendations inside the patients chart - Availability of more geriatricians. - Outcome: - More cooperation and collaboration between different specialties which improved the services we are delivering to this group of the population 4. Incorporating the family members and the patients actively in their plan of management Challenge: we found that the patients and their family members or caregivers were not involved in any part of their management plan and they usually were surprised by the decision of discharge without any help form the staff in how to deal with their loved ones at home and that created a lot of problems. The other main point was that many relatives belong to low socioeconomic status, so making them understand the needs of their elderly relatives and trying to help in their management was a bit of frustrating to them. Solution : However, with the help of the social workers in particular who tried to provide them with basic supplies to ease the mission for them. Outcome: the patients and their relatives are involved in their management plan from day one which was reflected clearly on the patients satisfaction and community satisfaction.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The geriatric care strategy has helped in evolving the geriatric care on the island. It has taken the elderly care to a new level with a unique type of service. The community awareness of the needs of this age group is increasing. The attention they are receiving nowadays is progressing in a constant rate. The main key benefits: 1. Providing a high quality services for the geriatric care in our country which can be a role model to other countries in serving this increasing sector of the population. 2. As one of the main aims of this project is to evaluate the patients from day one and put a full comprehensive assessments and plan for discharge , we were able to decrease the length of stay. 3. This is reflecting on the admission and the level satisfaction from the committee, patients and caregivers. 4. On clinical grounds, the admission rate and discharge is picking up in favor of everyone. The house medical care is changing too. The mobile units are covering a wider group of patients upon an agreement with the geriatric team. Due to this care, all medical problems are being identified early and consults to involve other specialties is done. All departments have shown good cooperation and communication skills. 5. We were able to create a well-trained, highly motivated team to be the start point for a more advanced geriatric care in the kingdom. we were able to access a a large number of geriatric patients that are in need for the services : 6. we covered 1409 cases in the main hospital for acute care over 6 years, 4857 cases in psychiatry hospital over 5 years , and 1692cases in 2015 in primary care 7. we also have the mobile geriatric services which reach the geriatric population at home and provide for them services : in 2015 , 1443 case were visited and number of visits were around 19000. 8. We were part of national geriatric plan , as we put the medical part of the plan 9. A lot of educational services for health care workers : 22 workshops were 605 health care workers were trained 10. A lot of consultation services were given for patients and relatives : around 514 in health centers , 11. We established educational materials in English and Arabic languages about the care of different geriatrics problems at home 12. Clinics that provide care for this population : number of visits for geriatric in health centers reached 300,000 in 2015. 13. To design a vaccination plan for the same population in different health facility , reaching 100% in inpatient an even the geriatric homes in 2015 , 1272 were vaccinated 14. A comprehensive preventive plan for females : for breast and cervical center 15. A medical assessment were done to even who resides in nursing home: 415 were assessed 16. Training sessions for nursing students : 17. Coordination with other NGOs : to increase level of awareness about geriatric care 18. Provide diet services specialized for geriatric population in all sectors : around 885 visits in the health centers 19. The plan for another post acute care facility , in process 20. Provide occupational therapy and physiotherapy services for who needed it . Achievement report from January 2016 to June 2016 21. Since January 2016, 107 new elderly patients were assessed and seen by the team members, in addition to follow up of the existing patients who are still in hospital and scattered all over SMC and Peripheral hospitals. This list of elderly patients is being reviewed in weekly bases for all patients who are 75 years old and above including new cases and existing ones. 22. Committee members meet in monthly bases with chairperson D. Jameela and discuss all the issues related to committee objectives, achievements, activities, plans, obstacles and so on… 23. Educational programs and workshops are being done in monthly bases for different health care providers including nurses, doctors, interns, students, health care providers in the primary health care, and allied services providers ( on going plan ) 24. Five workshops has been conducted, one for nurses from different departments , and three for interns. The following pagers will show details about conducted workshops. Each workshop was designed for 35 candidates, but the number was changed related to nomination and attendance. Date Category Candidates Number 13th January 2016 Nurses 30 22nd February 2016 Interns 35 14th March 2016 Interns 27 13th April 2016 Interns 31 16th May 2016 Interns 25 Total Nurses 30 Interns 118 Nurses+ Inters 148 Data Analysis of workshops 25. First workshop data analysis was not done because it has lot of missing data. 26. Data analysis of the four conducted workshops for interns will be found in the following pages. Workshop on 22nd Feb 2016, 35 interns attended. Overall view No Evaluation Aspects Strongly Agree Agree Disagree Strongly Disagree Not Applicable 1 I was well informed about the objectives of this workshop 46% 26% 9% 6% 6% 2 This workshop lived up to my expectations 29% 40% 14% 9% - 3 The content