Greys Hospital

Action Learning Pilot ProgrammeProject Khaedu

Greys Hospital - preliminary findings

2DPSA Training course material consolidated 2

Current situation


Greys is recognised for service excellence

s Greys hospital is considered one of the best hospitals within the province

n Recognised as being a flagship hospital

i Facilities at Greys hospital are well maintained

e Has won numerous awards including-Silver award for good governance (2004)-Best run neo-natal ward in South Africa in 2004 -Accreditation from COHSASA-Health-promoting hospital project-Performance assessment tools for hospital (PATH) Project-Participating in Baby friendly hospital initiative

Has numerous positive initiatives such as:-Asset management-Effective QIP initiatives


Service excellence is driven by…

c Good leadership within Greys

wFacilities are of a high standard and well maintained

f Processes are strong, especially within OPD

r Good level of service delivery

r Committed staff

“look at that patient as your family member” - ENA


Financial resources are being well managed…

Albert Luthuli Rob Ferreira King Edward Greys0

1,000

2,000

3,000

Rands per bed / day


Record keeping can be considered as a ‘Best Demonstrated Practice’

Records pre-pickedone day before appoint

Records placed inWard/clinic boxes

Files issued to patients

Pharmacy / wardReturn file

File stored in Pigeon-holes

Clerks file accordingTo D.O.B.

Patient receives treatment

Files archived once a year to clear OPD section


Record keeping can be considered as a ‘Best Demonstrated Practice’ (2 of 2)

Day of the month

Month of theyear

1980 – 04 - 26

1973– 04 - 26

1965 – 04 - 26

1943 – 04 - 26


And many initiatives contribute to continuous improvement at Greys Hospital

r Effective QI Programmes -Medical records committee

c Good M&E in the medical component

mRegular patient surveys

s Risk management committee


Despite this, numerous challenges exist…


Resourcesrequired

Actualbudget

2005 2006 2007 20080

100

200

300

400

Rands M

Lack of integration between HO and the hospital in terms of planning, funding and decision-making

“to be a tertiary hospital by 2007/08”

Shortfall

Mandate to become a tertiary hospital yet inadequate financial resources exist to staff and equip facilities

Illustrative


So who will staff this building?

Oncology section


Communication between management and staff must be improved

p Unions feel that inadequate communication between management and themselves exist despite a good relationship

h A perception exists that information is not effectively being filtered down from senior management and upward reporting mechanisms are not sufficient

“I’ve worked here for 26 years and have never been invited to any meeting” – GA


Challenges also exist in motivating staff due to..

e Staff shortages

e Lack of recognition of the work of lower level staff

i Staff are sometimes uninformed about critical decisions

mPerformance appraisals are not being done consistently

a Doctors absenteeism after ward rounds

i Staff development and training perceived to be inadequate, especially at lower levels

c Incoming bridging course student nurses joining Greys from clinics are not sufficiently skilled


The current organisational structure concerning GA’s should be reviewed

s Disadvantages of the current structure-Lack of flexibility when deploying GA’s to meet demand-No single manager responsible for representing and managing GA’s

Supervisor A

GA GA GA GA

Supervisor B

GA GA GA

Supervisor B

GA GA GA


And filling vacant post remains challenging

n Moratorium placed on all non-clinical staff

d Insufficient budget for filling vacant positions

g No approved organogram

n Post approval is a lengthy process

Process map for filling structured post

Post Creation Post Evaluation Advertise PostInterview and appointment

15 Months


The following suggestions are made..


At macro level, a decision should be made on the mandate for Greys hospital - Finance, staff and support should be provided strategically

Resourcesrequired

Actualbudget

2005 2006 2007 20080

100

200

300

400

Rands M

Shortfall

Illustrative


Initiatives to improve communication

mImproving communication between Management and Union reps

-Have more frequent IMLC’s-Consider reviewing chair for the IMLC’s to accommodate more frequent meetings

-Better adherence to meeting dates – annual planner

Improving communication between management and staff

-Ensure that supervisors regularly meet with staff at lower levels-Monthly reports on meetings should be made upwards-Translation of circulars into appropriate languages where relevant

-Specific induction programmes for incoming bridging course student nurses from clinics


Guidelines for successful communication between Unions and Management – a hypothetical example

e Clearly identify the issue-The objective is to pool all GA’s under a single manager

Work out and communicate the consequences of the decision

-A post will have to be created to manage the GA’s-The job descriptions of the GA’s will not change -The hours worked and levels of the GA’s will not change

Wins for the unions - GA’s will be better represented - GA’s will enjoy a more varied job - Jobs will be rotated

Wins for management - GA’s agree to sign PA’s - Unions agree to support change

o Attempt to create a win-win situation for both parties as well as for the efficiency of the hospital


Despite the challenging work environment, motivating staff is possible through…

Acknowledging excellence - especially of lower-level workers through:

-E.g. “GA/Nurse of the month” awards-Certificates and letters of thanks-Gift rewards for “cleaner of the month”

Management by walkabouts

l Once a year have motivational meeting with different staff groups – e.g. thanking orderlies for their role in winning the ‘xyz award’

Regular staff surveys

r Displaying letters of thanks and praise from patients on staff notice boards


Investigate potential benefits of pooling GA’s

Supervisor A

GA GA GA GA

Supervisor B

GA GA GA

Supervisor B

GA GA GA

GA Manager

GA GA GA GA GA GA GA GAGA GA

Team A Team B Team C


Investigate potential benefits of pooling GA’s

Under the new structure:r GA’s would be managed by a single manager

n GA’s would still report to unit heads

Benefits of poolingi Provides a more flexible workforce to meet demand – especially if GA’s are

converted to general orderlies

e GA’s have a single manager to monitor development and handle their concerns

l Unit heads have recourse to a single manager to handle GA’s issues

BUT this has to be well planned and clearly communicated


Thank you..

Documents

Greys Hospital