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HOSPITALS PROCUREMENT & SCM OF HEALTH TECHNOLOGY
CONTINUOUS QUALITY IMPROVEMENT INITIATIVE
Midrand, Johannesburg
19 February 2019
CONTENT PART A: PSM
Quality Improvement Project
PART B:
Potential Areas of Collaboration
PART A
PSM QUALITY IMPROVEMENT PROJECT
PROJECT BACKGROUND
PARTNERSHIP PUBLIC SECTOR PRIVATE SECTOR
MIN
A
Recognition that public administrators, hospitals and suppliers need to work together to fulfill a common aim:
• To offer quality and cost-effective healthcare services to the population of Eastern Cape by improving current procurement and supply chain management practices of public hospital
PROJECT DESCRIPTION
2017/18 2 Workshops
June & July
2018
Sep
Oct
Nov
Jan/Feb
2019
APRIL
Situational Analysis Secure Buy-in
& Sign Off by
ECDOH EMT
SLA Project
Launch Needs & Gaps Exploratory
Discussions
PROJECT TIMELINE
Strategy
Development
Situational Analysis • Challenges
• Needs
• Gaps
Project Goal Improving the effectiveness and efficiency of procurement and supply chain management of medical technology, devices and consumables in pilot hospitals in Eastern Cape Province, by • Implementing evidence-based PSM planning and solutions • Strengthening PSM leadership within the participating hospitals • Strengthening communication within and between the hospitals,
and between the hospitals and the Eastern Cape provincial authorities
• Building staff capacities and improving procedures and systems • Fostering meaningful cooperation between hospitals and the
private sector
Project Objectives 1. Improving demand and procurement planning in accordance with
national and provincial regulations and guidelines
2. Institutional capability analysis and systems strengthening, notably IT systems
3. Establishing lean PSM business processes within hospitals
4. Leadership Change management and training
5. Continuous SCM performance monitoring and management
Strategic Alignment National Strategy for Health • Strengthen financial
management of the health system by improving capacity, contract management and supply chain management
• Fight against corruption and
• Raise the standard of institutional quality by addressing some of the root causes identified by the Auditor General’s Office, notably adherance to technical specifications, planning, supervision and monitoring of contracts
ECDOH • Facilitating a
functional quality-driven public health system
• Enhancing institutional capacity through effective utilisation of resources
PSCM Project
Demand Management Capability Lean BP SCM
Leadership Performance
Governance
NMAH: L. Giwu LTH: M. Burns LTH: M. Sibiza FTH: N. Gqoli
FTH: N. Duric
GM: SCM
Work Stream #1
Demand Management
Progress in 2018
Over R500,000
• Joint Tertiary Hospitals HealthTech Committee established
• TOR Drafted oShares tender documents & technical specs
Under R500,000
• Joint preparation of: −List of general items that can be purchased
jointly by hospitals −List of items needing deviations
Next Steps
Over R500,000 (Jackie Cloete)
1. Draft Terms of Reference finalised and signed off
2. TH HTAC reconstituted
3. Development of Procument Plans 2019/2020 for Over R500,000 items
4. Identify “Nomenclatura” (GMDN) to be used within Technical Specifications
Under R500,000 (Alex Gqwebu)
1. Adopt List of Red Items
2. Advise on storage of tender and technical specifications and deviation documentation accessible to all hospitals (Shared Database)
3. Co-ordinate Market testing for deviation items lists
4. Discuss updated price lists and code conversion tables
PEOPLE SYSTEMS
Work Stream #2
SCM Capability
Progress 2018: Benchmarking LOGIS REPORT CAPABILITY ANALYSIS combined.xlsx
• In Summary −WC hospitals have significantly more staff in assets and contracts
units than EC. They indicate they can do effective contract management, EC does not.
−There are significant differences in productivity in demand management and procurement between EC and WC hospitals.
−It indicates they are likely rely on automisation of procedures and having relevant databases.
