5^th International Congress on Healthcare & Hospital Management December 03-04, 2018 | Rome, Italy

Biography:

Nicole Gerber is a Senior Research Associate and Project Leader at the Institute of Facility Management (IFM) at Zurich University of Applied Sciences (ZHAW), leading different research and development projects with a focus on healthcare. She can draw on various professional and entrepreneurial experience in different industries in addition to her MSc degree in Business Administration and MAS in Information Systems.

Abstract:

Statement of the Problem: Like in other industries, digitalization causes increased dependency on IT Services in hospitals. In healthcare, IT as a discipline and IT as departments were often seen more as a necessary evil than as an enabler or partner in the past. In hospitals, this firstly led to an unaligned, redundant, hard to maintain and thus costly development of the IT infrastructure and software landscape with many legacy systems and secondly to unclear service provisions without clear service level agreements and non-transparent pricing. Particularly with increasing cost pressure and higher need of compliance and risk management, IT departments in hospitals need clear IT Service Catalogues in order to provide the specific services needed and also in order to have more transparency of cost.

Methodology & Theoretical Orientation and Findings: In an iterative, consortial research approach including a University of Applied Sciences, consulting firms and several hospital IT experts, an IT Service Catalogue for Hospitals was developed based on existing literature but adding specific aspects for the hospital context. The main goal was a pragmatic approach in order to ensure implementation in practice.

Conclusion & Significance: The IT Service Catalogue for Hospitals provides a good practice standard for IT departments in hospitals taking into account the specific needs for the hospital industry and thus enables hospitals to do benchmarking due to the common understanding and definition of the catalogued services.

Biography:

Zaina Theresa has a Masters in International Hospitality Management from Auckland University of Technology and is working towards a PhD from Universiti Teknologi Mara. She has hospitality industry experience in both India and New Zealand. Her research interests are in the education and qualifications of hospitality managers and the value of hospitality qualifications. She focusses on exploring the scope of hospitality and widening the employability of hospitality graduates.

Abstract:

The authors of this paper noted the rapid growth of large retirement villages in Auckland, New Zealand. Many of these have several hundred units ranging from independent living to care home facilities. A number of large corporate organisations have become major players in this sector. Similarities were noted between how these operate and hotel corporations managing resort properties. The researchers therefore wanted to investigate who the people who are managing these facilities are, what their roles involve, and where they have come from in terms of educational background and industry experience. As there has been very little academic work done in this area from a hospitality management perspective, the researchers conducted an exploratory study gathering qualitative data through five in-depth interviews with the ‘village managers’ in charge of these retirement complexes. A range of organisations were included in this purposive sample from large international providers to an independent charity with one site. Findings were that managers were mostly well-qualified with degrees or post-graduate qualifications. Many had hospitality industry experience. None had a medical background although they all acknowledged the importance of the clinical services manager who reported to them. All emphasized the importance of a strong and committed team of staff, and the importance of building long-term professional relationships with residents who are well-educated professionals with high expectations. All of them expressed high levels of satisfaction with their roles and concern about the ability to recruit staff for the future.

Biography:

Alberto Budía has his expertise in the diagnosis and treatment of urinary lithiasis and endourologic procedures. He has developed a total quality management project based on process management, patient safety, care quality and efficiency analysis since 2012. In January 2018 this project got the ISO 9001:2015 and UNE: 179003 management certification. This project has improved the activity indicators, the patient safety (FEAM model), the efficiency (cost-effective algorithms) and patient quality perception. His model is based on continuous improvement creates new pathways for enhanced healthcare in public health systems. He has built this model after years of experience in research, evaluation and management in a Lithotripsy and Endourological Unit at a Spanish tertiary public hospital.

Abstract:

Statement of the Problem: The application of this methodology to the management of health services is very appropriate in times of crisis when demand continues to grow and there is no longer a growing funding that can adapt to this demand. The foundation of this methodology is the reduction of costs, the improvement of the feedback between the health personnel, the increase in the care and production quality, the decrease in the proportion of patients who do not show up at scheduled appointments, the improvement in the main indicators, as well as the reduction of human and system errors.

Purpose: The purpose of this work is to evaluate whether the application of the lean healthcare methodology is sustainable in a tertiary department of a Spanish health service public hospital looking for improving efficiency.

