HOSPITALS PROCUREMENT & SCM OF HEALTH TECHNOLOGY

CONTINUOUS QUALITY IMPROVEMENT INITIATIVE

Midrand, Johannesburg

19 February 2019

CONTENT PART A: PSM

Quality Improvement Project

PART B:

Potential Areas of Collaboration

PART A

PSM QUALITY IMPROVEMENT PROJECT

PROJECT BACKGROUND

PARTNERSHIP PUBLIC SECTOR PRIVATE SECTOR

MIN

A

Recognition that public administrators, hospitals and suppliers need to work together to fulfill a common aim:

• To offer quality and cost-effective healthcare services to the population of Eastern Cape by improving current procurement and supply chain management practices of public hospital

PROJECT DESCRIPTION

2017/18 2 Workshops

June & July

2018

Sep

Oct

Nov

Jan/Feb

2019

APRIL

Situational Analysis Secure Buy-in

& Sign Off by

ECDOH EMT

SLA Project

Launch Needs & Gaps Exploratory

Discussions

PROJECT TIMELINE

Strategy

Development

Situational Analysis • Challenges

• Needs

• Gaps

Project Goal Improving the effectiveness and efficiency of procurement and supply chain management of medical technology, devices and consumables in pilot hospitals in Eastern Cape Province, by • Implementing evidence-based PSM planning and solutions • Strengthening PSM leadership within the participating hospitals • Strengthening communication within and between the hospitals,

and between the hospitals and the Eastern Cape provincial authorities

• Building staff capacities and improving procedures and systems • Fostering meaningful cooperation between hospitals and the

private sector

Project Objectives 1. Improving demand and procurement planning in accordance with

national and provincial regulations and guidelines

2. Institutional capability analysis and systems strengthening, notably IT systems

3. Establishing lean PSM business processes within hospitals

4. Leadership Change management and training

5. Continuous SCM performance monitoring and management

Strategic Alignment National Strategy for Health • Strengthen financial

management of the health system by improving capacity, contract management and supply chain management

• Fight against corruption and

• Raise the standard of institutional quality by addressing some of the root causes identified by the Auditor General’s Office, notably adherance to technical specifications, planning, supervision and monitoring of contracts

ECDOH • Facilitating a

functional quality-driven public health system

• Enhancing institutional capacity through effective utilisation of resources

PSCM Project

Demand Management Capability Lean BP SCM

Leadership Performance

Governance

NMAH: L. Giwu LTH: M. Burns LTH: M. Sibiza FTH: N. Gqoli

FTH: N. Duric

GM: SCM

Work Stream #1

Demand Management

Progress in 2018

Over R500,000

• Joint Tertiary Hospitals HealthTech Committee established

• TOR Drafted oShares tender documents & technical specs

Under R500,000

• Joint preparation of: −List of general items that can be purchased

jointly by hospitals −List of items needing deviations

Next Steps

Over R500,000 (Jackie Cloete)

1. Draft Terms of Reference finalised and signed off

2. TH HTAC reconstituted

3. Development of Procument Plans 2019/2020 for Over R500,000 items

4. Identify “Nomenclatura” (GMDN) to be used within Technical Specifications

Under R500,000 (Alex Gqwebu)

1. Adopt List of Red Items

2. Advise on storage of tender and technical specifications and deviation documentation accessible to all hospitals (Shared Database)

3. Co-ordinate Market testing for deviation items lists

4. Discuss updated price lists and code conversion tables

PEOPLE SYSTEMS

Work Stream #2

SCM Capability

Progress 2018: Benchmarking LOGIS REPORT CAPABILITY ANALYSIS combined.xlsx

• In Summary −WC hospitals have significantly more staff in assets and contracts

units than EC. They indicate they can do effective contract management, EC does not.

−There are significant differences in productivity in demand management and procurement between EC and WC hospitals.

−It indicates they are likely rely on automisation of procedures and having relevant databases.

