بحث تخرج ادارة خدمات صحيه ومستشفيات 1435

[طالب المعرفة]

Kingdom of Saudi Arabia
King Abdulaziz University
Faculty of Economics and Management
Health Services and Hospitals Administration





Patient long stay term (problem and solutions)
Field research at King Fahd Hospital for Armed Forces in Jeddah
A research paper submitted to complete the practical training course HSA479






Prepaid by student
FAHAD RAJEH ALJUNAYBY
Student ID 1050384

The supervisor of the Head of Department
of Health Services and hospitals
Dr. Omar Zayyan Omar Alsharqi


2013











 
إهداء هذا العمل المتواضع

بالحمد ابدا والثناء المتوالي
وصﻻة ربي للنبي العدنان
بجﻻئل النعم العظيمة حطتنا
وحبوتنا بالصفوة الخﻻن
فاليك وحدك شكرنا وثناؤنا
ﻻ ينقضي ابدا مدى اﻻزمان

ابتاه لج باﻻمتنا لساني
فعظيم فضلك هزني وسباني
عيناك راقبت دروب مسيرتي
عبرالزمان برقة وحنان
فلعل هذا ان يكون تحية من خافقي يادائم اﻻحسان

يا ام هذه من ثمارك جنية
نضجت فصارت خير قطف دان
ما ضاع جهدك في الليالي عندما
قدمته متدفقا فغذاني
فلتهنئي نفسا وطيبي انني
ثمر يقدم منك للاوطان

وﻻخوتي اهدي السﻻم فانهم
كانوا على العقبات من اعواني
رافقتهم زمن الطفوله والصبا
فوجدت فيهم اصدق الخﻻني
ادعوا اﻻله ان يديم صفائهم
ويديمهم قربي على اﻻزمان


ياهيئة علمت فعلمت الورى
هذالعمري في الدنا شرفان
لكم ساهدي ماكتبت وانما
انا وردة وعطائكم ريحاني
شكرا لكم لسالف فضلكم
مازلت اذكر انكم قبطاني









كلمة شكر وتقدير
اشكر الله سبحانه وتعالى على كل النعم التي انعم علي بها ، كما اتوجه بالشكر لجميع اعضاء هيئة التدريس بقسمنا إدارة الخدمات الصحيه والمستشفيات على ما قدموه لي من عطاءات علميه خلال مسيرتي الدراسيه بالجامعـــه وأخص بالشكر كل من الدكتور / عمــر الشـرقي رئيس القسم والاستــاذ
الدكتور / طلعت الدمرداش والاستاذ الدكتور / محمد تنوير والدكتور / علاء الدين محمد خلف ابو نقطه والدكتور / حسين برعي والدكتور / هشام ملياني فلهم مني جزيل الشكر والتقدير والعرفان وانني لاتشوق لارى قسمنا بعد فترة قصيره لما يحصل فيه من تقدم سريع وتميز حيث كان مصدر فخر لكل من انتسب إليه .


















Table contents
Dedication
PART ONE
Brief about king fahad army hospital
KFAFH Mission
KFAFH Vision
KFAFH Value Statement
KFAFH Objectives
PART TWO
Brief about some king fahad army hospital departments administration
Departments chart
Social service
Medical Records
Medical reports
Medical reports
Department of Finance
Department of Public relationship
Procurement Section
Patient Affairs Department
Patient Relations Department
Department of Medical investigation
Department of family medicine Clinic
Department of Employment
External recruitment section
Internal recruitment section

 
Table contents
PART THREE
Patient long stay term (problem and solutions
definition of the problem
Facts & Figures
Causes of the problem
Relationship problem with Department of Family Medicine ( effects)
Proposed solutions
References



















PART ONE


King Fahd armed forces hospital in Jeddah
Historical brief :
The military hospital was established in Jeddah in 1395 AH , according with1975 AD a capacity of 75 beds only , on the 12th of thol qa'da in 1402 AH , the king Fahd Bin Abdulaziz, the Supreme Commander of the armed forces, bestowed to open the King Fahd armed forces hospital in Jeddah, and beds number became two hundred (200) beds (first expansion project) , in 21st of Jumada II of 1424 AH according with 19 August 2003 AD, His Royal Highness Prince Sultan bin Abdul-Aziz, second Deputy Prime Minister and Minister of Defense and aviation and Inspector General bestowed to open the second expansion project of the King Fahd armed forces hospital in Jeddah , This expansion added to the Clinical Hospital power at that time amounted to 125% of the total number of beds becomes 445 beds (second expansion project ) .
The hospital is currently submitting to the third expansion project where all patients-hypnotize (clinics, clinical and non-clinical services support) in a separate building to facilitate access to the service for reviewers of the patients and their families.

