TA for Capacity Building for Tertiary Care Services
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TA for Capacity Building for Tertiary Care Services An EU-funded project managed by the European Agency for Reconstruction Republic of Serbia MINISTRY OF HEALTH Politicians and policy makers – where are managers in policy creation? An inclusive approach for Tertiary health care policy in Serbia Katrava A , Jekić I.M, Boulton G, Rupert P, Christensen SB, Obrovački M, Novak S, Janković-Vuković T, Đukić V*, Peško P*, Dmitrović T*, Drašković D** Dujmović F**, Trenkić S***,Pavlović R**** EAR/EU SOFRECO Technical Assistance-TA Team, Belgrade * Clinical Centre of Serbia, Belgrade ** Clinical Centre of Vojvodina, Novi Sad *** Clincal Centre of Niš **** Clinical Centre of Kragujevac
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Republic of Serbia MINISTRY OF HEALTH. Politicians and policy makers – where are managers in policy creation? An inclusive approach for Tertiary health care policy in Serbia Katrava A , Jeki ć I .M , Boulton G, Rupert P, Christensen SB, Obrova čki M, Novak S, Janković-Vuković T , - PowerPoint PPT Presentation
Transcript of TA for Capacity Building for Tertiary Care Services
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Republic of Serbia
MINISTRY OF HEALTH
Politicians and policy makers – where are managers in policy creation?
An inclusive approach for Tertiary health care policy in Serbia
Katrava A,Jekić I.M, Boulton G, Rupert P, Christensen SB, Obrovački M, Novak S, Janković-Vuković T,
Đukić V*, Peško P*, Dmitrović T*, Drašković D** Dujmović F**, Trenkić S***,Pavlović R****
EAR/EU SOFRECO Technical Assistance-TA Team, Belgrade* Clinical Centre of Serbia, Belgrade** Clinical Centre of Vojvodina, Novi Sad*** Clincal Centre of Niš**** Clinical Centre of Kragujevac
Context
Background / Current situation
Methods
Results
Conclusions
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Context Traditionally, politicians and policy makers dictate to health care institutions managers national strategy for service delivery.
The EU/EAR Project provided to the Ministry of Health-MoH has been charged with
1. reforming tertiary care services2. developing and implementing 4 CC’s business plans and introducing change management training3. implementing an EIB loan of EUR 200M (project value EUR 280M ) for reconstruction and reequipping of the 4 beneficiary institutions:
– Clinical Centres in Belgrade, Novi Sad, Nis and Kragujevac.
All policy decisions made at a political level and in these 4 out of 120 inpatient institutions will have a trickle down effect to the rest of the system for
• patient care• teaching• research
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
CONTEXTHOSPITAL SYSTEM IN THE RS
Inpatient health institutions in the RS
122 inpatient institutions*
Cost
Low
High
THC
SHC
PHC
4 + 24 = 284 CC
4 CHC, 5 Clinics, 15 Institutes
56(40 General hospitals,16
Special hospitals)
38 (20 DZ, 18 zavodi)
Primary HC – outpatient care Chronic / prolonged / palliative care
MoH - Govt’ Agencies - HIF - PHI
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Context4 Clinical Centers of Serbia
•The four Clinical Centres, with– over 14.000 employees– approx. 240.000 admissions– approx. 110.000 surgeries and– approx. 1.745.000 outpatients visits– approx. 270.000 emergency visits– approx. 222.000.000 EUR annual operating budget
represent one-quarter of the activity and budget of the Serbian health care system, and are leaders for innovative changes in other sectors (primary and secondary health care).
•Managers of this small number of big institutions are increasingly asked to be members of policy bodies, along side top opinion leaders in the country - and they are influencing change at many levels.
•THC policy and renewed services delivery model is to be implemented by managers in the four Clinical Centres.
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Background
•In Europe, HC systems are gradually shifting from centrally to regionally and locally regulated and financed HC systems
•Traditionally, in the Serbian health care system policy and decision-making is centrally planned, regulated and managed.
