annual report 2017 saba health care foundation · privilege to present you with our annual report....

Annual Report 2017

Saba Health Care Foundation

Saba Health Care Foundation – Annual Report 2017

A Healthy Community Requires a Strong Foundation

The Board of Directors is pleased to present:

The annual report 2017


Annual Report 2017

As Board of Directors of Saba Health Care Foundation, it is my privilege to present you with our Annual Report. ‘A Healthy Community Requires a Strong Foundation’ and it takes a strong team to build a strong foundation. Saba Health Care Foundation provides comprehensive healthcare where love is key and our quality of care is the care we would want for our loved ones. We aim to always offer accessible cure and care in a safe environment, with dedicated staff that is inspired, well-educated and client friendly. We strive to continuously improve our quality of care.

With the passing of two category five hurricanes in September 2017 – which caused devastation to our island and our region – we have experienced a crisis with risk of calamity for an extended period, where amongst others access of care for our referred patients was not guaranteed. Crisis management was needed for months to ensure the best possible continuation of healthcare. Hurricane Irma and Maria and the weeks and months thereafter of crisis management have been the most difficult, arduous and heavy period in my entire career as Board of Directors. Fortunately, not one serious calamity took place, however this has been a huge risk. Various evaluation on all levels on the hurricanes and it’s after effects have taken place. Derived from these evaluations, adjustments to existing internal protocols and structures have been made. However, we need our stakeholders to make the necessary adjustments and establish structure for an inter-island plan to safeguard our community in case a crisis reoccurs. SHCF’s Supervisory Board, Management Team, Employees and I are very proud of the achievements highlighted in this report, as well as the way we dealt with the challenges we had to face. We invite you to spend time browsing through the report to learn more about how our motto ‘A Healthy Community Requires a Strong Foundation’ comes to life within our organization.

Joka A. Blaauboer M.D. Board of Directors, Saba Health Care Foundation


Table of Contents

1. Healthcare by Saba Health Care Foundation ....................................................................................... 6

2. Saba and its historical perspective on Healthcare .............................................................................. 7

Historical Perspective of healthcare on Saba ........................................................................................... 7

Dissolution of the Netherlands Antilles and effects on healthcare ............................................................ 7

Establishment of the Saba Health Care Foundation (SHCF) ................................................................... 8

3. Hurricane season 2017 ........................................................................................................................... 9

Atlantic Hurricane Season 2017 Overall ................................................................................................... 9

Direct effects on our Neighbours ............................................................................................................ 10

Direct effects for Saba ............................................................................................................................. 13

Hurricane Irma ........................................................................................................................................ 14

Hurricane Jose ........................................................................................................................................ 15

Hurricane Maria ....................................................................................................................................... 16

Post Hurricanes ....................................................................................................................................... 16

Post Hurricanes logistic problems ........................................................................................................... 17

Post Hurricanes logistic problems; addressing referral of non-emergency patients............................... 17

Post Hurricanes logistic problems; addressing other problems .............................................................. 18

Post Hurricanes logistic problems; consequences ................................................................................. 18

Post Hurricanes stress and depression .................................................................................................. 18

4. Organizational ....................................................................................................................................... 20

Vision & Mission ...................................................................................................................................... 20

Motto ....................................................................................................................................................... 20

Key values ............................................................................................................................................... 20

Staff Performance Evaluation Cycle ....................................................................................................... 20

Structure 2017 ......................................................................................................................................... 21

5. Governance ........................................................................................................................................... 22

Structure .................................................................................................................................................. 22

Governance 2017 .................................................................................................................................... 22

Governance workshop for the Boards 2017 and evaluations ................................................................. 22

Administrative merger with the Benevolent Foundation Saba ................................................................ 22

Meetings .................................................................................................................................................. 23

6. Financing ............................................................................................................................................... 24

Extending our services over the years .................................................................................................... 24

Financial Impact Hurricanes.................................................................................................................... 24

Care contract 2017 .................................................................................................................................. 24

Administrative merger with the Benevolent Foundation Saba ................................................................ 25

Continuation renovation Saba Health Care Foundation ......................................................................... 25

2017 Cost allocation ................................................................................................................................ 25


7. Healthcare & Strategic Developments ................................................................................................ 26

Home Health Care .................................................................................................................................. 26

Diabetic Clinic ......................................................................................................................................... 26

Staffing Clinic .......................................................................................................................................... 27

Pledge to support Breastfeeding ............................................................................................................. 27

Medication Induced Early Pregnancy Termination 2017 ........................................................................ 27

Collaboration Regionale Ambulance Voorziening Utrecht (RAVU) ........................................................ 27

Education ................................................................................................................................................ 28

8. Quality Developments .......................................................................................................................... 29

Patient Satisfaction Questionnaire Clinic ................................................................................................ 29

Quality & Policy Officer ........................................................................................................................... 29

Infection Prevention Committee or Workgroup Infection Prevention ...................................................... 29

Compliments, suggestions and Complaints ............................................................................................ 30

Safely Reporting Incidents (VIM; Veilig Incidenten Melden) ................................................................... 30

Quality Action Plan 2017 ......................................................................................................................... 30

9. Production 2017 .................................................................................................................................... 31

10. Medical Referrals 2017 ....................................................................................................................... 32


1. Healthcare by Saba Health Care Foundation

Saba Health Care Foundation’s medical care is provided in the A.M. Edwards Medical Center in The Bottom. Our patients consist of residents, medical students and faculty from the Saba University School of Medicine, and visitors to the island for leisure or business. Two island physicians, Dutch trained and BIG certified General Practitioners, together with a team of nurses render general practitioner care via our outpatient clinic on weekdays, 24/7 hospital care via our admission department and 24/7 emergency service via our Emergency Room and ambulance service.

We also provide medical assistance in case of accidents and disaster (GHOR; Geneeskundige Hulpverlenings Organisatie in de Regio). Saba Health Care Foundation supplies radiology, ultrasound and laboratory service. We also provide hospice care and mortuary service. We have a physical therapist in service and a dentist uses our facility for dental services. Our team of Home Health nurses and care assistants provides seven days a week home healthcare from 7am to 7pm. Next to the foundations Island Family Physicians, a variety of medical specialists and visiting paramedics from the region (Sint Maarten, Sint Eustatius, Bonaire and Curacao) hold clinics at our location. Our island physicians refer patients for further medical treatment abroad to receive specialist care. For these referrals to other healthcare providers, the health insurance Zorgverzekeringskantoor BES makes appointments, regulates the logistics, such as travelling related to these referrals and finances these referrals directly. Our patients are mainly referred to Sint Maarten and Saint Martin but also further away to Colombia and Guadeloupe. Few patients are referred to care providers in Aruba, Bonaire, Curacao and The Netherlands. Emergencies that cannot be treated on Saba are sent to Sint Maarten Medical Center. The health insurance Zorgverzekeringskantoor BES has contracted a 24-hours available helicopter service on Sint Eustatius for these medical evacuations (Medevacs). The distance to the Sint Maarten Medical Center, the closest hospital, is 50km. Emergency medical evacuation per helicopter to Sint Maarten Medical Center takes a minimum of 2 hours from door to door.


