Questions/Answers

South Africa´s health system faces multiple challenges, such as a high prevalence of Tuberculous and HIV/AIDS, a high amount of violence and trauma incidents as well as the ever-growing impact of climate change. Furthermore, the healthcare system is faced with austerity measures caused by severe budget cuts. Hence it becomes mandatory to implement measures to use resources more effectively and efficiently. Therefore, it is necessary to upskill hospital staff and empower them to apply management tools in a standardized way. These skills are implemented through a healthcare innovation hub of the hospital and summarized in the book “High performance in hospital management – a guideline for developing and developed countries” which is published as an international edition with Springer Publishing Company. The hospital is an academic hospital in Cape Town, Western Cape in South Africa. It serves a population of almost 5 million inhabitants and is used as a referral hospital by other hospitals in the province. This book provides a broad overview of what is needed to run hospitals and other health care facilities effectively and efficiently. All the skills and tools required to achieve this aim are elucidated including business engineering and change management, strategic planning and the Balanced Scorecard, project management, integrative innovation management, social and ethical aspects of human resource management, communication and conflict management, staff development and leadership. The guidance offered is applicable in both developed and developing countries. Furthermore, the relevant theoretical background is outlined and instructive case reports are included. Each chapter finishes with a summary and five reflective questions. Excellence can only be achieved when health care professionals show in addition to their medical skills a high level of managerial competence.

Cost-effective and equitable delivery of healthcare has become a challenge. In the South African context, it is becoming more and more difficult in balancing the burden of disease and the patient load within available resources, while still maintaining quality of care. As in many other developing countries public healthcare services need to support a growing population of uninsured citizens together with immigrants from elsewhere seeking care. While the reasons for the problem are both economic and related to health service design and delivery, it is compounded by an ageing population, a rising burden of infectious, non-communicable and life-style diseases and the global shortage of adequately skilled healthcare workers. The overall objective is to offer innovative healthcare for all. This can only be achieved if hospital staff is empowered to improve hospital processes to serve the need of their patients. In order to improve healthcare services a healthcare innovation hub was created where all hierarchical levels of the health care sector (clinical, administration, nursing) engage in a continuous improvement process.

The initiative shows an engagement with various stakeholders. It engages for example role-players from the public, private, governmental and academic sector. It enhances the responsiveness of public service delivery by upskilling people and enpowering healthcare workers to provide better services. It promotes participatory leadership as subordinates engage in goal setting, decision making, problem solving, team building and augmenting the managerial knowledge of the staff. It encourages staff to participate in a continuous improvement process. This makes institutions such as hospitals inclusive and ensures that the participation in decision making is taking place. By engaging all staff at various levels, a new and innovative idea is introduced in a public hospital in a developing country. Hence the capacity of public institutions, in this case hospitals is strengthened with results in improved service delivery, the better use of resources and less adverse incidents.

The overall aim is to deliver adequate and more equal healthcare through standardization and shortening of processes in combination with a continous improvement process. The book highlights how public hospitals can deliver better healthcare and attend to the increased burden of disease. The various initiatives improve people´s live independly of an acute or chronic disease. Besides, innovative approaches are encouraged to be developed and then applied to improve health outcomes.

The initiative aligns with the 2030 agenda to ensure healthy lives and promote well being for all ages. Human and financial resources are already constrained in public settings. Only when we use these resources skillfully and wisely we can deliver more adequate health care to serve the growing need of the population. Through the implementation of standardised management tools we serve our communities in a better way and deliver improved health care.

The initiative enhances the service delivery in public hospitals while we upskill and empower people to offer better service delivery. This leads to less critical incidences, a higher satisfaction rate of patients as well as staff, less waiting times and queues. These goals can be achieved by managing patients and hospital processes more efficiently. This initiative serves patients who are dependent on the service delivery of a public hospital. It includes neonates, children, adolescents, women, acute and chronic patients as well as oncology patients.

Suboptimal management and unskilled staff is responsible to be one of the major causes of inferior service delivery in hospital resulting in unnecessary death and treatment errors. This can be remedied by a holistic approach as summarised and outlined in the book.

The impelementation of a healthcare innovation hub in a public hospital is an innovative approach to drive innovation, leadership and change in a public health care setting. We developed a holistic and overarching framework that combines the needed soft and hard skills for hospital staff. These tools have been adapted and transferred to be relevant in hospital settings. Furthermore, they are applied through a Healthcare Innovation Hub of a public hospital. The following steps are described and recommened: 1 Engage Your Nurses, Clinicians and Patients to Drive Your Hospital 2 Create a Corporate Identity. 3 Develop Your Vision and Communicate It 4 Face Your Competitors 5 Improve Communication and Appreciation 6 Creating Positive Attitudes Towards Change 7 Develop and Communicate Your Strategy. 8 Find the Best Staff and Develop Their Skills 9 Manage Your Conflicts Professionally 10 Be a Visionary Leader

The initiative guides the executive management how to engage with healthcare worker, nurses, doctors, administration and multiple other stakeholders. Academics from the adjunct university gave input and feedback. In addition, various improvement projects have taken place and are ongoing in collaboration with the Commerce Faculty of the University of Cape Town. But overall the projects and initiative are self-sustained and are done without using major financial resources.

