Baish General Hospital implemented several innovative approaches to improve key performance indicators (KPIs) across different departments. In the emergency department, assigning a bed coordinator helped reduce wait times for admission and a dashboard improved monitoring of patient journeys. A centralized bed management department activated hospital-wide helped reduce length of stay and increase weekend discharges in the inpatient department. In outpatient, a calling center project reduced no-show rates by reminding patients before appointments. Data showed these approaches helped sustain steady performance in meeting KPI targets after overcoming initial impacts from the COVID-19 pandemic. Lessons from the projects' success were shared with other regional hospitals.

1. Ada’a Health – Most Improved Services
Hospitals

2. Name and type of organization
Contact Details
Baish General Hospital
Jazan
Name(s) of author(s)
Hind Hamoud Kherat
0553345875
Contact Number
Email
hkherat@moh.gov.sa
Jubran Hamoud Albeshi
0534068413
Contact Number
Email
jalbeshi@moh.gov.sa

3. Description Of Innovative Approach

4. Description of innovative approaches (Hospitals)
 ED patients have a long wait to be admit to the ward and ICU when a bed is available due to poor communication
between ED and IP staff which leading to solve this issue through:
 Assign ED bed coordinator to manage and follow patients disposition to other department
 ED team create a dashboard that include patient journey with time in each destination and recorded which resulted in
KPI improvement.
 Centralized Bed Management Department Activated in hospital
 IP team and bed management team create electronic form & use a tool called (RED 2 Green). This tool design to collect
data about each patient journey and that its' indicate whether the patient is ready for discharge and what reasons are
delaying their discharge. If they are not discharged must recorded as having a red day with a clear reasons. A Green day
when patient receives value adding acute care that progress towards discharge and when everything planned is done.
 Bed management and quality team created flow chart of patients' admission from ED, OR and OPD.
 Create "organization chart" of bed management unit that include different area in hospital (ED, OR, IP and OPD) with a
good impact to launch many projects correlation each other with effective outcome. For example in ED Bed coordinator
project that help to manage patients flow and disposition within 4 hours, whereas create OR coordinator to manage
patient flow between IP and OPD to schedule elective.
 Increased percentage of now-show rate in OPD which leading to solve this issue through launch call center team
project in OPD
 OPD team create an Excel sheet to collect data and analyzed reason of no-show rate. This demographic information
obtained to determined top 15 % of patients most likely to no-show. Begin calling patient 7 days before schedule
appointment as remainder which impact in monitoring and maintaining the KPI.
 Improve staff skills through conduct training and workshops in different area (ED staff, OR, OPD and IP staff).

5. Engagement with clinicians in improvement activities
RED 2 GREEN Training program with the participation of all relevant clinicians
 Clinicians had participate in approval of policy and procedure of projects.
 Increase awareness of clinicians the importance of provide care within 4 hours and follow that by
dashboard in ED.
 Weekly meeting between medical director, nursing director and domain leader, quality assurance
director and bed management unit to facilitate improve the procedure of patients' admission.
 In IP, clinicians have a clear role and engagement in bed management unit, that help to improve LoS
and weekend discharge indicators.
 Weekly meeting with patients experience department, PIO, CA and domain leaders of OPD, ED and
IP that to measure patients satisfaction.
 Monthly meeting with hospital director and stakeholders to discuss and mentor recommendation for
each projects.

6. Description: In 2020- the Percentage of patient disposition within 4 hours were slightly affected due to the pandemic of COVID 19,
after launch the project of Assign a bed coordinator supervisor to reduce waiting time between ED and admission to ward/ICU; the
KPI of door to disposition has sustained steady performance. Moreover, establish dashboard in the ED was the main key to mentors
and improve KPIs during the project.
Door to…
96.00%
98.00%
100.00%
Jan
Feb
Mar
Apr
May
Jun
Jul
98.30%
100.00% 100.00% 100.00% 100.00% 99.80% 100.00%
Door to disposition 4 h
2021
Door to disposition (% Patients
seen within 4 hours)
Patient Satisfaction -2021
Dashboard that Created at ED
to follow patients'disposition
CASE STUDY 1
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Apr May
100%
Baseline Data
For April and May of 2020
100%
 Emergency Department (MANDATORY)

7. Description: IN Outpatient department, the percentage of no-show was high which let OPD team to create the project of Calling
team Center to call patients before their appointments as a reminder, to decrease no-shows. In 2021 the KPI of No-show has reach to
target percentage 8% and sustained steady performance. However, this project has a good resulted by increasing patients’
satisfaction and changed customer culture which that courage them do not miss their appointment.
Patient Satisfaction -2021
CASE STUDY 2
0.00%
5.00%
10.00%
J A N
F E B
M A R
A P R
M A Y
J U N
J U L
9.20%
8.10%
6.90%
1.90%
1.80%
1.70%
0.80%
0.00%
20.00%
40.00%
60.00%
A P R
M A Y
20.00%
44.40%
Baseline Data
For April and May of 2020
2021
No-show Rate
 Outpatient Department

8. Description: Length of stay in the inpatient department rose above recommended level and percentage of weekend discharge was
much lower than world-class level due to covid-19, however after the project of centralized bed management activated; the LOS
decreased and percentage of weekend discharge increased and improve staff skills and knowledge of KPIs that sustained steady
performance and met the goal.
Length Of Stay Rate
Patient Satisfaction -2021
CASE STUDY 3
0
5
jan
feb
mar
apr
may
jun
jul
3.8 3.3 3.6 3.2
1.7
3.9 3
Length
Of
Stay
Rate
0.00%
50.00%
Jan
Feb
Mar
Apr
May
Jun
Jul
23.30% 27.20%
17.30%
24.50% 23.00% 21.60% 23.70%
Selected By PWC as a success story in southern region -2021
0.00%
20.00%
Apr May
8.50%
11.60%
Baseline Data For April and May of 2020
2021
6
8
10
apr may
8.2
7
2021
2021
Baseline Data For April and May of 2020
Weekend
Discharge
Rate
2021
 Inpatient Department

9. Sharing of lessons learned with other facilities
 Create a poster of bed management unit and share with south region as success story.
 Exchange experience of call center team project with Asir central hospital through PWC.
 Sharing the experience of kainexues website and monitor projects with other colleagues
from different hospitals in the region and RHD.
 PIO and CA visited the command center in RHD to discuss focus improvement projects
and learning new skills with dashboard.

10. Endorsement of facility director
Mr. Essa Abdullah Jafari
Hospital Director
The hospital director has assigned and approved an improvement projects with
stakeholders. He encouraged the developments in the areas that need to improve as well
as provided full support. Certificate of thanks and praise were presented to all staff
involved in the projects improvement process. the participation in Ada’a health awards
2021 approved by hospital director.

11. We Thank You for Your Participation in
Ada’a Health Awards 2021
End of Application