research symposium presentation nwaukao final

GSTM Symposium: 2013

HEALTHCARE SERVICE DELIVERY EFFICIENCY: PERFORMANCE OF GAUTENG HOSPITALS

Name: Oliver Nwauka

Study Leader: Dr Richard Weeks

Tel: +27824896240E-mail: [email protected]

MEM SYMPOSIUM



IntroductionRationale

• South Africans are not healthy.

• Healthcare ranks low in performance.

• Poor performance and service failure concerns.

• Challenge of transformation and reorganisation.

• Weakness in policy planning and facility management.

• Shortage of medical expertise.

Importance• Great dissatisfaction effects on all

stakeholders.

• Inappropriate planning, monitoring and managing service delivery.

• Existing service inequality.

• Societal loss of confidence and trust

• Several staff strikes and patients’ complaints .

• Evidence of waste of resources.

The service performance efficiency of healthcare delivery in the state hospitals and clinics is sub-standard relative to private hospitals within the same demographic and geographic region.


Research Objectives

Nature of service and performance level of Gauteng healthcare sector.

The extent, influence and the use of e-service and information access.

Influence of governance on healthcare service delivery.

Service availability and utilisation, facility capacity and resource allocation level.

Health policies and strategies usage, implementation and influence.

Identifying service gaps existing between the healthcare sectors.

To gain insight into the cause-effects of this minimal performance, patients’ dissatisfaction and the waste of resources in Gauteng public healthcare service sectors


Gauteng Health Demographics

11.9 million Surging and ‘Hospicentric’

Health Expenditure utilization crises

Burden of diseases

Complexities

Integrated Information System

Inadequacies

Human Resources

Deficiency

Policy and Strategy

Incoherence

Service Performance & Efficiency

Crisis

Spends 8.7% of GDP

Absorbs only 39% of budget

Consumes 50-60% (AV.) of the resources

25.6% Unemployment rate 97%Urbanely habituated

Accounts for 80%

Administrators’ failure to focus on efficiency and effectiveness

Non effectiveness of the referrals

Obsolete Equipment HIV and Infant Mortality Pandemic

TB co-infection rate 73%

• Excessive waiting period

• Overprescribing• Excessive length

of stays• Storage wastes• Low health

outcome• Vandalism, poor

maintenance, and theft

• Patient lost of confidence

• Staff burnout• Rude and uncaring

staff• Frequent out of

stock of essential drugs

• Lack of managerial accountability

Asthma, Hypertension, OverweightAppointments of unqualified managers

Uniform salary schedule

Slow pace in categorising hospitalsLack of policy guide on standardised wage rate

Low remuneration

Staff shortage due emigration

Absorbs 39% of doctorsDecrease in enrolment of nurses

Absenteeism and late comingStruggle to fill > 60% existing posts

Patient Information not linked

Hospital s’ information not linked to each other

The Gauteng public healthcare service performance Overview: The Cause-Effects


Concept of Healthcare and System Performance

2Information

System &Technology Innovation

1Leadership co-ordination,

supervision and Service

Delivery

4Resources/

Org. CapacityCarries out

health mandate

5Models of

CareHealth Care Approach

3Policy and strategy

Health regulation

6Patient and Population

Engagement

Assists patients in leading a healthier life

Increases the probability of safe and effective service delivery Minimizes service delivery gaps

Regulates and enforces services operation

Adopts specific health standards

Entrust resources, and responsibilities

Translates policy to practice

Personalized and evidence based care

Use of management guidelines

Avoidance of medical errors

Quality of care/ health reassurance

Communication with patient

1

6

5

2

3

4

Performs health care audits

Monitors and evaluates information

Ensures patients, and professional support

Ensures resource Mgt.

