Systems Approach to Hospital Operations - Department of Surgery

1. The Systems Approach to Hospital Operations - Using Department of Surgery as an Illustration Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg February 21, 2015 UP College of Public Health HA 202 [Organization and Management of the Different Hospital Departments]

2. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program

3. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Department of Surgery Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Applicable to any department, clinical and non-clinical! Surgery OR-RR ER Others

4. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program 22 elements Essential Interdependent Interfacing 22 elements – must be Aligned Integrated

5. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program 22 elements Essential Interdependent Interfacing 22 elements – must be Aligned Integrated

6. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Department of Surgery Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program

7. LEADERSHIP • LEADERSHIP of a department of surgery is the governing body of the department of surgery. • The head, the chairperson, or the leader is usually appointed by a higher office.

8. LEADERSHIP • The head usually has a group of staff of the department assisting him, such as the – vice-chair; executive officer; vice-chairs for service, training and research; executive committee; chairman advisory committee; and other committees dictated by needs of the department.

9. LEADERSHIP • The primary responsibility of LEADERSHIP is governance of the department of surgery.

10. LEADERSHIP • Using the definition of Business Dictionary, this responsibility includes the following: • “Establishment of policies, and continuous monitoring of their proper implementation, by members of the governing body of an organization. It includes mechanisms required to balance the powers of the members (with the associated accountability), and their primary duty of enhancing the prosperity and viability of the organization.”

11. LEADERSHIP • At the very start, the head should make clear who are the members of the highest governing body of the department and spell out their position (role); functions (obligations, duties and responsibilities); and authority (power and privileges). – These should be contained in publicized documents such as organizational chart and governance manual.

12. LEADERSHIP • As they govern the department, the leaders should continually develop the concepts, policies and procedures, and evaluation systems of the 22 elements contained in the framework.

15. WHOLE HOSPITAL CONCEPT AND DESIGN • WHOLE HOSPITAL CONCEPT AND DESIGN basically means the vision and mission of the hospital where the department of surgery is a part of. – The vision and mission of the department of surgery should be aligned with those of the hospital.

16. WHOLE HOSPITAL GOVERNANCE POLICIES AND PROCEDURES • WHOLE HOSPITAL GOVERNANCE POLICIES AND PROCEDURES means that the governing body of the department of surgery must consider, be aligned, respect, coordinate, collaborate and integrate the whole hospital’s governance policies and procedures when it makes its governance policies and procedures for the department.

17. WHOLE HOSPITAL OPERATIONS POLICIES AND PROCEDURES • WHOLE HOSPITAL OPERATIONS POLICIES AND PROCEDURES means that the governing body of the department of surgery must consider, be aligned, respect, coordinate, collaborate and integrate the whole hospital’s operations policies and procedures when it makes its operations policies and procedures for the department.

18. INTERFACING UNITS’ OPERATIONS POLICIES AND PROCEDURES • INTERFACING UNITS’ OPERATIONS POLICIES AND PROCEDURES means that the governing body of the department of surgery must consider, be aligned, respect, coordinate, collaborate and integrate the interfacing units’ (such as other clinical departments and non-medical departments) operations policies and procedures when it makes its operations policies and procedures for the department.

20. FUNCTIONS (AUTHORIZED) AND DETERMINANTS • FUNCTIONS means the officially authorized functions, both general and specific, of the department of surgery. – These have to be clearly and completely spelled out and publicized. – These will serve as the main steering wheel or compass for the department development as well as bases for interfacing with other departments in the hospital, and also for evaluation purpose.

21. FUNCTIONS (AUTHORIZED) AND DETERMINANTS • The determinants of functions of the department of surgery can be external and internal.

22. FUNCTIONS (AUTHORIZED) AND DETERMINANTS • The external determinants include 1) statutory and regulatory requirements (Laws, DOH, local gov’t, PRC, PMA, Specialty Societies and Boards, etc.); 2) quality and performance standards (such as PhilHealth Benchbook, Joint Commission International, Accreditation Canada International); and 3) community expectations.

23. FUNCTIONS (AUTHORIZED) AND DETERMINANTS • The internal determinants include 1) hospital’s top management desires and decision (such as vision- mission and taking resources into consideration) and 2) coordination and integration system with other units in the hospital.

