hospital kluster terengganu selatan - …hkemaman.moh.gov.my/images/pdf/hospital_kluster... · •...

U N I T K L U S T E R

HOSPITAL KLUSTER TERENGGANU SELATAN

(HKTS)

X RESIDENCE

SPECIALISTS

CONGESTED

SOPHISTICATED FASILITIES

SPECIALIST HOSPITALS

UNDERUTILIZED

BASIC FASILITIES

NON -SPECIALIST HOSPITALS

WHY HOSPITAL CLUSTER Sumber: Slide Dato’ Dr. Azman bin Hj. Abu Bakar 21.09.2016

RESIDENCE SPECIALISTS

Problems

• Overutilization of specialist hospitals

• *77% of 14 hospitals have BOR>85%

• Underutilization of non specialist hospitals

• *83% of 44 Non specialist hospitals have BOR < 50%

Contributory Factors

• Non Specialist Hospitals (NSH)

• Bypassing phenomenon

• Poor optimization of resources • Young doctors not motivated

• Specialist Hospitals • Rapid development of tertiary

services

• Services compete for facilities(OTs, ICU beds etc)

• Lack communication with NSH

• Increase demand

WHY HOSPITAL CLUSTER

• Outcomes

• Fragmented care

• Inefficiency and wastage of resources

• Delays in treatment

• Medical errors

• Hospital acquired infection

• Reduce patient /staff satisfaction

• Staff burn out *(CRC survey 2010-2011)

3 Mesyuarat JPPKK

5

SHARED OWNERSHIP AND OPERATION OF SEVERAL HOSPITALS

Redesign and reconfigure services Cluster wide Approach (Operations, Finance, HR)

• Type/scope of services that will serve cluster

– Level of services to be offered (rotation of

specialists, visiting specialists, phone

consultations)

– Minimum standards for services (clinical,

clinical support and non clinical support

services)

• Privileging processes at HC

• Care pathways and SOPs

• Infrastructure upgrades(ICUs, HDUs beds, OTs

etc)

• Lead Hospital as Head Quarters

• PTJ2 with dummy account for budget consolidation

• Hospital beds Management,

• EMR/Single Folder, folder to go along with patient

• Single billing

• Flexibility in HR deployment

• CSSD, blood bank, labs, catering services, HIMS,

• Centralization of procurement (Pharmacy, asset,

facilities management)

• Quality Management,

• Hospital Support services etc

• Case mix system

• Communications

• Monitoring & Evaluation

I N T E G R A T E D N E T W O R K O F

H O S P I T A L S A N D C A R E D E L I V E R Y

RESPONSIBILITY OF CLINICAL CARE WITHIN CLUSTER

• Specialty-LED in higher risk centers

• Specialty-DIRECTED in lower risk centers

• Single care pathway system throughout the cluster

• Easier and faster step-up care

• More flexible step-down care

• More competent MOs and paramedics

• More appropriate referral to higher centers

• More procedures done at lower risk centers

Specialists level leadership & responsibility

• Specifically assigned area of responsibility

• Rotating assignments between hospitals

• More senior staffing in district hospitals

• More junior staffing provided opportunities to train and gain more experience in lead hospitals

• On-call mechanisms using shared common pool in (non specialist) hospitals

Rostering and Staffing

7 Mesyuarat JPPKK

1. DECONGESTION

2. DECENTRALIZATION

3. IMPROVING

RESOURCES

UTILIZATION

• BOR Medical and O&G : at Specialist hospital

was 90-115% ---- now ↓ 80-85%

• Decentralization:

Plastic Surg. move to → Non Sp. H

• Ward: BOR non-specialist hospitals

was 30-50% ---- now↑ > 60-80%

• Operation Theatre:

0 procedure --- now → > 20/year

• Clinic:

0 Opthal pts --- now → >500pts/yr

BENEFITS OF CLUSTERING SUMBER: SLIDE DATO’ DR. AZMAN BIN HJ. ABU BAKAR 21.09.2016

5. KPI IMPROVEMENT

4. IMPROVING CARE/

COMPETENCY/SKILL at Non Sp. H

• Step down cases

was 39-52 cases/mth

now ↑ 87-99

• ED procedures: was <10/mth

now↑ > 20- 40/mth

CSSD

• High workload at Specialist Hospital

• Reduction of Downtime Autoclave machine from 26.8% to 6.3%

7. REDISTRIBUTION

Transfusion

Service

• IMPROVEMENT of 12.8% for blood collection ( 8774 units in 2013 to 9895 units in 2015) without adding more resources.

Pharmacy - Centralised Purchasing

• COST SAVING

• 2014 – RM 3,202.00

• 2015 - RM 10,851.00

6. CENTRALIZATION

MORE BENEFITS Sumber: Slide Dato’ Dr. Azman bin Hj. Abu Bakar 21.09.2016

SENARAI HOSPITAL KLUSTER KKM

KLUSTER

TERENGGAN

U SELATAN

(HKMN-HD)