Methodology & Theoretical Orientation: The implementation of the lean healthcare methodology in a urology department was conducted by carrying out the five consecutive steps described in this methodology. This was applied in three non-sequential phases: team training, process management and continuous improvement. The main source of information is the balanced scorecard for health systems management (CUIDISS). The comparison with other national urology departments was performed through the same platform (IASIST).

Findings: The implementation of this methodology translated into high practitioner satisfaction, increased the care production and improved quality indicators, mainly risk-adjusted length of stay, risk-adjusted complication index and risk adjusted mortality rate. The readmissions rate was the only indicator above the standard due to the adjusted length of stay. The application of this methodology resulted essential to improve the efficiency of the service and hospital.

Conclusion & Significance: The implementation of the lean healthcare methodology is possible in the Spanish public health care; however its sustainability depends on a parallel increase of resources to the care production and an intrinsic and extrinsic recognition of the unit, service or center that has incorporated it.

Biography:

Erum Gonsalves is a Manager, Business Process Reengineering at The Aga Khan University, a leading tertiary care 660 bedded hospital in a large metropolis, where demand for high quality healthcare is on the rise. She has been actively involved with major projects in the University hospital aimed at improving efficiency, eliminating bottlenecks and improving service quality to maximize value for patients. Streamlining the Inpatient Discharge Process was a major project she successfully implemented, facilitating annual bed hour savings of over 100,000 through reduction in discharge process time. This project was also awarded a gold award in innovation in hospital management category at the Hospital Management Asia Aug, 2017. Currently she is working with the hospital’s Emergency Department to increase patient throughput and Outpatient Clinics to minimize turnaround times. Besides her BPR centric work at the hospital, she has also been involved in various projects with the University.

Abstract:

Situated in the densely populated metropolis of Karachi, the Emergency Department(ED) at The Aga Khan University Hospital is arguably one of the most complex clinical settings, catering to the highest acuity patients. Inefficient processes in the ED delayed key activities resulting in a high average LOS of 10.3 hours for admitted patients, and 3.25 hours for discharged patients (2017). Consequently, the number of times an ED bed could be turned over in 24 hours went as low as 4 restricting ED bed supply. Hence in 2017: 4,741 patients left ED because of unavailability of bed (LBUEB) leading to a potential revenue loss of $2.8 million to the hospital.

 A thorough data analysis and time and motion study by the Business Process Reengineering (BPR) team revealed that wastages in the existing processes prolonged decision and transfer times to 4.75hours and 1.8hours respectively. To achieve faster throughput, it was imperative that clinical decisions were accelerated, staff roles were reorganized and manual activities were eliminated from work flows.

The project aimed to achieve a ‘leaner ED’ by aligning existing systems to meet user requirements, automating the bed tracking and standardizing the patient transfer process (SBAR). Furthermore, inter-disciplinary communication within ED staff was improved by introducing nursing team-leads in each area and a non-clinical shift-lead to expedite operational activities and reinforce smoother communication between ED and Inpatient Area.

 As a result, length of stay reduced by 1.7hours for an admitted patient and 0.25hours for a discharged patient. Subsequently, overcrowding reduced: 84% of P1 patients were assigned an ED bed within 10mins of Triage and LBUEB reduced by 44%.

Sustaining these results will potentially yield 50,200 additional ED bed hours annually. Capitalizing on 75% of these hours ED can potentially admit 20 more patients per day, earning the hospital an annual revenue of $4.1million.

Biography:

Emad Esmat is the professor & Head of General Surgery Department and Chief Clinical Surgical Departments at Theodor Bilharz Research Institute (TBRI). He was responsible for TBRI hospital management for more than 10 years and for the private hospital sector for 6 years. He has the "high diploma of hospital management" & he is an "international certified Lead auditor" (IRCA-UK) for the ISO 9001/2015 in addition of being International Assessor for Human Resources (SHL-UK). He has been included in Who's Who biography 2009 and also been nominated for many unique biographical centers like Who's Who in medicine and health care and the 2000 outstanding intellectuals of the 21st century 2009-2010, and in the top 100 health professional 2009, and also nominated as one of 2000 international profiles of accomplished leaders and great minds of the 21st century by American Biographical Institute.

Abstract:

The aim of this study is to assess the pattern of change in utilization and performance in GSD after implementing the new policies and procedures.

