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Service Development Program, 2001-2003

 

Philosophy

 

We believe that service should be:

 

The reason for existence of a department of surgery.

 

Rendered to the highest possible number of clients seeking assistance from a department of surgery.

 

Of the highest possible quality, with quality being loosely defined as client’s satisfaction and specifically defined as highest percentage possible in the resolution of the health problems of the clients with the least incidence of death, complications and disability and in such a manner that the clients are satisfied and will not file any complaint.

 

An effective and efficient provision of highest quality of medical care at the lowest possible cost.

 

Of the highest possible quality that is constantly promoted and improved by effective governance, continuous training of staff, and continual research.

 

 

Goal

 

To continually provide highest possible quality services to all clients of the department of surgery.

 

Performance Objectives (Targets)

 

Parameter

Target

How derived

Ideal

Realistic

Admissions/year

based on 80% occupancy rate

10-20% better than previous year

[no. of bed-day per year / ave. length of stay ] x 80% bed occupancy rate

Bed occupancy rate

80%

10-20% better

 

Average length of stay

4

1 –2 days better

 

Elective inpatient operations

Based on existing facilities and capability

10-20% better

no. of OR rooms/slots per week (3) x ave. no. of operations per OR day (6) x 52 weeks

Emergency inpatient operations

 

10-20% better

 

Ambulatory operations

 

10-20% better

 

Ambulatory clinic consults

 

10-20% better

 

Emergency room consults

 

10-20% better

 

Recovery rate

90%

 

 

Mortality rate

<1%

5%

 

Operative mortality rate

<%

5%

 

Morbidity rate

<5%

 

 

Cancellations

<10%

Better than previous year

 

Complaint

Zero

Not more than 3/year

 

Preoperative visits

2

3

 

Medical expense for major operations

 

Cost of essential needs

(P 5,000)

 

Tissue review (unnecessary operations)

10%

Better than before

 

Fibrocystic changes

 

Better than before

 

Normal appendectomy rate

 

Better than before

 

Disaster Preparedness Program

 

 

 

 

 

Strategies (General)

 

Effective leadership from chairperson down

            Effective in promoting achievement of performance objectives

            Effective in promoting achievement of the other strategies

           

            Leadership by training and coaching

Leadership by example

            Situational leadership – innovativeness and resourcefulness

 

Consultant-guided and assisted services from chairperson down

 

Structured departmental service development program with clear philosophy, directions, and policies; realistic short- and long-term targets; doable strategies; regular weekly and monthly monitoring; and continual quality improvement measures

 

Continuing education, training, and coaching of resident staff

 

Motivation-provision for resident staff

 

Donor-enticement or donor-development program 

 

 

Strategies (Specific)

 

Computation of the highest possible number of services that could be rendered to clients of the department of surgery.

 

2001- Computation of targets based on existing facilities and based on ideal standards and benchmarkings

 

2002 and 2003 – Computation of targets based on existing facilities and based on ideal standards and benchmarkings with adjustment to performance in the previous year.

 

Regular monitoring every Tuesday during the Preop and Postop Conference and Morbidity and Mortality Conference and during the Monthly Service Performance Report on the performance objectives and for any problems.

 

Action research on identified problems

Mandatory vs selective work-up of patients for elective operations

Sudden cancellation of scheduled elective inpatient operations

Tissue review on unnecessary operations

            Reduction of unnecessary fibrocystic changes operations

            Reduction of unnecessary appendectomy rate

Reduction and prevention of morbidities and mortalities

 

Prompt management of identified problems

 

Issuance of policies, directives, and procedures

Reduction of complaints

 

Support from top management

Lack of equipment

Lack of nurses

 

Multisectoral problem-solving and collaboration

            With anesthesiologists

            With nurses

            With pathologists

            With other departments

 

Donor development program

            Operasyon Pinoy

            Funds for indigent patients

            Electrocautery machines

            Surgical equipment

            Volunteer parasurgical staff program (medical secretary-clerk, nurse)

 

Training of surgical staff on quality service

 

Continual quality service improvement

 

 

Outcome

 

Parameter

Target

2001

2002

2003

Admissions

 

Better than 2000

Better than 2001

 

Bed occupancy rate

80%

Better

Better

 

Average length of stay

4

6

5

 

Elective inpatient operations

 

Better

Better

 

Emergency inpatient operations

 

Better

Better

 

Ambulatory operations

 

Better

Better

 

Ambulatory clinic consults

 

Better

Better

 

Emergency room consults

 

Better

Better

 

Recovery rate

90%

Better

Target reached

Target reached

Mortality rate

<5%

Target reached

Target reached

Target reached

Operative mortality rate

<5%

Target reached

Target reached

Target reached

Morbidity rate

<5%

Target reached

Target reached

Target reached

Cancellations

10%

10%

8%

6%

Complaint

Not more 3 per year

6

1

1

Preoperative visits

 

6

2

2

Cost of major operations

 

P 10,000 to P5,000 (Sept)

P 5,000

P 5,000

Tissue review (unnecessary operations)

10%

Baseline

Better

Better

Fibrocystic changes

 

Baseline

Better

Better

Normal appendectomy rate

 

Baseline

Better

Better

Disaster preparedness program

 

 

 

Formulated

 

 

Future Plans

 

To sustain and institutionalize the service development program

 

To improve further on certain service parameters that still need and can still be improved

 

To market the department of surgery so as to increase the present service capacity