is relevant to my job 46% 43% - - - 4 The workshop activities stimulated my learning 34% 26% 20% 6% 6% 5 The presenters were well prepared 34% 40% 3% 9% 6% 6 Presenter’s style of teaching and communication were attractive 26% 40% 17% 9% - 7 The visual aid was clean, used well and assisted my learning 49% 37% 3% 3% - No Areas for improvement 1 Clarify the workshop objectives 23% 2 Reduce to content covered in in the workshop 17% 3 Increase the content covered in the workshop 17% 4 Update the content covered in the workshop 11% 5 Improve the instructional methods 49% 6 Make workshop activities more stimulating 69% 7 Improve workshop organization 14% 8 Make the pre or post- test less difficult 6% 9 Make the pre or post-test less difficult 9% 10 Allot more time for the workshop 6% Pre-test and post-test marks and improvement of knowledge Mark Percentage Pre-test 15 and above 66% Less than 15 31% Post-test 15 and above 86% Less than 15 6% Overall improvement in marks 15 and above 20% Workshop conducted in 14th March 2016, 27 interns attended Overall view No Evaluation Aspects Strongly Agree Agree Disagree Strongly Disagree Not Applicable 1 I was well informed about the objectives of this workshop 48% 33% 4% - - 2 This workshop lived up to my expectations 26% 48% 7% 4% - 3 The content is relevant to my job 48% 37% - - - 4 The workshop activities stimulated my learning 30% 56% 4% 4% - 5 The presenters were well prepared 33% 48% 4% - - 6 Presenter’s style of teaching and communication were attractive 26% 44% 11% 4% - 7 The visual aid was clean, used well and assisted my learning 37% 44% 4% - - No Areas for improvement 1 Clarify the workshop objectives 26% 2 Reduce to content covered in in the workshop 19% 3 Increase the content covered in the workshop 7% 4 Update the content covered in the workshop 19% 5 Improve the instructional methods 33% 6 Make workshop activities more stimulating 67% 7 Improve workshop organization 30% 8 Make the pre or post- test less difficult 7% 9 Make the pre or post-test less difficult 15% 10 Allot more time for the workshop 15% Pre-test and post-test marks and improvement of knowledge Mark Percentage Pre-test 15 and above 52% Less than 15 33% Post-test 15 and above 63% Less than 15 15% Overall improvement in marks 15 and above 11% Workshop conducted on 13th April 2016, 31 interns attended Overall view No Evaluation Aspects Strongly Agree Agree Disagree Strongly Disagree Not Applicable 1 I was well informed about the objectives of this workshop 46% 23% - 3% 6% 2 This workshop lived up to my expectations 35% 35% 6% 10% - 3 The content is relevant to my job 32% 45% 6% 3% - 4 The workshop activities stimulated my learning 32% 45% 6% 3% - 5 The presenters were well prepared 32% 35% 13% 6% - 6 Presenter’s style of teaching and communication were attractive 32% 39% 6% 3% - 7 The visual aid was clean, used well and assisted my learning 42% 39% - 6% - No Areas for improvement 1 Clarify the workshop objectives 19% 2 Reduce to content covered in in the workshop 3% 3 Increase the content covered in the workshop 19% 4 Update the content covered in the workshop 29% 5 Improve the instructional methods 23% 6 Make workshop activities more stimulating 58% 7 Improve workshop organization 13% 8 Make the pre or post- test less difficult 13% 9 Make the pre or post-test less difficult 13% 10 Allot more time for the workshop 10% Pre-test and post-test marks and improvement of knowledge Mark Percentage Pre-test 15 and above 52% Less than 15 42% Post-test 15 and above 52% Less than 15 42% Overall improvement in marks 15 and above 0 Workshop conducted on 16th May 2016, 25 interns attended Overall view No Evaluation Aspects Strongly Agree Agree Disagree Strongly Disagree Not Applicable 1 I was well informed about the objectives of this workshop 40% 32% 4% - - 2 This workshop lived up to my expectations 8% 52% 16% - - 3 The content is relevant to my job 32% 40% 4% - - 4 The workshop activities stimulated my learning 20% 40% 12% 4% - 5 The presenters were well prepared 24% 28% 12% 12% - 6 Presenter’s style of teaching and communication were attractive 28% 28% 12% 8% - 7 The visual aid was clean, used well and assisted my learning 24% 40% 12% - - No Areas for improvement 1 Clarify the workshop objectives 16% 2 Reduce to content covered in in the workshop 20% 3 Increase the content covered in the workshop 4% 4 Update the content covered in the workshop 28% 5 Improve the instructional methods 36% 6 Make workshop activities more stimulating 60% 7 Improve workshop organization 24% 8 Make the pre or post- test less difficult 0 9 Make the pre or post-test less difficult 8% 10 Allot more time for the workshop 4% Pre-test and post-test marks and improvement of knowledge Mark Percentage Pre-test 15 and above 44% Less than 15 44% Post-test 15 and above 56% Less than 15 24% Overall improvement in marks 15 and above 12% Overall data analysis for 118 inters attended the four workshops. Overall view No Evaluation Aspects Strongly Agree Agree Disagree Strongly Disagree Not Applicable 1 I was well informed about the objectives of this workshop 47% 28% 4% 3% 3% 2 This workshop lived up to my expectations 25% 43% 11% 6% - 3 The content is relevant to my job 40% 42% 3% 1% - 4 The workshop activities stimulated my learning 30% 41% 11% 4% 2% 5 The presenters were well prepared 31% 38% 8% 7% 2% 6 Presenter’s style of teaching and communication were attractive 28% 38% 12% 8% - 7 The visual aid was clean, used well and assisted my learning 39% 40% 4% 3% - No Areas for improvement 1 Clarify the workshop objectives 21% 2 Reduce to content covered in in the workshop 14% 3 Increase the content covered in the workshop 13% 4 Update the content covered in the workshop 21% 5 Improve the instructional methods 36% 6 Make workshop activities more stimulating 64% 7 Improve workshop organization 19% 8 Make the pre or post- test less difficult 7% 9 Make the pre or post-test less difficult 11% 10 Allot more time for the workshop 8% Pre-test and post-test marks and improvement of knowledge Mark Percentage Pre-test 15 and above 54% Less than 15 37% Post-test 15 and above 64% Less than 15 21% Overall improvement in marks 15 and above 10%