Qualifications & Experience LOGIS REPORT CAPABILITY ANALYSIS combined.xlsx

Hospital School Tertiary Tertiary

SCM

Grand Total % School % Tertiary % Tertiary

SCM

Ave Exp

Years

LTH 31 11 2 44 70% 25% 5% 17

Frere Hospital 20 10 1 31 65% 32% 3% 13

NMAH 4 15 4 23 17% 65% 17% 15

MRH 3 3 6 50% 50% 0% 8

Frontier Hospital 4 8 12 33% 67% 0% 9

GSH 31 9 40 78% 23% 0% 10

TBH 50 23 2 75 67% 31% 3% 10

Grand Total 143 79 9 231 62% 34% 4% 13

• NMAH invests more in Training than any other of the facilities

1. Discuss the benchmark and analysis to identify the gaps and learning objectives

2. Incorporate project activities into Western Cape and EC Partnership for NHI

3. Review available ICT systems to enable EC staff and address staffing constraints and workload

- LOGIS; SCM REMS; and possible addition of solutions such as eTicket; eSignature; Data

Analytics; etc

- Sarah Baartman Stores Case Study

Next Steps

IMPLEMENTATION OF STANDARD OPERATING PROCEDURES

Work Stream #3 Lean Business Processes

Progress 2018

1. Head Office issued procedure manual and SCM Policy in June 2018 (from a 2007 Policy version.

2. Head Office issued amended and updated ‘Procurement Guideline Procedure: Competitive Bidding Process’ to guide on implementation of Delegations; November 2017

3. Facility Process Flows and implementation reviewed • Inter-facility variation • Aligned with Procurement Guideline

Procedure

Next Steps

1. Training on updated SOPs

2. Develop sustainable platfoms for engagement FAQ sheets

eForum for SCM

Electronic Compendium of SOPs readily available tracking policy updates & amendments to SOPs

LEADERSHIP ACTIVATION & EMPOWERMENT

Work Stream #4 SCM Leadership

Progress 2018

1. Baseline change management survey

done − Change Management Survey Questionnaire

and Results.xlsx

2. Draft PSM leadership training

programme (5 days, 40 participants)

being developed − Draft Course Outline Version 29112018.doc

LEA

DER

SHIP

A

CTI

VIA

TIO

N

Day 1

Supply Chain Management, Procurement and Medical

Device Regulations in South Africa

Ethics in Procurement & Anti-corruption strategies

Soft skills and team building activity I during the program

Day 2

Ethics in Procurement & Anti-corruption strategies

The Procurement Plan

Demand Planning

Tender Documentation and Technical Specifications

Day 3

Launch Event

Standard Operating Procedures (SOPs) for Tender

Management

Soft skills and team building activity II during the program

LEA

DER

SHIP

A

CTI

VIA

TIO

N

Day 4

Contracting and Contract Management

Health Technology Committee

LOGIS Capability (including Asset Management)

Inventory Management and Consignment Stock

Soft skills and team building III during the evening

Day 5

Supplier Performance Management

Quality Improvement in Health Technology Procurement

Change Management

Course Evaluation

Next Steps

1. Final Prep for Leadership Activation Workshop 28 February 2019 • Content

• Available Date for Launch (MEC and SG)

• Guest Speakers; Facilitiators

• Logistics February to March/April 2019

• ECDOH Skills levy access

2. Conduct 5-day SCM Leadership Training

3. Explore possibility of annual event

REPORTING & ACCOUNTABILITY

Work Stream #5

Performance Management & CQI

1. Strategy for CQI of Procurement and SCM at selected hospitals developed

2. Review of Performance Management mechanisms conducted • LOGIS implementation and use for performance

measuring in hospitals being addressed • Identified success and monitoring indicators as part

of the Quality Improvement Strategy

3. Performance management algorythm drafted

LOGIS REPORT CAPABILITY ANALYSIS combined.xlsx

Progress 2018

1. Migration to electronic traceable system • Fully functional intranet and internet network • Leverage LOGIS and available systems capability and

ensure reports routinely available to relevant stakeholders

• Identify systems gaps and explore cost-effective solutions

• Create online platform for collaboration in procurement

2. Develop performance assessment parameters tools 3. Regular performance review meetings at different levels

Pe

rfo

rman

ce

Man

age

me

nt

Syst

em

Weekly hospital meeting Monthly hospital meeting Quarterly interhospital meeting

Stakeholders Attend Agenda Attend Agenda Attend Agenda

Head Office • Realization of procurement plan

• Identify problems • Make weekly plans

and goals

• Realization of procurement plan (reports from LOGIS, number of processed orders…)

