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Rwandafinalpresentation 130419162730-phpapp02

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  • Scale, impact, complexity
  • Home to health care to hospital is going well! (dan’s and MAP team’s projects)Our project will focus on patient tracking to address follow up care and resource planning
  • Matt is the most skilled, Annie is the least skilled
  • <Point>Managed differently- Documentation: different among institutions- ID number: currently only for hospital- Record filing: currently only at hospital
  • Patient don’t have to carry the file for insuranceRegistrationFirst visit: Fill yellow appointment card, blue record, white patient card, submit 3 referral papersSecond visit and after: Submit yellow appointment card, white patient cardYellow card: Appointment card After consultation, date of the follow up visit written in the yellow card is different from yellow insurance cardAlmost everyone-Insurance 10% (hospital)-Insurance: over 200RFc covered (patient fee is maximum 200Rfc)ID number is not written in white patient card.ID number is only written in yellow appointment card(patient keeps) and blue record (hospital keeps)Even though the treatment finished once, patient have to keep that because it is the only wayTo know their each ID.
  • Create a vision for changeHelp staff connect with the vision of change. Help them understand their own roleE.g. survey. Not enough to obtain verbal approval. They understand the need for change, but not strong enough
  • Short term programs help address geographical constraints
  • Patient don’t have to carry the file for insuranceRegistrationFirst visit: Fill yellow appointment card, blue record, white patient card, submit 3 referral papersSecond visit and after: Submit yellow appointment card, white patient cardYellow card: Appointment card After consultation, date of the follow up visit written in the yellow card is different from yellow insurance cardAlmost everyone-Insurance 10% (hospital)-Insurance: over 200RFc covered (patient fee is maximum 200Rfc)ID number is not written in white patient card.ID number is only written in yellow appointment card(patient keeps) and blue record (hospital keeps)Even though the treatment finished once, patient have to keep that because it is the only wayTo know their each ID.
  • <Point>Based on the 3 background reasons, realistically, it is difficult to change current employee’s mind to do additional and unfamiliar work.However, electric data improves process efficiency, for example data to submit to MOH can be created at onceIn addition, it is evident that the day comes, when it should manage data electrically. (Maybe must convert paper data into electric data)There should be young, not so expensive worker with computer skills in younger generation. Hire those staff temporarily should be the best option. He might not need to come to Ruli. If it is not possible, assign staff with computer skills might be an option. For example, in Rukura healthcare center, there is less patient, less busy and several employee with computer skills. Not only assigning staff internal hospital, seeking also from heathcare center can be an option.
  • <Point>For mid-long term, the day will come, the day from when Health Center should manage patient record by its own decision or regulation of MOHCost efficient (same printing, purchase at once  scale merit)Easy to manageBetter for information sharingStandardization makes employee transfer easier- Managing by ID number and consistent filing system helps patient tracking much- In additon, Fax transmission will help those patient information sharing

Transcript

  • 1. A Path to Solving Ruli Hospital’s Patient Tracking ChallengesAnnie Snider, Kevin Wooster, Matthew Downer, Penelope Mallinckrodt, Yasuo Tsurumi3/8/2013
  • 2. Ruli Hospital and Health Centers provide animpressive array of health care servicesScaleComplexityPrideImpact
  • 3. Further elevate center of excellence through improved patient tracking Home Spring 2013 Project Health Care CenterSpring 2012 Project HospitalSummer 2012 Project
  • 4. Status Update Recommendation Successful? Include patient phone numbers in appointment setting call Use Microsoft Access for electronic registration andRuli Hospital appointment logs Sort new charts as created to reduce search time Return charts to registration after doctor consults Triage patients with appointmentsHealth Centers Shift appointment making from data manager to cashier Adopt electronic registration log Centralize patient record keeping
  • 5. Four Areas of Focus Behavioral Dynamics Patient Tracking Process Improvements Implementation Future Opportunities
  • 6. Behavioral Dynamics
  • 7. Behavioral Dynamics Intro Slide Area Need Recommendation Capabilities Quick way to understand Skills Matrix Knowledge and display staff capabilities Variability of Resources to meet demand Cross-Team Demand at peak times Collaboration
  • 8. Create a skills matrix to better understand capabilities Registration File Computer French English Interpersonal Adapts to System Skills Language Language Relations Change Annie Matt Yasu KevinPenelope
  • 9. Encourage cross-team collaboration to meet demand at peak times 8:00 14:00Consults Consults Registration Registration Accounting AccountingReception Reception
  • 10. Patient TrackingProcess Improvements
  • 11. Data collection and management systemsare inhibiting accurate patient tracking Area Need Recommendation Current tracking system duplicates work at every Standardize patient Data Collection level forms throughout system Current resources do not easily allow for consistentData Management Use Mutuelles Data and thorough data management