2. Saba and its historical perspective on Healthcare Since the dissolution of the Netherlands Antilles in October 2010, the islands of Bonaire, Saba and Sint Eustatius received the status of ‘Special Municipality’ or ‘Public Entity’ within the Kingdom of the Netherlands and together they form the Dutch Caribbean, also referred to as the BES-islands. Saba is the smallest island of the Dutch Caribbean and has about 2000 inhabitants. The tranquil and beautiful island, known as the Unspoiled Queen, rises from the ocean with an impressive 887m (2,877 ft.) and is 13 km2 (5 mi²) wide. There are trying economic and social conditions on our island. According to ‘Trends in the Caribbean Netherlands 2016’ by Centraal Bureau Statistiek (CBS), the bottom 25% of the Saban households must live on average $ 8,700, - per annum. The next 25% households have an average income of $ 19,400.-. Historical Perspective of healthcare on Saba

The A.M. Edwards Medical Center is located in The Bottom since 1980. The only major repair on the building took place in 1998 after hurricane George when part of the roof of the Medical Center was destroyed and the entire roof structure of the Medical Center was replaced and strengthened. Healthcare in the former Netherlands Antilles was characterized by lack of attention, support, money and resources that led to neglected healthcare institutions. As a result, there was a huge backlog in terms of quality of care and safety.

Dissolution of the Netherlands Antilles and effects on healthcare In 2004 a status referendum was held in Saba where 86% of the population voted for closer links to the Netherlands and for a constitutional change of the Kingdom of the Netherlands. With this political reform, the responsibility for healthcare in the Caribbean Netherlands would become the responsibility of the Dutch Ministry of Health (VWS). In 2008, the government of Saba and the Netherlands agreed to further develop healthcare based on the so-called Medium-term Plan Care and Housing BES (MLTP: Middellange Termijn Plan Zorg en Huisvesting BES). Part of the plan involved the privatization of the Medical Center on Saba. The privatization of the Medical Center consisted of two parts stipulated in an agreement; the acquisition of the staff of the Medical Center by a healthcare foundation and the sale of land and premises of the Medical Center to this healthcare foundation. In 2008 Saba government received a subsidy for the Medical Center from the Dutch Ministry of Health to purchase various medical equipment and furniture such as a sterilizer, digital X-Ray reader, Ultrasound machine, lab equipment, a vehicle for Home health, dental room décor and finance for an education program for some of the nurses.


On October 10, 2010 the constitutional renewal of the Kingdom of the Netherlands took place; the Netherlands Antilles ceased to exist, and Saba received the status of Public Entity or Special Municipality within the Kingdom of The Netherlands. Since this date, Saba is part of the Dutch Caribbean, but has other legislation than municipalities in the European part of the Netherlands. The most important amendment to legislation and regulations in care was the decision on health insurance, Besluit Zorgverzekering BES. This introduced a collective health insurance wherewith by law all residents are insured for healthcare expenses. As of January 1, 2011, Saba residents are insured through the health insurance Zorgverzekeringskantoor BES (ZVK). Establishment of the Saba Health Care Foundation (SHCF) December 14th, 2009 Saba Health Care Foundation (SHCF) was established, a founding process under leadership of the Dutch Ministry of Health. In December 2010, Saba Health Care Foundation received a subsidy from the Dutch Ministry of Health for the year 2010 thus in December 2010 the sale of land and estates took place via a Deed of Purchase of Property. Equipment for the ER, a generator, ICT server computers printers and scanners, new beds, and furniture for the waiting areas, cleaning carts and AFAS financial software were purchased. We financed various trainings and received two state of the art ambulances. In January 2011, all staff of the Medical Center was honorably discharged from services by the Public Entity of Saba (OLS) and employed by SHCF. In 2010/2011 all job descriptions and a job classification were made based on the Dutch healthcare model, and a Dutch Caribbean salary structure was set. In 2012 the first two-year collective labor agreement for healthcare institutions on Saba and St. Eustatius was signed. Saba Health Care Foundation is a nonprofit organization and its purpose is providing and facilitating medical care to the population of Saba. The basis of our foundation is the recognition of the fundamental dignity of clients and patients. At Saba Health Care Foundation, the constant aim is to further improve the quality of our services and our organization; become better and move forward. Coming from a great backlog, Saba Health Care Foundation targets towards the European Dutch standard level of care with a variety of investment, engagement, creativity, flexibility and customization (Sabanizing), in which we are continuously learning; change has become a constant factor.


3. Hurricane season 2017 Atlantic Hurricane Season 2017 Overall Saba is in the Atlantic Hurricane Belt. The Atlantic hurricane season falls between June and November and is the period in a year when hurricanes usually form in the Atlantic Ocean. Tropical cyclones in the Atlantic are called hurricanes, tropical storms, or tropical depressions. The 2017 Atlantic hurricane season was extremely active. The season produced 17 named storms of which 10 became hurricanes including six major hurricanes (Category 3, 4 or 5). Based on the Accumulated Cyclone Energy index, which measures the combined intensity and duration of the storms during the season and is used to classify the strength of the entire hurricane season, 2017 was the 7th most active season in the historical record dating to 1851 and was the most active season since 2005.

The 2017 Atlantic hurricane season was one that will leave a long-lasting impression on everybody in the Caribbean region. Its brute force, its path of destruction, and constant supply of new storms was a drain on everybody’s resources, strength and mental coping. In the Caribbean, nearly all the Antilles saw sustained tropical-storm-force winds. Only a few islands completely escaped wind impacts from a tropical cyclone this year: Jamaica, the Cayman Islands, the ABC islands and the Grenadines.