Methodology: This is a retrospective observational study. Electronic data were collected from the medical record unit of TBRI from the year 2001 until 2016. Hospital utilization indices; admission, surgical operations, and bed utilization indices; average length of stay (ALOS), bed occupancy rate (BOR), bed turnover rate (BTR) and mortality rate (MR) were calculated before and after implementing the new policies and procedures as from 2007 onwards.

Results: the shift to more skilled and major surgical operations were doubled, the increase of elective surgeries >3 folds of emergency operations, the increased outpatient flow >3 folds, decreased mortality rate, and the improvement in hospital bed indices; decreased ALOS, increased BOR and increased BTR, are the indicators used to show the raise of performance in GSD. The year 2016 showed the optimization of all hospital indices: ALOS 5.5, BOR 74.2, BTR 48.9, and MR 0.1.

In conclusion: Although quality improvement may not appear in the initial years of a program, persistent implementation of hospital quality policies will ultimately lead to future better quality of patient care.

Biography:

Steffi Jerry Mammen is currently pursuing her MHA Degree along with clinical duties at the Inamdar Multispeciality Hospital. She is a budding Researcher having her expertise in pharmacology. Interacting with other healthcare professionals, providing knowledge, information, patient counseling and awareness in a country where pharmacy is under-rated profession is a part of her work profile. She has published research papers in various national and international journals

Abstract:

Purpose: The purpose of this work is to study the adverse drug reactions (ADR’s) reported from wards and critical units at a tertiary care hospital in Pune. The adverse drug reactions were analyzed by Naranjo’s algorithm scale and Hartwig severity assessment scale and the outcomes were studied.

Methodology: This observational and interventional study was conducted for 6 months from November 2016-May 2017 in an inpatient setting at a tertiary care hospital in Pune. The data was captured only in wards and critical units. Patients of all age groups and either sex were included in this study. The adverse drug reactions were checked for their causality and severity by performing the Naranjo’s algorithm scale and Hartwig’s scale respectively. The outcomes were studied. Data analysis was done by descriptive statistics.

Results: Total of 50 adverse drug reactions were reported from wards and critical units. 21-30 years age group was reported to have more adverse drug reactions. The most common organ affected is the skin 32 (71.11%), followed by respiratory system 3 (6.66%) and nervous system 3 (6.66%). Vancomycin 5 (20%) was the drug having majority of the ADR’s. The commonly reported ADR in this study was rash and itching 29 (64.44%). According to Naranjo’s algorithm scale, 23 (51.11%) suspected ADR’s were probable, 17 (37.77%) ADR’s were possible and 5 (11.11%) were definite. As per Hartwig’s severity assessment scale, majority of the ADR’s were mild 21 (46.66%), followed by moderate 20 (44.44%) and severe 4 (8.88%). The outcome of the ADR’s was all recovered 38 (84.44%) during the study period.

Conclusions: There is a need for more spontaneous reporting. After an ADR has occurred, patient counseling is mandatory. The active involvement of a clinical pharmacist to capture ADR’s and awareness given via training to other health care professionals can help change the scenario in under-reported hospitals

Biography:

Aydin Teymourifar completed his BSc in Statistics at Tabriz University, Iran (2005–2009) and achieved MSc in Industrial Engineering from Anadolu University, Turkey (2011–2014). He is a Ph.D. candidate in Industrial Engineering at the Eskisehir Technical University. His research interests are production scheduling, simulation, and healthcare management.

Abstract:

Efficiency measurement of health organizations using the Data Envelopment Analysis (DEA) has gained importance with increasing spending on health services. The aim of this study is to analyze the efficiency of 10 surgical services of a hospital and also to offer suggestions for increasing their productivity. At first, as seen in Figure 1, decision-making units, model, input and output of some previous studies are summarized. Then, the input-oriented model of the DEA method under Variable Returns to Scale (VRS) is used to measure the efficiency of sections. The model has 2 inputs, i.e. the number of personnel and beds, and also 2 outputs, i.e. capacity utilization rate, the total number of operations. Data Envelopment Analysis Toolbox of MATLAB and Excel are used to analyze the data. After recognizing the efficient and inefficient sections, the efficient ones are ranked with Andersen and Petersen model, Tone’s SBM model and cross efficiency evaluation, whose advantages and drawbacks for the ranking are discussed. The results prove that it is possible to increase the efficiency of the sections with efficient using the current resources and without increasing costs

