Building Collaborative Leadership within the Public … case...Building Collaborative Leadership within the Public Health Sector: ... • Core business vs Non core ... Comelec, P&S,

Building Collaborative Leadership within the Public Health Sector:

Inkosi Albert Luthuli Central Hospital

Dr SM DhlomoMEC for Health – KZN: Sibaya

Casino 10/09/09

AERIAL VIEW OF IALCH

Physical Environment

• The lay out- gate, laundry, nurses residence is like a five star hotel.

• Doctors have decent rooms, parking, library/study result in increased morale

• Decent admin block, entrance and wards

COMMISSIONED IN 2002

RATIONAL/LOGIC

• Core business vs Non core• Rationalisation of tertiary and quaternary

services (KZN and E.Cape)• Resource limitation• Risk transfer

• Core business vs non core- 100% Outsourcing of facility management

• Equipment- The company buys, maintains and trains the staff on use of equipment which improves the running of the services in hospital

• When equipment reaches its life it is sold and the fund goes back to maintenance of equipment

• RATIONALISATION- Idea of academic hospital came before 1994

conceptualisation was to have a improved King Edward VIII hospital, but there were no funds. King Edward is a full combo, Wentworth limited service, Addington (racial lines-oncology etc.)

- Resource limitation• Treasury approached along PPP lines to enable

Government to free resources for improving health services (10 point plan in health)

• Risk Transfer-Strikes cripples the non core functions of

hospitals which drives the strikes.-Core functions therefore become affected-Risk here is transferred to Private Partner.• Clinical staff deals with the core business.

Approach to Feasibility Study - IALCHEssentially a three component PPP

Facility Management - Hard and SoftIT systems - Installation, maintenance, management and refreshment

Medical Equipment - Installation, maintenance, management and refreshment

Public sector Comparator costed with required outputs as though provided by public sector

Included public sector retained costs (HR & Consumables)

Risk adjustment exercise

•In 1996 report of hospital strategy commission by DOH was presented titled Achieving Equity, Efficiency and Accountability: A vision and strategy for SA public hospital.•The strategy realised that for efficient function of hospital we needed appropriate management structure with key ingredient that informed the SMT.•10 Point Plan of Health

SCOPE About Inkosi Albert Luthuli Central Hospital (IALCH)

Management Structure

Why the Public Private Partnership Route?

Impilo Consortium

The Electronic Patient Record

Electronic Patient Record Effect

Applications Architecture

The Penalty Regime

What Could We Learn?

Management of Public Private Partnership

About IALCH

Referral Hospital with a Distinct Entry/Exit criteria

PPP Contract for 15 years – in the 8th year of operation

In partnership with IMPILO CONSORTIUM

The Contract includes

Medical Equipment (Procure, Maintain and Replace)

Non-Medical Equipment (Procure, Maintain and Replace)

Film less and Paper-less Operation (Leading to Electronic Patient Record)

Full Information Management &Technology Services (IM&T)

Hard and Soft Facility Management (FM)

About IALCH

800 + 46 Burns Unit-bed Tertiary Central Hospital

•807 Beds are usable•39 Beds are in the Critical Care Domain and are not utilised due to HR Challenges

There are 19 Theatres inclusive of:•2 Trauma theatres and 1 Burns Theatre

RESIDENCE•Total: Single Units: 318•En-Suite: 88•Double Share: 24•Duplex: 6

How do Patients get referred here?

Referrals can be from one of the following origins:

· Referrals from other hospitals through Doctor to Doctor consultation · Revisits/Follow-ups

Appointments Appointments can be requested telephonically or by e-mail. Alternatively, the referral letter can be faxed or posted to the hospital, after which an appointment can be given.

An Appointment Reference Number is generated and the referral hospital/doctor advised of the number. If the appointment is requested by e-mail, the referral letter must still be produced at the time of the appointment.

The Partnership

The Partnership

=+ IALCHPPP

Liaison Committee

DOH-Core

Impilo-Non-Core

PrimaryActivities

SupportActivities IM & T FM Med

Equip.

