8 USES OF HOSPITAL RECORDS

Sometime in 2011, I went back home (Benin-City) to visit my parents. While there, I decided to "browse" my personal record file that my Dad had kept from the day of my birth. The file contained my birth certificate, the first comic book I wrote, my primary school results, my secondary schools results and a lot of other records. Some of which I won’t share with you! Looking through that file, I was able to trace my educational journey from kindergarten (Well, not really. More like "akara school") to university. I could even recall things and people that I had long forgotten. I was amazed that my parents had kept such good records for all their children. I really can’t say the same for myself (and I have just two)!

That visit got me thinking about the importance of good records to an individual and an organization. To me, the most important organization where good records are crucial to its very existence is the hospital. Unfortunately, hospitals in general and private hospitals in particular are notorious at keeping poor records. Admission data, diagnosis data, monthly income records, pharmacy records and laboratory data are all poorly kept. I was told of a private hospital that burns (yes, burns) patient's folders after 4 years claiming that they have expired. How absurd! Without proper health records, we cannot make progress as a nation. Keeping records means having a good history. History helps us to take decisions today that will eventually shape our future. This implies that you cannot effectively plan for the future without having a good record of the past. A wise man once said "the faintest ink is sharper than the sharpest memory".

 I came across a study some years ago called the Framingham Heart Study. It was part of the learning tools in my Online Bio-statistics course at the Harvard School of Public Health. This study was started in 1948 and it involved an initial population of about 5000 people. Today, the children and grandchildren of some of the initial enrollees have been enrolled in the study. The Framingham Heart Study has helped improve our understanding of CHD and HTN in the last 70years or so. This is the result of good record keeping.

What drives me first and foremost is a burning desire to see the quality and standard of healthcare improve in Nigeria (and across the African continent). This will be achieved if the healthcare professionals themselves embrace change and commit to self-improvement; not only in clinical skills but also in managerial skills. So, to the multitudes that share this desire, I say “let’s go on”.

Now, why is it important to keep good hospital records? What are the uses of hospital records? I will write on 8 uses of hospital records. There are a lot more.

1.     Research and planning

2.     Assessment and evaluation

3.     Detection, Prevention & Control

4.     Process improvement

5.     Profit

6.     Provides confidence

7.     Effective Resource Management

8.     National Security

1.     Research And Planning

Good hospital records form the bedrock of any clinical research project. Can you imagine how difficult it will be to get the National HIV prevalence rate if health facilities do not send in HIV data?(let’s assume that the records are actually accurate) Without good records, a researcher will lack data on which to build his/her research. Without research findings, there can be no action plan on HIV/AIDS. You can step this scenario down to your local facility. Research leads to improved understanding of present knowledge and discovery of new facts. This invariably leads to better planning.

2.     Assessment And Evaluation

When you study your hospital records, you will be able to assess and evaluate your hospital’s performance. Let’s take Delivery records for instance: A glance at the annual delivery record will show the number of life births, still births and ENND. You can maybe calculate the cumulative incidence of ENND, compare with the state average (if the records are available!), assess the deviation of your facility from that average and then evaluate the effectiveness of your hospital delivery methods. You may discover that most of the ENND occurs when a particular staff is on duty. All the conspiracy theorist can get to work now! (Have you seen the movie ‘coma’? Watch it and you will get the drift).

I will end this post here. The article on hospital records will continue in my next post. 

HOW TO REDUCE AND ELIMINATE FINANCIAL WASTE IN YOUR HOSPITAL

The phrase “Hospital Economy” is a common one used in many clinical settings. It literally means conserving hospital materials to prevent waste. Hospital Entrepreneurs do this to minimize cost and maximize profit. Sometimes, the practice of hospital economy is taken to the point of trying to ligate a bleeder with the last tiny piece of suture remaining! I am sure surgeons will know what I am talking about.

But I have since discovered that the practice of hospital economy contributes little or nothing to the productivity of the hospital. It is better rather, to adopt trusted and tested principles of productivity to minimize waste. After all, medicine is a science and doctors are scientists not artisans. It is important therefore that we rely more on proven productivity techniques rather than on trial and error methods.