Direct effects on our Neighbours The following is gathered from the National Hurricane Center Tropical Cyclone Reports. Irma caused 44 direct deaths as a result of her strong winds, heavy rains, and high surf across the Caribbean Islands and the southeastern United States. The majority of the causalities were in the Caribbean Islands, where Irma’s winds were the strongest. In St. Martin and Saint Barthelemy combined 11 deaths were reported, 9 in Cuba, 4 in Sint Maarten, 4 in the British Virgin Islands, 3 in the U.S. Virgin Islands, 3 in Barbuda, 1 in Barbados, 1 in Haiti, and 1 in Anguilla. In the United States, 7 direct deaths were reported, and an additional 85 indirect deaths occurred, 80 of which were in Florida. Hundreds more were injured before, during, or after the hurricane. About 6 million residents in Florida were evacuated from coastal areas. Hurricane Irma's brute strength was not something we have seen before. Irma held on to Category 5 status for three consecutive days in the Atlantic, but even more impressive was that it held on to its peak intensity – 185 mph – for 37 hours which set a world record. Hurricanes of this intensity often undergo fluctuations in intensity, but Irma did not. Hurricane Irma made more than a half dozen landfalls along its devastating path. The list below shows the intensity of Irma at the time of each landfall. • Barbuda: Category 5, 185 mph • St. Maarten/St. Martin: Category 5, 185 mph • BVI (2 landfalls): Category 5, 185 mph • Little Inagua, Bahamas: Category 5, 160 mph • Northern Cuba (possibly a few landfalls): Category 3-4, 125-160 mph • Florida Keys: Category 4, 130 mph • SW Florida: Category 3, 115 mph

Hurricane Irma depopulated the entire island of Barbuda. At least 95% of the island's structures – including hospitals, schools, homes and docks – were damaged or destroyed. Following the catastrophic damage unleashed on the island, the government of Antigua and Barbuda forced a mandatory evacuation of Barbuda, with residents being brought to Antigua. Few residents have made the return trip to Barbuda even months after the evacuation order was lifted due to insecurity on the island, the inability to build new shelter, and local politics.

Like Barbuda, St. Maarten took a direct hit from catastrophic category 5 hurricane Irma. On the French side of the island, 90% of the structures were damaged with 60% of those being considered uninhabitable. Irma’s intense winds heavily damaged the marina and ripped trees out of the ground. Total losses are estimated to be near 1 billion USD. On the Dutch side of the island, Irma caused severe damage to the airport and damaged or destroyed about 70% of the structures. In addition to the 4 deaths, the hazards from Irma injured 23 people.


St. Barthelemy was in the southern eyewall of Hurricane Irma and suffered significant damage, like the surrounding islands. Preliminary assessments from the French government indicate that economic losses could exceed 480 million USD. Irma passed over Anguilla and caused widespread damage. Most homes and schools were destroyed, and the only hospital on the island was severely damaged. About 90% of the roads were impassable, and the strong winds uprooted numerous trees and power poles. Hurricane Irma made two direct landfalls in the British Virgin Islands (BVI), both at peak intensity; one on Tortola and another on Ginger Island. Damage in the BVI was extensive, and on some islands it was catastrophic. Many buildings and roads were left in ruins. Authorities from the islands reported that it would take several months to restore electricity.

Damage in the U.S. Virgin Islands when Irma hit, was most notable in St. Thomas and St. John. In both islands, widespread catastrophic damage was reported, and the islands were stripped of their foliage. Collapsed homes, businesses, and power lines were reported. In addition, the fire and police stations collapsed, and the hospitals experienced major damage. In St. Croix, although the damage was not as severe, about 70% of the homes and structures suffered damage.

Maria caused 31 direct deaths in Dominica with 34 missing. In Guadeloupe, two direct fatalities are attributed to Maria: one person died from a falling tree, and another was swept out to sea. In Puerto Rico, the death toll is highly uncertain, and the official number stands at 65, which includes an unknown number of indirect deaths. It should be noted that hundreds of additional indirect deaths in Puerto Rico may eventually be attributed to Maria’s aftermath pending the results of an official government review. One person died from drowning, and another was killed by a mud slide in St. Thomas. Four persons were swept away by floodwaters, and another individual perished in a mud slide in the Dominican Republic. Three persons died due to floodwaters in Haiti. In the United States, four persons drowned due to rip currents. Maria caused catastrophic damage in Dominica, with the majority of structures seriously damaged or destroyed, and most trees and vegetation were downed and/or defoliated. According to media reports, the estimated damage total in Dominica is at least $1.31 billion. The agricultural sector was essentially eliminated. The once-lush tropical island was effectively reduced to an immense field of debris. Dominica’s Prime Minister, Roosevelt Skerrit, described the damage as “mind-boggling”. The roofs of the majority of buildings and homes were either damaged or blown off. There was extensive damage to roads. Power, phone, and internet service was cut off, leaving the country almost cut-off from the outside world. In Guadeloupe hurricane-force wind gusts and heavy rain from Hurricane Maria caused a great


deal of damage, especially along the southern portions of Basse-Terre Island. An estimated 80,000 homes were without electricity. Among all the U.S. Virgin Islands, St. Croix was the most severely affected by Maria. Wind damage was evident across the entire island with many fallen trees, downed signs, roof damage and complete destruction of many wooden houses. Excessive rainfall generated significant flooding and mud slides across the island. In St. Thomas and St. John, most of the roofs, signs and trees had already been destroyed or damaged earlier by Hurricane Irma, but large rainfall accumulations generated flooding and mud slides across all these islands. Some 80 percent of the USVI remained without power more than a month after Maria battered the U.S. territory. Numerous ports were closed following the pair of hurricanes due to structural damage but have since reopened.

Maria's Category 4 landfall on the Puerto Rico devastated the Island. The destructive power of storm surge and wave action produced extensive damage to buildings, homes and roads. Marinas and harbours were severely damaged due to the waves and currents associated with the surge. Across the island, buildings suffered significant damage or were destroyed. Trees were downed, splintered or defoliated. River flooding was unprecedented, especially in the north. Hundreds of families needed to be rescued from their roof tops.

Maria knocked down 80% of Puerto Rico’s utility poles and all transmission lines, resulting in the loss of power to all the island’s 3.4 million residents. Cell phone service was lost, and water supplies were knocked out. At of the end of 2017, nearly half of Puerto Rico’s residents were still without power, and by the end of January 2018, electricity had been restored to about 65% of the island. Less than 8% of Puerto Rico's roads were open and usable a month following Maria’s passage over the island. Puerto Rico may take years to fully recover from Maria's devastation.

The Atlantic Basin on September 8th 2017with hurricanes Katia, Irma and Jose


Direct effects for Saba As Medical Center and Emergency Responder we carry a great responsibility towards the safety of our patients and community, especially during a major event such as a hurricane. Saba Health Care Foundation has a Hurricane Plan in place which involves all departments of the organization in cooperation with the Benevolent Foundation Saba. The Hurricane Plan is designed to ensure full preparation before the start of a new hurricane season. Atlantic Hurricane Season 2017 was very eventful for Saba in the month of September. During that month Saba was under the direct threat of three major hurricanes, of which eventually two major category five hurricanes – Irma and Maria – impacted our island directly. Hurricane Irma is the strongest Atlantic hurricane since 1851 when records were first kept.

