Presentación de PowerPoint - HOPE Agora · F. INANCING (1) Money. is needed for good healtcare, but not for given care. HOPE TEAM GREECE. Amsterdam; 28 May 2014. First of all Financing

“FILOTIMO” HOPE TEAM GREECE 2014

Christina Andersson (Sweeden)

Mette Bille (Denmark)

Vaida Lankauskiene (Lithuania)

Lara Pino Domínguez (Spain)

Amsterdam; 28 May 2014

Presenter

Presentation Notes

Kali Mera! Welcome to the presentation from the Greek group.

HOPE TEAM GREECE. Amsterdam; 28 May 2014

THESSALONIKI

University General Hospital of Thessaloniki, AHEPA

680 beds

ATHENS

SOTIRIA Regional Chest Diseases Hospital of Athens

710 beds

Presenter

Presentation Notes

We have visit Sotiria Hospital in Athens and AHEPA Hospital in Thessaloniki and investigated following topics to be important for the quality.

FINANCING (1)

Money is needed for good healtcare, but not for given care.


Presenter

Presentation Notes

First of all Financing. As you all know Greece have been in financial crisis since 2009, which means that the health care system lacks money and money is needed for good health care, but not for given care, which Greece really have proved.

Just an EXAMPLE of the hospital

budget. (AHEPA Hospital,

Thessaloniki)

From 90 € million 2010… … to 60 € million 2011

… to 42 € million 2012

… to 32,5 € million 2013

… to 28,5 € million 2014

FINANCING (2)


Presenter

Presentation Notes

This is an example from AHEPA Hospital of the budget decreasing from 2010 to 2014 and you can see a decrease from 90 million euro 2010 down to 29 million euro this year.

FINANCING (3)

Money is needed for good healtcare, but not for given care.

Do the best out of the money you have.

Work ”voluntary” is needed in countries in economical crises.


Presenter

Presentation Notes

- But greeks are really doing the best out of the money they have! - We have investigated that work voluntary is needed in countries in economical crises, which can be to work without salary, to work overtime without being paid and even to buy materials like gloves from their own pocket.

IMPLEMENTATION OF PRIMARY HEALTH CARE (1) The National Health System in Greece (ESY)

MINISTRY OF HEALTH AND SOCIAL SOLIDARITY

ATTICA PIREAUS &

AEGEAN SEA MACEDONIA

MACEDONIA-THRACE

(Central-East) THESSALY

PELOPONESSES, IONIAN, EPIRUS & Western Greece

CRETE

HOSPITAL PRIMARY HEALTH CARE

EMERGENCY

OUT- PATIENTS CLINIC REGIONAL BOARD

ADMINISTRATIVE SECTOR MEDICAL SECTOR NURSING SECTOR

SOCIAL SERVICES DEPARTMENT HEAD OF DOCTORS HEAD OF NURSES

DOCTORS & NURSES

DEPARTMENTS


Presenter

Presentation Notes

Implementation of primary health care: The national health system in Greece is built up with the Ministry of health and social solidarity at the top. Further on Greece is divided into 7 regions. Each region contains several hospitals. Each hospital is runned by a manager and the regional board. The hospital is divided into administrative sector, medical sector and nursing sector. Each hospital then have different departments and at each department the doctors and nurses are divided with different directors. The departments do not have their own budget, only the manager of the hospital takes decision concerning money and the Greek national health system is mainly runned by insurances payed by the patients. Due to the big economical crises right now about 20% of Greeks inhabitants can not afford to pay the insurance. The hospitals we have visited both have an emergency and an out-patient clinic. The hospitals in the same area takes turn to have their emergency open for patients. For example AHEPAs emergency was open every 4th day for 24 hours and took then care of about 700 patients with different severity of illness, everything from catching the flue to having a heart attack. After 24 hours of opening, the emergency clinic closes and another emergency clinic in another hospital in the area is opening. A lot of patients are going to the emergencies because there are just a few primary health care centers in Greece. They are all connected to a hospital but from the beginning of next year they will depend directly under the Ministry of health of each region. To implement the primary health care would reduce the number of patients at the emergency and probably make the system more efficient with a better quality for the patient and from what we have understood the Ministry of health are just now taking about to implement more primary health care centers in the entire Greece.

Laws & Regulations could help to improve the Quality.

Implementing a Quality Management System with the aim of being able to receive the ISO:9001 granted by the International Organization for Standardization.

LAWS & REGULATIONS


Presenter

Presentation Notes

In other European countries quality is regulated by laws and regulations and it may help to improve the quality. A few departments in the hospitals we have visited in Greece are certified by ISO 9001 and some are working on it. We know that the Hellenic Accreditation System is working to affect the Health Ministry to legislate the quality in healthcare.

SAFE SURGERY

ASSESMENTS OF FRAMEWORK

HOME & COMMUNITY INTEGRATED CARE

ORGANIZATION OF GOOD PRACTICES FOR THE PATIENTS (1)


Presenter

Presentation Notes

We have found some examples at our hospitals of good practice for the patients with focus on quality:

SAFE SURGERY: The effective implementation of the WHO Surgical Safety Checklist is the

simplest, cheapest and most effective measure to increase patient safety in the surgical procedure.



Reduction of complications and death with 1/3

Presenter

Presentation Notes

Safe Surgery is a checklist used before, during and after the surgery with the purpose to increase the safety and quality for the patient. The checklist has been proved to decrease the complications and death with one third.

SAFE SURGERY





Presenter

Presentation Notes

Assessments of framework is a tool where different professionals work together to inventory good and bad things at the hospital and then prioritize them according to which ones can be done without money and are easy. Everything that changes in the program has to be proved and documented before changing.

