Presentacin de PowerPoint

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Process-Based Management in the Andalusian Public
Health Service
Directorate-general for Quality, Research and
Knowledge Management Directorate-general for
Health Care
19 April 2007
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IN THIS PRESENTATION WE WILL LOOK AT

• Andalusian Regional Health Ministry-overview
• Healthcare Processes-Our Approach
• Identifying and Establishing Process Priorities
• Designing the Processes
• Implementation of the Processes in the
• Healthcare System
• Evaluation and Assessment

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INFRASTRUCTURE

• 7,700,000 POTENTIAL USERS/CLIENTS
• 81,000 EMPLOYEES
• 33 HOSPITALS AND 4 HIGH RESOLUTION CENTRES
• 32 PRIMARY CARE DISTRICT ASSOCIATIONS
• 7 BLOOD TRANSFUSION CENTRES
• 7 HEALTH CARE MANAGEMENT AREAS
• 061 PUBLIC COMPANY FOR HEALTH EMERGENCIES
• 8 COORDINATION CENTRES
• 1,508 BUILDINGS/CENTRES
• 4 FOUNDATIONS FAISEM, THE HEALTH QUALITY AGENCY
  , HEALTH AND PROGRESS, IAVANTE

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ANDALUSIAN PUBLIC HEALTH SYSTEM
IN ONE YEAR

• 600,000 Hospital Admissions
• 10 Million Specialist Appointments
• 640,000 Operations
• 3.5 Million Patients seen in Casualty Departments
• 55.5 Million Primary Healthcare Appointments
• 7,187.65 Million Budget

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STRATEGIC FRAMEWORK
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STRUCTURE OF ANDALUSIAN REGIONAL HEALTH MINISTRY
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DIRECTORATE GENERAL FOR QUALITY, RESEARCH AND
KNOWLEDGE MANAGEMENT
MISSION To promote the Continuing Improvement of
the services offered to the general public by
furthering quality and innovation in health care
services, research, knowledge management and
accreditation systems. VISION To be a Reference
Point for Quality for the Andalusian Public
Health System based on the continuing and
progressive implementation of improvements to all
sectors involved in the health service. VALUES Ou
r work is inspired by values which regard the
Citizen as the central figure of our activities
based on Teamwork, Cooperation, Continuity,
Creativity and Innovation.
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PROCESS-BASED MANAGEMENT
A management system governed by principles of
total quality which aims to provide professionals
with the knowledge of which aspects to improve
and with the tools to effect improvements.
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APPROACH

• Focus on the patient
• Leading role of the professionals
• Start with clinical health care processes
• Focussing on health care continuity
• Aim for effectiveness
• Integrated development (case history, portfolio
  of services , skills maps, clinical management
  ...)

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STAGES OF THE PROJECT
Identifying and establishing process priorities
Designing the processes
Implementation
Assessement and improvement
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IDENTIFYING AND ESTABLISHING PRIORITIES FOR KEY
PROCESSES
Information sources analysed

• Most frequent GRDs
• Surgery waiting lists, specialist opinions and
  additional tests
• Statistics for preventable mortalities
• Healthcare surveys
• CMBD data
• Portfolio of PC and SC

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IDENTIFYING AND ESTABLISHING PRIORITIES FOR KEY
PROCESSES

• ...the processes identified

• Are related to strategic aims, necessities and
  patients expectations
• Show clear opportunities for improvement
• Great variability
• Frequency
• Comprehensive

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PROCESS DESIGN METHODOLOGY

• ...to start by specifying the areas of health
  care actions, defining the recipients, exploring
  their expectations, designing itineraries,
  looking for evidence, defining activities, skills
  and resources, creating graphics and providing an
  appropriate set of indicators.

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TRAINING OF WORKING GROUPS

• Professional involvement
• Multi-disciplinary and multi-funcional groups
• Methodological support

• Guidelines for design and continuing
  improvement
• Session scripts
• Bibliographical support

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CARE PROCESS...


Type 1 Diabetes
Preferential access for any kind of problem Ease
in acquiring instruments for controls Coordination
between GPs and hospital doctors Professionals
with knowledge and experience Appropriate
information permanently available for
decision-making Psychological care for youths and
their families
Other Specialists
Opthalmologist
Visiting the endocrinologist
(periodic monitoring)
prescriptions
Paediatritian/GP/Nurse Periodic monitoring
a
More frequent appointments Single
appointments Telephone helpline Also medical care
on demand
Hospital
Health Centre
Private Healthcare Specialist
Hospital
Professionals with knowledge and
experience Problems solved in situ Preferential
and rapid access
b
Hospital Ward
Casualty
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ONCE EXPECTATIONS HAVE BEEN IDENTIFIED....
They are included in the health care processes,
transforming them into quality characteristics of
the tangible services offered
Health care Aimed at the patient Information
Aimed at the patient and family Coordination
Aimed at the Healthcare Professionals
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GENERAL DESCRIPTION
SEQUENTIAL SPECIFICATION WHO does it... WHAT
is done... WHERE it is done... WHEN it is
done HOW it is done....
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QUALITY REGULATIONS
ALL ACTIVITIES MUST HAVE QUALITY FEATURES BASED
ON THE BEST MEDICAL EVIDENCE AVAILABLE. DO WHAT
NEEDS TO BE DONE, AND DO IT WELL. FIRST TIME!
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SKILLS WITHIN THE HEALTH CARE PROCESS

• Necessary skills
• Knowledge (KNOW...)
• Skills ( KNOW HOW...)
• Attitudes ( BE, WILLINGNESS...