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
ContextFundamentals that will transform
the health care system
• Economic pressures will mount – annual budget – approx. EUR 220 mil – increase 2,5 times over last 5 years
• Professional expectations are growing about delivery patterns to which Serbian health care system should aspire – overall over 14.000 employees – over 1000 University Professors and over 2500 MD
• Patient expectations about health service will rise in the years ahead – over 2.300.000 patients annually – over 110.000 surgeries
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
BackgroundAdministration of the Serbian Public Health Care
System GOVERNMENT
MINISTER OF HEALTHNATIONAL HEALTH COUNCIL HEALTH INSURANCE FUND
DEPUTY MINISTER OF HEALTH
ASSISTANT MINISTERS
Health Policy+ Planning
Health Insurance+ Financing
Sanitary Inspection + Public Health
International Relations + Project Coordination
Organization of Health Service+ for Health Inspection
NATIONAL ETHICS BOARD
NATIONAL AGENCY FOR ACCREDITATION OF HEALTH CARE FACILITIES
PRIMARY HEALTH CARE CENTERS
HOSPITALS
NATIONAL PUBLIC HEALTHINSTITUTE
REGIONAL +MUNICIPAL OFFICES
REGIONAL +MUNICIPAL OFFICES
PATIENTS
For tertiary level health care the current Health Law and various decrees suggest that tertiary level services should :
Occupy approximately 6,000 beds representing 0.8 per 1,000 population
Much of the current law and regulation concentrates on “inputs” (size of facility, staff numbers, equipment etc.), whereas contemporary THC planning (and indeed primary and secondary care planning) should focus on:
– An overall service perspective (rather than an institutional perspective) covering the whole range of health care interventions for particular patient groups and the identification of the respective role of each level of health care in the health care continuum (e.g. the cancer network);
– Outputs, types of output and outcomes (e.g. cardiac surgery – numbers and types of revascularization procedures) with inputs being inferred from outputs, using a variety of quantitative and qualitative measures;
– Matching service need/demand with viable units of clinical organization from the perspectives of clinical and economic effectiveness (given that a number of tertiary level services often require access to high cost infrastructure and technologies), affordability and clinical governance.
CURRENT SITUATION – Legal framework to address strategic planning /
Reform of the THC services
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Hospital system in the RS – Facts and figures Tertiary health care, number of beds per 1000 population
Catchment area THC beds per 1000 pop
1.7 M population 1.5 per 1000 pop.
3.2 M population** 2.5 per 1000 pop.
2.6 M population 1.1 per 1000 pop.
7.5 M population
Target: 0.8 per 1000 pop.
Central
North
South
Lack of strategic planning of network and health services over the past 15 years.Weakness of refferal system. Hospital and health sector standards (set by IPH) are rigid, historical, normative, and largely input – based are not related to new organisational models and modernisation. Hospital reimbursement systems are not linked to efficiency, effectivness, output and performance (outcome). The change alone would have a profound impact on the size and nature of the hospital network. Data systems at hospital level are extensive, yet information for operational and performance management of a large modern health care and hospital system is inadequate and under developed.
The application of inconsistent data definitions, the quality assurance of data and variable methods of dealing with data, hampers reliable inter regional and inter hospital comparison.
CURRENT SITUATION – Inefficiencies and Drawbacks created by the current situation
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Limitations of current legislation underpinning services planning
Services planning is occurring in context of significant organizational changeLegislation has its part to play in facilitating or hindering such change
However, there is recognition of the complexity of health care environment and stakeholders within it
In an attempt to introduce services planning as strategic planning involving key stakeholders/managers
CURRENT SITUATION
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Methods•The EU/EAR Project inclusive approach that links
–organizational change in institutions and–policy change at a national level
•is endorsed by the MoH, and for the first time provides the opportunity for mangers to be involved in both.
