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Management: Safety and efficiency Figure 2: Magic triangle to increase patient safety and efficiency in health care Workflow Customized aystem including architecture • Processes • Sub-processes • Tasks • Organizing structure Source: Author Patient Staff qualification Figure 3: Typical phases of planning and realization a hospital Source: Author patient-stay ratio; ✚ the improvement and complexity of medical procedures and devices; ✚ the growing population combined with; ✚ the wish to stop medical tourism into western countries by; planning new hospitals in countries with developing health care systems. Two issues to increase patient safety and efficiency In conclusion it can be foreseen, that the problems concerning Technology Customized system including architecture • Medical technology • Building technology • Information technology Customized teaching and training of • Employees • Teams inefficiency of hospitals and low level of patient safety will increase in future. To avoid this scenario, one issue is to integrate the specialized knowledge of processes, hygiene, medical and building technology and training at the very beginning of the planning process of a new hospital or the reconstruction of an existing hospital. The result of such an innovative knowledge based process is: ✚ workflow adapted architecture; ✚ workflow adapted medical technology; ✚ synchronized processes in the various facilities of the hospital; ✚ decrease of nosocomial infections by implementing the highest level of hygiene standards; ✚ increase patient safety manipulating complex medical devices and building technology. Figure 2 shows the magic triangle to increase patient safety and efficiency in health care. Figure 3 shows typical phases of planning and realization of hospital and Figure 4 shows the important sub-phases of the standardized planning process to increase safety and efficiency of the planning process as well as the operation of the future facility or hospital. To ensure such results it is imperative that all persons involved in the decisions and planning process of a new hospital agree on the procedure and define in a first workshop the goals, e.g. disciplines located in the hospital, number of ambulant patients per day, number of physicians and nursing staff performing procedures, standard of the realization like first class, etc. This has to be fixed in a “Document of specification” and signed by the administration, investors and planning team. This document also includes data and analysis gained from best hospital practice audits of current workflow within the various facilities of the existing hospital, hygiene standards, medical and building technology as well as the degree of training and specialization of the employees. In the second phase the ideal workflow discussed and developed with the hospital staff will be described and documented. This will be transformed in a “Layout specification” which describes the rooms including medical technology, building technology and hygiene properties as well as their local relations. In the third phase the architect uses this “Layout specification” for his first sketches of the floor plan. It will then be discussed with the future users especially the medical staff and will be checked in a kind of second opinion by specialized workflow, logistics, hygiene and waste management professionals, which come out 28 World Hospitals and Health Services Vol. 47 No. 4
Management: Safety and efficiency Figure 4: New phases of planning 1. Workshop with administration Documentation of specification of needs 2. Workshop with employees Description of optimal workflow 3. Transforming to layout specification including - Medical technology - Building technology - Hygiene properties with a detailed expertise about pro and cons of the concept (Koneczny and Matern 2006a; 2006b). From our experience performing this kind of “peer review,” it is remarkable that most of the concepts fit the needs of nursing staff, administration and doctors, some fit the needs of the patients (regarding protection of privacy) but very few plans fit the needs of ergonomics/safety and efficiency of medical procedures, hygiene. Most of them neglect waste management. After the first peer review some iterative circles may be necessary to find the most efficient and safest hospital design before the construction can start but it always is much faster than the traditional way of planning and most importantly it drastically reduces the mistakes normally made in during planning. Additionally, the advantage of this standardized procedure is transparency to all people, experts, investors and administration including the Ministry of Health involved in the project. Parallel to the construction of a new