• Identify problems (what can be solved at hospital and what on provincial level)

• Make monthly plans

• Structural and policy problems

• Knowledge and skill sharing

• Coordination of provincial tenders

• Annual procurement plans coordination

Auditor general office

CEOs

Finance manager

Store manager If needed

Clinical engineering

If nedeed

Procurement team

Interested end users

SCM MONITORING DYNAMICS

Weekly hospital meeting Monthly hospital meeting Quarterly interhospital meeting

Stakeholders Attend Agenda Attend Agenda Attend Agenda

Head Office • Realization of procurement plan

• Identify problems • Make weekly plans

and goals

• Realization of procurement plan (reports from LOGIS, number of processed orders…)

• Identify problems (what can be solved at hospital and what on provincial level)

• Make monthly plans

• Structural and policy problems

• Knowledge and skill sharing

• Coordination of provincial tenders

• Annual procurement plans coordination

Auditor general office

CEOs

Finance manager

Store manager If needed

Clinical engineering

If nedeed

Procurement team

Interested end users

SCM MONITORING DYNAMICS

Weekly hospital meeting Monthly hospital meeting Quarterly interhospital meeting

Stakeholders Attend Agenda Attend Agenda Attend Agenda

Head Office • Realization of procurement plan

• Identify problems • Make weekly plans

and goals

• Realization of procurement plan (reports from LOGIS, number of processed orders…)

• Identify problems (what can be solved at hospital and what on provincial level)

• Make monthly plans

• Structural and policy problems

• Knowledge and skill sharing

• Coordination of provincial tenders

• Annual procurement plans coordination

Auditor general office

CEOs

Finance manager

Store manager If needed

Clinical engineering

If needed

Procurement team

Interested end users

SCM MONITORING DYNAMICS

Next Steps

1. Planned migration to electronic systems leveraging available capability

2. Finalise & Sign-off Performance Assessement parameters

3. Adopt performance review system & integrate into routine management performance systems at institutional & provincial levels

MANAGE PROJECT IMPLEMENTATION INCLUSIVE OF CHALLENGES & RISKS DECISIONS & RISK TABLES 20190124.XLSX

DECISIONS &

SUPPORT AGREED TO

Manage Project Risks

Require EC Top Management commitment and endorsement

Require renewed commitment and participation from all 6 hospitals and EC DOH going foward

• CEO Forum & SCM Forum • Review workstream participants and send names to

Tanya Vogt, email: tanya@samed.org.za and tantaswa.bolo@echealth.gov.za

3. Operational Plan for 2019 • To organize and institutionalize the

expected outcomes of the EC Hospital Pilot

PART B Areas of Collaboration

MANDATE: LONG & HEALTHY LIFE FOR ALL

IMPROVING HEALTH OUTCOMES & QUALITY OF CARE EQUITABLY IN

EASTERN CAPE PROVINCE

LONG & HEALTHY LIFE FOR ALL • Tackling Disease Burden of SA

•Approach = PHCA Disease Prevention Health Promotion Manage disease burden Rehabilitate patients

QUADRUPLE BURDEN OF DISEASE Maternal, newborn & child health

1% of global burden 2-3 times average for comparable countries

Communicable Diseases 17% of HIV burden 5% of TB Burden

Violence and Injury

1,3% global burden (2 x global average injuries; 5 x homicide)

Non-communicable Diseases

1% global burden 2-3 x average developing countries

ECONOMY POST 1994

CHALLENGES

▪ Unemployment

▪ Social & Economic Inequality

▪ Poverty

SLOW ECONOMIC GROWTH

Job creation

Attract investment: ▪ State Capture & Corruption

▪ Conditions to conduct business

▪ Government effectiveness

Land and tenure reform

PROBLEM STATEMENT All Citizens of EC Province

Legitimately demand good quality healthcare and expect improved health outcomes and a positive experience of

cost-effective care

despite a quadruple burden of disease increasing the demand for care at a time when costs for healthcare is

escalating, but resource envelopes are highly constrained due to decreasing budget allocations and the pressure of

medico-legal settlements

REGIONAL, TERTIARY & CENTRAL HOSPITALS

PATIENT-CENTRED CARE

▪Health outcomes – safe, effective and reliable care

▪Experience of Care – standard that satisfies communities

▪Addresses Burden of disease

▪Value for Money - Cost-effective & cost-efficient

VALUE PROPOSITION

Excellent Patient Outcomes

Positive Patient Experience

Value For Money

Continuity of Care by Collaborating Team of Experts

OPTIMAL PATIENT OUTCOMES • Optimal improvement of function • Minimal risk of adverse events • Acceptable minimal length of stay • Good pain management

