efficient management: success stories of partner facilities

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Efficient Management: Success Stories of Partner FacilitiesAssociate Professor, Chair of Social Medicine, Health Care Organization and Medical Law, Ivano-Frankivsk NMUZoya Tsikhon23 April, 2015Kyiv

1Training for Managers and Implementation of Management InstrumentsEfficient management practices and approaches are key to good functioning of a facility and the system. If a manager has a strategic vision and experience using management instruments, he will be able to identify weaknesses and strategies to overcome them much more easily.The Program has offered Head Doctors short trainings on relevant management issues.Topics for the trainings were chosen based on managers practical needs. Also, international experience was actively involved, and it was adapted to Ukrainian circumstances.2Topics for Trainings for Health Care ManagersHealth Care Quality ManagementElements of Strategic ManagementSituational AnalysisStakeholder AnalysisDecision Making3Topics for Trainings for Health Care ManagersHealth Care Quality Management

Technological ManagementImplementing Principles of Energy EfficiencyMonitoring Concept and InstrumentsRegionalization of Perinatal CarePerinatal Audit and BABIES MatrixFundraising (involvement of additional resources)4Head doctors who were trained under Program say it allowed them to change their management vision and approaches, that facilitated their work, they were able to get a more in-depth view of the processes, they better understood efficient management mechanisms.

5Many Management Instruments Have Been Implemented in Partner FacilitiesUnderstanding monitoring principles allows Head Doctors to constructively perceive monitoring results and recommendations provided.

With the help of S matrix HCF review perinatal indicators that lets them identify problem issues.

SWO analysis and stakeholder analysis are used by managers in their routine work for situation assessment and decision-making

6Many Management Instruments Have Been Implemented in Partner FacilitiesKnowledge about fundraising has helped some Head Doctors to involve additional resources to renovate their facilities and purchase medical equipment

OpenMEDIS software (see Section on Implementing ICT-based Instruments) was installed in 55 partner facilities to analyze information about medical equipment and decision-making regarding its maintenance and use

7Implementing Principles of Energy Efficiency at Pilot Health Care Facilities

8Thats How Decisions Were MadeAfter training on energy efficiency the majority of hospitals took measures on facilities insulation. After implementing energy saving technologies more comfortable conditions were created both for patients and staff

9Principles of Energy Efficiency Were Implemented in All Pilot RegionsIn total, in partner regions principles of energy efficiency were implemented in 64 partner facilities.

For example: In Ivano-Frankivsk Oblast, 65% of partner HCFs were transferred to alternative types of heating.Estimated annual savings will be 12,97 MIO UAH or 2,128 MIO m3 of natural gas.

Investors input 6,7 MIO UAH

10Energy Efficiency in Kolomyia In January 2015 the Kolomyia CRH has changes the gas heating to alternative heating by wood chips that gives the opportunity to save approximately 25% of the budget for energy

11Examples of Implementing Principles of Energy Efficiency in Volyn OblastHCFs in Volyn OblastWhat has been done for energy efficiencyExpenditures (UAH)Outcome Manevytska Central District HospitalReconstruction of a boiler room and installation of a heating boiler 950- (fuel type wood chips)547 500Fuel consumption to produce 1 Gcal has decreased by 1.8 % Over the heating season cost of saved energy resources will be 69,2 K UAHRozhischenska Central District HospitalReconstruction of a gas boiler room and transfer to solid fuel (wood chips)1 200 000.00 UAHComfortable heating rate was provided, economic benefit due to this introduction is about 600 K UAH per year12Examples of Implementing Principles of Energy Efficiency in Volodymyr-Volynskiy Terrritorial Medical UnitHCFs in Volyn OblastWhat has been done for energy efficiencyExpenditures (UAH)Outcome LaundryInstalling automatic laundry machines70 000Savings

8 000 UAH/monthCDHInstalling boilers to get hot water65 000Estimated savings

12 000 UAH/month13Reconstruction and Renovation of Facilities Providing Perinatal Care

14The Program Helped Partner Facilities Managers to:correctly determine priorities for renovation/reconstruction of health care facilities and for purchasing of medical equipment

get funds for the HCF from various sources (communication with administration, using principles and practices of fundraising)

assess and apply a principle of rational zoning prior to reconstruction or renovation

15Application of fundraising knowledge helped some Head Doctors use additional resources to renovate facilities and purchase medical equipment

16Mohyliv-Podilsk Hospital Head Doctor: Our desire to participate in the program inspired large-scale changes in infrastructure and equipment!