Yes

Initially the initiative was set up in hospitals of developed countries, in this case in Germany and Switzerland. The initiative significanty reduced waiting times in Emergency units, improved staff and patient satisfaction and reduced Near Mised incidents and incidents by using critical incident reporting and the Swiss Cheese Model. It was then adapted according to the needs to a developing country, South Africa. Based on this concept a holistic and unique framework was developed that can be applied in any other health care sector and health system. Each chapter of the book can be individually downloaded. Case studies highlights the practical approach. At the end of each chapter reflective questions are given that can be used in the individual setting. The goals of each chapter are summarized in the beginning. https://link.springer.com/book/10.1007/978-3-662-49660-2?no-access=true

The initiative covers social (soft skills), economic (hard skills) and offers an environmentally sustainable approach. In addition to the SDG 3 it addresses SDG 13 to take urgent actions to combat Climate Change by creating green, healthy and sustainable hospitals that mitigate their impact on climate change and reduce their carbon footprint. This is outlined in our article on green hospitals (see added link) http://www.samj.org.za/index.php/samj/article/view/11768/0 To reduce resources lean management tools and the reduction of waste are outlined and examples are given. Besides, methods are given how to reduce the amount of financial resources through Business Engineering and re-Engineering and the application of the Balances Score Card. This goes hand in hand by using resources more economically, more effectively and efficiently.

The initiative was started over 6 years ago and then adapted to a developing country index. The Healthcare Innovation Hub was established 4 years ago and promotes sustainable and innovative healthcare. Since this time various initiative are taking place, e.g. two innovation drives were conducted. The relevant management tools are standardized and highlighted in the book “High performance in hospital management” that is applicable in all health care settings worldwide aiming to improve service delivery. There is no limitation in relation to the durability of the initiative.

Yes

The initiative is regularly evaluated by the staff. Besides, it was evaluated by external examiners and recommended to write it up as a book. Other parameters such as incidents, adverse incidents, patient and staff satisfaction as well as waiting times are monitored and analysed on a regular basis. These parameter clearly show that overall service delivery has improved and lives could have been saved.

According to the continuous improvement process we optimize hospital management tools and methods on a regular basis. Regular feedback sessions take place and new healthcare initiatives are started and implemented throught the healthcare innovation hub.

The following indicators are used: The patient journey within the hospital and on the healthcare platform by using adequate and new electronic referral systems. The patient´s experience in the hospital by analysing the patient satisfaction rate. The amount of adverse incidents are documented and analysed. Critical incident resporting and the Swiss Cheese Model is rolled out in the hospital in order to reduce the hospital infection rate and avoidable deaths. The amount of patient complaints is monitored and analysed. The hospital infection rate is monitored and regulary reported. Initiatives such as antibiotic stewardship and standardisation of peripheral and central lines have been impelented throughout the hospital. Waiting times in the emergeny units and outpatient clinic are monitored and processes are improved. All these indicators are monitored and analysed on a regular basis and displayed by visual management. Through this approach the outcome and efficiency of the actions taken are evaluated on a regular basis.

The project is done as a collaboration between the University of Cape Town, private health care providers, the provincial government and other service providers (e.g. e-health appliances). Healthcare is delivered and seen as a platform approach. It engages nurses, administration staff, clinicians, government representatives, academics and the private sector. For example solutions from the private sector are taken up and then transferred and rolled out in the public sector, e.g. electronic referral systems but also vice versa (e.g. reduction of carbon footprint, green and healthy hospital initiative).

We have implemented visual management to make the used tools more perceptive and applicable for all levels of staff. The initiative aims to upskill people and engage them in a continuous improvement process. Through the healthcare innovation hub we drive innovation, improved service delivery and change through regular engagement with staff of all hierarchical levels. Hence it becomes necessary to provide lectures on various topics (healthcare ecomomics, rational use of resources, soft skills, managerial skills, etc.) which are performed at the healthcare innovation hub and at other healthcare facilities. We use a bottom up instead of top down approach to engage all levels of hospital staff including administration, clinical and medical staff as well as students to make the implementation of innovative and new projects more successful and implement change. The book supports the initiative as a reading material and learning tool.