HOSPITALS VALUE PROPOSTION DEFINED POSITIVE PATIENT EXPERIENCE

• Friendly, helpful & caring Staff

• Clean facility & reliable infrastructure

• Acceptable waiting time

• Hotel & support services of acceptable standard

• Experienced clinical & support teams

• Continuum of Care across service levels

CONTINUITY OF CARE

• Centres of Excellence o Collaborating Multi-disciplinary Teams o Integrated Care

• Research used to continuously guide quality improvements & lead innovation

VALUE FOR MONEY

• Lean patient pathways • Transfer savings to the patient • Leverage SCM for safe & cost-effective consumables

QIP: ALTERED PATTERN OF WORK

1. Manage Demand

2. Improve Capability

3. Lean

Process

MENTAL HOSPITALS

Compliance with Mental Health Act No 17 of 2002

▪ Appropriate access to care with community-based approach

▪ Voluntary, assisted and involuntary patients, State patients and mentally ill prisoners

▪ Procedures to be followed

▪ Human rights approach – respect, dignity, free from discrimination, informed consent

CHALLENGES & INTERVENTIONS

1. Lack of resources for mental heath care (Acute beds & staffing)

2. Information systems to monitor quality of mental health services ensure transparency and accountability eg seclusion; use of ECT

3. Improve quality assurance measures for mental healthcare amongst psychiatric and general hospitals (standard treatment guidelines)

Long-term systematic plan needed for appropriate mental health services:

▪ General Hospitals and DHS provide relevant acute care

▪ Audit tool to routinely assess performance, capability & quality

▪ Contracting private sector psychologists & psychiatrists

▪ Strategic Community Partnerships

OPPORTUNITIES FOR CONTINUED COLLABORATION WITH SAMED

▪ Annual Collaborative Workshop in EC ▪ Information-sharing between and within sectors

▪ Continuing Professional Development – refresher course; industry updates; etc

▪ Reward & Recognition Programme

▪ Sponsoring individual and facility awards for innovation in health technology

▪ Facility Health Technology Management QI projects and that link technology to improved patent outcomes, experience of care and cost-effectiveness

THINK TANK:

▪ Curbing escalating costs of medical technology

▪ Developing local capability for quick responses for Repair and Maintenance of critical medical technology

▪ Collaborate to strengthen contract management

Door to Needle Time 53 min (60min)

Quickest DTN: 20min

ACKNOWLEDGEMENT

THANK YOU

COST-EFFECTIVE CARE

POSITIVE PATIENT

EXPERIENCE

OPTIMAL PATIENT

OUTCOMES

PERSON-CENTRED

CARE

PHARMACEUTICAL SERVICES

Pharmaceuticals play a vital role in the prevention and treatment of major causes of death and disability in the developing world.

High costs and frequent shortages

Management techniques developed to optimize the use of scarce resources not being applied optimally in all institutions/Districts

Medicine shortages and improper use of pharmaceuticals can not only lead to financial losses but also have a significant impact on patient well-being.

INTERVENTION Rational drug use and improved drug management practices to ensure cost-effective management, supply and use of pharmaceuticals; and, ultimately, save lives and improve health

ANNEXURE 5 Pharmaceuticals Notes.docx

INTERVENTIONS

FOUNDATIONAL: Supplies in & reduce stock-outs

1. Measure performance& identify QI areas

2. Assess capability

3. Assess compliance

OPTIMISATION: reduce costs & improve efficiency

1. Understand cost-drivers (ABC; VEN)

2. Existing resources used appropriately

3. Drug inventory management, cost-containment & improved efficiency

TRANSFORMATIVE: improved clinical outcomes & safety

Clinician and Patient-Centric

1. Clinical Outcomes

2. Patient Experience

3. Burden of Disease

4. Demand for Care