Tasks:
King Fahd program for the armed forces is committed to provide the highest levels of patient care for hospital treatment and to continue development and improvement for the benefit of patients and staff , In accordance with the highest international standards of medical excellence that within the resources and possibilities .
The hospital provides a wide range of primary, secondary and tertiary medical services to members of the Saudi Arabian Armed Forces and their dependents. The Cardiac Center, situated within the main hospital, is the only adult cardiac surgical facility in the Western Region Established a hospital for the treatment of military and civilian personnel and their families of the Ministry of Defense and Aviation and also patients who receive treatment from the owners of orders as well as the validity of certain categories of patients from the Saudis (Seven diseases: Cancers and diseases of the liver, kidneys, heart, polio and AIDS newborns and their physical defect or deformity) Organizational connect for the hospital and the services provided :
King Fahd Hospital of the Armed Forces organizational connected with General Directorate of Medical Services

Targets :
• The adoption of the principles of development and quality improve at all times and in all the circumstances.
• Promoting and implementing educational and educational activities for health care.
• Ensuring the rights and dignity of patients in health care field .
• Raising the level of health education for patients and society.

KFAFH Mission
The King Fahad Armed Forces Hospital Programme shall deliver the highest standard of care to its eligible patient population, within available resources and continue to develop as a centre of excellence for its patients and staff.
KFAFH Vision
To be a Hospital recognised by patients and staff for excellence and compassion in service and care.
KFAF Hospital will be; the best place to receive care, the best place to practice medicine, and; the best place to work
 
KFAFH Value Statement
We, at KFAF Hospital, hold these values to be fundamental:
Patient-Centered Care. In all our endeavors, we are guided by the needs of the patient, creating a partnership that is effective and personal across the continuum of care.

Professionalism. We will uphold public trust in the healthcare profession by our conduct, standard of service and quality of medical care.
Responsibility. We accept personal accountability for the work we do.
Quality. We consistently strive to provide the highest quality, safe patient care. We will always practice CARE values when delivering care and services to our patients.
Teamwork. We will foster a work environment of collaboration and partnership, trust and mutual respect.
Safety. We are dedicated to creating the safest hospital for all.
Integrity. We are committed to the highest ethical standards in our conduct.
Commitment. We share the Mission and Vision of the hospital and will do our part to achieve them

KFAFH Objectives
1. Quality Improvement and efficiency shall be the culture of the organization at all times.
2. To encourage and undertake education activities related to health care, its promotion and management.
3. To ensure that the rights and dignity of patients and their carers are respected.
4. To promote health education to the patients and community.
5. Maintain and improve a challenging, motivating and patient-focused work environment where all our people are empowered, held accountable and recognised for high levels of performance.
6. Work in teams to achieve our mission and to continuously maintain, improve the quality, efficiency and effectiveness of our total service.
7. Promote Quality activities within the Hospital and provide support to all departments and staff in conducting Quality Improvement Activities.
8. To promote professional ethics among Hospital staff.
9. To provide for the well being of all staff in its employment by providing proper working procedures, a safe working environment, comprehensive medical services, appropriate housing and terms and conditions of service consistent with the Kingdom's Labour Law requirements.
10. To promote and encourage research to improve the quality of medical care in the hospital.

Financial resource :-
From the budget of the Ministry of Defense and Aviation Financial compensation from the accounts of patients
 
PART TOW

Brief about some king fahad army hospital departments

Departments King Fahd Armed Forces hospital departments established by the care, medical or surgical specialties.