Liaison CommitteeHlanganani

&Co-lateral structures

Our Value Chain

Our Value Chain

InfrastructureProcurementTech. Development

Human Resources

In-b

ound

Logi

stic

s

Out

-bou

ndLo

gist

ics

Mar

ketin

g&

Sal

es

Ope

ratio

ns Service

Delivery

Delivery

Primary Activities

Supp

ort A

ct.

The Linking Pin Role

The Linking Pin Role (Core Business Structure)

Senior Management TeamSenior Management Team(SMT)(SMT)

Domain Management TeamsDomain Management Teams(DMT)(DMT)

Cost Centre Management TeamsCost Centre Management Teams(CCMT)(CCMT)

SMT

SMTH

RM

anag

er

Fina

nce

Man

ager

Chi

efEx

ecut

ive

Med

ical

Man

ager

Nur

sing

Man

ager

== SMTSMT++++ ++ ++++

Syst

ems

Man

ager

Clinical Domain Groupings

SURGICAL DOMAINSURGICAL DOMAIN MEDICAL DOMAINMEDICAL DOMAIN PERI-OPERATIVE CARE DOMAIN

PERI-OPERATIVE CARE DOMAIN

PROFESSIONAL ALLIED TO MEDICINE DOMAIN

PROFESSIONAL ALLIED TO MEDICINE DOMAIN

MOTHER & CHILD DOMAIN

MOTHER & CHILD DOMAIN

CLINICAL HOD’SOpthalmologyNeurosurgeryNeurologyCranio FacialENTBurnsOrthopaedicVascularUrologyCardiothoracicMaxillo FacialTraumaStomatheraphyPlastics

CLINICAL HOD’SRespiratoryMetabolic/ EndocrineRenalHaemodialysisPeritoneal-dialysisPlasmaphoresisInfectious DiseaseGI & LiverDermatologyRhematologyCardiologyOncologyHaematologyBone Marrow transplants

CLINICAL HOD’S

Theatres 1 – 19

ICU 1 – 4

Burns

Trauma

Anaesthetics

CCU & Cat Lab

HOD’SPhysiotherapyOccupational TheraphySpeech Therapy/AudiologyDieteticsClinical PsychologySocial WorkGeneral ImagingMedical PhysicsRadiology

CLINICAL HOD’SObstetricsGynaecologyPaediatric ClinicsPaediatric Surgery NeonatesMothers Lodges

DMT & Accountability

DMT -ACCOUNTABILITY

ANMDBM

CEO

CCM

FinMangr.

Clin.HoD

HRMangr.

SystMangr.

MedMangr.

NursMangr.

Cost Centers

•This ensures accountability and team work.e.g. Case managers can easily notice whatever is happening with patients resulting in increased performance and dedicated staff.

Impilo Consortium StructureImpilo Consortium Structure&&

ShareholdingShareholdingSiemens

(31%)Siemens

(31%)AME (20%)AME (20%)

Drake & Scull (9%)

Drake & Scull (9%)

Vulindlela (26%)

Vulindlela (26%)

Mbekani (7%)

Mbekani (7%)

Omame (7%)

Omame (7%)

IMPILO CONSORTIUM

MEDICAL EQUIPMENT

SIEMED

Vulindlela / Siemens

IM & T EQUIPMENT & SOFTWARE

AME Africa

AME / Vulindlela

FACILITIES MANAGEMENT

Drake & Scull

CCS, Ikhwezi, Fedics,Iliembe, York Int, Supreme Air,

Siya Zama, Khulani, Zonke,Omame, Mbekani, Millennium, Mozzies,

Savuka, Mounties,Edison, Schindler, Comelec,

P&S, Minerva

East Coast Medical

Olympus Labotech

Leica Zeiss Nucletron

Agfa Maquet Braun

Amercare Sirona Miele

Draeger

Business ConnexionHP

BCX / CDE Occulus

InFocus HealthMedicom

Siemens Medical Solutions

INTRODUCTION

INTRODUCTION

InternetIntegrationwith PACS

EPR

Nursing-InformationMedical Indications

Integration of all important

Medical Information

Laboratory Results

Reporting

Intensive Care Unit

IntegratedPatient

Information

IntegratedPatient

InformationWEB

ACCESSTELEMEDICINE

© AME international Ltd, all rights reserved

The IALCH Electronic Patient RecordThe IALCH Electronic Patient Record

•IALCH is a paper, less hospital.Efficiency-Lab results are entered into a computer, Doctors don’t get frustrated by waiting for results e.g X-ray,-Learnt from the Doctors strike that it is one thing to pay them well but is another to have good working conditions.