Biography:

Prachak Bouphan has his expertise in Public Health Administration and passion in quality management of the health personnel in health organization. He completed PhD in Development Science, his Master’s degree in Development Administration and Bachelor of Science in Public Health. He is currently an Associate Professor and also acts as a Chairman of Master’s program in Public Health Administration

Abstract:

This cross sectional descriptive research is aimed to study factors affecting the community health center performance of sub-district health promoting hospital directors in Khon Kaen province Thailand. The samples involved 180 health personnel selected by simple random sampling from the 248 population who were responsible for community health center performance. The study collected both quantitative and qualitative data. Focus group guidelines were used to collect the data from 12 people’s key informants who could provide intensive information on the topics. The questionnaire was examined and verified by the three experts for content validity and items objective congruence (IOC) of all items more than 0.5 and tested for reliability in pilot study of Cronbach’ alpha coefficient was at 0.95. Data was collected between March 1^st and 31^st 2016. The data distribution was performed by descriptive statistics including percentage, mean, standard deviation, median, minimum and maximum. The inferential statistics were Pearson product moment correlation and stepwise multiple linear regressions. The level of statistical significance was set at 0.05. The findings revealed that the overall motivation, the key success factors and the community health center performance of health promoting hospital directors were at high level with averages of 3.90 (SD=0.37), 3.53 (SD=0.55) and 3.70 (SD=0.57), respectively. The motivation variable, motivator factors, hygiene factors and key success factors had moderate positive relationship with community health center performance of health promoting hospital directors with r=0.534 (p-value <0.001), r=0.529 (p-value <0.001), r=0.392 (p-value <0.001) and r=698 (p-value <0.001), respectively. The motivation factors; responsibility and three key success factors; quality development in healthcare and image, the link between sub-district health promoting hospital and the central hospital and people forum could predict community health center performance at 56%. Incentives and salary compensation followed by community health center management and participation are some of the initiatives taken towards community health center performance.

Biography:

Chanaphol Sriruecha is currently an Associate Professor with expertise in health system administration, including health policy and health economics. He contributes in the evaluation research for the improvement of health care system in Thailand such as the national emergency medical service and road accident prevention for local administration.

Abstract:

This is a cross-sectional descriptive research aimed to study motivation of health officers affecting the long-term care for the elderly at sub-district health promotion hospital in Phetchabun province, Thailand. The sample contained 127 health officers randomly selected through systematic random sampling from 157 population. Both quantitative and qualitative data was collected during March and April 2017 by using structured questionnaires and focus group discussion. The questionnaire was examined and verified for content validity and tested for reliability yielding of all items. IOC value exceeded 0.5 and alpha coefficient was 0.97. Descriptive statistics including percentage mean, standard deviation, median, minimum, maximum and inferential statistics including Pearson’s product moment correlation and stepwise multiple linear regressions were employed in data analysis. The results showed that the motivation and the performance of the sample respondents in long-term care for the elderly were found at high level with average score of 3.52 of 5 (SD=0.43) and 3.65 (SD=0.54) respectively. The motivation variables of both motivation and hygiene factors had moderate positive relationship with statistical significance to the performance of the elderly long term care (r=0.557, p-value<0.001), (r=0.547, p-value<0.001) and (r=0.501, p-value<0.001) respectively. There were two motivation variables i.e., work itself and policy and administration could join predicting their performance in the elderly long-term care for 39.8%. (R²=0.398 p<0.001).

Biography:

Her passion about management has brought Lana Emilia into Hospital Management post graduate program of Brawijaya University on 2016. She eagerly wants to improve the health services system in Indonesia. She always believes that the human resources are the most important assets of an organization. The success or failure of an organization is largely dependent on the caliber of the people working therein. The project she has been working on under supervise

Abstract:

Universal Health Coverage (UHC) organizers owning in Indonesia with the concept of the National Health Insurance (JKN), which is implemented and organized through the Social Security Organizing Agency (BPJS), still raises a polemic, especially for medical staff. The problem that occurs is the problem of paying for health services using the INA-CBG package which depends on the diagnosis and the procedure for each disease is considered to be still less relevant. The doctor must be precise in setting the diagnosis and procedure that must be done for a disease, if the doctor performs an examination to make a diagnosis and performs the procedure against the disease outside the clinical pathway (the clinical pathway), then the costs cannot be claimed to BPJS, meaning the hospital must bear these costs. The impact is that hospital staff are forced to work harder because they serve more patients, while facilities and equipment are limited. Satisfaction of medical staff is very important in the hospital industry, which is a factor that influences the performance of resources in hospitals which has an impact on the service of JKN patients in hospitals. Therefore, this study was conducted to obtain an overview of the work satisfaction of medical staff in the service of JKN patients at RSIA Puri Bunda. This study uses a descriptive analytic research method with a cross sectional study approach, with a sample of 104 medical staff consisting of doctors, midwives and nurses. The results showed that the satisfaction of medical staff in providing JKN services was quite low with a percentage of 56% (less satisfied). The lowest satisfaction level on the subvariable job return is 36% (very dissatisfied), social responsibility is 45% (dissatisfied), organization and administration is 51% (dissatisfied), job itself is 52% (dissatisfied), working environment is 54% (less satisfied). While professional loyalty has the highest satisfaction of 79% (satisfied) and internal environment at 77% (satisfied).

Biography:

Mutushev Alibek Zhumabekovich is a staff member of "Scientific production and technical center Zhalyn". Worked in the project "Development according to the standards of developed countries of domestic technology for obtaining innovative products - Carbon nanosorbent" Ingo-2 "for medical purposes" for program-targeted financing. He works as a commercialization specialist in the project of commercialization of research results on the topic "Creation of the first production of domestic hemosorbents of laminar flow", "Creation of a technological line for the production of pharmaceutical enterosorbents". During the execution of the project work, determined and achieved the clear objectives of the project when balancing between the amount of work, resources (money, labor, materials, energy, time, quality and risks, performed managerial duties on grant and program-target projects.

Abstract:

According to statistics of the World Health Organization, burns occupy the third place among other injuries, especially in case of natural disasters and military conflicts their number increases dramatically. It is known that among the burned patients with superficial and limited deep burns prevail, accounting for 75-80%. In connection with these, the development and implementation of new innovative wound healing dressings with high efficiency is an urgent problem. Today in the world of surgical practice high absorption capacity dressing is widely used for wound healing. Unfortunately, in Kazakhstan a simple dressing is used without any auxiliary substances for fast wound healing. In this regard, it is urgent to search for and develop new highly effective wound healing materials. The purpose of this research work is to study the healing properties of wound healing dressings. In accordance with the goal, tasks formulated were: modeling of mechanical and burn wounds; application of a wound dressing with activated charcoal from rice husk for the treatment of mechanical and burn wounds. As an object of study, eight monthly white laboratory rats with an average body weight of 220-250 g were used. Studies were performed on 18 laboratory rats. To apply burns to the flame, cotton wool, gauze wipes moistened with alcohol were used and mechanical wounds were applied by damaging the skin with a scalpel.

Dressings in the experimental groups changed every three days, observed epithelialization of wounds and there was a presence or absence of purulent exudate in the wounds. Studies carried out on rats have shown that the wound dressing has a pronounced, wound-healing effect. At the same time, the healing time for wounds came much earlier than in the control. Wound dressing series are more effective in the treatment of mechanical wounds. In all animals with mechanical wounds, partial epithelialization of the wound was observed three days after the application of the wound and eight days after the application of mechanical damage complete wound healing was observed. And in the control group, the complete healing of the mechanical wound was observed only 15 days after the injury was applied. Also, in the treatment of a burn wound, this dressing promoted the rapid healing of wounds in comparison with the control that is within 20 days of the complete healing of the burn wound was observed. The results obtained showed that the wound dressing can be used in the treatment of burn injuries. Carbonized rice husks and colloidal silver that are part of the dressings contribute to the rapid healing of wounds by absorbing the wound by the carbonized rice husk and preventing the formation of purulent exudate with colloidal silver as a potent antiseptic. Based on the experimental results obtained it can be concluded that the dressing can be used in practice for the treatment of burn disease.