Qualifications & Experience LOGIS REPORT CAPABILITY ANALYSIS combined.xlsx
Hospital School Tertiary Tertiary
SCM
Grand Total % School % Tertiary % Tertiary
SCM
Ave Exp
Years
LTH 31 11 2 44 70% 25% 5% 17
Frere Hospital 20 10 1 31 65% 32% 3% 13
NMAH 4 15 4 23 17% 65% 17% 15
MRH 3 3 6 50% 50% 0% 8
Frontier Hospital 4 8 12 33% 67% 0% 9
GSH 31 9 40 78% 23% 0% 10
TBH 50 23 2 75 67% 31% 3% 10
Grand Total 143 79 9 231 62% 34% 4% 13
• NMAH invests more in Training than any other of the facilities
1. Discuss the benchmark and analysis to identify the gaps and learning objectives
2. Incorporate project activities into Western Cape and EC Partnership for NHI
3. Review available ICT systems to enable EC staff and address staffing constraints and workload
- LOGIS; SCM REMS; and possible addition of solutions such as eTicket; eSignature; Data
Analytics; etc
- Sarah Baartman Stores Case Study
Next Steps
IMPLEMENTATION OF STANDARD OPERATING PROCEDURES
Work Stream #3 Lean Business Processes
Progress 2018
1. Head Office issued procedure manual and SCM Policy in June 2018 (from a 2007 Policy version.
2. Head Office issued amended and updated ‘Procurement Guideline Procedure: Competitive Bidding Process’ to guide on implementation of Delegations; November 2017
3. Facility Process Flows and implementation reviewed • Inter-facility variation • Aligned with Procurement Guideline
Procedure
Next Steps
1. Training on updated SOPs
2. Develop sustainable platfoms for engagement FAQ sheets
eForum for SCM
Electronic Compendium of SOPs readily available tracking policy updates & amendments to SOPs
LEADERSHIP ACTIVATION & EMPOWERMENT
Work Stream #4 SCM Leadership
Progress 2018
1. Baseline change management survey
done − Change Management Survey Questionnaire
and Results.xlsx
2. Draft PSM leadership training
programme (5 days, 40 participants)
being developed − Draft Course Outline Version 29112018.doc
LEA
DER
SHIP
A
CTI
VIA
TIO
N
Day 1
Supply Chain Management, Procurement and Medical
Device Regulations in South Africa
Ethics in Procurement & Anti-corruption strategies
Soft skills and team building activity I during the program
Day 2
Ethics in Procurement & Anti-corruption strategies
The Procurement Plan
Demand Planning
Tender Documentation and Technical Specifications
Day 3
Launch Event
Standard Operating Procedures (SOPs) for Tender
Management
Soft skills and team building activity II during the program
LEA
DER
SHIP
A
CTI
VIA
TIO
N
Day 4
Contracting and Contract Management
Health Technology Committee
LOGIS Capability (including Asset Management)
Inventory Management and Consignment Stock
Soft skills and team building III during the evening
Day 5
Supplier Performance Management
Quality Improvement in Health Technology Procurement
Change Management
Course Evaluation
Next Steps
1. Final Prep for Leadership Activation Workshop 28 February 2019 • Content
• Available Date for Launch (MEC and SG)
• Guest Speakers; Facilitiators
• Logistics February to March/April 2019
• ECDOH Skills levy access
2. Conduct 5-day SCM Leadership Training
3. Explore possibility of annual event
REPORTING & ACCOUNTABILITY
Work Stream #5
Performance Management & CQI
1. Strategy for CQI of Procurement and SCM at selected hospitals developed
2. Review of Performance Management mechanisms conducted • LOGIS implementation and use for performance
measuring in hospitals being addressed • Identified success and monitoring indicators as part
of the Quality Improvement Strategy
3. Performance management algorythm drafted
LOGIS REPORT CAPABILITY ANALYSIS combined.xlsx
Progress 2018
1. Migration to electronic traceable system • Fully functional intranet and internet network • Leverage LOGIS and available systems capability and
ensure reports routinely available to relevant stakeholders
• Identify systems gaps and explore cost-effective solutions
• Create online platform for collaboration in procurement
2. Develop performance assessment parameters tools 3. Regular performance review meetings at different levels
Pe
rfo
rman
ce
Man
age
me
nt
Syst
em
Weekly hospital meeting Monthly hospital meeting Quarterly interhospital meeting
Stakeholders Attend Agenda Attend Agenda Attend Agenda