  • 12. Standardizing records between healthcenters will make processes more efficientLocation Forms Record Keeping Patient Hospital Form Record Ruli Appoint- By visit dateHospital Referral Mutuelle ment Form Card CardRuli &Nyange Patient Mutuelle Mutuelle No recordHealth Form Card Document storedCenter Other Patient Mutuelle Mutuelle No recordHealth Form Card Document storedCenters Rukura Health Center
  • 13. Multiple forms with the same information lead to inaccurate data, duplicated work and bottlenecks 1. Reception 2. Insurance 3.Registratio 4.Consultation 5.Accounting 6. Pharmacy Make copy of and Submit Examination, Remit Pick up patient accounting referral form treatment, etc. payment for medication insurance Fill in the diagnostics card insurance file and Pick up blue treatment Remit record Orientation Payment Same Data ID ID ID ID ID ID Invoice to MutuelleInsuranc Insuranc Insuranc Insuranc Insuranc Insuranc mutuelle Document e e e e e e Patient Card Patient Card Patient Card Patient Card Patient Card Patient Card Patient takes home Health Info may Referral Referral Referral Referral Referral be sent to Form Form Form Form Form Center Data Manager CHW Nurse Record Patient Patient delivers to may be Record Record reception filed and stored at hospital
  • 14. Result of complicated data collection • Disorganized files • Duplicated records • Cluttered workspace • Long patient wait times
  • 15. Mutuelle Office
  • 16. The Mutuelles are excellent source ofexisting patient data High adoption rates mean that 80+% of population already have aSubstantial health record Mutuelles verify symptoms, diagnosis and treatment twice in the Accurate same month of health facility visit (this is done at the district level) Both paper and electronic records are highly organized and accessibleOrganized • There is already a mutuelle office at every health center • Mutuelles already understand the health center patient file systemConnected • Mutuelles already partner with health centers for community health education
  • 17. Patient arrives with ID/Insurance card, oneform circulates and information is utilized Mutuelle ID/Insura Document nce Mutuelle Office/Reception •Check in •Pick up medical chart Pharmacy Accounting Mutuelle Mutuelle Document •Pick up medication •Remint payment for Document consultation Data Mutuelle Community Manager Worker Health Worker Accounting Reception Mutuelle •Pay for tests and treatement •Enter system (wait area) Mutuelle Document Document Consultation Mutuelle Document
  • 18. Benefits to both patient care facilities andmutuelles outweigh challenges Challenges Solutions Perceived conflict of interest Governance system proposed by the senate in March will strengthen checks and balances and improve the Mutuelles’ ability to maintain quality data Mutuelles currently do not track Maintaining hospital and health non-members or lapsed center records enables local members Mutuelles to implement targeted marketing to increase adoption Some mutuelles only keep Central government oversight electronic records of costs, not will enable efficient training and diagnoses resource allocation
  • 19. Integrated Mutuelle Governance Central Government MoH Mutuelle Fund AdministratorsHospital/Health Center Mutuelle District (Audits and Overviews) Clinicians Finance/Accounting Mutuelle Sector Administrative Staff HR (Day-to-day Management) Operations Data Manager Mutuelle Data (Local Mutuelle office) Reception/Registration
  • 20. Mutual gains create impact on overall health of the communityAction Benefit to Mutuelle Cost ImpactCollect and Consumer data allowing Minimal There is a positive correlationmaintain records targeted marketing between mutuelle membership andfor non-members which increases the quality of health. A mutuelle adoption rate member is 51% more likely to visit a health center than a non-member1Store patient data Data representing entire None Better community education lowersat the community population enables spread of disease and poor healthhealth center mutuelle to act faster practices with education  Lowers costsServe as hub for Clear understanding of Minimal Consistent reporting of health statusdissemination of health status allows for to all stakeholders; better informsdata efficient actuarial community health workers which processes. In addition, improves follow-up care better follow-up care lowers mutuelle costs.1. Bayege, Innocent. Contribution des mutuelles de sante à laccessibilite de la population aux services de sante. Université Nationale Rwanda. [Online]. 2005
  • 21. Implementation
  • 22. Identify obstacles and solutions for implementation Process Resource Prior Recommendations Successful Change Addition Include patient phone numbers in appointment setting call Use Microsoft Access for electronic registration andRuli Hospital appointment logs Sort new charts as created to reduce search time Return charts to registration after doctor consults Triage patients with appointmentsHealth Centers Shift appointment making from data manager to cashier Adopt electronic registration log Centralize patient record keeping
  • 23. Manage change carefully to ensure longterm success Align key Motivate and Consolidatestakeholders Communicate
  • 24. Align Key Stakeholders• Define stakeholders more broadly • Include the three sisters• Enlist a core change team • Ensure suitable personal attributes • Endow with positional power & credibility• Map stakeholder resistance and support • Focus on neutral and positive to generate critical mass
