Transforming Compassion Innovation Trust

Hospital Services Management

Component-wise priority activities

Component 01: Continuation of support to secondary and tertiary care hospitals

Hospitals are the face of the healthcare system of any country. The HSM operational plan will continue to support the services for the physical facilities those have already been constructed or expanded under the previous sector Programs and not yet been transferred in the non-development budget till its transfer. Salaries and allowances for the staffs, diet, equipment, drugs and other logistics will be supported through this OP. At the same time, any completed new construction or expansion of secondary, tertiary and specialized facilities under the 4th sector program will be supported. Proper procurement, store and asset management and stringent financial management will be ensured through effective and comprehensive monitoring system.

  • District Hospitals: The OP aims to provide support for upgrading all existing district hospitals to 250 bed facility. The district hospitals where new medical colleges are established will be continued to be used as Medical College Hospitals until new medical college hospitals are being functioning. The district hospitals will be the referral hospitals for the corresponding upazila health complexes (UHC) of the district as well as will provide primary healthcare services (ESP) to nearby catchment urban population.

Activities:

  • Salaries, allowances, logistic support services/ or operational cost for existing expanded/ constructed facilities to be continued till their transfer to non-development budget
  • Supply of equipment and logistics to the completed new construction or expansion facilities under the 4th sector program
  • Ensuring services of Essential Service Package (ESP) at all district hospitals; a separate arrangement of it will be made by setting a Primary Healthcare Centre/facility for the urban catchment area at all district hospitals.
  • Improvement of waiting area for the patients at OPD and for patient’s attendants in the hospital premises, outside the ICU, CCU and other specialized services centers.
  • Supply of equipment, furniture and logistics for Kuwait Bangladesh Friendship Government Hospital, Uttara, Dhaka and Bangladesh Korea Friendship Hospital, Savar, Dhaka
  • Capacity development of service providers and managerial staffs.
  • Standardization of different level hospitals in respect of manpower, instrument/ equipment and bed distribution according to different discipline.
  • Ensuring community participation in the management process.
  • Diet related issues: Diet categories will be reorganized to make it inclusive for all types of patients in the hospital (Diabetic patient, CKD patient, ICU patient, Obese patients etc.)

Medical College Hospitals:

The capacity and efficiency of Medical College Hospitals will be enhanced. The Old Medical College Hospitals will be upgraded to 1000 bed facility with all specialized services available. Medical College Hospitals will be used as the tertiary level referral hospitals with all facilities and services.

Activities:

  • Salaries, allowances, logistic support services/ or operational cost for existing expanded/ constructed facilities to be continued till their transfer to non-development budget
  • Supply of equipment and logistics for the completed new construction or expansion facility under the 4th sector program
  • Arrangement for setting up a Primary Healthcare Centre/corner for delivery of ESP for urban population for the nearby catchment area at all Medical College hospitals. An initiative to engage the Community Medicine Department of the Medical College in the activity of Primary Healthcare centres will be instituted. Placement of Intern doctors in the centres will be encouraged
  • Improvement of waiting area for the patients at OPD and for patient’s attendants in the hospital premises, outside the ICU, CCU and other specialized services centres.
  • Capacity development of service providers and managerial staffs.
  • Ensuring community participation in the management process.
  • Setting up Thalassemia Prevention and Management Centre
  • Diet related issues: Diet categories will be reorganized to make it inclusive for all types of patients in the hospital (Diabetic patient, CKD patient, ICU patient, Obese patients etc.)

Specialized Institutes and Hospitals:

HSM OP will continue to support the existing Specialized National Institutes and hospitals. The National Institutes will be regarded as a truly national centre of excellence providing state of the art specialized services as well as acting as a national resource centre for providing technical support and guidance in the field of their respective subjects throughout the country. Terms of references will be introduced for the National Institutes and specialized hospitals.

  • Salaries, allowances, logistic support services and/ or operational cost for existing expanded/ constructed facilities to be continued till their transfer to non-development budget
  • Supply of equipment and logistics for the completed new construction or expansion under the 4th sector program
  • Improvement of waiting area for the patients at OPD and for patient’s attendants in the hospital premises, outside the ICU, CCU and other specialized services centers.
  • Strengthening of National Institutes for acting as National resource center and providing technical and stewardship role in their respective services relevant to the operational plan.
  • Development of Terms of Reference (TOR) for the National Institutes for supporting the health Sector programme to ensure providing technical support to  the National programme for standard setting and quality assurance, development of Protocol and SOP, training, assist monitoring, conducting research and providing necessary support for developing a referral system in the relevant field through UHC, District hospitals, MCH and Specialized Institutes
  • Capacity development of service providers and managerial staffs.
  • Strengthening of ‘Bangladesh Institute of Tropical and Infectious Diseases (BITID)’ the national institute for Tropical Medicine & ID, Fauzdarhat, and Chittagong.
  • Establishment of National Institute for Geriatric Care at a suitable place in Dhaka.
  • Establishment of Bone Marrow Transplant Unit in NICRH.
  • A standard for providing diet suitable for the patients for the institutes by reorganizing the existing structures.