Head Office • Realization of procurement plan
• Identify problems • Make weekly plans
and goals
• Realization of procurement plan (reports from LOGIS, number of processed orders…)
• Identify problems (what can be solved at hospital and what on provincial level)
• Make monthly plans
• Structural and policy problems
• Knowledge and skill sharing
• Coordination of provincial tenders
• Annual procurement plans coordination
Auditor general office
CEOs
Finance manager
Store manager If needed
Clinical engineering
If nedeed
Procurement team
Interested end users
SCM MONITORING DYNAMICS
Weekly hospital meeting Monthly hospital meeting Quarterly interhospital meeting
Stakeholders Attend Agenda Attend Agenda Attend Agenda
Head Office • Realization of procurement plan
• Identify problems • Make weekly plans
and goals
• Realization of procurement plan (reports from LOGIS, number of processed orders…)
• Identify problems (what can be solved at hospital and what on provincial level)
• Make monthly plans
• Structural and policy problems
• Knowledge and skill sharing
• Coordination of provincial tenders
• Annual procurement plans coordination
Auditor general office
CEOs
Finance manager
Store manager If needed
Clinical engineering
If nedeed
Procurement team
Interested end users
SCM MONITORING DYNAMICS
Weekly hospital meeting Monthly hospital meeting Quarterly interhospital meeting
Stakeholders Attend Agenda Attend Agenda Attend Agenda
Head Office • Realization of procurement plan
• Identify problems • Make weekly plans
and goals
• Realization of procurement plan (reports from LOGIS, number of processed orders…)
• Identify problems (what can be solved at hospital and what on provincial level)
• Make monthly plans
• Structural and policy problems
• Knowledge and skill sharing
• Coordination of provincial tenders
• Annual procurement plans coordination
Auditor general office
CEOs
Finance manager
Store manager If needed
Clinical engineering
If needed
Procurement team
Interested end users
SCM MONITORING DYNAMICS
Next Steps
1. Planned migration to electronic systems leveraging available capability
2. Finalise & Sign-off Performance Assessement parameters
3. Adopt performance review system & integrate into routine management performance systems at institutional & provincial levels
MANAGE PROJECT IMPLEMENTATION INCLUSIVE OF CHALLENGES & RISKS DECISIONS & RISK TABLES 20190124.XLSX
DECISIONS &
SUPPORT AGREED TO
Manage Project Risks
Require EC Top Management commitment and endorsement
Require renewed commitment and participation from all 6 hospitals and EC DOH going foward
• CEO Forum & SCM Forum • Review workstream participants and send names to
Tanya Vogt, email: [email protected] and [email protected]
3. Operational Plan for 2019 • To organize and institutionalize the
expected outcomes of the EC Hospital Pilot
PART B Areas of Collaboration
MANDATE: LONG & HEALTHY LIFE FOR ALL
IMPROVING HEALTH OUTCOMES & QUALITY OF CARE EQUITABLY IN
EASTERN CAPE PROVINCE
LONG & HEALTHY LIFE FOR ALL • Tackling Disease Burden of SA
•Approach = PHCA Disease Prevention Health Promotion Manage disease burden Rehabilitate patients
QUADRUPLE BURDEN OF DISEASE Maternal, newborn & child health
1% of global burden 2-3 times average for comparable countries
Communicable Diseases 17% of HIV burden 5% of TB Burden
Violence and Injury
1,3% global burden (2 x global average injuries; 5 x homicide)
Non-communicable Diseases
1% global burden 2-3 x average developing countries
ECONOMY POST 1994
CHALLENGES
▪ Unemployment
▪ Social & Economic Inequality
▪ Poverty
SLOW ECONOMIC GROWTH
Job creation
Attract investment: ▪ State Capture & Corruption
▪ Conditions to conduct business
▪ Government effectiveness
Land and tenure reform
PROBLEM STATEMENT All Citizens of EC Province
Legitimately demand good quality healthcare and expect improved health outcomes and a positive experience of
cost-effective care
despite a quadruple burden of disease increasing the demand for care at a time when costs for healthcare is
escalating, but resource envelopes are highly constrained due to decreasing budget allocations and the pressure of
medico-legal settlements
REGIONAL, TERTIARY & CENTRAL HOSPITALS
PATIENT-CENTRED CARE