Storm (cat.) Watch issued

Watch discontinued

Warning issued

Warning discontinued

Effect on Saba

Tropical Storm Arlene - - - - -

Tropical Storm Bret - - - - -

Tropical Storm Cindy - - - - -

Tropical Depression Four - - - - -

Tropical Storm Don

Tropical Storm Emily - - - - -

Tropical Storm Fred - - - - -

Tropical Storm Franklin - - - - -

Hurricane Franklin (1) - - - - -

Tropical Storm Gert - - - - -

Hurricane Gert (2) - - - - -

Tropical Storm Harvey - - - - -

Hurricane Harvey (4) - - - - -

Pot. Tropical Cyclone 10 - - - - -

Tropical Storm Irma - - - - -

Hurricane Irma (5) 03 SEP 21:00

06 SEP 16:00

04 SEP 15:00

06 SEP 16:00

Major

Tropical Storm Jose - - - - -

Hurricane Jose (4) 07 SEP 15:00

09 SEP 18:00

- - None

Tropical Storm Katia - - - - -

Hurricane Katia (2) - - - - -

Tropical Storm Lee - - - - -

Hurricane Lee (3) - - - - -

Tropical Storm Maria - - - - -

Hurricane Maria (5) 17 SEP 03:00

20 SEP 15:00

17 SEP 21:00

20 SEP 15:00

Minor

Tropical Storm Nate - - - - -

Hurricane Nate (1) - - - - -

Tropical Storm Ophelia - - - - -

Hurricane Ophelia (3) - - - - -

Tropical Storm Phillip - - - - -

Tropical Storm Rina - - - - -

Atlantic Hurricane Season 2017, Effects for Saba Overview Chart


Hurricane Irma In the early morning of September 6, 2017 Hurricane Irma raged over Saba. SHCF’s “Hurricane” plan was followed and on September 1, 2017 the Emergency Operational Committee was activated according to protocol. This year the Committee was formed out of both organizations; the Benevolent Foundation Saba (BFS) was incorporated into the Hurricane plan of Saba Health Care Foundation. On September 1, 2017 an emergency “WhatsApp” group was started for the Emergency Operational Committee in order to be constantly informed about updates on the weather, preparations and ongoing concerns. Two Joint preparatory meetings were held on September 3 & 4, 2017 and a debriefing was held on September 11, 2017. All preparations were done according to protocol; the buildings were secured, equipment was protected, maintenance check lists were done, diesel and gasoline tanks were filled, food and water and other supplies were stocked up, Home Health patients were prepared, vulnerable Home Health patients were admitted to the hospital, hurricane boxes for the shelters were distributed etc. etc. According to protocol several of our vulnerable patients were flown to St. Maarten, such as our dialysis patients and pregnant women with a medical indication to deliver in the near vicinity of a gynecologist. This was done in close consultation with St. Maarten Medical Center, their specialists and ZVK. Close contact was held with the government disaster committee, who gave regular and very clear updates on our situation. There was communication with Fundashon Mariadal who made known they would be available post Irma for any help needed for Saba Health Care Foundation. On the evening of September 5, 2017, one hour before curfew, all the preparations were done and “Team A” including several managers of BFS and Saba Health Care Foundation were present. Constant weather updates were provided for. Around 4 am on September 6, 2017, category five winds reached the Bottom; winds shook the concrete building of the hospital and pulled on the doors and shutters which put pressure on ears and created an insecure and scary feeling to all present. They were an intense four hours and the extreme winds lasted for a total of eight hours. The hospital functioned as one of the public contact points; several Sabans called for help and reported loss or damage to their roofs. These messages were all collected and brought forward to the government disaster committee. Our generator performed accordingly and WIFI was available all the time, as were the landlines. The communication towers in Sint Maarten got damaged which led to lack of mobile and radio communication; communication via mobile phones was only possible via “WhatsApp” to those who were connected to WIFI. In the afternoon when winds eased somewhat, patients from outside with minor cuts and fractures came in.


During and directly after the passing of Irma an emergency call from St. Maarten Medical Center came in. St. Maarten Medical Center had critical patients that had to be flown out acute. St. Maarten Medical Center’s only means of communication was their landline which hardly had any reach; Saba Health Care Foundation was part of the linking pin to connect St. Maarten Medical Center with the outside world. During the preparations and hurricane, staff of both organizations performed excellent. “Team A” was released by “Team B” on Thursday September 7, 2017. According Saba Health Care Foundation’s protocol, post impact assessment was done September 7, 2017 including Inspection of the buildings.

Thursday September 7th 2017 the possibility of Medevac for medical emergencies to be flown out by Fundashon Mariadal with their air ambulances was established. A protocol was drafted immediately between Saba Health Care Foundation and Fundashon Mariadal which also allowed Saba Health Care Foundation to consult with their specialists; Fundashon Mariadal has offered tremendous support after Irma in many ways.

Hurricane Jose Immediately after the passing of Irma, Saba had to prepare herself for the treat of Hurricane Jose. Another major hurricane – Cat. 4 – that was coming directly towards us. All available staff was put to work to clear the debris Irma left behind in case Jose would be a hit. All over the island residents, government workers and Dutch Military assisted in a grand island-wide clean up. As Sint Maarten and its hospital Sint Maarten Medical Center suffered tremendous damage all vulnerable patients were flown out. On Saturday September 9th Saba’s last patients (Dialysis and Pregnant) were evacuated to the ABC islands. On September 9th Jose curved more and more north and the watch was discontinued. The relief we all felt can be seen in the statement Governor Jonathan Johnson released via Twitter.


Hurricane Maria Preparations and procedures were similar to those of Irma; meetings and debriefing were held. The curfew started for hurricane Maria on Monday September 18, 2017 at 10pm, and on Wednesday morning September 20, 2017 curfew was lifted. However due to lots of rain the governor advised everyone to remain indoors the remainder of that day. “Team B” reported to work on September 21, 2017. Hurricane Maria was a major threat even though the maximum sustained winds did not feel as strong as Irma’s in our buildings. A major concern was that Hurricane Irma had possibly weakened the roofs especially the roof of the BFS, the building of the BFS is owned by Saba Health Care Foundation. The roofs also withstood hurricane Maria.

During the peak of Hurricane Maria on September 20, 2017 the hospital received a call for assistance for an emergency. Police were called and decided they would escort the patient from their home to the hospital. The medevac of this critical emergency had to wait until transportation was possible, there was close contact between Saba Health Care Foundation and the specialist on Bonaire Fundashon Mariadal to provide the best possible care for this patient. Patient was flown out as soon as the airports re-opened on September 21, 2017. Post Hurricanes Building assessment A Building assessment was done after Hurricane Maria by an external party. The roof of the BFS has partly lifted and needed repairs, as some minor repairs for Saba health Care Foundation. The following damage post Irma and Maria has been identified:

• Gutters and downspouts damaged in BFS – These needs replacing.