SAFE SURGERY





Presenter

Presentation Notes


HOME VISITS

INSURANCE

SOCIAL CARE

PRIMARY CARE

TERCIARY CARE

E-HEALTH UNIT SOTIRIA HOSPITAL

- COPD Patients - Case Manager - Multidisciplinary Team - Empowered Patient

Patient centred services, suported by ICT solutions.

KeyWords:

QUALITY of CARE

QUALITY of LIFE (QoL)



Presenter

Presentation Notes

The e-Health Unit of Sotiria Hospital takes part in an EU-project about: HOME & COMMUNITY INTEGRATED CARE Patients suffering Chronic Obstructive Pulmonary Disease (COPD) can perform measurements through a T-shirt they are wearing and control their disease at home without going to the hospital. In this project the patient is in the center and it definitely increases the quality of care and the patients’ quality of life

TECHNOLOGY

… Information continuity

From the perspective of ICT, one of the great developments that aims to increase the quality of care.

Electronic Health Record. (PILOT PHASE)

Electronic Prescribing can reduce the risk for medication errors.


Presenter

Presentation Notes

Greece are using electronic prescription for medications and a primary healtchare center in Greece participate in a pilot for starting to use electronic health record. This is important for the information continuity and quality.

INDICATORS FOR QUALITY IN THE PUBLIC HEALTH CARE

PATH

EXAMPLES: Mortality from stroke (30 days after hospitalization); Using blood components; Day surgeries; Prophylactic use of antibiotics, etc.

http://www.pathqualityproject.eu/what_is_path.html


Presenter

Presentation Notes

PATH is measurable quality indicators used in some hospitals in Greece. AHEPA have used the indicators since 2012. Some indicators that are measured are mortality from stroke and the usage of blood. The results are sent to the Ministry of Health and Social Solidarity to get money for quality improvements in the hospital. The results are not public for the patients.

MANAGEMENT (1)

Hierarchical organization

Lack of staff (mainly nurses)

Cooperation


Presenter

Presentation Notes

- Greece has, in our opinion, an hierarchical bureaucratic organization which may affect the efficiency, the teamwork and the quality for the patient. – Lack of Staff (mainly nurses)

01234567

1990 1995 2000 2004 2006 2009

NURSES DOCTORS

DEVELOPMENT RATE PER YEAR FOR DOCTORS AND NURSES/1000 INHABITIANTS. GREECE.OCDE,2010.

MANAGEMENT (2)


Presenter

Presentation Notes

This graph shows the development rate from 1990 up to 2009 of the numbers of doctors (red line) and nurses (blue line) per 1000 inhabits.

4,57 4,39 4,37 4,29 3,92 3,76

3,19 2,98 2,83

2,39 2,3 2

1,59 1,24

0,88 0,61

00,5

11,5

22,5

33,5

44,5

5

RATIO NURSES/DOCTORS.OCDE,2009

MANAGEMENT (3)


Presenter

Presentation Notes

This graph show the ratio number of nurses per doctor and as you can see Greece has a ratio of 0.61 nurses per doctor. At the moment the university has decided to reduce the medicine students to get a better ratio.

MANAGEMENT (4)

Hierarchical organization

Lack of staff (mainly nurses)

Cooperation


Presenter

Presentation Notes

Cooperation between professionals, departments, hospitals and within the country may help to improve the quality

OPINIONS ABOUT THE BIGGEST QUALITY CHALLENGES

“No clear quality indicators to measure” (Primary Health Care)

“Lack of money to buy materials and external controls” (Hematology Lab)

“Greece have high level of bureaucracy in decision process” (Biochemistry Lab)

“Quality strategy from EU and the Government is needed” (Immunology Lab)

“Standardized procedures are needed to increase the efficiency and the quality” (Pathology Lab)

“Quality Department within each hospital with dedicated people with power to make decisions”

(Nuclear Department)

“Teamwork, especially between nurses and doctors, may increase the quality,” (Cardiac Clinic Department)

“Get the health care in Greece evidence based” (Cardiac Surgery Department)

“Implementation of primary healthcare is needed” (Head Nurse Office)


Presenter

Presentation Notes

We have asked at different departments for their opinion about what they think is the biggest quality challanges in the Greek Health Care System right now and we got this answers:

Financing

Implementation of Primary Health Care

Laws & Regulations

Organization of good practices for the patients

Technology

Indicators for quality in the Public Health Care

Management

Opinions about the biggest quality challenges


Presenter

Presentation Notes

If you have payed attention to the red letters in each slide of our presentation you will realise the conclusion of our presentation which is the greek word “FILOTIMO”

Financing


Laws & Regulations


Technology


Management



Financing


Laws & Regulations


Technology


Management



Financing


Laws & Regulations


Technology


Management



Financing


Laws & Regulations


Technology


Management



Financing


Laws & Regulations


Technology


Management



Financing


Laws & Regulations


Technology


Management



Financing


Laws & Regulations


Technology


Management



Presenter

Presentation Notes

FILOTIMO: This word means “To work with your heart without expecting anything”. Filotimo is the biggest quality for the patient in the Greek Health Care System through the economical crises. We have everyday experienced this in different nice ways and we will try to bring it back home to our country and implement it.

F

I L O T I M O

Ευχαριστώ! (Thank you)


Christina Andersson (Sweeden)

Mette Bille (Denmark)

Vaida Lankauskiene (Lithuania)

Lara Pino Domínguez (Spain)

Presenter

Presentation Notes

Thank you all for listening and for giving us the opportunity to introduce you to the greek Filotimo

Documents

Presentación de PowerPoint - HOPE Agora · F. INANCING (1) Money. is needed for good healtcare, but not for given care. HOPE TEAM GREECE. Amsterdam; 28 May 2014. First of all Financing