Land Mines in Health Care

1. Land Mines in Health Care Presented by Keith Bonsall Director, Halcyon Management Services Specialists in Hospital Management

2. To Provide Care to a Patient one needs the following basics……….. • Oxygen • Suction • Defibrillator • Medical devices e.g. intubation • Measuring devices e.g. vital signs monitors • Diagnostic services e.g. Radiology and pathology • Medication • Dressings and other surgical devices

3. But to ensure the appropriate application of these “tools” one needs…… • Competent doctors • Competent nurses • Competent support staff These 3 critical components make up the ultimate team in ensuring the wellbeing and life of a patient!

4. Therefore the Landmines!!! • Doctors lacking in diagnostic skills • Nurses lacking in clinical skills • Support staff not understanding their role in the patient care process

5. These Landmines Leads to…………… • Poor quality of care • Adverse advents • High risk to patient • Higher cost of care

6. Focus on Nurses • Consensus on shortage of resources • Supply and demand economics are forcing increase in costs • Constant cry from Nursing that there is a shortage on the Ward or in Theatre • Limited job satisfaction • Nursing becomes “just a job”!

7. What Does a Nurse Do? • Studies conducted in USA have shown that between 30 – 40% of a Ward nurses time is spent on non-nursing duties! • Ordering stock • Counting stock • Running to get script from pharmacy • Administration duties • Telephone usage • Walking between sluice, stock, linen and equipment rooms

8. Management’s Objective : Prevent the Landmines • To keep the nurse at the bedside • Applying her/his knowledge and qualification, skills and experience in providing the best nursing care • Eliminate, or at least reduce, adverse events and therefore risk to patient • Generally reduce exposure to any risk (patient, staff, public, financial loss, fire and safety etc) • Training, training, training!

9. Structural Limitations • Policies, protocols or SOP’s that are out of date and not practical • Scope of practice that may limit flexibility to categories of staff • Procedures and processes that are not efficient e.g. too much paper or too many levels of communication • Low performing people that are not counseled, guided or trained to produce more effectively • No Risk Management structure in place

10. Definition of Risk • “A risk of danger, a possibility of incurring loss or misfortune” • “Risk is the chance of something happening that will have an impact upon the achievement of objectives……” • “An adverse event that impacts negatively on the outcome of patient”

11. Some Core Sources of Land Mines • Communication – between all persons and stakeholders in the care delivery process • Finances – relating to revenue, costs, cash flow, working capital, funding and controls • Information management – data accuracy, timeousness, validity, accessibility • Quality assurance – customer satisfaction levels, clinical outcomes, infection rates, death rates • Coordination – leadership, management styles, attention to detail, processes, systems, integration of multi-functional departments

12. Land Mine Categories : How the Hospital Functions (The Drivers) • What physically happens (process and outcomes) • Who people interact with • The degree to which customers (patients) interact with staff • The skill level required to provide the services within the function • The tools and equipment required to provide the services • The physical working environment • The general external environment that impacts on that function • The laws and regulations that may govern that function

13. Land Mine Areas • Nursing • Skill, competence and qualification of Nurses • Compliance with standard operating procedures (SOP’s) • Complying with infection control procedures • Needle stick injuries • Complying with doctors orders exactly as prescribed • Appropriate supervision, management and support • Regular training in clinical techniques and updating nursing practices • Regular training in improving interpersonal relationships

14. 7 Effective Management Responsibilities that will Reduce Landmines and Their Impact • Credentialing of medical staff – Doctors and Nurses • Incident monitoring and tracking • Complaints monitoring and tracking • Infection control • Documentation in the medical record • Support by management to ensure that nurses are spending at least 90% of their time at the bedside • Managing compliance with SOP’s

15. Summary • “Doctors cure, Nurses care” – ensure that this team is optimally functional • “First, do no harm” – ensure that attitude of staff towards patients (and colleagues) is positive and appropriate • Doctors and Nurses are at the forefront in the delivery of quality patient care – ensure that all supporting infrastructures are designed to achieve this consistently

16. Elimination of Landmines will: • improve quality of care • improve staff satisfaction • improve clinical outcomes • reduce cost of care

17. The Dynamics of Control and Influence The Management of Outcomes Through the 2 Drivers: The Hospital and Doctor

18. What Influence Does Hospital Management Have Over Key Operational Factors?

19. The Patient

20. Profitability

21. Performance and Capex

22. Financial Cash Flow

23. Are All Your Ducks in a Row??

24. Thank You!