  • 25. Motivate and Communicate• Create a sense of urgency • Securing verbal buy-in is not enough• Connect changes to a deeper purpose • Link to impact on patient• Implement visual management tools (Whiteboards) • Information becomes more widely accessible • Celebrate successes • Enhance cross-team collaboration
  • 26. Sample WhiteboardFriday, March 8th, 2013 Record Keeping Outstanding Records Mon Tues Wed Thurs Fri 27 Patients Treated / Electronic Records Entered Key Personnel Issues Dr. Avite In Office Ministry of Health supervisor visits Friday Sister Carmen In Office In Kigali X-Ray machine is not working MOH Admin Out of Office until Thurs. Doctor #1 In Office Drug X stock is low Doctor #2 In Office Only one doctor next Thursday Dept. Chiefs In Office
  • 27. Consolidate gains• Align systems with the changes • Recruitment & training • Performance appraisal and rewards• Align structures with the changes • Fill key positions with right people• Plan for quick wins • Start small • Maintain momentum
  • 28. Future Opportunities Rotational Program Expand the Community Health Worker Role
  • 29. Rotational programs expand training andhelp make Ruli a center of excellence Hospital Registration Ruli Rukura Data Reception Manager Already has clinical rotational program Nyange Surgical Rushashi Consults Maternity Muhondo
  • 30. The Community Health Worker program canbe expanded to improve Patient tracking Potential Opportunities Impacts Patient Interaction - Improved quality of care - Serve more Rwandans - May identify unknown contributors - Can get holistic view of Patients to patients’ maladies - Can have more time with patient Observation + Monitoring - Improved patient outcomes - Chronic conditions - Earlier interventions - Signs of infection - Fewer secondary visits to HC s or Hospital - Side effects of medication - Lower recurrence rate Follow through of treatments - Less need for 2nd visit to HC or Hospitals - Less development of drug resistant strains (e.g., tuberculosis)
  • 31. Conclusion
  • 32. Key Takeaways • Skills MatrixBehavioral Dynamics • Cross-Team Collaboration Patient Tracking • Record StandardizationProcess Improvements • Mutuelles Data • Align stakeholders Implementation • Communicate and motivate • Act and consolidate • Rotational ProgramFuture Opportunities • Expand Community Health Worker Role
  • 33. Questions
  • 34. Contact Info Team Members Email Address Matt Downer Yasuo Tsurumi Annie Snider Kevin Wooster RwandaTeam2013@umich.edu Penelope Mallinckrodt
  • 35. Appendix
  • 36. Patient flow: Ruli Hospital 2. Insurance 1. Reception and 3.Registration 4.Consult- 5.Accounting 6. Pharmacy accounting -Make copy of - Fill in/submit ation - Make - Medicine to patient - Fill in the documents payment for be pick up insurance file - Necessary medicine and insurance -pick up treatment, card - Make examination personal blue examination, - Orientation payment for record etc. given consultation • Blue • Blue Patient Patient record is carried record back to registration Patients bring in by nurse Patients bring back • White • White • Yellow • Yellow • White• Yellow • Yellow appoint Insurance Patient Appoint Insurance Referral Patient Form Card ment Card Card ment Card Card card - General Info (name, address, etc.) - Information about vital, diagnosis, medicine ID number
  • 37. Patient flow: Ruli & Nyange Health Centers 1. Insurance 2. Reception 3.Consult- 4.Accountings 5. Pharmacy 6. Insurance Office - Office - Check ation - Medicine to symptom and - Make be pick up -Bring back-Pick up - Necessary sort out payment personalpersonal treatment, - Check vital examination, sheet (Blue)sheet (Blue) signs etc. given Data ManagerPatients bring in set appointment Patients bring back if patient needs to • White • Yellow • White be referred.• Yellow • White Referral Insurance Patient Insurance Patient Form Card Card Card Card (if referred to hospital) - General Info (name, address, etc.) - Information about vital, diagnosis, medicine ID number
  • 38. Patient flow: Other Healthcare Centers 1. Reception 2. Insurance 3.Consult- 4.Accountinga 5. Pharmacy 6. Insurance - Check Office Office ation - Make - Medicine tosymptom and payment be pick up -Bring back sort out - Necessary -Pick up treatment, personal - Check vital personal examination, sheet (Blue) signs sheet (Blue) etc. given Data ManagerPatients bring in set appointment Patients bring back if patient needs to • White• Yellow • Pink be referred. • Yellow • Pink Insurance Simple Referral Insurance Simple Card Notebook Form Card Notebook (if referred - Information about vital, diagnosis, medicine to hospital) ID number
  • 39. A new way of electronic recording inthe hospital• For more efficiency and future needs Detach from daily operation Assign inputting electronic data to others with computer skills • Hire temporary (young) staff having Reception computer skills for a day per week only for data input Pharmacy Registration or • Assign existing staff (in both hospital and healthcare centers) having computer skills and quite low- Consultation Accounting utilization time in a week to data input for a certain hours per week
  • 40. Standardization among hospital and healthcare centers Long term proposal • Start keeping records also at • Track and Keep patient healthcare centers information based on ID number • Manage with the same format unified among the hospital and among the hospital and healthcare centers healthcare centers Image (example) Image (example) -Top side Basic patient info -Patient card -Shelf for patient record (ID, address, etc) 0000 ID number: Diagnosis  1000 XXXX information -reverse side 1001  2000 2001  3000 Diagnosis information 3001 Year &date  4000