There are several sources of financial waste that you can find in the healthcare industry. I will highlight a few.

1. Excessive Production and Idle Time
Excessive production occurs when there is a mismatch between supply and demand. When you supply more than is demanded, you invariably experience over production. A good example of excessive production in the healthcare industry is employing more workers than is needed. This means your supply of workers exceed the demand (patient load) you have. There is then a supply (workers)- demand (patients) mismatch. This leads to the incidence of idle workers who consume financials but contribute nothing to the hospital process. To handle excessive production and idle time, you must match your supply with your demand.

2.Re-work
Rework is a repetition or correction of a process because of quality problems. It happens when the initial product does not meet the expected standard requirement. Rework is a painful and costly process. A healthcare example of rework is readmission.
It is very important that you quickly identify and correct rework in your hospital. To correct rework, you must analyze and solve the causes of rework. Consider the example below.

 Mr. Nwoye is a 72-year old hypertensive and diabetic of over 20 years duration. He was initially discharged 2 days ago (after spending a week on admission for sepsis secondary to UTI). He has just being rushed back to the hospital in septicemic shock. On inquiries by the Medical Director, it was discovered that the resident doctor discharged him without appropriate follow-up medication. Mr. Nwoye’s eldest son is a consultant nephrologist in the UK. So, there can be no cover up. The hospital may not be able to charge them for the new treatment.

The above case may sound extreme but it is an example of rework. Mr. Nwoye was discharged from hospital before regaining full fitness and without proper medication.

Readmission leads to wastage of resources-time, money, skill, efforts etc. 

Re-admissions can cause patients to lose confidence in your ability as a healthcare provider. It will portray you as being incompetent and hurt your productivity levels.

It is very important that you quickly identify and correct rework in your hospital. To correct rework, you must analyze and solve the causes of rework. You should critically and objectively evaluate your methods, materials, machines and manpower.

 An unbiased evaluation will help you ascertain the source of the defect. After detecting the reason for the rework, you must move to prevent a re-occurrence.

A good approach is to adopt quality management practices e.g Total Quality Management (TQM) and Six Sigma Concept of management. TQM simply states that every worker in the organization must produce quality at all times. The production of quality products/services should begin from the management team down to the least paid ward attendant. The emphasis of the Six Sigma Concept on the other hand, is that you must get it right the first time. Mistakes can be costly in medicine and a failure rate of 0.1% may lead to death. You must make the right diagnosis, use the right medication, and employ the right personnel the first time.

3. Waiting Time 

It is said that patients spend more time waiting to access treatment than the actual time spent on receiving treatment! Your goal in this instance is to reduce the waiting time in your hospital to the barest minimum. However, you cannot solve a problem until you understand the dynamics of that problem. To understand why patients wait, you must first understand the concept of the bottleneck.

The bottleneck is that resource (manpower or machine) in your hospital process with the least capacity. The bottleneck could be viewed in terms of “inter-department” or “intra-department”. In the “inter-departmental” view, one of the departments in your hospital could be the bottleneck in its working relationship with other departments. Once you can solve the problem of the bottleneck, then you are on your way to reducing waiting time.

Cheers!

HOW TO INCREASE YOUR HOSPITAL PROFIT MARGIN AND MAKE MORE MONEY

INCREASE YOUR  HOSPITAL  PROFIT MARGIN

 Today, I will like to share with you some principles that can help you increase your profit margin and grow your money in the present economic era.

You do not need to be an Economist to realize that the current drop in the global crude oil prices will affect the world economy, your hospital inclusive.

The secret to business survival is not just in increasing your fees (though that may help) but in controlling your expenses. The most important point of control is Inventory Control.

Your inventory consists of drugs, materials and other consumables in your hospital. Most of your income is tied up in your inventory. If your staff pilfers your drugs, you will lose income and your profit will drop. If you overstock your pharmacy/store, you may run out of working capital to keep your business going. If you under-stock your store, you will have frequent stock-out episodes which can reduce your efficiency. You must therefore know how to strike the right balance in inventory management.