• Roof lifted in BFS – This needs to be secured before next hurricane season.

• Water damage to internal paint and ceilings – This needs to be repaired.

• Ceiling partially came down in Administration Building – This needs to be replaced.

• Water damage to one of the ICT servers – This needs to be replaced.

• Damage to perimeter fencing in some areas – This needs to be replaced.

• Signage damaged in Admin building – This needs to be replaced.

These repairs have all taken place in the beginning of 2018.


What Went Well

• Hurricane Plan proved itself and was of major value.

• Superb teamwork within teams and between BFS and SHCF.

• Solid leadership of management team members.

• Facility staff members performed well despite being reduced.

• “Teams A & B” performed excellent.

• Aid from Fundashon Mariadal for consultation and Medevac.

• Care for those patients from Saba that were sent to the ABC islands. What was critical

• Our vulnerable Saba patients were on Sint Maarten, which was severely damaged. After the passing of Irma these patients had to be evacuated from a devastated area.

• Our dependency of St. Maarten, not only for medical care but also as transportation-hub; logistics were not organized sufficiently which led to the hampering of patient transportation and incoming supplies.

• Bringing across to external parties of the crisis on Saba; upscaling GHOR (Geneeskundige Hulp Organisatie in de Regio) to arrange transportation of non-emergency patients and goods did not happen. Structure needs to be brought to regional crisis management; we need a Plan B in case Plan A falls away, as it did during this crisis.

The debriefing after Hurricane Maria by our team acknowledged two major concerns, logistic problems and post-traumatic stress. Post Hurricanes logistic problems Many logistic problems existed as Saba’s airport and harbor were non-accessible for some time except for military personnel. On our neighboring island Sint Maarten airport and harbor had a fall out for a very extensive period and overall our region was severely damaged. This led to a variety of transportation problems such as transportation of:

• semi-emergency patients

• non-emergency patients,

• supplies such as water and food,

• medical supplies

• lab materials or lab sent outs,

• staff abroad that needed to return to Saba to work

• visiting specialist and visiting paramedics Other challenges

• The Saba Dispensary – a private branch of a pharmacy on Sint Maarten – ran low on medication and had serious issues getting medication timely to Saba.

• We were unable to log into the lab system of the laboratory on Sint Maarten, to retrieve results of lab tests that had been done before the hurricanes.

• Contacting the treating specialist of Sint Maarten Medical Center was near impossible.

• Obtaining supplies from our usual suppliers – for example St. Maarten, Florida, Puerto Rico, St. Thomas, etc. – was difficult as our entire region was severely affected by the hurricanes.

Post Hurricanes logistic problems; addressing referral of non-emergency patients On September 9th ZVK notified us that an Air Bridge for transportation of semi-emergency and non-emergency patients was to be established. The health insurance Zorgverzekeringskantoor BES needed help from Saba Health Care Foundation to find, allocate and group all referrals of non-emergency patients into semi-urgent and less urgent. This was done by our island physician.


As no transportation for this group of patients had come about since the end of September, Saba Health Care Foundation started contacting many entities to help establish this essential transportation. Amongst these entities were the health insurance Zorgverzekeringskantoor BES, the Ministry of Health VWS including the Inspectorate, the Rijksvertegenwoordiger and Public Entity Saba. Despite numerous attempts from Saba Health Care Foundation to draw attention to this and plead for solutions there were only promises that this was a focal point and that it would be arranged for shortly. A regular flight to disclose Saba to neighboring island did not materialize in 2017, our insurance company was unable to regulate transportation for these referrals to Aruba, Bonaire, Curacao, Colombia or the Netherlands. The establishment of transport for this group of patients took too long. It wasn’t until 2018 that the non-emergency patients started to be referred and receive specialist medical treatment; many have waited more than six months for an elective doctor’s visit. Together with St. Maarten Medical we did manage to host some visiting specialists to tend to our patients on Saba. Due to this delay some semi-emergency patients became medical emergencies and were sent out via the medevac from Fundashon Mariadal. Post Hurricanes logistic problems; addressing other problems

• Public Entity Saba worked hard on water and food supplies and was successful in achieving this.

• A supply logistics group was set up to coordinate medical supplies for Saba Health Care Foundation and Saba Dispensary where we looked for solutions for each batch of supplies.

• A logistic coordinator was appointed on Saba.

• Public Entity Saba helped seeking an external logistic person but was not found/implemented.

• One shipment of relief aid came in via the military; one shipment of medication and medical supplies for Saba, St. Eustatius and Sint Maarten each was sent to St. Maarten Medical Center. However, this shipment was not distributed after it arrived on St. Maarten and never reached Saba.

• Ordering of medication and supplies remained a challenge until December 2017.

• Several staff from our admission department, and newly hired staff for Home Health and Lab were unable to reach Saba for several months which hampered the functioning of these departments.

Post Hurricanes logistic problems; consequences Due to the above, a crisis with risk of calamity was a reality for Saba Health Care Foundation and patients for several months. From the start the insurance Zorgverzekeringskantoor BES, the Ministry of Health VWS including the Inspectorate of Health, the Rijksvertegenwoordiger and Public Entity Saba were informed, and frequently reminded of this crisis. We did not receive the help we requested to solve the serious issues mentioned above. Post Hurricanes stress and depression Post hurricanes, due to the traumatic experience for self and loved ones – many Sabans have


families on neighbouring islands that were severely damaged – a lot of our staff but also many residents of Saba and our neighbouring islands suffered from stress and negative psychological effects, such as disappointment, anger, frustration, disputes, loss of support, exhaustion, disillusionment and depression. The following actions were taken:

• All managers were made aware to share with their staff that post impact depression, frustration, anger and many other emotions could be triggered and that this could influence our operations, teamwork and the behavior of our clients/patients.

• The staff of Mental Health Caribbean (MHC) was asked to do a survey for both BFS and SHCF staff. 50% of staff attended; two had signs of serious PTSD (Post Traumatic Stress Disorder) and many had negative effects such as sleeping disorders.

• Support was offered by Mental Health Caribbean and by our organizations. Both SHCF and BFS have been promoting “care for each other” and Mental Health Care was available to support when requested.

King Willem-Alexander listening to residents of Saba who lost their roofs during Hurricane Irma.

Some impressions of the damage on Saba after Hurricane Irma


4. Organizational Vision & Mission To provide comprehensive care of exceptional quality through a variety of healing disciplines to all people on Saba. Be a forerunner in setting a standard of delivering general practitioner care and hospital care combined and provide integrated health care linking a large diversity of health care chains. Ensure accessible health care on island working in close collaboration with health care providers in and outside of the region. Be a patient centered organization striving to provide the best possible service to patients and those close to them, working with compassion and courtesy in a positive work environment where staff can develop to their full capacity and show commitment to the health of Saba.