Name of the Sub-Activity :

  • Pay and allowance of Officers and Staffs
  • Diet
  • Other Medicine
  • MSR Supplies
  • Instruments, equipment, vehicles & other assets
  • Cleaning and washing
  • Security
  • Special expenditure (Laundry)
  • Petrol and Oil
  • Water and Electricity
  • Stationeries, other consumables
  • Spare Parts
  • Repair and Maintenance
  • Support fof strengthening of National Institutes
  • Monitoring and Supervision.
  • Establishment of Bone Marrow Transplant Unit in the National Cancer Research Institute & Hospital
  • Others

Component 02: Strengthening of Clinical Service delivery in secondary (DH) and tertiary hospitals (MCH, Specialized institute)

Hospitals are most utilized part of the entire healthcare system in Bangladesh. The clinical service delivery system in the hospitals is expected to be significantly improved thorough the following activities.

Activities

  • Ensuring all essential service package (ESP) services at all district hospitals and develop a referral linkage with lower level hospitals and ensure preferential treatment of referred patients.
  • Introducing training for basic life support (BLS) to all health care professionals and advanced life support (ALS) training to all internee doctors, newly recruited assistant surgeons. Strengthening the program through PSE among medical colleges.
  • Emergency Obstetrics and Neonatal Care (EmONC) and gender issue: A model of providing EmONC at the district hospital will be developed with Technical Assistance and will be replicated in all district hospitals in a phase wise manner. Gender issues including establishment of VAW corner in DH, Gender responsive budgeting and Gender auditing will be addressed.
  • Strengthening of Hospital emergency system including management of casualty: The emergency department of Medical College Hospitals and Specialized institutes will be strengthened by provision of Emergency care and resuscitation linked with inpatient & ICU, Observation beds, short stay bay, diagnostic and Imaging facilities with Emergency OT.
  • Ensuring 24/7 Comprehensive Emergency management system in all district hospitals and possible linkage with EmONC services and Inpatient departments
  • Strengthening of quality management of Snakebite and other poisoning at district and Medical College Hospitals will be ensured. A model Snake bite and Poisoning Management clinic will be established in Chittagong Medical College Hospital (already in existence through local initiative) and will be replicated to other 7 Divisional headquarters medical colleges.
  • Strengthening of Trauma management by establishing casualty departments and provision of casualty OT in the emergency.
  • Ensuring proper management of NCD emergencies such as Stroke, Acute Coronary Syndrome, Diabetic Ketoacidosis, Acute exacerbation of COPD in the Emergency/in patient with manpower and resources.
  • Expansion of specialized services such as ICU, CCU, NICU, SCANU, Dialysis units, stroke units in all Medical College Hospitals with development of Manuals and SOPs.
  • Expansion of specialized services such as ICU, CCU, NICU, SCANU, Dialysis units, in all district hospitals with development of Manuals and SOPs.
  • Some designated beds in different major clinical departments of hospitals will be renovated as High Dependency Unit (HDU) to provide upgrade emergency care in Medicine, Surgery, Obstetrics & Gynecology and Pediatrics with SOPs developed for management and optimal use
  • Scale up of ‘Shishu Bikash Kendra’ focusing comprehensive care of autism and neuro-developmental disorders including facility for diagnosis and management of epilepsy (considering the life span need of the National Strategic plan for neuro-developmental disorders 2016-2021 (health care components by MOHFW, and for other components stewardship).