24. Examples of Functions of a Department of Surgery: General Function: •To provide medical services to all patients with surgical diseases who seek consultation and treatment in the hospital. Specific Functions: •To examine all patients with a possible surgical diseases and afterwhich, to make a rational and accurate diagnosis. •To provide treatment to all patients with surgical diseases. •To provide training in surgery. •To promote research in surgery

25. Examples of Functions of a Department of Surgery: General Function: •To provide quality health services to all patients needing management in the field of surgery (general surgery, colorectal surgery, pediatric surgery, urologic surgery, neurosurgery, plastic and reconstructive surgery, thoracocardiovascular surgery, and orthopedic surgery).

26. Examples of Functions of a Department of Surgery: Specific Functions: •To provide quality health promotion and disease prevention program in the field of surgery to clients in need of such service. •To provide quality and safe diagnostic and therapeutic procedures to all patients with surgical problems. •To provide quality and safe pre-operative, intra-operative, and post-operative surgical care to all patients in need of such health care service. •To provide quality rehabilitative health programs in the field of surgery to all clients in need of such service.

28. SERVICES (AUTHORIZED) AND DETERMINANTS • SERVICES means the officially authorized medical services, both general and specific, that the department of surgery will provide as dictated by the authorized functions. – These have to be clearly and completely spelled out and publicized. – These will serve as the bases for development, interfacing with other departments in the hospital, and also for evaluation purpose.

29. SERVICES (AUTHORIZED) AND DETERMINANTS Examples of Services to Offer (based on authorized functions): •Health promotion and disease prevention program •Diagnostic program •Therapeutic program •Pre-operative, intra-operative, and post-operative surgical care program •Rehabilitative health program

31. SERVICE OUTPUTS (COST-EFFICIENT / VALUE-BASED) • SERVICE OUTPUTS means the ultimate goals of the department of surgery in terms of service, which are generally and basically cost-effective or value- based services. The two adjective-phrases are closely related and may mean the same thing.

32. SERVICE OUTPUTS (COST-EFFICIENT / VALUE-BASED) • However, nowadays, the buzz -phrase is valued based services. This means that for every healthcare service rendered, on the part of the patient-clients, there is a perceived value for the money spent.

33. SERVICE OUTPUTS (COST-EFFICIENT / VALUE-BASED) • Value is usually defined as health outcomes over cost of delivery of the outcomes. • In simpler terms: good health care delivery outcomes (good results) such as optimal surgical mortality and morbidity rates; success treatment rates; and quality and safe services with reasonable costs and expenses.

35. DOH LICENSING AND STRUCTURAL REQUIREMENTS • DOH LICENSING AND STRUCTURAL REQUIREMENTS means compliance to DOH Guidelines in the Planning and Design of a Hospital and Other Health Facilities; Safe Hospital Initiative – structural, non-structural, and functional indicators; Building Code; Fire Code; local government requirements; etc.

37. PHYSICAL STRUCTURE (LOCATION AND SPACE) • PHYSICAL STRUCTURE refers to a geographical space or area in the hospital to construct the department of surgery to receive patient- and physician-clients requesting for services and to house the staff who will perform the functions of the department. • Service requirements as dictated by the authorized functions is the first determinant of the PHYSICAL STRUCTURE of a department of surgery.

38. PHYSICAL STRUCTURE (LOCATION AND SPACE) • The other determinants of the PHYSICAL STRUCTURE are the following: • 1) statutory and regulatory requirements; • 2) DOH Licensing Requirements (DOH Guidelines in the Planning and Design of a Hospital and Other Health Facilities and Safe Hospital Initiative – structural, non-structural, and functional indicators); • 3) Building Code; • 4) Fire Code; • 5) local government requirements;

39. PHYSICAL STRUCTURE (LOCATION AND SPACE) • 6) SPECIALTY requirements particularly on training and research; • 7) human resource program; • 8) equipment and material program; • 9) data / documents / records program; • 10) budget program;

40. PHYSICAL STRUCTURE (LOCATION AND SPACE) • 11) risk management program; • 12) business development program; • 13) quality standards; • 14) community expectations; • 15) efficiency; • 16) case load; and • 17) owners’ wants.