• Different phases of development
• Advanced
• Optimum
• Excellent

• Classification of skills
• Desireable (D)
• Essential (E)

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• MAP 1
• CEREBROVASCULAR ACCIDENT
• HEALTH CARE FOR MULTIPATHOLOGICAL PATIENTS
• ANXIETY, DEPRESSION AND SOMATIZATIONS
• OSTEOARTHRITIS OF THE KNEE AND HIP
• CERVICAL CANCER AND CANCER OF THE UTERUS
• BREAST CANCER/EARLY DIAGNOSIS
• CATARACTS
• MIGRAINES
• CHOLECYSTITIS AND CHOLELITHIASES
• PALLIATIVE CARE
• DEMENTIAS
• TYPE 1 AND 2 DIABETES
• ABDOMINAL PAIN
• CHEST PAIN ( GENERIC, AMI, ANGINA
• STABLE, UNSTABLE, IAM WITHOUT ST, STABLE ANGINA,
  ACUTE AORTIC SYNDROME and TEP).
• PREGNANCY, LABOUR AND PUERPERIUM
• CRONIC OBSTRUCTIVE PULMONARY DISEASE
• HIP FRACTURE

• TONSILLECTOMY/ADENOIDECTOMY
• ANEMIAS
• ARRHYTHMIAS
• ASTHMA
• SERIOUS TRAUMA CARE
• COLORECTAL CANCER
• SKIN CANCER
• DYSPHONIA
• THYROID DISFUNCTION
• DYSPEPSIA
• FEVER OF INTERMEDIATE DURATION
• CIRAL HEPATITIS
• LUNG CANCER
• EARLY HEALTH CARE
• ABNORMAL UTERINE HEMORRHAGES
• ABDOMINAL HERNIAS
• CHRONIC VEIN INSUFFICIENCY
• MIDDLE EAR INFECTION
• ARTICULAR PROSTHESIS

MAP 2
CLINICAL LABORATORIES SURGICAL BLOCK IMAGE
DIAGNOSIS HAEMOTHERAPY CLINICAL NUTRITION
Support Processes
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PORTFOLIO OF SERVICES BY HEALTH CARE PROCESS

• Definition
• Criteria for inclusion
• Criteria for offering
• Primary health care
• DCCU-AP (critical and emergency health care
  department primary health care)
• SCCU-AH (hospital critical care and accident
  service)
• Specialist health care
• Medical and surgical hospitalization
• Quality regulations
• Target population
• Information and record systems
• Indicators (production, technical-scientific
  quality, effectiveness,..)

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EVALUATION OF QUALITY REGULATIONS

• Basic Quality Regulations
• Criteria for inclusion and exclusion and
  exceptions
• List of variables for measuring regulations
• Indicators
• Sources and variables (CMBD CIE )

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IMPLEMENTATION

• Inclusion of Processes in management tools
• Reinforcement of inter-level structures
• Carrying out prior analysis of the situation
• Ensuring local adaptation
• Internal communication plan
• Training programme
• Ensuring measurement and assessment
• Strategies for continuing improvement

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IMPLEMENTATION (1) MANAGEMENT TOOLS-1

• Subsidised Courses
• SAS-Primary Health Care District
• SAS-Hospital
• SAS-Management Area
• Collaboration agreements between hospitals and
  districts
• Management agreement UGC
• System of incentives
• Guaranteed response times (surgical, specialists
  and additional tests)

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IMPLEMENTATION(2) MANAGEMENT TOOLS-2Objectives

• By the end of 2006 the hospital, in coordination
  with the healthcare districts, must have
  implemented a minimum of 20 phase 2 health care
  processes within the hospital area by the end of
  2006. Those newly incorporated will implement
  phase 1 health care processes.
• Joint annual control panel of 10 health care
  processes

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IMPLEMENTATION(3) MANAGEMENT TOOLS-3Objectives

• Processes with priority implementation should be
  selected in the following way
• Compulsory processes Guaranteed response time
  processes included in the Decree 96/2004 (State
  gazette nº 62, 30 March), comprehensive plans,
  high frequency and special attention groups. All
  must be included.
• Priority Processes included in comprehensive
  plans At least 5 must be included in this group.
• Others The remaining processes developed by the
  Regional Ministry are included in this group. At
  least 3 must be included.

