The Critical Elements for Hospital Success - Part 2
[Continued from Part One here]
External Factors include:
Environmental considerations. (e.g. adjacent hills, rocks, water table, soil, subsoil strata). These weigh heavily on any structure and need detailed assessment by a geologist.
Traffic and access. Public convenience, parking regulations, emergency evacuation to and from other facilities, jurisdiction questions of local and state laws, etc.
Location of nearest Fire Department. Response time and easy accessibility of fire fighting apparatus.
Location of other Medical Services: A nursing home, A burns unit, An MRI, etc. Transfer Capabilities: Ambulance services to transfer the spillover of casualties in case of a disaster.
Utility Capability: Such as electricity, water, gas, and sewage. Their location and access can affect where the facility can be located.
Public Transport: The availability of this service is a significant influence.
Parking is always a major item, Presenting one of the biggest challenges. Adequate parking may take up more than the space required for the actual project.
Internal Factors include: (For extensions in existing facilities).
Minimum disruption of existing functions: Relation of activities adjacent to the extension, Overall flow of public traffic as well as movement of professionals must be taken into consideration, blending of the façade into the general style of the building. Balancing how well can an owner or organization complete a project against how soon the project is required by the community.
The planners/managers must ensure to produce a structure that reflects the needs of the people who will work and get treated in it. The process of building hospitals becoming more and more complicated as the planners have to take care of building structure, fire hazards, health codes, Inspection agencies and certificates of need, certifications, licensure, and accreditation. Balancing needs, desires, costs, and regulations is a high-wire act that a healthcare manager has to perform. One should diligently think before conceiving a plan to build a HCE. Ideally, the designer also has to be an advocate for all the stakeholders. The main stakeholders are. Patients, Administrators, Doctors, Nurses, Paramedics, Skilled Technicians & Workers, Pharmaceutical & Electro med Industry, Financers (allocated health budget if Government or individual financer), economics, medical practices in vogue in respective regions/countries, enforcement requirements, public relations, social workers & politicians, & community at large. Every stakeholder’s perspective has to be consulted and his/her interest must be respected and due acknowledged[13].
Patient’s Perspective: The proposed HEC has to be easy to reach, The infrastructure must be welcoming & clean, spacious and comfortable waiting areas, the edifice of confidence, user friendly, safe & trustworthy, accessibility under one roof, privacy and dignity be ensured and socially acceptable
Administrator/Health Care Manager’s Perspective: A Health Care Manager’s ability to work under constraints imposed on healthcare facilities today, is directly related to his ability to know, how to make the necessary activities happen, and happen at the right time. The main points to keep in mind may include, the amount of traffic and access, the location of the nearest fire department, the location of other medical services, transfer capabilities to other facilities in case of mass casualties or for specialized services if not available, utility capabilities, public transportation, parking spaces, and capable of withstanding all types of disasters
Doctor’s Perspective: Easy approach, commensurate professional workplace, safe separate covered parking, strong enough to withstand all natural calamities so a secure place to work, functional areas not disturbed by visitors, privacy and dignity of patient guaranteed, good climate control, well illuminated with good electricity backup and well ventilated, pleasant & easy to clean
Nurses & Paramedics: Spacious corridors and wards, quick accessibility to all functional areas, all functional areas connected by ramps, well-placed duty stations and retiring areas, least disturbance by visitors, privacy for intimate patient care, non-slippery floors, plenty of safe storage space for medical stores, good climate control and ventilation and quick and hygienic disposal of waste
Technician’s Perspective: Least complicated equipment, furniture, and fixtures, easy to reach replaceable parts, easily washable, even & non-slippery floors, waste disposal shoots at all floors, well-separated and color-coded pipes and wiring, layered maps of all lines and fittings and no crisscrossing of lines and pipes.
The most important three critical success factors to assure that the organization will remain vibrant as the future unfolds include:
Excellence in Governance.
Highly Competent Leadership Team.