Biography:

Nuraly Assiya Mambetkyzy is an employee of "Scientific production and technical center Zhalyn" has established itself as a responsible employee. She have maintained the course of project work defined and achieved the clear objectives of the project when balancing between the amount of work, resources (money, labor, materials, energy of time, quality and risk,performed managerial responsibilities for grant and program-targeted projects. She has no disciplinary penalties, was repeatedly rewarded on the basis of work with cash bonuses. She is hardworking, has high working capacity and take responsibility for the outcome of its activities

Abstract:

Extracorporal detoxification-hemosorption is currently a newly developed and studied method. Hemosorption is the process of removing blood toxic substances and metobolites of various spectra. In connection with environmental problems in recent years, interest in hemosorption has increased significantly as a simple, affordable, non-traumatic method of therapy. To expand the scope of this method, it is necessary to create new hemosorbents. At the present time, data has appeared that substantiate the advisability of refusing the use of antibacterial agents in the treatment of acute intestinal infections and the need to strengthen pathogenetic therapy with the aim of minimizing adverse effects on the patient's body. At present, in connection with the expansion of the application area and the creation of new chemicals, as well as the increase in the volume and range of medicines, the importance of studying the study of toxicology - the science of acute and chronic poisoning is growing. The problem of detoxification of the body has a special significance in the treatment of toxicological diseases. Development of materials for hemosorption from available raw materials is an urgent task. In this work, a method has been developed for the use of a carbonized rice husk for the manufacture of a carbon monolith used for hemosorption. The uniqueness of the development lies in the fact that it allows the removal of medium and large molecular weight protein toxins from the patient's blood that are formed during the development of multiple organ failure and which are involved in the manifestation of septic shock. The same hemodialysis works at the membrane level and is able to purify the blood only from low molecular weight toxins. Unlike hemodialysis, hemosorption makes it possible to absorb medium and large molecular toxins. This mechanism is achieved due to the microcellular structure. As a result of the study, it was found that the production of carbon monolith is most optimal with the use of "mother milk", which is obtained by mixing components not of the carbon part. Then to the carbon composition - CRSH the addition of "mother milk". Thus, the developed composition of carbon monolith preparation allows to obtain a plastic mass for the preparation of hemosorbent with a microstructure. The carbon monolith is characterized by a large number of mesopores compared to similar sorbents "dust" which does not swell in an isotonic solution. It has an increased hardness, purity, high hemocompatibility, which reduces the standard anticoagulation allowance by a factor of 1.5.

Biography:

Nicole Gerber is a Senior Research Associate and Project Leader at the Institute of Facility Management (IFM) at Zurich University of Applied Sciences (ZHAW), leading different research and development projects with a focus on healthcare. She can draw on various professional and entrepreneurial experience in different industries in addition to her MSc degree in Business Administration and MAS in Information Systems

Abstract:

The first version of the Service Catalogue for Non-medical Support Services in Hospitals (LekaS) was developed in a consortial research approach between the Zurich University of Applied Sciences, several hospital associations and industry partners. The goal of LekaS was to have a clear and comprehensive definition and differentiation of the non-medical support services in hospitals in order to facilitate a common understanding of the type and scope of the services, and to enable a clear product bundling. The overarching aim of the initiative was to have a standardized basis to define clear and comparable Service Level Agreements, to make detailed process descriptions and improvements, to systematically discuss relationships and dependencies between the strategic, tactical and operational levels, to improve financial transparency and thereby to develop and implement sensible benchmarking approaches, as well as to have a well -founded basis for discussing cost-cutting measures (Gerber & Läuppi, 2015, p. 8). The conceptual basis was the norm “SN EN 15221-4 (2011) Facility Management: Taxonomy, Classification and Structures in Facility Management”, however the catalogue was adapted specifically to the branch. Meanwhile, several applied projects in the field as well as feedback from practitioners have provided hints about how to complete and refine the catalogue. LekaS Version 2.0 is therefore newly-structured, is more complete and adapted to the most recent findings from different research and development projects.

Biography:

Claudio Beltramello is a MD, specialized in Public Health with Diplomas in Healthcare Management and in Business Administration, has a deep knowledge and wide experience in health care quality management. He has being working in the past 12 years as senior consultant and educator for several Italian hospitals and local health trusts. He also teaches hospital management at the Padova University Faculty of Medicine. Previously he operated as a healthcare manager at international level for the World Health Organization for 3 years and for a non-profit organization running health projects in poor Countries for 4 years. He speaks English, French and Portuguese as foreign languages

Abstract:

In health care management a few approaches and tools exist: ISO certification, international accreditations, total quality management, lean management, clinical risk management, process management, project management, clinical pathways; health technology assessment, clinical audit and others.