480 thousand UAH were allocated from the Oblast budgetLocal budget money were involvedMoney of sponsors were involvedWe applied recommendations of Program experts regarding correct zoning

17Mohyliv-Podilsk Hospital Vinnitsa Oblast

18Rozhischenska CDH Volyn OblastActivities:

Participation in fundraising training in KyivDevelopment of design estimates for project fundraisingLooking for potential investors interested in project implementationNegotiations with investor (Charitable Foundation of an MP of Ukraine Serhiy Martyniak European Vector)

19Rozhischenska CDH Volyn Oblast

20Tlumatska CDHIvano-Frankivsk OblastVisit of Mother and Child Health Program experts to the facilityFacilitys staff decision and management commitment regarding necessary reconstructionDeveloping technical documentation with help of Program expertsSubmitting proposals to the Oblast level (OSA and Oblast Council) 350 thousand UAH allocated Support by stakeholders (San Gaben company 200 thousand UAH, businesses, entrepreneurs) Using money of local government 250 thousand UAH

21Ivano-Frankivsk Oblast

Tlumatska CDHVerkhovinska CDH

Dolinska CDHKosivska CDHKaluska CDH22Ivano-Frankivsk Oblast Perinatal CenterReconstruction of the old admission department area was driven by objective reasons:Construction of a new building was stopped;Patients and visitors complained;New Head of OSA Health Department visited the OPC;Looking for potential investors;Involving OPC staff to renovations.

23Ivano-Frankivsk Oblast Perinatal Center

24To reconstruct admission department of the Oblast Perinatal Center it took:12 thousand UAH from Oblast budget;Money from investors and charity (dairy production facility of Ivano-Frankivsk, gas station, Caritas, charitable contributions).

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All Maternity Departments at Partner Oblasts Have Implemented New Technologies in Perinatology

Kolimiyskiy MHGorodenkivska CDHRozhischenska CDHIvano-Frankivsk OPCMohyliv-Podilska OHIC26New Perinatal Technologies

Gorokhivska CDHKhmilnytska CDHKalynivska CDHIFOPCH27Medical Equipment The Program together with Head Doctors, Oblast HD/MOH, AR Crimea, regional teams has defined key needs of facilities regarding medical equipment to provide perinatal care. Medical equipment have been purchased for 56 partner facilities through bidding performed per international requirements.28Steps performed by Facilities Managers Regarding Purchasing New Medical EquipmentActual medical equipment needs assessment.Analysis of associated costs (consumables, spare parts, maintenance and repair).Training of personnel who will be working with the new equipment for its efficient use. Creating technical conditions for the equipment to work properly.Issue of maintenance for future.

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During one of the previous phases of the Program it was suggested to establish Medical Equipment Maintenance Centers as part of health care systemIn Ivano-Frankivsk Oblast Pediatric Clinical Hospital, Medical Equipment Maintenance Office was established under the Program, it continues to work today too32Regionalization of Perinatal Care and Health Care Reform in Ukraine Another success story.Under the Program, it was the first time in Ukraine that efforts were made to involve family physicians to provision of perinatal services.A Perinatal Services Package was developed and approved by the Order of MOH Ukraine of 12.07.2010N 560 About the Pilot Project to Implement Perinatal Services Package It was proposed to implement perinatal care system in accordance with levels -- of care provision.These steps were the first attempt to regionalize perinatal care in pilot Oblasts of Ukraine.33Implementation of management instruments by partner facilities managers yielded the following changes in terms of quality of perinatal care provided: Key performance indicators were improved: Normal delivery rate has increased up to 80-86%.Partner deliveries rate has increased 7-fold and on average it is 85-93%.Death rate in maternity hospitals of the 1st level decreased 5-7 times (down to 0 - 1%0).Neonatal morbidity rate has decreased 2-3 times.Implementing in utero transportation system and delivery before 32 weeks gestation at level 85-90%.

34A lot has been changed Sometimes it is hard to believe we used to do it differently Switzerland

Ukraine, Ivano-Frankivsk

35We learned how to save babies with severe abnormalitiesSwitzerland

Ukraine, Ivano-Frankivsk

Victoria S.36We learned how to care about babies with extremely low birth weight

Sashko . , birth weight 940g37Effect of Project Activities on I

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