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Management of waiting lists at national level in Croatia. R Management of waiting lists at national level in Croatia. R

Management of waiting lists at national level in Croatia. R - PowerPoint Presentation

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Management of waiting lists at national level in Croatia. R - PPT Presentation

Assist ProfDragan KorolijaMarinić Consultant surgeon University Hospital for Tumours Zagreb Croatia University Hospital Center Sestre milosrdnice Assistant Minister of Health 2014 june2016 feb ID: 556938

2015 waiting patients days waiting 2015 days patients 2014 time decreased average hospitals lists hospital services results ratio increase

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Slide1

Management of waiting lists at national level in Croatia. Reinventing the wheel...

Assist. Prof.Dragan Korolija-Marinić

Consultant surgeon

University Hospital for Tumours, Zagreb, Croatia

University Hospital Center

Sestre milosrdnice

Assistant Minister of Health (2014 june-2016 feb)Slide2

Presentation content

1. Hospital sector status in Croatia

2. Business process improvement

a) Main activities

b) HTA

c) Waiting lists management – Programme Plus

3. ConclusionSlide3

1. Hospital sector statusSlide4

Reducing waiting list for elective care

Policy strategies:

Increase supply –

increasing activity

, increasing capacity,

using capacity more efficiently.

Reduce demands –

ilness prevention, prioritising patients, eliminate inappropriate tests and

treatments.

Local organizations strategies –

incentives and sanctions for hospitals which meet

targets.

Kreindler SA Br Med Bull, 2010.Slide5

Devil’s triangle

Negative financial results

Not enough doctors Not enough money

Hospital underperformance Big waiting lists

Not enough patients

 Slide6

Angels Triangle - Thesis:

Will more efficient process improve results ?

Positive financial result

Human resources Rational resources

managment usage

Optimal performance Short waiting lists

Gudilenes and pathways

implementation

sdgbsbSlide7

Number of services in hospital sector (2011 – 2014)

sdgbsb

Outpatient service

Inpatient treatmentSlide8

Major change in 2015....D-Day

National insurance fund leaving the Treasury

Operating indipendently

Mid-term planning

Pay-for-performance contracting for hospitalsSlide9

Programme

P

lus – patients in the center of care

Start-up:

11 Feb 2015 –

World Day of the sick

Target: increase access and efficiency of services, additional working hours: Wednesday afternoon and Saturday morning.

Programme evaluation – decrease in average waiting time (days) and number of patients on waiting lists...Slide10

Program

me

plus

– first ten weeks

First four weeks: 21.451 patients

Ten weeks:

47.139 patients !!

Great public support...media, NGO....Slide11

Number of services (patients) –

Jan / March

2015 vs. 2014Slide12

Results – first ten weeks – national level

Significant decrease in average waiting time

Apr

2014 - 155

days vs. Apr

2015 - 132

days

(15 %)

Seasonal increase compensation (February - April) 2014 –

increase for 58.678

referals (01.02 - 08.04.2014.) 2015 –

increase for 16.547 referals

(01.02 - 14.04.2015.)

42.131 referals less (patients waiting) compared to 2014 !! Slide13

First ten weeks results - national level

Significant decrease in number of patients waiting (green)

Significant decrease in average waiting time in days (green)

Trends by specific procedures

Programme bensfits

Gastroscopy

Colonoscopy

MRI

Cardiac

ultrasound

11.02.

20.04.

Ratio

11.02.

20.04.

Ratio

11.02.

20.04.

Ratio

11.02.

20.04.

Ratio

No

of patients

4.450

3.919

-12%

3.968

3.963

0%

19.499

18.402

-6%

16.110

15.090

-6%

Av.

waiting time (days)

81

74

-9%

115

109

-6%

212

206

-3%

214

204

-4%Slide14

Positive examples from Croatian hospitals

20.04. vs 11.02.

MSCT

UHC Rijeka

Number of patients decreased from 605 na 453

(25%)

Average waiting time (days) decreased from 66 to 58

(13%)

Cataract surgery

UHC RijekaNumber of patients decreased from 876 to 530

(39%)Average waiting time (days) decreased from 154 to 118

(23%)Slide15

Positive examples from Croatian hospitals

Cardiac ultrasound

GH Bjelovar

Number of patients decreased from 836 to 333

(60%)

Average waiting time (days) decreased from 320 to 241

(25%)

UHC Rijeka

Number of patients decreased from 1.388 to 970

(30%)Average waiting time (days) decreased from 150 to 122 or zero! (19%)Slide16

Waiting lists comparison 2014 vs. 2015

1.1.2014.

15.6.2014.

31.12.2014.

13.4.2015.Slide17

Waiting lists comparison 2014 vs 2015Slide18

Results

Feb 2015. – Ratio of hospitals with service within 60 days

Nov 2015. – Ratio of gospitals with service within 60 days

First consultation

64%

74%

Clinical examination

80%

81%

Gastroenterology

35%

71%

Cardiology

50%

71%

Neurology

93%

93%

Ophtalmology

39%

43%

Therapeutic procedures

29%

43%

Cataract surgery

29%

43%

Diagnostics

60%

67%

Gastroscopy

64%

82%

Colonosscopy

70%

76%

Mamography

76%

96%

Abdominal ultrasound

56%

57%

Carotid color doppler

81%

80%

Breast ultrasound

38%

37%

Cardiac ultrasound

37%

52%

Total – 13 services

60%

69%Slide19

Final results

Activities started in Feb 2015:

Programme plus, 72 HOURS, Open days week, Top ten doctors.

1,2 milion services more (total of 13,2 mil.).

21 % reduction in average waiting time (days)

from February do December 2015.

Minimal additional cost.

42 percent of hospitals had positive balance sheet at the end of 2015.Slide20

Conclusion

More efficient and productive processes can decrease waiting lists and result in better hospitals

performance –

Increase supply !!

Key points are more services and proactive

localhospital

management

.

Administration must be present in hospitals !

After 20 years this was the first year to achieve financial stability in healthcare sector as oppose to some European countries....Slide21

Thank you for your attention...

‘The only way is up’