Better health related choices

Patient education in self-care


Key Hospital Performance DimensionsPerformance Assessment Tool for quality improvement in

Hospitals (PATH ) Framework

Safety (Evidence of Risk Reduction)

Patient- Centeredness (Satisfaction and Experience)St

aff O

rient

ation

(w

elfa

re ,

abse

nce,

and

Sa

tisfa

ction

)

Clin

ical

Effe

ctive

ness

(A

ppro

pria

tene

ss o

f Car

e)

Resp

onsi

ve G

over

nanc

e (A

nsw

ers

to n

eeds

and

D

eman

ds)

Tech

nica

l Effi

cien

cy

(Red

uctio

n of

was

te)


Healthcare Team

Healthcare Organisation

Patient

Resource Stewardship/Emancipation

SatisfactionSatisfaction and Support

Nature of Support, resources and Expectations

Operational Design of Healthcare delivery

Nature Of Relationship

Health Outcomes

and Impacts

PerformanceMeasures

Service Delivery

(Inputs)

PerformanceMeasures

Performance Measures and Service Delivery

Outputs(Services)

Functional Process


Technical Efficiency Measures

Service Delivery ProcessWhat is done

InputsAvailable and

accessible Resources

OutputsOutcomes and

Impacts

Data Envelopment Analysis (DEA)

LP method that measures DMUs for complex institutions

Technical Efficiency (TE)

Operates Standard of the best practice production Frontier

• Multiple input-output quantities

• Random noise less of a problem

• Price data is difficult to find

• Compares DMU’s directly against a peer or combination of peers.

• IRS = Output increases by a larger proportion more than Input

• CRS= Operating at Optimal Scale

• VRS= DRS or IRS• DRS = 2xinput ≠ 2xoutput

• The most efficient DMU (TE =100%) relatively ‘envelopes’ DMUs.

• Higher the ratio, the higher efficiency.

• Uses less weighted inputs per weighted output


Technical Efficiency Data and Graphs

District Regional Private0

2

4

6

8

10

12

D/BE/B

3 4 5 6 7 8 9 10 110

1

2

3

4

5

6Efficiency Frontier

Number of Admissions/Bed Capacity

No

of

Disc

harg

es/B

ed C

apac

ity

DMUs D/B E/B TechnicalEfficiency Score (TE) %

Variable Return to Scale

(VRS)

Constant Return to Scale (CRS) %

Scale Efficiency

Score %SE=VRS/CRS (%)

District 4.2 (0.40)

1.9 (0.35)

40 60 65 92

Regional 6.5 (0.63)

1.6 (0.29)

63 37 71 52

Private 10.4 (1.00)

5.5 (1.00)

100 100 100 100


Performance Results• A dissatisfaction rate of 76%, an evidence of

service failure.• No reliable means of tracking patients’

information and records.• Excessive length of hospital stays.• Shortage of speciality doctors • Increased workload due to burden of diseases• Low staff-patient ratio.• Non-enabling working environment


Performance Results cont’d

• Theft, poor decision-making, Vandalism, fraud. • Frequent unavailability of essential medications. • Managerial incapability to match Service with

demand.• Abuse of resources by patients due to loose policies• Loose communication gap among stakeholders.• Non engagement of patients by other stakeholders’ • Ineffective referrals system due to non electronic

data exchange.


Recommendations• Update facilities, and enhance communication Link.

• Precise management review for all the core hospital and clinic functions’.

• Establish common and well functioning integrated information system.

• Continuously engage healthcare team in decision making.

• Assess periodically practice performance of the healthcare team.


Recommendations Cont’d

• Introduce risk and efficiency management short training courses

• Appoint professionals at the top-level positions.

• Continuously engage Leaders through a learning process.

• Use activity based payment to improve the system’s ability.

• Privatisation is recommended as the final remedy to this crisis.


Conclusion

Win-Win

Transformational

Changes

Value

Care

Del

ivery

ponsibility

Patient

• Develop a robust Information Infrastructure

• Accessibility

• Responsiveness / Timeliness

• Strive for good Service Perception

• Build a culture of Value, shared accountability and Innovation

• Focus on prediction, prevention and early detection/ treatment

• Help patients lead a healthier Lifestyles

• Enable Self management and shared decision

Res


Recommendations for Further Research

• Conduct efficiency study among all Gauteng health clinics and all levels of hospitals.

• As a lifecycle process involving people and technology, research shall be directed on healthcare service delivery, aimed at tailoring the requirements for the satisfaction of all the stakeholders’ .


Questions

HEALTHCARE SERVICE DELIVERY EFFICIENCY: PERFORMANCE OF GAUTENG HOSPITALS

Thank you !

research symposium presentation nwaukao final

Documents

service availability

service gaps

system performance

existing service inequality

service failure concerns

poor performance

healthcare sectors

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