42. EQUIPMENT AND MATERIAL PROGRAM • EQUIPMENT AND MATERIAL PROGRAM means the identification, acquisition, and maintenance of equipment and materials needed to facilitate an effective and efficient functioning of the department of surgery.

43. EQUIPMENT AND MATERIAL PROGRAM • The program has to take into account the key functions and services of the department, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system.

45. HUMAN RESOURCE PROGRAM • HUMAN RESOURCE PROGRAM means the identification, acquisition, and maintenance of staff (surgical consultants, surgical trainees and parasurgical workforce) needed to facilitate an effective and efficient functioning of the department of surgery.

46. HUMAN RESOURCE PROGRAM • The program has to take into account the key functions and services of the department, statutory and regulatory requirements, and other objectives like business development and requirements of the SPECIALTY.

47. HUMAN RESOURCE PROGRAM • The basic requirement is adequacy of human resource both in number and competency. • The number of staff needed is dependent on a lot of factors, primary of which are: Department of Health hospital licensure requirements; workload / caseload; Department of Labor and Employment requirements; wishes of the owners for cost-efficiency at the same time promoting customer delight.

49. POLICIES AND PROCEDURES / CLINICAL PRACTICE GUIDELINES / CLINICAL PATHWAYS • POLICIES AND PROCEDURES / CLINICAL PRACTICE GUIDELINES / CLINICAL PATHWAYS refers to the operations and patient management processes that are needed to facilitate achievement of the functions and goals of the department of surgery.

50. POLICIES AND PROCEDURES / CLINICAL PRACTICE GUIDELINES / CLINICAL PATHWAYS • They provide order; promote standardization; facilitate communication; promote effectiveness and efficiency; and provide a guide to present and future staff, among other things.

52. DATA / DOCUMENTS / RECORDS PROGRAM • DATA / DOCUMENTS / RECORDS PROGRAM means the identification, acquisition, and maintenance of data, documents, and records needed to facilitate an effective and efficient functioning of the department of surgery.

53. DATA / DOCUMENTS / RECORDS PROGRAM • The program has to take into account the key functions and services of the department, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system.

55. RISK MANAGEMENT PROGRAM • RISK MANAGEMENT PROGRAM refers to a planned and systematic process or program to reduce and/or eliminate the probability of a “risk” that usually results in injuries, losses, and legal suits..

56. RISK MANAGEMENT PROGRAM • The more common types of risks in a hospital or department are the following: – 1) Risk for natural disasters (earthquake, flood, tsunamis, fire, etc.); – 2) Risk for man-made disasters (fire, felony, bomb threat, terrorism, etc.); – 3) Risk for medico-legal suits (arising from patient care); – 4) Risk for non-medico-legal suits (not arising from patient care); and – 5) Risk for tarnished reputation.

58. BUSINESS DEVELOPMENT PROGRAM • BUSINESS DEVELOPMENT PROGRAM refers to a program that will develop the business of the department of surgery to make it viable and sustainable.

59. BUSINESS DEVELOPMENT PROGRAM • The objective of the program is to attract new patient-clients and maintaining previous patient- client base. • Another objective of the program, particularly in private hospitals, is to attract new physician- clients and maintaining previous physician-client base.

60. BUSINESS DEVELOPMENT PROGRAM • The basic strategies in a business development program are marketing, public relations, and reputation enhancement.

62. IT-ENABLED SYSTEM • IT-ENABLED SYSTEM refers to the use of computing technology, such as hardware, software, networking, and Internet for the following purposes:

63. IT-ENABLED SYSTEM • 1) to promote efficiency in the performance of functions and accomplishment of services; • 2) to manage information of the department of surgery – getting, storing, protecting, processing, transmitting as necessary, and later retrieving as necessary;

64. IT-ENABLED SYSTEM • 3) to create interconnection with other units in the hospital for timely communication, coordination and collaboration in the accomplishment of services of the unit; and • 4) to communicate with the patient- and physician-clients both in and out of the hospital.