Clinical
• Anaesthesia
• Cardiac Services
• Dental Services
• Emergency
• Diabetes and Endocrinology
• Hospital Specialty Clinic (HSC)
• Medicine
• Nephrology
• Nursing
• Obstetrics/Gynaecology
• Paediatrics
• Preventive Medicine
• Primary Care
• Psychiatry
• Surgery
Non-Clinical
• Finance
• Human Resources (HRD)
• Information Services & Technology (IS&T)
• MEDEVAC
• Operations & Maintenance
• Patient Affairs
• Purchasing
• Supplies
• Support Services

Clinical Support Services
• Medical Laboratory
• Pharmacy
• Radiodiagnostics & Medical Imaging

Administration
• Programme
• Deputy Programme
• MSD Administration
• Academic Affairs & Training (AA&T)
• CQI & PS
• Field Medicine
• Government Relations
• Inventory Control
• PMD Audit
• Public Relations
• Religious Affairs
• Security Office







Social service department :
The social service department seeks to help the human , which is the essence of our attention and is the essential foundation in hospitals, health, and social centers , Through the professional practice of social workers , As well as helping the individual and his right to self-determination , offering the possible services in the community , get rid of the barriers and problems that can lead to maladaptation and the social harmony between him and the social environment , To promote the principle of social solidarity, As the social service of the hospital worked to broaden its services , To deal also with the patient family, and its services are on full measure of integration and efficiency , To include the preventive and treatment and constructional services .

Medical records department:
Preparing and maintaining the accurate documentation of medical records , in record time and access to medical information, technical, administrative and statistical required data , In accordance with professional standards and applicable legal.

Medical reports department:
The Department of medical reports is from the main hospital departments , is reflecting the true image of the hospital , Where it served greatly the most official governmental bodies , Which depends on it to give all the reports from the official certified and approved , all this under the umbrella of the precision and speed in execution, Where are print and export more than 50 daily various reports of injuries and criminal drug cases and sugar as well as medical reports , Because this size is important, it is necessary to work on the improvement and continued support to the Department through the expansion of the vision and the plan relies on short and long term goals to achieve high quality and satisfy all customers.
Finance department:
It is the body that financial impact of a financial operation is finishing at it in the hospital , it exports the results of the work in terms of profit or loss and other benefits to employees or suppliers or other entities , it works to protect the financial interests of the hospital and ensuring and getting the rights of hospital at others , Working by professionally qualified method , The section staff and scrupulously and honestly seek to provide relevant financial services for each customer with the utmost effort and dedication with the discipline of the legitimacy of the deal and rights save and ethics , To reach our ultimate goal after God bless take care of patients and their families, it will enhance the hospital's reputation as a leader in the offer of health care according to international standards.

Medical investigations department:
this section is receiving the complaints of the citizen or resident Against any special medical section of the hospital, that requires them to the Medical Services Department of health professional to see the errors by claiming special right (dieh, compensation,) as well as to consider the health professional errors that result in death, or damage of a member of the body , Or loss of benefit, or even if there is no private right of action .

Human resources department :
Appointing a cadre of skilled and most qualified for employment , Be able to perform its duties and responsibilities in the best performance for the hospital , To maintain a harmonious relationship and the quality of the workforce , For all the hospital staff including customers outside also.


Employment department:
The hospital's hiring policy is based on its needs for competencies that meet the requirements of specific jobs, we seek to the hiring of competency required by job , Therefore, the employment is not a priority, but according to the empty jobs and work requirements.
External recruitment department:
One of its tasks is the search for the best qualified cadres from various countries of the world through a selection of employment offices have good experience in the selection and provision of manpower.
Internal recruitment department:
One of the priorities of this section is establish national competencies in all disciplines gradually and the opportunity for youth to work to achieve the highest possible saudization and sought by all .
Family medicine department:
family medicine programs is focusing on the expansion of basic health services in an integrated manner with a high degree of efficiency and full coordination between primary care and specialized services to provide the best services for populations most at risk, such as pregnant women and children under 5, the elderly and people with special needs, And integration of program and preventive actions with remedial work and health education.
Patient relations department:
this Department provides the assistances for all inpatient and outpatient patients , It is the link between doctors and patients and the patient Affairs Department , On the other hand, the basic task of solving and terminate all patient problems that may occur and satisfy the patients consistent with the labor laws in the hospital .
Office of admission and discharge
this section is making to enter the patients with limiting the previous promises in hospital to make them sleeping , By treating physicians in the specialty clinics and plus to the patients through the emergency departments , Taking into account the eligibility and competence of medical files and set up notifications to the military in-patients and birth of babies in hospital and civil status of deceased patients.