Motto A healthy community, requires a strong Foundation. Key values Our key values: Love, Trust, Patient Centered, Respect and Quality are continuously emphasized. Saba Health Care Foundation puts effort in creating a safe work environment where tasks and responsibilities are clear, with open communication, and where the competence of the staff is evaluated and used.

Our employees fall under the Collective Labour Agreement Health Care Saba & St. Eustatius, a CLA shared by employees working for Saba Health Care Foundation, Benevolent Foundation Saba, St. Eustatius Health Care Foundation and St. Eustatius Auxiliary Home Foundation. The partners of this CLA also make use of the same job descriptions and job classifications based on the Dutch healthcare model and make use of the FWG Dutch Caribbean salary structure. Staff Performance Evaluation Cycle Since 2013 we perform staff evaluations via a performance evaluation cycle with an annual planning, progress and evaluation session according to the SMART (Specific, Measurable, Achievable, Relevant, Time Bound) principal. The evaluations help making decisions on salary advancement, education, training, and career planning. This cycle has given our organization an enormous boost, as the performance evaluation cycle:

• has our key values as guiding principles;

• has confidentiality as a highlighted topic;

• complement and further enhance a result-oriented way of coaching and working;

• stimulate the personal growth of the employee in line with the organizational objectives;

• further develops employees functioning, performance, commitment and motivation;

• enhances employee’s capacities and talents;

• stimulates employees taking ownership by delegating tasks and utilizing down time more effective;

• focusses on team spirit;

• enhances communication within the organization;

• helps in achieving a culture change, where we constantly strive to improve further, where making mistakes is allowed and feedback is given in a positive way.


Over the years, the performance evaluation system has matured, and the fruits of the system are becoming more abundant. During these individual meetings, strategy is shared with all staff which increases their awareness. With this we achieve great results via cultural shift in our organization. The evaluation cycle inspires our staff to collaborate and work together toward our vison. Staff is taking more and more initiative to set objectives for themselves in line with organizational goals. After the hurricanes in September 2017 “care for each other” has been a focal point during the evaluation sessions. Structure 2017

SHCF Staff

1 Jan

31 Dec

Full-time 40 41 Part-time 0 1

TOTAL 40 42

Contract Type

1 Jan

31 Dec

Permanent 33 33 Temporary 7 9

TOTAL 40 42

Additional Staff

1 Jan

31 Dec

Call-up 5 5 Seconded in 0 0

Seconded out 0 0

Governance

1 Jan

31 Dec

Supervisory Board 5 4 Board of Directors 1 1

Organizational Chart version May 1st 2017


5. Governance Structure Saba Health Care Foundation is an autonomous non-governmental organization consisting of two boards; the Supervisory Board and the Board of Directors. The Board of Directors governs the organization and is responsible for the strategy, policy and management of the organization. The Supervisory Board oversees that the chosen strategic direction is being followed and has a monitoring role towards the Board of Directors and the general affairs as well as supporting the Board of Directors and functioning as its sounding board. Governance 2017 The Supervisory Board in 2017 consisted of Chairman Mr. Sydney Sorton, Supervisory Board member since October 28, 2010; Vice-Chairman Mr. Richard Scholten, Supervisory Board member since August 1,2011; Mrs. Wilma Hassell, Supervisory Board member since December 14, 2009, Mrs. Elisabeth Levestone-Timmerman Supervisory Board member since May 21, 2016. Mr. Theodorus Jolles, Supervisory Board member since June 16, 2016. Mrs Wilma Hassell served two terms as Supervisory Board member for Saba health Care Foundation and according to the rooster van aftreding resigned in December 2017. A procedure to recruit new Supervisory Board members was started, and in 2018 two new board members have joined the supervisory Board. Mr Jolles moved to the European Netherlands and became remote Supervisory Board member as of December 2017. In July 2017 the management assistant of the BFS also became Bestuurssecretaris to assist to further professionalize the boards. Governance workshop for the Boards 2017 and evaluations In July 2017 a continuation was given to the good governance workshop of 2016 with the workshop Governance code Healthcare 2017, held by an external consultant for both Boards.

This has led to several action points entailing the adaptation of the statutes in accordance to the governance code 2017. It has also made us consider:

• how we can improve our governance,

• how we ensure continuity in governance,

• how we counteract (possible) conflict of interest,

• how we increase our influence on healthcare in the region

In accordance to the Statutes, evaluations were held together with the external consultant, evaluation by the Supervisory Board on the Board of Directors, evaluation between the Boards on communication and evaluation of the Supervisory Board. Administrative merger with the Benevolent Foundation Saba On April 1st of 2016 Saba Health Care Foundation and the Benevolent Foundation Saba (BFS) joined forces in an administrative merger (Bestuurlijke fusie) with a shared Board of Directors and Supervisory Board.


Both organizations are linked administrative while financing and thus the financial operations of the two organizations, remain separate. The BFS manages ‘The Home’, a care institution for elderly and disabled people on the island of Saba. The Home wants to support their clients with service-centered care and services tailored to the individual needs of the client with respect, interest, enthusiasm and expertise. Preserving autonomy, identity, self-esteem and quality of life of the individual client are core concepts. In 2016 BFS in conjunction with the Island Government of Saba developed the LIFE Activity Center, a center dedicated to increasing quality of life and independence for elderly & disabled residents of Saba through recreation, education and socialization. LIFE stands for: ‘Love, Independence For Elders’ and has two locations on Saba. The BFS is situated in the building connected to and owned by Saba Health Care Foundation. The merger has enabled both organizations to work closer together and facilitate a better integration of healthcare on Saba. This has led to further professionalization and an increase of knowledge and skills of our collective employees. We have increased efficiency as many support functions for Saba Health Care Foundation and the BFS are shared, such as the Kitchen, Finance, Facility and we share Human Resources where possible. Meetings Supervisory Board

Meeting General Management Team

Meeting Medical Management

Team Meeting

2016 8 4 7 2017 6 4 12

There were frequent meetings between Director and Management Team members individually, as well as department meetings.


