The project analyzed BMC’s challenge on overstaying patients, and proposed and installed systems and operational innovations to help alleviate this problem and improve the discharge process of the Center. Eventually, this should lead to the provision of improved quality of patient care services.
Background and Problem
One major challenge in the Philippine health sector is broadening access to appropriate and adequate health facilities for the poor and the marginalized sectors of the society. But with the institutionalization of the Department of Health Facility Enhancement Program (DOH-FEP) , quality and affordable health care will be assured and be available to everyone. As a DOH-retained hospital, the BMC is mandated to provide high quality health care services to all patients requiring hospitalization. The current BMC administration has already installed programs to continuously upgrade its quality of health services. However, one problem has persistently encumbered the hospital with increasing economic costs, leading to the diminution of the quality of service to the people. This is the case of overstaying patients.
Solution and Impact
A system-level approach in designing and implementing innovations in specific stages of the discharge process was utilized to reduce the incidence of overstaying. A higher level of inter-organizational communication and coordination was integrated in the discharge process as well as the strategies adopted from other health institutions to address the overstaying problem. The project was implemented in three phases. Phase 1 is the assessment phase, where the status of the hospital was analyzed, and its key needs and concerns were identified. The second phase is the implementation and interventions designed to reduce the incidence of overstaying patients through an integrated discharge system. The third is composed of activities to monitor and evaluate the operations of the discharge process and identify specific areas for improvement. At the onset, the impact of the improved discharge process on overstaying days from June to August 2014 did not present a clear trend.
However, the average number of overstaying days showed a decreasing trend of about 10.5 percent between June to July, and July to August, or an overall reduction of 19.9 percent from June to August of 2014. This is validated by the August 2013 and August 2014 data, which also showed an 8 percent decrease of the average number of overstaying days. The cross-departmental coordination needs of the system require changes in long-standing procedures and practices, the probable reason for the lack of immediate and substantial effects. Nonetheless, the statistical results already showed evidence of fledgling successes even after only a few weeks of interventions. Figures on patient satisfaction of services and personnel showed an initial negative movement from the period of April to June, and June to July.
This, however, improved from July to August as a sign of a more effective discharge system slowly being felt. The assessment of factors for overstaying showed that about two-thirds of the cases are due to the lack of patients’ capacity to promptly settle their accounts. This socio- economic issue is being addressed by an information campaign on estimating hospital expenses and financial aid availment. The internal discharge processes are also noted to have minimal effects on overstaying. This reveals a likelihood that the streamlining is already reducing the procedural bottlenecks.
The early successes can be mainly attributed to the strong support extended by the BMC management, and the active coordination and engagement of stakeholders – both within the organizational structure of the hospital, and from external entities.
The major deliverables of the project are: (1) the design and installation of an integrated discharge process from access to discharge of patients; (2) the adoption of a patient classification system as to the type of discharge planning; (3) the computerization of the discharge system; and (4) improving customer satisfaction levels. The system was installed in the Obstetrics-Gynecology Department. To monitor changes in the incidence of overstaying, the number of patients who stay beyond what is necessary and the number of days of overstaying was measured.
A longer time frame to track changes, more focused monitoring and assessments, a more comprehensive database, and programs for behavior and attitude modification for the staff may be required for the new system to manifest significant improvements in the satisfaction levels of patients and watchers. To ensure the effectiveness of the integrated discharge process, a continual quality improvement had been implemented to all clinical areas of the Bicol Medical Center. At the start of the conceptualization of the project in 2014, only 54.9 percent of patients were discharged within 24 hours considering the limited number of patients registered in the discharge process.
By 2015, 70.8 percent were discharged within 24 hours. On the succeeding year, 86.8 percent were discharged within 24 hours. At present from January to August, 2017, 91.5 percent were discharge within 24 hours. The result of the data monitoring from 2014 to present shows a progressive improvement on discharges of patients. The strict implementation of the integrated discharge process contributed to the enrichment of other systems in the hospital such as the IHOMIS (Integrated Hospital Operation Management Information System) where all the data of the patient were captured from admission to discharge.
The prompt processing of PhilHealth requirements helped the indigent patients (classified as NBB or no balance billing patients) to be enrolled to point of care PHIC services and the provision of the medical assistance program. The billing section promptly provides the patients’ bill in all clinical areas to ensure early discharges of patients. At present, BMC started an online prescription where all patient needs for medication where automated to ensure that they will be treated immediately, thereby facilitating speedy discharge. The institutionalization of the integrated discharge process has indeed made a great impact on the provision of quality care to the patients of Bicol Medical Center. It did not only improve patient satisfaction but also the enhancement of the different systems and processes of the organization, and made a vast amount of savings amounting to 12 million pesos from 2015 to present.
Note: This initiative is based on the Public Management Development Program (PMDP) Re-Entry Plan of Ms. Wilhelmina C. De Castro of the PMDP Middle Manager Class Batch 4 (Bato-Balani).