▪Health outcomes – safe, effective and reliable care
▪Experience of Care – standard that satisfies communities
▪Addresses Burden of disease
▪Value for Money - Cost-effective & cost-efficient
VALUE PROPOSITION
Excellent Patient Outcomes
Positive Patient Experience
Value For Money
Continuity of Care by Collaborating Team of Experts
OPTIMAL PATIENT OUTCOMES • Optimal improvement of function • Minimal risk of adverse events • Acceptable minimal length of stay • Good pain management
HOSPITALS VALUE PROPOSTION DEFINED POSITIVE PATIENT EXPERIENCE
• Friendly, helpful & caring Staff
• Clean facility & reliable infrastructure
• Acceptable waiting time
• Hotel & support services of acceptable standard
• Experienced clinical & support teams
• Continuum of Care across service levels
CONTINUITY OF CARE
• Centres of Excellence o Collaborating Multi-disciplinary Teams o Integrated Care
• Research used to continuously guide quality improvements & lead innovation
VALUE FOR MONEY
• Lean patient pathways • Transfer savings to the patient • Leverage SCM for safe & cost-effective consumables
QIP: ALTERED PATTERN OF WORK
1. Manage Demand
2. Improve Capability
3. Lean
Process
MENTAL HOSPITALS
Compliance with Mental Health Act No 17 of 2002
▪ Appropriate access to care with community-based approach
▪ Voluntary, assisted and involuntary patients, State patients and mentally ill prisoners
▪ Procedures to be followed
▪ Human rights approach – respect, dignity, free from discrimination, informed consent
CHALLENGES & INTERVENTIONS
1. Lack of resources for mental heath care (Acute beds & staffing)
2. Information systems to monitor quality of mental health services ensure transparency and accountability eg seclusion; use of ECT
3. Improve quality assurance measures for mental healthcare amongst psychiatric and general hospitals (standard treatment guidelines)
Long-term systematic plan needed for appropriate mental health services:
▪ General Hospitals and DHS provide relevant acute care
▪ Audit tool to routinely assess performance, capability & quality
▪ Contracting private sector psychologists & psychiatrists
▪ Strategic Community Partnerships
OPPORTUNITIES FOR CONTINUED COLLABORATION WITH SAMED
▪ Annual Collaborative Workshop in EC ▪ Information-sharing between and within sectors
▪ Continuing Professional Development – refresher course; industry updates; etc
▪ Reward & Recognition Programme
▪ Sponsoring individual and facility awards for innovation in health technology
▪ Facility Health Technology Management QI projects and that link technology to improved patent outcomes, experience of care and cost-effectiveness
THINK TANK:
▪ Curbing escalating costs of medical technology
▪ Developing local capability for quick responses for Repair and Maintenance of critical medical technology
▪ Collaborate to strengthen contract management
Door to Needle Time 53 min (60min)
Quickest DTN: 20min
ACKNOWLEDGEMENT
THANK YOU
COST-EFFECTIVE CARE
POSITIVE PATIENT
EXPERIENCE
OPTIMAL PATIENT
OUTCOMES
PERSON-CENTRED
CARE
PHARMACEUTICAL SERVICES
Pharmaceuticals play a vital role in the prevention and treatment of major causes of death and disability in the developing world.
High costs and frequent shortages
Management techniques developed to optimize the use of scarce resources not being applied optimally in all institutions/Districts
Medicine shortages and improper use of pharmaceuticals can not only lead to financial losses but also have a significant impact on patient well-being.
INTERVENTION Rational drug use and improved drug management practices to ensure cost-effective management, supply and use of pharmaceuticals; and, ultimately, save lives and improve health
ANNEXURE 5 Pharmaceuticals Notes.docx
INTERVENTIONS
FOUNDATIONAL: Supplies in & reduce stock-outs
1. Measure performance& identify QI areas
2. Assess capability
3. Assess compliance
OPTIMISATION: reduce costs & improve efficiency
1. Understand cost-drivers (ABC; VEN)
2. Existing resources used appropriately
3. Drug inventory management, cost-containment & improved efficiency
TRANSFORMATIVE: improved clinical outcomes & safety
Clinician and Patient-Centric
1. Clinical Outcomes
2. Patient Experience
3. Burden of Disease
4. Demand for Care