6. Financing Saba Health Care Foundation is financed via advances from the Dutch Caribbean Health Insurance; Zorgverzekeringskantoor BES (ZVK). Saba Health Care Foundation aims to accomplish better quality-care as we are still faced with a major backlog. We are in the process of increasing safety for our patients and staff, providing more patient- and staff- satisfaction, and provide more privacy with our multi-phased renovation project. A solid financial foundation is in place with our financial team consisting of: Head Finance, Finance and Payroll Employee, and an external controller. The Finance Employee from Benevolent Foundation Saba (BFS) joined the finance team of Saba Health Care Foundation as of December 2016, to start one finance department team for both BFS and Saba Health Care Foundation as of 2017. Extending our services over the years Over the years we have improved our quality of care by investing in our buildings, our equipment, training and educating our staff, hiring higher educated staff and we have expanded our services. As of 2015 we receive extra budget for physical therapy and a visiting diabetic nurse. Saba Health Care’s vision is to provide the population of Saba with care that enables people to stay independently at their own home as long as possible. Over the years we have strengthened our Home Health Care team (wijkzorg) and have been able to achieve this goal. The Home Health Care team has expanded from 2011 having one Licensed Practical Nurse to in 2017 a team of four nurses and two Care Assistants. Financial Impact Hurricanes After the hurricanes of September 2017, repairs needed to be made to the buildings. We received an incidental compensation via the Public Entity Saba for hurricane cost relief. Care contract 2017 In December 2015, an agreement for 2015-2016 (Overeenkomst zorginstelling 2015-2016), was signed between Saba Health Care Foundation and ZVK together with an annual agreement for 2015. The Annual Agreement (Jaarafspraken) for 2016 including the budget for 2016 was signed on March 17, 2016. In December 2016 Saba Health Care Foundation requested ZVK continuation of the agreement seeing that no new agreement was established yet, mainly related to the added control protocol. Financing by ZVK continued and negotiations concerning the care contract including a control protocol continued in 2017. In November 2017, the first 5-year agreement was signed for 2017-2021 (Meerjaren zorgovereenkomst), between Saba Health Care Foundation and ZVK, for which each year an annual agreement (Jaarafspraken) including budget needs to be agreed upon. The annual agreement 2017 was also agreed upon in November 2017.


Administrative merger with the Benevolent Foundation Saba Due to the hurricanes and their after effects, the framework agreement between Benevolent Foundation Saba (BFS) and Saba Health Care Foundation has not materialized in 2017. In 2017 we did agree on a cost allocation between the two organizations. As a result of the merger with the benevolent foundation the foundation improved synergy through shared salary services of approximately 3,6% of the annual operational budget. Continuation renovation Saba Health Care Foundation During the financial year the foundation acquired a loan to assist with the upgrade and renovation of the medical center. The loan is repayable in 10 years in which the interest and amortized repayment is covered by a subsidy from the ZVK. The plan was to continue our renovation project with the renovation of our two main patient areas’ – the Clinic and the Admission Ward – in the second half of 2017. Due to a variety of circumstances including the hurricanes we experienced a delay. A review of suppliers for the renovation project was necessary due to severe hurricane damage in St. Maarten. Many companies were no longer able to function. Our main concerns were for the flooring company and rolling shutters. We have been forced to source alternative companies. These critical renovation phases of our two main patient areas have started in March 2018 and are expected to be completed in the fourth quarter of 2018. 2017 Cost allocation


7. Healthcare & Strategic Developments Throughout 2017 developments took place to enhance and maintain the quality of healthcare on Saba. Home Health Care Our team of Home Health nurses provide care for elderly, clients with chronic diseases, physically and or mentally disabled, vulnerable clients and clients recovering from medical conditions. The care varies from ADL care, wound care, care related to prevention related to chronic disease such as diabetes or heart and vessel diseases, medication care, palliative care, social visits and domestic care, to weekly consultation in the Youth Clinic. Over the years, the number of clients of Home Health has steeply increased, and we have increased the number of our Home Health staff accordingly. In 2017 we have expanded our team with a Registered Nurse. In 2017 we strived to start working with Care Plans, however implementation of the Care Plan was delayed due to insufficient staff. Due to the hurricanes Irma and Maria, the new Registered Nurse scheduled to start September 1, 2017 was unable to travel to Saba as there were no flight available due to the devastation of the region including the airport of Sint Maarten. Only mid November 2017 the RN Home Health reached Saba and started to work.

Medication review for our Home Health patients takes place quarterly and in May 2017 the dispensary on Saba has started to make blisters for all the Home Health clients, and thus improving our care. In November a specialist elderly care (Specialist Ouderen Geneeskunde) was invited to visit Saba for Benevolent Foundation Saba. She reviewed twelve client files and spoke to four clients. She gave her input on how we can further improve the care for our clients including medication review. The aim is to have the specialist elderly care visit Saba yearly.

Diabetic Clinic In 2017 continuation was given to our Diabetic Clinic, the clinic is open to all (pre)diabetic patients living on Saba and helps to achieve better diabetic care and prevention of diabetic related complications. The Diabetic Clinic started in September 2016 when our island physicians together with our Clinic team and diabetic nurse initiated a now bi-weekly clinic. The diabetic nurse works for the White and Yellow Cross Care Foundation on St. Maarten as a district nurse specialized in diabetes. In 2017 due to personal circumstances and followed by the post hurricane logistic problems she was unable to travel to Saba for an extensive period of many months.


Our team of island physician together with our Head Nurse Clinic gave continuation during this time and carried on the care for our diabetic patients on Saba. Staffing Clinic After the resignation of one of our permanent doctors in December 2016, it took us a long time to fill the vacancy with a permanent island physician. Therefore, in the year 2017 we had a substitute island physician. In January 2017 we hired a part-time medical secretary to assist the Clinic Head Nurse with managerial and personnel tasks as well as administrative support. Pledge to support Breastfeeding In May 2017 we pledged our support for breastfeeding mothers who work for our organization. With this we hope to encourage mothers to keep breastfeeding also when they return to the job. Medication Induced Early Pregnancy Termination 2017 In February 2016, we signed an agreement with Fundashon Mariadal, the healthcare organization on Bonaire, to participate in early pregnancy termination. Fundashon Mariadal obtained extension of their license (participatie Wafz vergunning) to include Saba Health Care Foundation. As of April 2016, Saba Health Care Foundation may perform medication induced early pregnancy termination in case of unwanted pregnancy of less than nine weeks. In 2017 four medication induced pregnancy terminations took place, of which one needed a procedure in Sint Maarten Medical Center to complete the termination. Collaboration Regionale Ambulance Voorziening Utrecht (RAVU)

Saba Health Care Foundation was in search of assistance to further improve emergency care including emergency trainings, protocols on emergency care, and updating emergency equipment. As of February 2017, RAVU and METS assist us with optimizing the ambulance and first responder care with their expertise and experience on a variety of fields, and RAVU will support Saba Health Care with different projects. RAVU is responsible for the ambulance dispatch in the province Utrecht, European Netherlands and in 2008 RAVU established the METS Center. In this Medical Training and Simulation Center ambulance staff and chain partners are trained and accredited, with emphasis on patient safety.

We train twice a year with a visiting team from RAVU/METS in the most realistic possible environment making use of scenario’s and at times train together with other emergency services such as the fire department and including simulation patients. We have decided to follow the Landelijke Ambulance Protocols, LPA, to warrant up to date medical care in case of emergencies and are adjusting our protocols and work accordingly. We have upgraded our emergency equipment and aim to follow the state of the art in equipment for emergency care.


