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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 [email protected]
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Untuk dimenangi !
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