The choice of one or another – the operation of matching the problem at stake to a particular tool according to its suitability for that class of issues – is rarely based on evidence. Instead, it usually depends on the manager’s personal attitudes (1). Moreover, literature shows that once a particular tool is picked up, it is then applied with a kind of “all or nothing” attitude, with its promoters aiming at demonstrating that the one applied is the only really effective (2, 3). As a matter of fact, commonalities and complementarities among different healthcare management tools/approaches are numerous, and a wider view is therefore pivotal for quality improvement purposes (4, 5). In an effort to adopt such a wider view (6), this work proposes an integration of three relevant tools: lean management, clinical risk management and clinical pathways. Their main goals are respectively: to reduce waste and improve value and efficiency; to reduce adverse events to patients and improve safety; to increase appropriateness linking clinical choices to the best available evidence and improve effectiveness.

All relevant documentation on the three tools stresses the importance of four similar steps:

a) An analysis of the actual process the patients go through and of the concrete activities performed by health personnel in wards/departments that need improvement.

b) A further examination of the processes involving patients and personnel through a specific lens:

- Lean management focuses on increasing value through the elimination of wastes (muda) with the application of dedicated tools (value stream map, visual management, 5S, pull system, kanban and others). (7)

- Proactive clinical risk management focuses on the identi-fication of the potentially dangerous steps applying the FMEA (Faiure Mode and Effect Analysis) in order to “close the holes in the cheese” before an adverse event might occur to a patient. (8)

- Clinical pathways focus on the reduction of variability among health professionals by means of an alignment of diagnostic and therapeutic decisions with the recommendations of the reference clinical guideline. (9)

c) An overhaul of the process according to the optimal model worked out.

d) The actual implementation of the changes followed by monitoring and evaluation of the results using SMART indicators.

The times are ripe in healthcare management for removing barriers and integrating different approaches -getting the best out of each of them (10).

Depending on the context and the problems under scrutiny, value stream mapping (lean) or FMEA or clinical pathways can be more appropriate. What may result in critical advancement, however, is that, when it comes to the common step of process re-engineering, an integration of the three approaches is conducive to the improvement of several quality dimensions at once

Biography:

Enrico Rosso is a resident doctor in Public Health. He is deeply interested in hospital management, HTA and value based healthcare. He speaks English and French. Currently he is resident doctor in Public Health at University of Padua, Italy.

Abstract:

Statement of the problem: The volume of surgical procedures is increasing around the World: it is estimated that 235 million interventions are performed every year worldwide. (1) In 2006, 46 million surgical interventions were carried out only in the USA; one third of these were for patients older than 65 years (2). Moreover, surgery is one of the most expensive activity in a hospital. Due to the above reasons, data analysis of operating rooms (ORs) is crucial for hospital managers. In particular, performance evaluation of efficiency, effectiveness and safety is the basis for internal and external benchmarking (3).

Methodology & Theoretical Orientation: Our study was conducted in two 400 beds hospitals of Veneto Region, Italy (10 operating rooms with 9 surgical specialties in hospital A and 9 operating rooms with 5 surgical specialties in hospital B). We did not consider Ophthalmology in the analysis. The main objective of our study was efficiency improvement. Data were extracted from the ORs information system called “Opera” which is imputed in real time by nurses. We investigated two types of indicators for each surgical specialty in the two hospitals: times and activities.

For the times indicators median and mean were utilized to measure: a) Surgical times (skin-to-skin), b) Anesthesiological times and c) Turnover times (patient exits- patient enters)

Findings: We analyzed 6108 surgical procedures performed in nine months (period: September 2017 to May 2018). On occupation index (time between the first patient entering the operating room and the last patient coming out over the total scheduled time 08:10-14:30), General surgery was the best in hospital A (88%), while Otolaryngology was the best in hospital B (90,1%). The worst performance was Orthopedics in both hospitals (64,7% in hospital A vs 75,7% in hospital B). Again, the best surgical specialties for first incision times were General Surgery in hospital A (mean 08:57, median 08:45) and Otolaryngology in hospital B (08:47; 08:43); the worst Orthopedics in hospital A (mean 09:17; median 09:14) and General Surgery in hospital B (09:18; 09:05). Considering turnover times, Gynecology was the fastest in hospital A (mean 23 minutes, median 19 minutes) and Otolaryngology in hospital B (18; 18), while Orthopedics was the slowest in both hospitals (32 minutes, mean and median in hospital A; 35 minutes mean and 34 minutes median in hospital B). The percentage of different times are shown in Figure 1 (hospital B as example).