Education Saba Health Care Foundation had the following trainings, lectures, seminars and education programs which were continued, started and/or completed in 2017: - Accelerated Registered Nurse Course - ICT Job Training - AGH PCN Portal Training - Instrument Sterilization - Bedrijfskunde - Kwaliteit en Process Management - Diabetic And Elder Foot Check - PAHO Communication in Health - Driving License - Postgraduate course 'BESt Doctors - Dutch A1 Language Course - Prescription Form Training - Dutch B1+ Language Course - Professional & Specialization Cleaning in Healthcare - Electro Job Training - Promedico - Feedback Workshop - RAVU Emergency Staff Training - Good Governance - Sanitation & Hygiene Care in Healthcare Facility - Helicopter Onboard Safety - Youth Care Job Training - HUREX Disaster Exercise

Some trainings planned for 2017 were cancelled or postponed to 2018 due to the Hurricanes

and the logistical problems that came with them.


8. Quality Developments Patient Satisfaction Questionnaire Clinic During the summer of 2017 a survey was handed out to all patients visiting the Clinic to evaluate

the service of our staff, facilities, treatment and overall satisfaction. With the help of a summer

student 200 questionnaires were distributed in both Spanish and English to cater to all our patients.

A total of 174 questionnaires were completed and gave us valuable information.

The overall results showed that

• 95% of the patients are content with their care and

• 86% rates the overall satisfaction above a 7 on a scale from 1 to 10.

Our top ratings were Facility, Staff and Treatment.

The feedback we got were

related to parking, waiting time

and privacy. These will be focal

points for us for the upcoming

years.

In order to continue to improve

our care and quality, we aim to

conduct a patient satisfaction

survey every five years.

Quality & Policy Officer In June 2017 our Quality & Policy Officer resigned. The vacancy was filled in October 2017 with

a part time Quality & Policy Officer for both Saba Health Care Foundation and Benevolent

Foundation Saba (BFS).

Infection Prevention Committee or Workgroup Infection Prevention In 2015 Saba Health Care Foundation and BFS initiated a committee together with Saba’s Public

Health Department (PHD Saba) to further improve hygiene measures and infection prevention in

the healthcare sector; Workgroup Infection Prevention (WIP). The WIP consists of four healthcare

professionals from Saba Health Care Foundation, BFS, and PHD Saba.

The infection prevention workgroup, initiates, coordinates, supervises and monitors the

implementation of infection prevention policy in the broadest sense of the word. The main

objective is to limit transmission of infectious disease, thus improving patient and employee safety.

An Infection Control & Safety Audit was executed in 2017 to compare the results of 2015 and

2016.


Compliments, suggestions and Complaints Every patient has the right to make a complaint about any aspect of our care, treatment or service.

Saba Health Care Foundation encourages this feedback as input to improve the service. We have

a complaint officer that takes an independent position and will review if the complaint can be

solved via internal mediation.

In 2017 there were five complaints, two of these complaints where for other organizations and

have been redirected. The remaining complaints were about communication between staff and

patients, and one concerned a referral.

Safely Reporting Incidents (VIM; Veilig Incidenten Melden) The VIM Instrument – reporting and learning from (near) incidents – is intended to continuously

improve quality of care by learning from previous experiences. It gives an overview on the how

and why of unwanted events in the care process.

The emphasis is on creating awareness for possible improvements by reporting (near-) incidents

and reporting on a blame free concept. Not the mistake of a person is central, but the conditions

under which staff works and the way care is organized; at the moment an unwanted event occurs,

one asks how and why it happened and what can be done to prevent this in the future, one does

not wonder who the cause was.

Several department incidents have been reported which we use to further improve its quality.

Quality Action Plan 2017 A Quality Action Plan was made by assessing the status of implementations and key areas to

address and maintain. The Quality System is a cycle of 12 months, which focuses on: care and

medical, collaboration with other healthcare providers, hygiene and infection prevention,

medication control, VIM, HR, educational development, patient and staff satisfaction, facility and

IT, documentation and archiving. The plan has a review-cycle per department.

As part of the Quality Action Plan a review was done of existing policies and standard operating

procedures. Improvements were made with adding and implementing new policies.


9. Production 2017

A.M. Edwards Medical Center JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL

Admission 23 8 20 16 16 17 9 48 27 33 67 20 304

Ambulance 4 5 7 6 8 4 6 3 4 6 6 13 72

Consults 1075 1030 1162 1049 1155 1188 1132 1198 798 1151 1222 1107 13267

Delivery 1 0 0 1 0 0 0 0 1 1 0 0 4

ECG 42 8 49 16 15 10 15 11 5 48 24 11 254

Emergencies 131 101 92 60 79 75 140 110 73 91 115 63 1130

Helicopter 0 1 1 5 4 0 1 2 0 2 1 2 19

Laboratory 974 644 879 742 883 1112 923 771 432 754 736 509 9359

Medication Refill 128 399 432 305 91 339 331 330 371 288 281 288 3583

Minor Surgery 8 7 8 7 4 1 6 5 2 1 3 10 62

Morgue 2 0 1 0 0 1 1 1 0 0 1 1 8

Physical Therapy 108 88 138 110 109 133 159 113 73 114 131 88 1364

Wound care 65 75 80 81 129 70 80 140 73 42 45 28 908

X-ray 57 26 94 28 50 60 50 63 36 73 74 19 630

TOTAL 2618 2392 2963 2426 2543 3010 2853 2795 1895 2604 2706 2159 30964

Home Health JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL

Visitation 596 656 777 756 717 846 673 695 760 744 865 691 8776

Bath Assistance 26 64 134 63 49 92 45 49 58 60 37 33 710

Doctor Visit 16 0 3 0 2 0 1 2 0 0 0 0 24

TOTAL 638 720 914 819 768 938 719 746 818 804 902 724 9510

Visiting Specia-list & Paramedics JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL

Visiting specialist 61 85 95 75 36 52 37 92 0 73 35 29 670

Insole Ortopedics 0 18 0 0 0 0 16 21 0 0 0 0 55

Instrument Maker 9 5 0 12 7 0 10 14 0 0 0 0 57

TOTAL 70 108 95 87 43 52 63 127 0 73 35 29 782


10. Medical Referrals 2017 Figures provided by ZVK

Sint Maarten

856

Saint Martin

100

Aruba

61

Colombia

55

Bonaire

47

Guadeloupe

8

Curacao

6

The Netherlands

6


A Healthy Community Requires a Strong Foundation

Thank you for reading Saba Health Care Foundations

Annual Report 2017

To stay informed on the developments within our organization we invite you to follow us on our social media platforms.

@SabaHealthCare

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