Platform HP / CompaqORACLE

Material MgmtFinancial

AdminSystems

SAP FinancialsHL7 HL7

PACS

Sienet

SIEMENS

Network CISCO

Microsoft

OfficeInternetIntranet

Desk-top

RadiotherapyLantis

SIEMENSHIS

RIS

PhIS

MEDICOM

EPR

LIS

HL7

SQL

DocumentMgmnt

RemedyHelp Desk

Executive Info System

ApplixTM1

CriticalCare

Monitoring

Siemens

Oracle

© AME international Ltd, all rights reserved

Applications ArchitectureApplications Architecture

How Did The EPR Affect Nurses & Doctors

Initially notes taking is slower– This is normal. And it improves

No lost notes. No excusesNo ‘lost’ or illegible orders – or results!Orders and results available much quickerX-rays and Scans available to all – not just reportsImproved patient care– Notes ALWAYS available– Instructions include timescales – AND can be checked!– Records are complete – and very obvious if not!

No repeated entry of basic detailsEntire history within the hospital is available

The Partnership

• THE AGREEMENT is BETWEEN:(1) KWAZULU NATAL DEPARTMENT OF HEALTH, acting for and on

•behalf of the KwaZulu Natal Provincial Government;(2) COWSLIP INVESTMENTS (PROPRIETARY) LIMITED (company

•registration no 2000/027079/07); and (3) IMPILO CONSORTIUM (PROPRIETARY) LIMITED (company

registration no 2001/007273/07).

• Ithala is a statutory company wholly owned by the KwaZulu Natal ProvincialGovernment and Cowslip is a wholly owned subsidiary of Ithala.

• Cowslip was established for the purposes of the project and subscribesfor shares in Project Company.

Management of PPP

The accounting officer or accounting authority is responsible

for ensuring that a PPP agreement is properly enforced, and

must establish mechanisms and procedures for –a) monitoring and regulating the implementation of, and performance in terms

of, the agreement;

b) liasing with the private party;

c) resolving disputes and differences with the private party;

d) generally overseeing the day-to-day management of the agreement; and

e) reporting on the management of the agreement in the institution’s annual

report.

Management of PPP

A PPP agreement does not divest the accounting

officer or accounting authority of the

responsibility for ensuring that the relevant

institutional function is effectively and efficiently

performed in the public interest.

Management of PPP

Management Framework at IALCH

• Senior Management Team

• Joint Operations Management

(Hlanganani)

• Penalty Committee

• Liaison Committee (Principals)

• Collateral Structures (Operational Level)

Penalty Regime

Main Focus of the regimeAvailabilityAvailability of critical areas of the hospitalof critical areas of the hospitalResponse to calls for helpResponse to calls for helpRestoration of ServiceRestoration of ServiceQuality of deliveryQuality of delivery

Termination Points & Rand PenaltiesTermination arrangements for persistent poor performance over time –Firm but fair

Lessons Learned?

Is the PPP process the answer to all outsourcing in Health?

Yes - if you have done your homework.

Yes - if you have a clear vision of where you want to go

Yes - if the project is big enough, big enough to realise economies of scale.

Yes - if there is complete commitment to the procurement process

No - if you think it is the easy way out

No – if you think that the outsourced functions are no longer your responsibility

No – if you think it is going to save you millions

Project and contract management skills will be required

Courage, Vision and Leadership from top management is a prerequisite

3 DIMENSION CT SCAN REPORTING STATION

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FOYER OF THE FLAGSHIP HOSPITAL OF KZN

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