Activities:

  • Establishing child and family-friendly Shishu Bikash Kendra’s (SBK) within public hospitals across the country. In this connection scaling up 20 newly established SBK and existing 15 SBK with in this OP Period.
  • Appoint & Train a core team of Multidisciplinary Professionals including child health physicians, child psychologists, developmental therapists and training coordinator to provide quality services from all Shishu Bikash Kendra’s.
  • Functioning all SBK with deployment of required human resources logistics and equipment.
  • Apply strategies and tools for early screening ensuring management of all developmental delays, disorder, impairments, disabilities and mental health issues.
  • Establishing a digital data-base related to child development and disability across Bangladesh.
  • Develop a mechanism to achieve the goal of established ‘Shishu Bikash Kendra’ through continuation of services by recruited trained human resources.
  • Provide continuous training considering newest technology & strategies.
  • Activate monitoring & supervision system for further improvement of services.
  • Establishment of geriatric and palliative care services at all Medical College Hospitals & geriatric care in district hospital, DH.
  • Development and introduction of ‘Clinical Management Protocol’, Infection control Program, Evidence based Practice, introduction of communication skill development program, and Clinical audit and risk management programs.
  • Establishment and scale up of baby, adolescent and women friendly hospital initiative
  • Addressing gender issue including Gender Responsive Budgeting (GRB), gender violence, appraisal of health care professionals on sexual assault.
  • Club foot management in NITOR, all medical college and district hospitals
  • Cleft palate and reconstructive surgery services at medical college hospitals
  • Establish Thalassemia Prevention and Management Centre in Dhaka Medical College Hospitals and replicate in different MCH of divisional headquarters.
  • Strengthening of quality laboratory services at all DH and MC hospitals with provision of ward side selected emergency tests
  • Strengthening of quality radiology and imaging services at all DH and MC hospitals
  • Introducing IT based reporting system and sending the laboratory and radiology reports
  • Strengthening of Medico-legal services at district hospitals

Name of the Sub-Activity :

  • Strengthening of hospital emergency system
  • Expansion of specialized services such as ICU, CCU, NICU, SCANU and Dialysis unit
  • Providing mental health services at secondary and tertiary hospitals
  • Geriatric and Palliative care
  • Comprehensive Thalassemia management care
  • Clinical Management protocol, EBP, Risk management and Accreditation
  • Baby, Women and Adolscent friendly hospital initiative
  • Shishu Bikash Kendra
  • CEmNOC and gender issue
  • Club foot, cleft palate and reconstructive surgery
  • Specialized Outreach surgery
  • Strengthening of Laboratory and Imaging services
  • Strengtheing of medicolegal services at district hospitals
  • Establishment of HDU facilities at major departments of medical college hospitals
  • Introduction of ALS and BLS training for all service providers

Component 03: Private Healthcare Facilities

The close partnership and collaboration between public and private hospitals is vital for ensuring comprehensive coverage of all healthcare needs of people. But it is imperative that private healthcare facilities should be under close supervision. The regulatory framework will be updated.  A comprehensive private healthcare act should replace the age old 1982 ordinance. Establishment of an autonomous National Accreditation body for accreditation of hospitals and laboratories will contribute to the delivery of quality care in private sectors.

Activities

  • Strengthening of HSM for monitoring and supervision of expanding private health sector (hospitals, diagnostics, private practice)- for profit and non-profit (HR, space, logistics, transport, IT support).
  • Development of a Comprehensive Monitoring strategy and policy with Technical assistance.
  • Provision of Standard Medical Waste Management, ensuring quality care and a referral system in Private facilities. Regular advocacy workshops with private healthcare facilities will be organized.
  • Approval of National accreditation bill. Establishment of National accreditation body and functional accreditation program.

Name of the Sub-Activity :

  • Development and implementation of regulatory framework for private sector hospitals
  • Capacity development of concerned Officials and workers
  • Accreditation of private hospitals, clinics, diganostic centres
  • Development of a comprehensive monitoring strategy with Technical Assistance and Monitoring & Supervision
  • Advocacy workshop at Private hospitals, clinics for emergency management, serving poor etc.
  • Monitoring and Supervision

Component 04: Quality of Care

Ensuring quality of care at all service points is the key issue in the management of HSM operational plan. The development of National healthcare standards is vital in maintaining a consistent service delivery throughout the country. The OP will introduce the 5S-CQI-TQM approach in the management of all secondary and tertiary care hospitals. Improvement of hospital environment, ensuring proper service delivery, maintaining the quality of care and a cordial management-community relationship are the main focus of the TQM approach. . Active participation of lower and mid-level managers wills play the key role for proper implementation of the Program.