Pareto’s Principle

Controlling hospital inventory is a herculean task. Herculean because the amount of drugs, needles, syringes, etc used in running a hospital is enormous. How can you then keep track of them all and still have time to perform your clinical duties?

The answer was given by an Italian Economist, Vilfred Pareto in 1906. His principle is based on the "vital few and the trivial many" or the 80/20 rule. Applying this principle, 80% of your stock should usually consist of slow moving/inexpensive items. The remaining 20% of inventory are fast moving/expensive items. Think about that for a moment. Also, 80% of your hospital's total inventory cost is caused by only 20% of all items.

This means that YOU must identify the "vital" 20% in your inventory and actively monitor them. For the "trivial" 80% of items, you can assign an inventory manager to monitor their usage and report back to you. This will keep you on top of your inventory control while freeing more time for you to perform other duties.

In addition, it is important that you understand the six sigma concept. This is because providing high quality service is cheaper in the long run. The six sigma concept will guide you in your quest for quality.

                                               

                         

Six Sigma Concept

I want to introduce to you the SIX SIGMA CONCEPT in hospital management. It simply means striving for near perfection and attaining zero-defects in your hospital processes. It means that 99.9% is not good enough. Why? You may ask.

If 99.9% is good enough, Statisticians say we will have 1 hour of unsafe drinking water every month, 500 incorrect surgeries every week, 3000 iatrogenic neonatal injuries every year etc.
With the implementation of the SIX SIGMA CONCEPT, this will be reduced to only 10 neonatal injuries per year. How does it really work?

Here are some steps to achieving near perfection in hospital management.

Step 1: Identify your product or service e.g. Healthcare.
Step 2: Identify your customers and their needs e.g. Corporate bodies, General populace etc.
Step 3: Identify what you need to provide satisfactory service to your customers.
Step 4: Define the process for doing your work.
Step 5: Mistake-proof the process and eliminate wasted efforts.
Step 6: Ensure continuous improvement.

Let me share some excerpts on efficient and effective hospital management from the book, HOSPITAL MANAGEMENT MADE EASY.
                                                                                                               
"The goal of hospital management is to ensure the efficiency and effectiveness of
hospital operations.

Efficiency describes the relationship between input and
output in a production process. For example, if a hospital attends to 15
patients in the OPD daily, how much of hospital resources were deployed to
process these 15 patients? And how much was derived from these patients? If the
output outweighs the input, then the process is efficient. Another example
could be how many cannulae were used by the staff nurse before she could set up an IV line for a patient? Is there wastage in the process? If you notice wastage, then training will help to improve staff performance and ultimately improve efficiency.

Effectiveness on the other hand, relates to hospital methods. Some questions to ask in defining efficiency are “Are my methods achieving the right results the first time? How satisfactory are my methods to my patients? What can be done to improve my methods? How can my hospital get it right the first time?” An important factor in effectiveness is the quality of human resources that your facility possesses. A very important human resource is the hospital manager. How (S)He perceives the hospital and its products is critical to business success.

When the hospital is seen as an organization that produces and markets a product, it helps hospital managers to achieve organizational objectives. The product is the final output of the hospital process. The hospital process begins from the registration of the patient, to consultation with a doctor, to laboratory
investigations, pharmacy visit, nursing care and drug administration and
finally terminates at the patient discharge.  A good hospital manager will ensure that the patient is the king at each point of the hospital process. The patient should
leave the hospital process with the product he/she came for – Good Health. If the
patient leaves with anything less than this, you would have produced an unsatisfied
customer (patient). Such a patient may not agree to return for a follow – up
visit and will definitely not recommend you to someone else".
 

So, increasing your profit margin is a combination of eliminating waste (improving efficiency) and ensuring effectiveness in hospital operations.

Endeavor to read more about Pareto’s Principle and the Six Sigma Lean Concept.

Cheers!

WHY HOSPITAL MANAGEMENT?????