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The ministry of health has taken the responsibility of providing the best medical care for the geriatric population and through this project we were able to provide the best quality of care for this population By improving the health status of this population and improving the life expectancy we were able to gain trust in the quality if care we are providing. As all the types of services now is integrated it is easier for the patients and their care givers to receive the care they needed in a smooth and amore accessible way and that also decrease redundancy and decrease costs of services

 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)
In general this project was to reach a large group of the most vulnerable population where we discovered that there are number of cases with neglect and abuse and the needed the services we are providing This was achieved through the program as it is multidsiplianry and we are not only treating the medical problems but also looking into the social, and psychological problems In order to ensure the success of this program, the team out a clear plan with a clear indicators to monitor during the process. We had to evaluate our action plan several times and modify it in order to make sure that at the end we can accomplishes the main objectives. The following strategy was followed: METHODOLOGY AND METRICS 1. A multidisciplinary team with enough knowledge and expertise to evaluate and monitor the process according to the internationals standards 2. A well designed data collection form and recommendation forms 3. An innovative software for entering the data for the recommendations 4. A daily structured round on the cases for close monitoring 6. A passionate and well educated members 7. Regular meetings to discuss the progress and provide comments and plan for improvements 8. Regular feedback for the concerned and the end users MEASURING PERFORMANCE We used the following measuring performance indicators 6. the rate of recording all the geriatrics indicators including the dementia score, bed sores and physiotherapy score. 7. RECOGNITION The project has been acknowledged and highly supported by the 1. Acknowledged by the health care workers ( the end users) 2. The high authority in the Ministry of health 3. The Bahrain center for excellence In general : 7. The strategy was regularly monitored by statistical analysis of the number of admitted patients, duration of stay and the outcome. The data was collected by the admission bureau employee. The data is reviewed by the heads of the program to asses the efficiency of the steps taken. 8. In addition, a verbal communication is done with the physicians receiving geriatric population about their level of satisfaction of the provided services. 9. Weekly meeting to discuss the cases with the team members to discuss the cases and provide the best plan of action for them. 10. Monthly meeting to review the strategy and put the action plan and more educational sessions for the organization. 11. Daily walking rounds are conducted by the multidisciplinary team members to ensure that their recommendations are being followed up and to address any problem immediately. 12. A feedback reports are being submitted to the decision maker in the ministry in order to help in future planning for the geriatric services.

Contact Information

Institution Name:   Ministry of health
Institution Type:   Ministry  
Contact Person:   Jameela alsalman
Title:   Head of geriatric committee in secondary care  
Telephone/ Fax:   00973 36515138
Institution's / Project's Website:  
E-mail:   f.anwar@pmc.gov.bh  
Address:   Po box 12 , Manama , bahrain
Postal Code:  
City:   Manama
State/Province:  
Country:  

          Go Back

Print friendly Page
video porno.. brasileiros xxx xhamster