Activities

  • Developments/updating and Implementation of National Health Care Standards at secondary and tertiary hospitals.
  • Introduction of different SOPs and quality improvement tool kits in healthcare facilities
  • Capacity development of the service providers regarding TQM approach (5S-CQI)
  • Orientation and motivation of community to help management for smooth functioning of healthcare facilities
  • Introduction and maintenance of TQM approach of management at district and tertiary care hospitals.
  • Continuation of operational research on quality issues
  • Coordination with Quality Secretariat (HEU) and hospitals under DGHS & private sector
  • Introduction of standard patient care forms (all type of patient request & report) for hospitals
  • Development of Hospital Manual and SOPs related to quality of care and ensuring the SOPs in practice.

Name of the Sub-Activity :

  • Functioning of QIT and WIT at hospitals
  • Implementation of 5S
  • Capacity development of service providers
  • Patient Information, Registration and Quee Management System
  • Implementation of PDCA model
  • Development of QI Monitoring framework and regular monitoring of QI activities
  • Logistics Support
  • Honourium, Remuneration & Consultancy

Component 05: Safe Blood Transfusion

Universal access to safe blood for the patient is the cornerstone of the Safe Blood Transfusion Program. Blood should be collected from eligible non remunerated voluntary blood donor after proper grouping, screening, cross-matching, rational use of blood or its component with standard transfusion procedure, post transfusion follow up with improved transfusion services in a quality ensured procedure.

Activities:

  • Voluntary Blood donor Pool
  • Haemovigilance
  • Improved Transfusion Service
  • Transfusion Transmissible Infection & Quality Control

Name of the Sub-Activity :

  • Pay and allowance of Officers and Staffs
  • Voluntary blood donor pool
  • Hemovigilence
  • Improved Transfusion Services
  • Transfusion transmissible infection & Quality Control
  • Supply of logistics and consumables

Component 06: Introduction/implementation of Medical Waste Management at Public & Private Hospitals

Effective implementation of Medical waste management in the public and private hospitals is a key determinant of improvement of hospital environment and providing quality service. Capacity development and awareness of the service providers will be the most important aspect of MWM. Supply of logistics and technical support to the hospitals together with smooth coordination with local government agencies and department of environment will ensure the proper implementation of the program. Enforcement of Medical Waste Management rules may be of great help for achieving the goals. For out-house management of medical wastes PPP model and outsourcing will be encouraged.

Activities

  • Awareness building for service providers and recipients.
  • Supply of necessary logistics for MWM to DH/MCH/Specialized Hospitals.
  • Establishment of in-house waste management system including temporary waste storage room.
  • Establishment of Out-house management in collaboration with local government bodies (CC/Municipality).
  • Dissemination and Implementation of National guideline for Medical waste management in all stage.
  • Capacity development of the service providers.
  • Provide service charges for Out-house management of generated MW from DH/MCH/Specialized Hospitals.
  • Coordination with local government agencies and Department of Environment.
  • Establish monitoring & supervision system for functioning Standard MWM in private healthcare facilities.

Name of the Sub-Activity :

  • Capacity development of Health Managers and Service providers for inhouse MWM
  • Support for outhouse MWM
  • Establishment of Temporary waste storage house
  • Supply of logistics and consumables
  • Research (in coordination with PMR OP)
  • Honorarium for Consultants and Remuneration
  • Advertisement and Publicity
  • Printing, Stationeries and others

Component 07: Introduction and scale up of the Structured Referral system

The aim of structured referral system is to maximize the utilization of UHC and load minimization of the secondary and tertiary level hospitals by introduction of effective upward and downward referral system. Structured referral system is to be rolled out countrywide from Primary, Secondary and Tertiary level hospitals by defining the specific catchments area in collaboration with other related departments and OPs. By ensuring the ownership and accountability of the hospital service provider, referral system will be implemented effectively.  Patient will be made properly aware and priority clinical management will be ensured by successful implementation of referral system. Development of data base of the referral patient will be ensured by introduction of different referral registers, form, diseases code, ICD-10, etc.

Activities

  • Preparation and implementation of referral procedures and rules across the health tiers, within the institutes, and between institutes.
  • Capacity building of the service providers, orientation of hospital management.
  • Development, finalization, printings, dissemination and distribution of different forms, guideline and registers to different hospitals.
  • Development of Referral data base and automated referral system.

Name of the Sub-Activity :

  • Development and implementation of referral guideline
  • Development and introduction of referral forms and electronic databases
  • Orientation and capacity development of all stakeholders

Component 08: Patient Safety

Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often lead to adverse healthcare events. According to the World Health Organization (WHO) patient safety issue is an endemic health concern. Patient safety involves applying lessons learned from business and industry, adopting innovative technologies, educating providers and consumers, enhancing proper reporting systems, and developing new economic incentives. Patient safety has emerged as a powerful force in the current movement to improve quality and lower cost in health care. Patient safety involves minimizing the risk of error to patients.