LATAR BELAKANG Daera

h

Popul

asi Hospital Jenis

Kema

man

450,0

00

Hospital

Kemam

an

Pakar

Major

Dungu

n

173,2

00

Hospital

Dungun

Tanpa

Pakar

HSN

Z

H

D

HK

MN

HTA

A

80 km

70 km

60 km

Disiplin HKMN Pakar

HD

Perubatan 3

Pediatrik 3

Psikiatri 2 *

Nefrologi 1

Pembedahan

3

Ortopedik 3

O&G 3

Oftalmologi 1 *

ORL 1 *

Kecemasan 2 *

Anestesiologi 2

Patologi 2

Radiologi 2 *

Rehabilitasi 1 *

Jumla

h Katil ICU

Dewan

Bedah

Ambula

n

HK

MN 150 6 4 10

HD 100 0 0 8

Jumlah

Anggota

Juml

ah

MO

Jumlah

Paramedik

HKM

N 933 119 368

HD 449 36 204 *Pesakit Luar

sahaja

PEMBAHAGIAN KEPAKARAN

PROJEK HOSPITAL KLUSTER: TERENGGANU SELATAN

Hospital Kemaman Hospital Dungun

Perubatan Am, Pediatrik

- Step Down Care

Perubatan Am

- Step down care

Pediatrik

- Step down care

O&G

-reducing referrals

A&E

- Increase

appropriateness of

management

OBJEKTIF

OBJEKTIF UMUM • Meningkatkan kesamarataan dan kebolehcapaian

perkhidmatan kepakaran bagi populasi Terengganu Selatan, terutamanya di Kemaman dan Dungun.

OBJEKTIF KHUSUS 1. Menurunkan BOR Pediatrik dan Perubatan di

HKMN (Lead Hospital, LH) dan meningkatkan BOR di HD (Non Lean Hospital, NLH).

2. Meningkatkan appropriate management referral pesakit bagi kes kecemasan di NLH.

3. Mengurangkan rujukan kes Obstetrik & Ginekologi dari NLH.

4. Meningkatkan bilangan kes pembedahan di LH.

S

T O

W

STRENGTHS WEAKNESS

THREATS OPPORTUNITIES

HKMN: Bilangan Pakar dan MO

yang optima. Turn over rate MO yang

rendah.

HD: Bilangan MO dan paramedik

yang mencukupi.

Turn over rate MO yang rendah.

HKMN:

Fasiliti terhad.

Jarak yang jauh antara hospital.

NICU back-up yang terhad (4 katil

sahaja).

Hanya 3 Dewan Bedah yang

berfungsi penuh akibat kekurangan

anggota paramedik

HD:

Tiada Dewan Bedah.

MO kurang kompeten.

Tiada ICU/ HDW back-up.

HKMN: BOR yang tinggi bagi Perubatan

& Pediatrik.

HD: BOR yang rendah.

Mother rooming-in. Jumlah kes rujukan daripada

O&G yang tinggi. Laluan jalan raya yang baik.

HKMN: Pesakit tidak menerima step-

down care di HD. Pengangkutan pesakit ke HD

hanya bergantung kepada

pengangkutan hospital daerah.

HD: Infrastruktur yang masih kurang

optimum di HD.

EXPECTED OUTCOME No. Objektif Khusus KPI Sasaran

1. Menurunkan BOR Pediatrik dan Perubatan di LH dan meningkatkan

BOR di NLH

1. Meningkatkan BOR di NLH. > 80%

2. Meningkatkan penerimaan pesakit untuk step-down care.

> 60%

3. Mengurangkan BOR Pediatrik & Perubatan di LH. < 85%

2. Meningkatkan appropriate management referral pesakit bagi kes kecemasan di NLH.

4. Meningkatkan appropriate management referral daripada NLH.

> 90%

5. Peratus anggota kesihatan dari NLH (telah bekerja ≥ 1 tahun) yang dilatih dan diberi Sijil Privileging.

> 50% (tahun ke-1) > 75% (tahun ke-2) 100% (tahun

ke-3)

3. Mengurangkan rujukan kes Obstetrik & Ginekologi dari NLH

6. Peratus rujukan bagi kes berkaitan komplikasi kandungan trimester pertama dari NLH.

< 80%

7. Meningkatkan BOR disiplin Obstetrik di NLH. > 50%

4. Meningkatkan

bilangan kes pembedahan di LH

8. Bilangan anggota NLH yang menjalani attachment

di LH. > 10 orang

9. Meningkatkan kes pembedahan di LH. > 20% *

*dari tahun

sebelumnya

PERTANDINGAN LOGO

DAN MOTO

Contoh MOTO

“Right care, Best care,

Accessible to all”

Contoh LOGO

• Reka bentuk mestilah baru dan asli serta tidak

mengandungi unsur atau elemen yang boleh dianggap

sensitif dan boleh menyinggung mana-mana pihak.

• Logo hendaklah dihasilkan dalam bentuk “softcopy”

menggunakan format ber-resolusi tinggi.

• Pereka hendaklah memberi keterangan atau penjelasan

ke atas ciptaan logo.

SPESIFIKASI PENCIPTAAN LOGO

• Terbuka kepada semua warga Kluster Terengganu Selatan

• Penyertaan adalah PERCUMA

• Peserta boleh menghantar seberapa banyak penyertaan (hanya 1

nama, logo & moto akan dipilih sebagai pemenang).

• Semua logo & moto yang direka mestilah asli dan tidak ditiru dari

mana- mana logo & moto tempatan mahupun luar negara.

• Hadiah RM 100 untuk logo dan RM 100 untuk moto terbaik.

• Tarikh tutup penyertaan sehingga 31 Mei 2019.

• Emailkan penyertaan kepada annas@moh.gov.my

SYARAT & TERMA PERTANDINGAN

Wang tunai bernilai

RM200

Untuk dimenangi !

HADIAH

TERIMA KASIH