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IMPLEMENTATION(4) MANAGEMENT TOOLS-4Objectives

• Cerebrovascular Accident Start of
  de-aggretating treatment within the first 48
  hours in 75 of patients with signs of
  de-aggregation.
• Care of the multiple pathology patient The
  percentage of multiple pathology patients
  identified by EBAP will be over 6 of the over-65
  population assigned to this service.
• Cervical cancer/cancer of the uterus The
  percentage of patients in FIGO stages from IIB to
  IVB in post-treatment stages should be less the
  15 of the total number of cases and this number
  the trend should be to decrease.
• Breast cancer The percentage of patients
  diagnosed with invasive tumours should follow a
  decreasing trend in relation to the data from
  2005.
• Cholelithiasis/cholecystitis Where surgery is
  necessary at least 70 of the patients will
  receive laparoscopy...

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IMPLEMENTATION(5) Organisational Structure

• Defines priority criteria and apply priorities
  to the processes to be implemented
• Constitutes the development and implementation
  teams
• Sets up the timetable
• Is responsible for ensuring feasibility

Joint Interlevel Committee

• Designates the person responsible for the
  process
• Establishes a working timetable
• Delimits the process and/or subprocess
• Carries out a situation analysis
• Identies and manages problems prior to
  implementation
• Establishes basic objectives in connection with
  the implementation
• Selects the indicators
• Driving force behind the implementation process
• Communication plan

Process Development and Implementation Groups
(PC-EC)
Local implementation teams. Improvement groups

• Responsible for local implementation and process
  improvement

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IMPLEMENTATION(6) Prior Analysis and Local
Adaptation

• Describe what is currently being done
• what is being done correctly
• what is being done unnecessarily
• what isnt being done but should be
• Analysis of records and information systems.
• Problems related to training, resources,
  organizational measures, critical issues
  detected.
• Prioritization and plan of action

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IMPLEMENTATION(7)Communication Plan

• Design of internal communication plans for the
  professionals involved and for different levels
  of health care

Helps professionals to change and become involved
Offers transparency, coherance and precision
TO WHOM
WHO
HOW
WHEN
WHAT
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IMPLEMENTATION(8) Training Programs-1
Processes prioritized after local situational
analysis
Interactive CD
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IMPLEMENTATION(8) Training Programs-2
Virtual Environment
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IMPLEMENTATION(8) Training Programs-3
Blended Learning

• Interactive CD-ROM

www.procesosasistenciales.com
Virtual Environment


david.riley_at_iavante.es
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IMPLEMENTATION(8) Training Programs-4

• 100 Local Training Coordinators trained
• 8,500 Health Professionals trained 2006
• 31,739 Accesses to e-learning platform in 2006
• 25,000 Training Target by 2007

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ASSESSMENT AND IMPROVEMENT
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PROCESSES IMPLEMENTED PRIMARY CARE HEALTH CARE
DISTRICTS 2006
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THANK YOU VERY MUCH FOR YOUR ATTENTION
WE WILL BE PLEASED TO ANSWER ANY QUESTIONS YOU
MAY HAVE ARISING FROM THIS PRESENTATION
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Additional Information Facts, Figures and Results
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IMPLEMENTATIONTraining plan

• Priority will be given to the necessities
  detected by the situation analysis

• Cervical cancer/cancer of the uterus
• Effective selection programme
• Training in triple sampling
• Cytology interpretation (Bethesda)
• Handling of outpatients (colposcopia-biopsy)
• Deciding on HPV

• Breast cancer
• Mammary exploration
• Treatment of benign lesions
• Counselling and HATD techniques
• Reconstruction and breast implant techniques
• Sentinel lymph node...

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IMPLEMENTATION. Assessment
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INFORMATION SYSTEMS PRIMARY ATTENTION

• 3 coexisting computer systems TASS, Diraya 3 and
  Diraya 4.
• TASS distributed servers.
• Diraya 3 distributed servers and centralized
  information.
• Diraya 4 completely centralized. Centralized
  information.
• Non-computerized centres.

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EVOLUTION OF THE PROCESSES IMPLEMENTED ACCORDING
TO PROVINCE 2003-2006
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PATIENTS, INCLUDING PROCESSES 2004-2006
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PAI CERVICAL CANCERCoverage 2005-2006
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PAI CERVICAL CANCERCoverage 2005-2006
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PAI DIABETESCoverage 2005-2006
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PAI DIABETESCoverage 2005-2006
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Nº of patients with at least one diagnosis of
HbA1c lt 8 2005-2006
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Nº of patients with at least one diagnosis of
HbA1c lt 8 2005-2006
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PAI HBP- Prostate cancerCoverage 2005-2006
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PAI HBP- Prostate cancerCoverage 2005-2006
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PAI Pregnancy, Labour and Puerperium Coverage
2005-2006
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PAI Pregnancy, Labour and Puerperium Coverage
2005-2006
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Nº of women who make their 1st visit before the
12th week of gestation 2005-2006
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Nº of women who make their 1st visit before the
12th week of gestation 2005-2006
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OBSERVANCE OF QUALITY REGULATION CONTROL SHEET
PC-HC, 2006