Conclusion: Overall efficiency in the ORs of the two hospitals is good. However, General Surgery, Vascular Surgery, Breast Surgery in hospital A and Otolaryngology in hospital B proved to have much higher performances compared to the other eight surgical specialties considered. Analyzing the main reasons of these differences, an intervention to spread the concepts of lean/six sigma approach and the culture of parallel processing has begun. (4). Results also showed the need of two recovery rooms in order to reduce anesthesiological times as well as a shortage in the number of nurses.

Biography:

Md.Rashed Alam is an Associate Professor in Population Science and Human Resource Development with particular expertise on adolescent reproductive health and fertility. He leads a research group on reproductive health and fertility at Rajshahi University (RU) with approximately 10 multidisciplinary researchers. Over the last 12 years he has lead a few number of research projects in Bangladesh, aiming at more effective program implementation of HIV/AIDS knowledge, awareness and attitudes; women’s working status on fertility and determinants of academic performance of the university students. He has joined various training program such as reproductive health and HIV/AIDS and initiatives in science education, research and capacity building in home and aboard. He was also awarded scholarships on the above degree. He presented at various conferences in home and aboard and published 14 research articles in various journals. He is the leader of departmental indoor and outdoor games

Abstract:

Methods: We adopted the PRISMA consensus statement. PubMed database were searched on February 13, 2016. 24 studies were included, 10 studies go to the quantitative synthesis and others go to narrative reviews. Meta-analysis was used to pool the result of the individual studies.

Results: Adolescent pregnancy found to be significantly associated with higher risk of low birth weight (LBW), (OR, 1.50; 95% CI 1.27–1.78), preterm birth (PTB) (OR, 1.49; 95% CI 1.15–1.93), small for gestational age (SGA) (OR, 1.33; 95% CI 1.13–1.56) and neonatal mortality (OR, 1.45; 95% CI 1.20– 1.76). Lower risk of cesarean delivery (OR, 0.77; 95% CI 0.60–0.98) also reported among the adolescent mothers. Risk of perinatal mortality also found lower (OR, 0.80; 95% CI 0.42–1.51) among adolescent mothers however, the risk was not statistically significant.

Conclusion: The findings concluded that adolescence pregnancy increase the risk of LBW, PTB, SGA, neonatal mortality. The risk of cesarean delivery and perinatal mortality found lower among adolescent mothers. Increased awareness about the adverse effect of adolescent pregnancy outcomes may protect rules in adolescent marriage and help to reduce such outcomes for the welfare of mother as well as children.

Biography:

Ghadeer Majed is biomedical engineer graduate from Sudan from University of Medical Science and technology (UMST) with Honor degree first class in july-2018 and she was the first in this specialization and starting her career from sep-2018 as teacher assistance in the University Medical Science and technology (UMST). She take A+ in the graduation project “A Non-Invasive Device for Detecting the Lung Cancer Using the Exhaled Breath”. She is a highly motivated and has the ability to adapting herself in different environments and has good knowledge in programming language. Her goal is to become a fully qualified biomedical engineer and continue developing her skills and gain working experience.

Abstract:

Statement of the Problem: The traditional way of diagnosing lung cancer are invasive, expensive and time consuming procedure. Lung cancer is one of the most popular type of cancer. It is a world threatening disease as symptoms usually don't appear until on a late stage of a patient life. The need for a rapid method of detection is highly needed in the world of oncology. This paper has focused on a non-invasive, cost effective and instant method of detection. The design of this detection device is based on analyzing some of the biomarkers that can be found in a human breath, known as volatile organic compounds (VOCs). This detection tool is comprised of face mask, microcontroller, TGS sensors and a display unit. Twenty-four subjects were selected from different categories (male/female and smokers/non-smoker). Twelve of them were normal while others were patients with lung cancer. There is a high relation between the high concentration of these VOCs and the presence of lung cancer in any human body.

This study has proved that biomarkers can detect the presence of lung cancer, and that the higher the concentration of the VOCs the higher the probability of lung cancer presence.