Activities

  • Development, finalization, printings, dissemination and distribution of Patient Safety guidelines.
  • Orientation of healthcare service providers based on guidelines about patient safety issues: incident reporting, medication safety, adverse drug reaction monitoring, surgical safety, infection control including hand wash, crisis management tools, death audit etc.
  • Provision of logistics for DH, MCH, Specialized Institutes for addressing patient safety issues
  • Ensure Patient safety issues are properly addressed at Private Medical College Hospitals and other private health care facilities.
  • Incorporation of Patient safety issues in undergraduate curriculum and internship training.

Name of the Sub-Activity :

  • Development, dissemination and distribution of Patient Safety Guidelines
  • Workhops and Orientation of Service Providers regarding Patient Safety issues
  • Supply of logistics and consumables

Component 10: Capacity building of the hospital managers on right procedure of procurement and inventory system.

The effective administration of hospitals at different levels need to procure a wide range of equipment, medical and surgical instruments, state of the art laboratory and imaging machineries, need assessment and their proper maintenance. The system requires an efficient Store management, Asset management and above all maintaining a high standard of financial propriety.

Activities

  • Capacity development of concerned managers, officials and staffs
  • Development of Manuals, SOPs and guidelines
  • A comprehensive framework of monitoring and supportive supervision

Name of the Sub-Activity :

  • Capacity development of health managers
  • Development of Manauals, SOPs and Monitoring framework

Component 11: Repair, Maintenance and Disposal of Vehicles, Biomedical equipment and others

Hospital Services Management OP aims to all necessary support for maintenance and servicing of all vehicles, electrical and electronics equipment, biomedical instruments to keep them functional. TEMO is responsible for providing maintenance, repair and replacement of parts to all vehicles under DGHS. NEMEW is responsible for providing installation, maintenance and functioning support to hospital instruments and medical equipment. This is vital to ensure continuous functioning of the health systems. The maintenance and replacement services beyond the capacity of those two organizations should be outsourced to ensure proper functioning.

Activities

  • Setting up of Division based NEMEW & TEMO centers
  • Provision of common minor Repair-Tyre, Battery, Dent Paint, Mirror, Light, Horn, Shock absorber, Belts, Servicing at TEMO
  • Installing, maintenance, repair and functioning of AC, refrigerators, generators, Suction machines, OT table, OT lights by NEMEW
  • Provision of outsourcing the maintenance work beyond the capacity of NEMEW and TEMO
  • Regular holding of condemnation board for smooth disposal of non-repairable nonfunctioning vehicles, furniture, equipment
  • Development of a SOP & procedure for proper disposal of electro medical equipment.

Monitoring, Research and Evaluation:

Evidence generation for improved health care services at secondary and tertiary hospitals:

  • Development of monitoring and evaluation framework, and monitoring checklist.
  • Effect of key hospital innovations (e.g. patient safety, waste disposal) (to be made in next sector program) on patient satisfaction and outcome.
  • Evaluation of the Operational Plan.
  • Pattern and number of patient’s requiring primary health care (CBHC) in DHs, MCHs.
  • Feasibility of using IT in referral and in improving management of acute coronary syndrome and stroke.
  • Feasibility of using IT in patient management (OPD, in patient and emergency).
  • Feasibility of using IT in laboratory reporting, including histology reporting of FNAC samples.
  • Feasibility of using IT in radiology & imaging reporting.
  • Prevalence of TB in diabetic patients in Bangladesh.
  • Prevalence of hospital acquired infection in Bangladesh.
  • Prevalence of infection in diabetic patients in Bangladesh.
  • Prevalence of infection in cancer patients in Bangladesh.
  • Setting up hospital cancer registries in 19 Medical Colleges.
  • Situation analysis: dietary need have admitted patients and other diet related issues.
  • ‘Demonstration project’:
  • Teaching primary health care to medical professional students (MBBS, Nursing and Medical Assistants) in the ESP area of Medical College Hospital.
  • Can improved communication skill lead to better patient satisfaction?

A comprehensive monitoring and supervision framework for secondary and tertiary hospitals will be developed with technical assistance. The framework will include regular monthly reporting and yearly statement of activities Capacity development of concerned officials at DGHS, divisional and district level will be done. A quarterly meeting with hospital administration regarding management and quality of care issues is planned.

Name of the Sub-Activity :

  • Strengthening of TEMO
  • Strengtheing of NEMEW