66. BUDGET PROGRAM • BUDGET PROGRAM refers to a program to project future income and expenses of the department of surgery which are reflected in a document (budget) and to use the projected future income and expenses (budget) as a guide for day-to-day performance and financial evaluation at planned intervals.

67. BUDGET PROGRAM • The usual expected outputs of the program are achievement of financial targets; effective and efficient utilization of resources; and controlled expenses.

69. ARCHITECTURAL DESIGN / ENGINEERING / CONSTRUCTION • ARCHITECTURAL DESIGN / ENGINEERING / CONSTRUCTION refers to the establishment of the PHYSICAL STRUCTURE of the department of surgery which has to take into account all the other elements identified in the framework, particularly the functions and services requirements.

71. REGULAR PERFORMANCE EVALUATION AND CONTINUAL IMPROVEMENT PROGRAM • REGULAR PERFORMANCE EVALUATION AND CONTINUAL IMPROVEMENT PROGRAM refers to appraising extent of accomplishment of the department of surgery in its authorized functions and business plans at planned intervals (quarterly, biannually, and annual) and to determine areas of improvement and to act on them.

73. Department of Surgery Design and Development Framework • There you are, the 22 essential, interdependent and interfacing elements to establish, develop, align and integrate in the governance of a department of surgery. • It will take years to fully develop all the 22 elements, at least 6 years perhaps on a full time basis. So, start now.

74. Department of Surgery Design and Development Framework • My specific recommendation is for all governing bodies of departments of surgery to use this Department Design and Development Framework or Administrative Design and Development Program as a guide and checklist.

75. Department of Surgery Design and Development Framework • Once all the 22 elements are fully developed and aligned and integrated to each other and to the entire hospital system, chances are, the governance system of the department of surgery will be judged to be excellent.

77. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Categories Common Problems Suggested Strategies • Man • System and Method • Machine / Equipment • Money / Other Resources • Trends

78. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Categories Common Problems Suggested Strategies MAN Consultants Residents Colleagues in other units Chief of Hospital / bosses Competencies Quantity Integration, coordination, collaboration Personality Leadership and managership Investor in People Standards Managing your boss Use of a multisectoral / multi-professional committee memberships

79. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Categories Common Problems Suggested Strategies SYSTEM AND METHOD Lack of systematization Lack of standardized procedures Use DOH requirements Use quality standards (PhilHealth Benchbook, JCI, ACI) Policies and procedures Clinical practice guidelines Clinical pathways

80. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Categories Common Problems Suggested Strategies MACHINE / EQUIPMENT Lack of management system Lack of calibration Lack of preventive maintenance Policies and procedures MONEY Other resources Limited Leadership Innovativeness

81. Whole Hospital Concept and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures A Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Services Cost- efficient / value- based Determinants of Functions / services requirements Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Categories Common Problems Suggested Strategies TRENDS Rapid changes - difficulty in coping Knowledge management system (constant tracking and continual education) Benchmarking Innovativeness

82. A Systematic Approach to Hospital Operations: A Unique Framework Applicable to all Departments Dr. Emer Faraon •Provide the class with a systematic approach in managing department operations. •Give and explain the unique diagram you created to achieve the goals of learning, planning, and administration. ROJoson – Systematic approach 1 – All-department approach Systematic approach 2 – Systems approach or perspective Systematic approach 3 – Framework with inputs, throughputs, and outputs Use a department to illustrate.

83. The Systems Approach to Hospital Operations – Using the Department of Surgery as an Illustration Learning Objectives: • General understanding of the philosophy, objectives, structure, staffing, policies, systems, and methods of selected hospital services and departments • Working knowledge of the responsibilities of hospital managers in directing and coordinating the various units • Glimpse of common problems in these hospital units

84. Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg December 10, 2011 2 hours Any further questions, comments, discussions – rjoson2001@yahoo.com 0918-8040304

85. Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg December 10, 2011 2 hours Interested? ROJ’s Websites: https://sites.google.com/site/ rojlecturesupcph/home

86. Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg December 10, 2011 2 hours Interested? Mailing List rjoson2001@yahoo.com Egroup upcph_mha_roj_students_2011onwards@yahoogroups.com Facebook Reynaldo O. Joson

Systems Approach to Hospital Operations - Department of Surgery

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