Patients affairs department:
patient relations department is the link between patients, reviewers and program management , Were selected in the spot on the first floor of the main building to the armed forces hospital , Where is the focal point for coordination between the departments of Interior sleep and outpatient and emergency departments and sections of the heart and the kidneys.
purchases : purchases management is important for program departments , To ensure all requirements of medicines and medical and surgical supplies, vehicles , medical and non-medical equipment , supplies and laboratory supplies, dental supplies, spare parts for the maintenance department , Office Tools, and maintenance supplies .

Public relations department:
clarify and detect health aspect and the role of health education among members of the armed forces , Public Relations Department is responsible for many of the tasks and responsibilities such as coordinating, preparing and arranging for visits and receptions , ceremonies , seminars, conferences and health education campaigns , In addition to monitoring the press and preparing appropriate plans for each activity in accordance with the rules of organization and procedure for events in the armed forces , Controlling the instructions and guidelines in this respect in order to highlight the role of the program and the extent of its medical and technical and administrative discrimination and development .

PART THREE
Patient long stay term (problem and solutions)

Problem definition :
The problem of patients with long-term stay(Which means occupation of beds long time and most of the medical service provided during that period to them as care services without the need for a medical procedure or medical examinations),The period of a long-term stay is limited by more than 30 days , the problems affecting the overall level of service, As well as raising the cost compared with the severe cases where 10% of sections beds of the hospital plus 20 % of beds medicine used to care for patients with long-term stay , as well as chronic diseases are the most common among the elderly, such as high blood pressure by 45% of the total population,Followed by diabetes 36% according to statistics of Saudi Heart Association ,these patients are at risk of complications leading to the need for long-term care by 15% for patients aged 60 years , this percentage increases to 25 % to over 65 % of the age as global statistics ,this will increase the future of long-stay patients which exacerbates the problem , in addition to the big pressure on the resources of the hospital clinical and operational owing to the following factors:
• some patients of long-term stay over six years in intensive care.
• Emergencies requiring hospitalization in increasing.
• Future expectation for long-term stay is three times at the moment.
• increasing of patients number treated in hospital more than 37,000 new file for 2007.
• The absence of nursing care beds and rehabilitation beds .
• The cases that need to enter the hospital are increasing .



facts and numbers:
Published in the annual report from King Fahd armed forces hospital in Jeddah, for 2007 as follows:
Cost Length average of stay in hospital Patients number Department
478666 119 20 MEDIACL
5442000 907 6 ICU
234000 234 5 PAEDIATRIC
164000 82 10 SURGICAL
1542000 257 6 VIP SUITE
452000 113 4 CCU
8312666 51 Total

The total number of patients: 51 patients , The stayaverage in hospital is 285 days , the stay of these patients ranges from more than two and half month to six years and there are two of them more than three years and one has more than six years , the cost according to these patients is between 12-14 million for 2007 and includes all services provided for each bed.

problem relationship with department of family medicine (effects):
1. Duplicate revision patients for section until getting a bed makes waiting period so long for other reviewers.
2. Increased pressure on doctors and health staff.
3. Increased pressure on the patient which may lead to the deterioration of his health and his health problems may appear because of complications.
4. The loss ofpatients confidence in the system of hospital and increased complaints to hospital management and other official bodies.

 
The causes of the problem:
1. A lack of infrastructure.
2. The kind of disease.
3. The kind of treatment.
4. Organizational reasons.
5. The refusal of some families and patients taking them from hospital.
6. There are some powerful, who use their power and social status to keep some patients who took their right to treatment and do not require their sick to keep them hospitalized but are in need of home care (Statement by Dr. Mansour bin Mohammed agent consultant and head of the Department of therapeutic medicine Department of the medical service of armed forces).