Strong Physician Integration
Globally, healthcare leaders are increasingly looking to embed the principles of continuous quality improvement in their own organizations. Empowering staff to deliver safe, high-quality, and reliable care can provide guaranteed success in results. From improved patient experience to enhanced staff satisfaction, adopting proven methodologies offers a powerful opportunity for organization-wide change ultimately leading to Hospital Service Excellence and thus success [14]
Defining Hospital Service Excellence:
Operational excellence is a culture; a philosophy about how to deliver healthcare/Hospital service excellence. The term ‘operational excellence’ (OE) describes a way of working for healthcare organizations and systems. Operational excellence has to be fully and durably supported by the entire organization including the board; by specialists; and where necessary, by external facilitators and supporters. It must start right from the point of conception of a Health Care Establishment (HCE) may be a small or a large one. At a practical level, it works by identifying problems in healthcare systems and processes and encouraging and empowering frontline staff to develop and implement solutions that address the root causes. Through Operational Excellence, the entire team seeks to align direction, goals, and objectives whilst empowering and enabling the frontline teams to own and drive improvement ‘bottom-up’ to allow leaders and managers to coordinate larger changes for improvement[15].
Hospitals and healthcare systems across the world are redefining their missions to provide premium hospital service excellence and enhance patient experience thus proving the success[16]. As the new paradigm of healthcare, the mission of hospital service excellence is vital to cultivating patient engagement and integral to the long-term sustainability of every hospital and healthcare system in the respective country[17]. The formula for successfully cultivating a culture of client and hospital service excellence is not one size fits all. Many elements are dependent on a facility’s needs and the patients and families the facility serves. However, several elements prove to be key components for providing the optimal patient experience and top-quality healthcare services[18].
Every moment is critical when crafting the perfect patient encounter and customer service experience. Physicians and management should remember the patient encounter begins as soon as a patient enters the Emergency Department (ED) and does not end when the patient leaves but after the post-discharge follow-up. Use the welcome period to make the best first impressions. Minimizing delays in initiating treatment is important to satisfying patients and will improve treatment times, overcome capacity constraints, and allow for clear communication with patients[13]. Continue to round on patients to ensure clear communication and to keep patients and family members informed. When a patient is prepared for discharge, it is important to ask if they received excellent care. Think of this as a way of prompting customer service feedback and giving a verbal summary of the visit given by the clinician[19].
Behind every successful department is an exceptional leader who is consistent in providing guidance and feedback to all team members. A successful leader offers communication and leads by example. Dissemination of individualized clinician feedback, goals, and group data is key when coaching team members to success. Share actual data, patient grievances, and letters so everyone can see first-hand how patients perceive them[14]. Review each clinician’s patient approach and provide constructive feedback and strategies for improvement. As an effective leader, it is important to review scores with the administration to establish clear communication of performance and real-time monitoring of the group trends. Effective leaders recognize top performers and celebrate their successes publicly. Praise should be done so liberally and often to ensure the team is recognized and appreciated[20].
Value-based approaches to organizing healthcare delivery are widely touted as critical to improving the health outcomes of patients worldwide and controlling runaway healthcare costs. Value is defined as the outcomes that matter to patients and the costs to achieve those outcomes.
Over the years there have been many efforts to improve the system such as the use of evidence-based medicine, safety initiatives, electronic records, care coordinators, personalized or precision medicine, and population health to name a few. All helping the establishment become successful in improving outcomes and controlling costs. They proposed a single unifying goal for health care, to deliver value for the patient. Health care delivery needs to be organized around the medical conditions patients have, and accurately measure the outcomes that matter to patients.
While designing a Health care facility one must remember that the planner has to constantly interact with all the stakeholders who may be having different workplace requirements. At the same time keeping in mind functionality, social and cultural demands as well as aesthetics. It is by no means an easy task to do, A co-design with hospital staff at the early stages of a design process can contribute to the experience of the designers’ knowledge on users' needs and services provided in each building and in their specific context, thus increasing operational efficiency. Reflecting on the multiple meanings of hospitals can help to inspire a creative, and ultimately more acceptable, response to local circumstances. The key issues such as organizational transformation, role of leadership, culture of service excellence and training the employees in achieving service excellence in healthcare should always be given due emphasis. The hospitals should not underestimate the importance of excellent customer service in achieving the service excellence in healthcare. The hospitals should develop a customer excellence master plan and provide the training to its employees in service excellence aspects
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