children's hospital association annual leadership conference 2014 california gertrude's...
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Presentation by Gordon Otieno Odundo Chief Executive Gertrude's Children's Hospital on how the hospital provides its services in Nairobi , its suburbs and more recently in mombasa . Key Learning Objectives: Learn how Hospitals can engage in primary care sustainably and still maintain high bed occupancy rates Understand how providing quality services will attract high number of patients at affordable prices Demonstrate how increasing use of technology is essential to maintaining continuity of care Payers and policy makers will learn how to create systems and incentives to ensure patients are treated at the most cost effective level of care. Gertrude's Children's Hospital, Nairobi Kenya is the longest established paediatric hospital in East and Central Africa. The hospital is reaching out into peripheral clinics to offer child health services, vaccination and primary care. Seven day working, a shared record and IT for scheduling ensures that waiting times are very low and that continuity of care is maintained. In a competitive market forming an early relationship with children and their families is important and a well organised clinic, in a convenient location and staffed with skilled and well qualified professionals is an important part of this strategy. The model is very successful and won a Millennium Development Goal Award and is being copied by other providers in the country. The Benefits of Being a Charitable Trust Gertrude's Children's Hospital is a charitable Trust, meaning that all profits are ploughed back into the hospital. It is overseen by a Board of Trustees who offers their services voluntarily in the day-to-day running of the hospital, since they are responsible for all policy decisions. Nor do they receive any rewards or emoluments for the charitable work they do. Odundo clarifies this: “First and foremost we are a Trust, meaning we are in the private sector charging fees for our services, but we don’t have shareholders. By doing this, any surplus we generate gets reinvested into the facilities, allowing us to buy more equipment and expand our services. That’s a model we have adopted and works successfully for us.” Paying patients provide the main monetary income for the hospital's routine management; Gertrude's is often reliant on donors for the purchase of the expensive paediatric equipment it requires to remain an up-to-date organisation. Any appeals for funds are almost always for the charitable work to which the hospital is committed. In October 2013, the hospital received a generous donation of KSh 50 million from I&M Bank and Bhagwanji Raja Foundation, so were able to install state of the art equipment in both the Intensive Care Unit and Radiology department units. The hospital also hosts charitable events to give even more back hosts a Golf tournament where it raises money for the children. The hospital also has a separate Trust registered called ‘Gertrude’s Hospital Foundation’, which wTRANSCRIPT
Delivering High Quality, Low Cost Care at Scale through Primary Care: A Case
Study from Gertrude's Children's' Hospital, Nairobi ,Kenya
Gordon Otieno Odundo
Chief Executive Officer
Background of Gertrude’s Children's Hospital Outline the context of Child Health in Kenya
Overview of our activities Governance and ownership CSR – Un Global Compact Information Technology
Staff and Capacity Development Patient Safety and quality
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Causes of Child Mortality - Kenya
Source: World Health Statistics 2011, WHO
16%
20%
9%
11% 1% 10%
10%
8%
3%
19% 3%
Pneumonia Diarrhoeal Causes HIV/AIDS Malaria
Measles Prematurity Birth Asphyxia Neonatal Sepsis
Congential Anomalies Other diseases Injuries
Cause Deaths
Total Deaths 188,928
Diarrhoea 38,802
Pneumonia 30,406
Malaria 20,666
Neonatal causes = 31% of under 5 mortality
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North Eastern
80
Eastern 52
Rift Valley
59
Nyanza 149
Western 121
Central 51
Nairobi 64
Coast 87
Child Health Situation- Kenya
Deaths per 1,000 live births for the 10-year period
before the survey
Kenya National Bureau of Statistics & ICF Macro
Kenya 74
Under-five Mortality by Province
Child Health Situation- Kenya Progress in Infant and Under-five Mortality Rates, Kenya
1990/2009 (KDHS)
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Hospital Entrance
Our Network
Governance
Registered Trust with tax exempt status
Board members serve on a voluntary basis
All surpluses reinvested in the hospital
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Hospital Morbidity
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Clinical Governance
The hospital was ISO 9001:2000 accredited in July 2008 and recertified ISO 9001: 2008 in September 2011 and in July 2014. Pursuing JCI in 2015
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Gertrude’s Children’s Hospital wins Millennium Development Goals Award
for the second year …For their efforts towards reducing
child mortality
The awards were presented at a special ceremony organized by United Nations Development Programme in Kenya, Ministry of State for Planning, National Development and Vision 2030, Millennium Development Goals Trust Fund and the Government of Finland and attended by various players.
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The American Academy of Paediatrics (AAP) states that a variety of factors are associated with potential for increased
demand for paediatrician services Trend
Increased insurance coverage and improved access for children when health care reform provisions are implemented
A growing shift in the number of pediatrician office visits for children
previously cared for by family physicians (who may have increasing numbers of adult patients in their practices for the
same reason)
Changes in the type of and demand for pediatric services deriving from advances
in genetics and other technologies
Increasing numbers of medically complex and/or fragile pediatric patients
Increasing need for pediatricians to address developmental, educational, and mental health issues with their patients
Increasing prevalence of chronic diseases in children
Our observation
70 % of our clients have insurance cover
We attend to children only
It will be while for this to impact us in Kenya
Evidenced by high referral to ICU
We offer one stop services
Greatest growth has been in chronic attendance clinics
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Critical Skills Needed
AAP in a 2008 survey found that
• There were too few local child/adolescent psychiatrist s to meet referral needs
• 87% cited a shortage of developmental-behavioral pediatricians
• 82% reported insufficient pediatric dermatologists.
• More than half of those surveyed reported shortages of pediatric medical subspecialists in rheumatology, neurology, adolescent health, endocrinology, and gastroenterology
Gertrude’s Institute of Child Health and Research
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