Lack of infrastructure:
1. the absence of nursing care homes .
2. the absence of no activated house care.
3. The absence of stroke unit.
4. The absence of a palliative (pain management or pain)

The kind of the disease:
1. stroke
2. spine injury
3. obstructive pulmonary
4. Cancer
5. complications of chronic diseases
kind of treatment:
1. rely on respirators.
2. stomach nutrition .
 
Organizational reasons :
1. There is no united method of assessment (assessment of health conditions) .
2. No plan for exit and follow-up (by physician discretionary).
3. Lack of departments exit coordinator (follows the doctors, the nurses, and reporting).
4. No medical paths (medical path for each case after diagnosis).
5. The lack of support rehabilitation program (lack of specific program for each case, and conversion to Rehabilitation ).
6. no activated of the standing orders for exit (where there is a specific time for each case).

Proposed solutions:
Temporary short-term solutions:
Solutions temporary short-term (within six months).
• Activation of durable orders for patients exit.
• putting united method for the assessment and identification of needs.
• Putting the plan protocols for exit.
• Activating the role of the social worker by persuading the patient should leave the hospital and help him physically, psychologically and socially.
• Contacting with the patient's family and relatives and convince them to get him out of the hospital.

Organizational solutions for the medium term (within two years):
• The development of home care and primary care.
• Establishing a database for this group of patients, and Development of software for evaluation and follow-up.
• Putting the training strategy .
long-term problem solutions :
1. Establishment of centers for nursing care or rehabilitation.
2. Rental of beds from private hospitals.
3. Encourage and provide home care standards and monitoring administration and follow-up by the hospital and training for families to take care of her patients.
4. Motivating the people by appropriate funds to cover the costs of the nurse as a temporary solution to encourage relatives to care for their loved ones.
5. The fundamental solution is management of the hospital as a private hospital and insurance on all employees of the armed forces

















الحلول المقترحه :-

حلول مؤقته قصيرة الامد ( في غضون ستة اشهر )

• تفعيل الاوامر المستديمه لخروج المرضى
• وضع طريقه موحده للتقيم وتحديد الاحتياجات
• وضع بروتوكولات خطه الخروج
• تفعيل دور الاخصائي الاجتماعي من خلال إقناع المريض بضرورة مغادرة المستشفى ومساعدته مادياً ونفسياً واجتماعياً. الاتصال بأسرة المريض وأقاربه وإقناعهم بإخراجه من المستشفى

حلول تنظيمية متوسطة الأجل (في غضون سنتين)

• تطوير الرعاية المنزيلية وربطها بالرعاية الأولية .
• .وضع قاعدة بيانات لهذه الفئه من المرضى وضع البرامج لمحو سبة للتقيم والمتابعه
• وضع استراتيجيه التدريب
حلول دائمه طويلة الاجل

• انشاء مراكز تختص بالعناية التمريضية أو التأهيلية
• استئجار أسرة لدى مستشفيات القطاع الخاص .
• تشجيع وتوفير الرعاية المنزلية بمعايير جيدة وجهاز مراقبة ومتابعة من قبل المستشفى وتدريب الأسر على العناية بمرضاها
• تحفيز الأهالي بمبالغ مناسبة لتغطية تكاليف ممرض أو ممرضة كحل مؤقت لتشجيع الأقارب للاهتمام بذويهم
• الحل الجذري هو إدارة المستشفى كمستشفى خاص والتأمين على جميع منسوبي القوات المسلحه .




 

References :

1. Annual report of patients with long-term stay issued by King Fahd armed forces hospital in Jeddah in 2007.
2. Al-Jibreen, Jibreen, Ali (2002) the role of sociologist with long-stay patients in hospitals, applied study on some city hospitals in Riyadh .
3. Aliktsadih newspaper number 4863 date February 3, 2007.
4. Human Right Watchwebsite on link :http://www.hrw.org/ar/news/2011/06/02-5


اخوكم / فهد راجح الجنيبي

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السلام عليكم ورحم الله وبركاته
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