hospital, designed from scratch, the recruiting of the key personnel has to start. The medical staff should be taught and trained in the processes, as well as the safe usage of medical devices. Minimally the future technical and administrative directors should be integrated in the planning and construction. Special study and training programs including “train the trainer” concepts ensure the high level of manual, intellectual and team skills that are necessary to operate a new hospital safely and efficiently from the first day of operation. Therefore, fully equipped training facilities like the “Experimental-OR” in Tuebingen are useful, where medical staff can be team trained in processes and personally trained in the use of medical devices and technologies before they treat real patients. Examples for such trainings are: ✚ the “OP-Führerschein ® ” (OR license) as the certificated entrance lever for everybody who needs to work in an OR including sales people and technicians. ✚ OPTeamA ® (OR team assistant). This course serves to qualify new employees to perform basic tasks in the operating room. Thus, the existing personnel may be relieved from those duties so as to focus on more critical and challenging aspects of daily work. 4. Scribbles and expertise / second opinion regarding: - Workflow (patient and staff) - Logistics - Waste management - Hygiene Lessons learned To increase safety and efficiency hospital planning has to be organized as a holistic standardized approach. It is necessary to integrate the processes of hospital planning, realization, procurement and start-up as well as recruiting, teaching and training of the future personnel. An initial signed “Document of specification” is mandatory for standardized and transparent realization of new facilities or entire hospitals and clinics. An early “peer review” of the ground floor plans as well as the desired equipment is the challenge to eliminate expensive failures and increase the safety and efficiency of the new facility or hospital. ❏ Ulrich Matern is CEO of wwH-c GmbH/innovative Hospital. He is a general surgeon and Associate Professor for Medical Technology. In research and consultancy he focuses on hospital workflow, ergonomics and usability of medical devices. He is Laureate of the Hodeige Foundation and the University of Cologne. He represents the German Society of Surgeons in several standardization committees. References 5. Final ground floor Source: Author DAK-BGW Gesundheitsreport, 2005 Stationäre Krankenpflege, page 31. Koneczny S., Matern U., 2006a. Checklist for the evaluation of OR systems including architecture and instrument design, In Proceedings IEA2006 Congress, Edited by R.N. Pikaar, E.A.P. Koningsveld, P.J.M. Settels, Elsevier Ltd. 2006. Koneczny S., Matern U., 2006b. Combining Checklists and Staff Surveys – A Powerfull Tool to Evaluate Operating Rooms, HFES-Proceedings 2006: 834-834. Matern U., Koneczny S., Scherrer M., Gerlings T., 2006. Arbeitsbedingungen und Sicherheit am Arbeitsplatz OP, Dtsch Ärztebl 2006; 103(47): A 3187–92, english Version in the internet:Working Conditions and Safety in the Operating Room www.aerzteblatt.de Merz B., Oberlander W., 2008. Berufszufriedenheit: Ärztinnen und Ärzte beklagen die Einschränkung ihrer Autonomie, Dtsch Arztebl 2008; 105(7): A-322 WHO, 2011. Health care-associated infections Fact Sheet, http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. World Hospitals and Health Services Vol. 47 No. 4 29
Page 1 and 2: 2011 Volume 47 Number 4 www.ihf-fih
Page 3 and 4: Contents Contents volume 47 number
Page 5 and 6: Editorial Editorial ERIC DE ROODENB
Page 7 and 8: Imaging 2.0 - Sharing your vision.
Page 9 and 10: Policy: China Figure 1: Three eras
Page 11 and 12: Policy: China need to be closely mo
Page 13 and 14: Policy: Japan Figure 2: The disaste
Page 15 and 16: Policy: Egypt Public policy and med
Page 17 and 18: Policy: Egypt consider the potentia
Page 19 and 20: Policy: Democratic Republic of the
Page 21 and 22: Policy: Democratic Republic of the
Page 23 and 24: Management: Paediatric hospitals Th
Page 25 and 26: Management: Paediatric hospitals pa
Page 27 and 28: Management: Mongolia Table 1: Chara
Page 29: Management: Safety and efficiency I
Page 33 and 34: Clinical care: Noncommunicable dise
Page 35 and 36: Clinical care: Noncommunicable dise
Page 37 and 38: Opinion matters Self: You think a s
Page 39 and 40: Reference World Hospitals and Healt
Page 41 and 42: Reference World Hospitals and Healt
Page 43 and 44: IHF corporate partners Meet IHF cor
Page 45 and 46: IHF corporate partners ROYAL PHILIP
Page 47 and 48: Inject Geography into Your Electron
Page 49 and 50: Reference IHF Events calendar 2012
Page 51 and 52: Healing Environment. Healthy Busine

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