During one of the Christmas holidays, I had a discussion with a friend who is a Resident in one of the Teaching Hospitals. We talked about my Hospital Management Books. He was of the opinion that he didn't need stuff like that to succeed. His question was "Why do I have to know anything about hospital management or administration? Medicine is a holistic discipline." I pointed out a couple of things to him.

First, EVERY health professional will eventually get involved in private practice. The reason is simple. You can work for the government for only 35 years or till age 65 (whichever comes first).

So, let’s assume you are a resident like him preparing for your Part II Exams. 

When you pass, you become a Consultant and get employed somewhere. Fine. You work maybe 3 days/week, earn maybe N 650, 000/month and eventually retire. What next? You set up a private practice that never really gets off the ground. You begin to wonder why. Afterall, you are a skilled Pediatrician, patients should be flocking into your clinic. Then it hits you! Business is different from Medicine. Hospital management is no child's play. 

You need to know the game in order to play it successfully. You may then find out you never really had the time to develop that aspect of your career!

I don't want you to ever get to such a state in your potentially great career. Examples of such "failures" abound all around us.

Recently, at an AGPMPN-organized CME in Bayelsa State, someone else asked these questions: WHY HOSPITAL MANAGEMENT FOR DOCTORS? WHY DO WE HAVE TO LEARN ABOUT HOSPITAL MANAGEMENT?

This was my reply:

• ·         Nobody can work with the government for ever. You need to be futuristic in your thinking and learn skills that will help you achieve your dreams.
• 
  
• ·         Some doctors in administrative positions in public hospitals rely too heavily on the Directors of Administration. As a result, they may be misled to take the wrong decisions. Therefore you really need to develop basic management principles to function effectively.
• 
  
• ·         An untrained person practicing as a doctor is referred to as a quack. In the same way, an untrained person managing a Hospital without learning management skills will be unable to build a world-class standard facility. Such a doctor may only succeed through "trial and error". You certainly do not want that.

Since the medical curriculum is reasonably biased towards clinical courses, we need to explore other avenues where we can learn management skills to be relevant in today's world. The CME is an excellent opportunity to do that.

So, lets introduce more hospital management/administration courses in our CMEs. That way we will be building a solid foundation for our great futures.

Thanks for reading.

See you soon!

2015: A YEAR LIKE NO OTHER

I welcome you to a brand new year-2015! It is a year filled with possibilities, potentials, challenges and victories for you and your facility.

Towards the end of every year since I have been married, my lovely wife (being the planner in the family) starts "harassing" me with questions about the coming year. She wants to know my plans (not resolutions) for our family in the New Year. I must confess that I am quite lazy when it comes to planning (at least compared to her). However she forces me to put on my thinking cap (!) and think the coming year through from January to December.

If you have not done so, that is what I want you to do immediately after reading this post. Get a pen and paper and write your plans for 2015. And if you have already written your plans, read on because you will learn a few new things.

First, just write whatever comes to your mind no matter how absurd it may sound. It is important to write out your plans because the written document will serve as a reference point or road-map for your facility in 2015. Next, categorize those plans into the following categories:

-Financial plans

-Marketing plans

-Production plans

-Administrative plans.

Or you could departmentalize your plans viz

-OPD plans

-Pharmacy plans

-Theater plans 

-Ward plans etc

The next thing you need to do is to scrutinize each of those plans based on the feasibility or otherwise of the plan. Don't be over-pessimistic or over-optimistic. Be realistic and futuristic. Eliminate the ones that aren't workable, and then build on the ones that are workable. Think of new and better ways to serve your patients this year. Think of better ways to motivate your staff.

Following this, outline the plans you are going to implement. Set a target for how soon you want to implement them. After you have done this, communicate your plans to your staff. You need to discuss those plans and get the input of your personnel. This is important because a plan that is not accepted by your staff can never work. If possible modify them after the brainstorming session with your top level staff. 

Then go ahead and implement them. Please note that no plan is set in stone. Plans should be flexible and you are free to change your plans if they are not working.

On a final note, your plans should emphasize SMART goals.

S-Simple

M-Measurable

A-Acceptable

R-Realistic

T-Time Based

Enjoy 2015