•For the first time, planning at a national level–is service/patient group rather than institution based–involves practitioners
•managers in Tertiary Health Care - THC institutions - providers•Institute for Public Health-IPH - planners•Health Insurance Fund-HIF – purchasers
Improve accessibility to tertiary level care for patients.
Move from input – based planning (eg.size of facility, number of staff, equipment etc.) to focus more on outputs (eg. cardiac surgery – number and types of revascularization procedures) and outcomes (eg. improved health status of population)
Role of standards, accreditations and clinical guidelines.
MethodsHealth sector reform – strategic shifts in future role and
organisation of the hospital sector
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
MoH aim is, to produce a modern tertiary health care policy for Serbia and to establish distinct policy development, business planning, commissioning and financing and performance management processes and capacities for tertiary level health care. Appropriate CARE, in the appropriate SETTING, at the appropriate TIME
Major issues :• Access to Care• Quality of Care• Cost of CareThe extent of the health system contribution of the 4 CCs means that any
change in their organization and financing aimed to enchance efficiency and quality will have a further “trickle down” positive impact on the entire health care system.
The Goal
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Methods – to achieve the goal
•The official EAR/TA mechanisms include:–Project Steering Committee –THC Expert Group and Task Forces (mandated by the Ministerial Decree)
–the Clinical Centres Senior Managment–Clinical Directors–Business Planning Work Groups
Tertiary Healthcare
Strategy/ Policy in Serbia
(National level)
DesignMaster Plan for each CC
Business Plans for each CC
Nationallevel THC Task Forces(by specialty)
CC BPWork Groups
Institute’s Management
CC Senior Management
EIBEAR/TA
MoH/THC Expert group
EIBEAR /TA
EIBEAR/TA
Design &SupervisionConsultants
MoH/PIU
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Results •Areas the MoH is seeking advice on include:
– THC service provision models– Organizational structure of institutions– Redefinition of capacity plans and capital investments (facilities and equipment) for THC institutions and redefined THC services– HR planning– Models for financing of and contracting with THC institutions– Health technology assessment (HTA)
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Results
•Since establishment in June 2006–THC Expert Group has developed, completed and presented most general parts of the THC policy–now needs to address the more detailed issues to convert THC policy into strategy.
•Additionally, THC service-specific Task Forces have been formed by Ministerial Decree to advise on practical issues of
– THC policy, strategy and implementation– for Serbia’s three population catchment areas (North, Center and South) until end 2008.
MoH THC Expert Group with EAR/TA Tertiary Care Project:Definition for THC in the RSCriteria for identifying tertiary level care services Categorisation and Classification of Tertiary level care (national level provision, regional level provision and complex case - mix)Task Forces (specialty/patient group - specific) to be established in January 2008 for tertiary level service planning and organisation of care delivery across the network
Results - Implementation PossibilitiesTHC Services
Policy and Strategy Implementation
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
Results
•Hospital Managers of 4 big university institutions and their teams are increasingly involved in THC policy development through all mentioned bodies and mechanisms.
Build bridges / network partnerships across the 3 levels of care– Pivotal role of physicians/managers– Relationship building
• Leadership and trust• Incremental and “ big – bang ” approach
– Alligned incentivesEnhance efficiency and quality
– Invest in modern management tools• Build HR talent and core competencies• Capable managers need access to appropriate information to enhance decision - making• Need standard coding system (activity and financial data, diagnostic procedures)
– Measure outcomes• Data performance tools (activity and financial data – ABC)
Patient empowerment– Informed patients – access to information– Active participation in process / well - being– Manage expectations
Conclusions3 steps towards a healthy and viable future
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
THANK YOU
Annette KatravaDeputy Team Leader & Hospital ManagerEAR/EU Project
Capacity Building of the Ministry of Health for Tertiary Care Services
Technical Assistance – TA Sofreco Project Office
11000 Belgrade, Serbia
Pasterova st. 1/III
TA for Capacity Building for Tertiary Care ServicesAn EU-funded project managed by the European Agency for Reconstruction
