Quality Improvement Highlight: METAS Adventist Hospital- ()

Dr. Anil Kumar Chillimuntha

Embrace Change: Building today’s leaders

Friday, October 19, 2018 For my thoughts are not your thoughts, neither are your ways my ways, declares the Lord. As the heavens

are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts”.—

Isaiah 55:8–9

“But select capable men from all the people—men who fear God, trustworthy men who hate dishonest gain—

and appoint them as officials over thousands, hundreds, fifties and tens”.—Exodus 18:21

Inspired from Great Leaders in Bible:-

Moses, Joshua, King David, Queen Esther

GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE •Metas Adventist Hospital – 300 Beds

•Established in 1920 (98 Years).

•Territory: Southern Asia Division of Seventh- day Adventists.

•Located in Surat, , India. •Western India - 3 hrs from

GLOBAL HEALTHCARE CONFERENCE 1920- Pr. O.W Lange Opened a Dispensary 1940- Clinic Moved to Timaliyawad in Udhana 1936- Small Clinic at Station Road 1941-Hospital with 20 beds was opened

GLOBAL HEALTHCARE CONFERENCE 1978-School of Nursing & College of 1965- Bed strength increased to 120 Physiotherapy

GLOBAL HEALTHCARE CONFERENCE 2008- Bed strength increased to 250 2010- Bed strength increased to 275

GLOBAL HEALTHCARE CONFERENCE METAS ADVENTIST HOSPITAL - WITH 300 BED CAPACITY

GLOBAL HEALTHCARE CONFERENCE Initial state of Hospital-1920 Current state of Hospital-2018

GLOBAL HEALTHCARE CONFERENCE Building Today's Young Leaders Journey : Childhood Journey : Adulthood

Drought – 1975 Riots -1992

Latur Earthquake – 1993 Earthquake – 2001

Plague – 1994 Terrorist Attack – 2002

Communicable Diseases : (Gandhinagar)

. Scabies - 1980 Floods – 2006

. Conjunctivitis - 1983 Terrorist attack –2008

. Chicken Pox ( Mumbai)

Floods – 1996 H1N1 – 2009

Cyclone – 1998 Cholera- 2012

Bird Flu – 2017

GLOBAL HEALTHCARE CONFERENCE Drought-1975 Building Today's Young Leaders Cholera 2012 Communicable disease Disasters

Swine flu 2010 Plague-1994

Floods2006 Cyclone -1998 Earthquake-2001 in Surat

GLOBAL HEALTHCARE CONFERENCE How can we stop further What does humanity deterioration of our need in such an habitat and human environment? values?

How can we make this world a better place to live?

GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE Dr. Anil Kumar Chillimuntha Vice – President Hospital Affairs METAS Group of Hospitals

GLOBAL HEALTHCARE CONFERENCE Problems faced AS A YOUNG LEADER Before Embracing Quality & Change

GLOBAL HEALTHCARE CONFERENCE Problem Faced As Young Leader

Elderly Staff Lack of awareness about New Technology 1 Limited Resources and Trends 8 2

Difficulty To Build Culture Huge Debts Problems among Employees 7 Faced 3

Lack of Dedicated Doctors Incapability of Staff to 6 4 Adapt New Changes & Challenges 5 Employees Resistant to Change

GLOBAL HEALTHCARE CONFERENCE A. Status Of Structure In 1999

1. Old Dilapidated Building. 2. No Patient Friendly Structural flow. 1

3. Bed Strength – 120. 2 Average Occupancy - <10 %. 5 4. Inadequate Patient & Employee Safety Tools. 3 5. OT Roof - Asbestos Sheets. 4

GLOBAL HEALTHCARE CONFERENCE B. Status Of Resources In 1999

Insufficient No Equipments Lack of Diagnostic Advanced Services Technology

OT with Facilities Lack Of Intensive Asbestos Roof Care Services

Less Absence Of Manpower Less Flow of Specialized Patients Departments

GLOBAL HEALTHCARE CONFERENCE C. Status Of Services In 1999

Lack of Inadequate No Ambulance Limited Scope Superspeciality Diagnostic Services of Services Doctors Services

GLOBAL HEALTHCARE CONFERENCE D. Status Of Equipments In 1999

One Wheel Chair & Stretcher for the Whole 02 No Pulse Oxymeters Hospital 01

Lack Of Sterile Articles 03 Reuse Of Patient Care For Patient Care EQUIPMENTS Articles ( Thermometers, 06 Respiratory Masks

04 Simple Cots & No Multi Para Monitors & Hard Mattress 05 Ventilators

GLOBAL HEALTHCARE CONFERENCE E. Status Of Quality Practices In 1999

Patient & Employee High Mortality Rate Safety Compromised

Decrease Patient High Sentinel & Near Satisfaction Rate Miss Events

Decreased Employee Satisfaction Index High Medication Errors

GLOBAL HEALTHCARE CONFERENCE F. Status of Infection Control in 1999

Increased Needle Stick Injury Rate Increased Urinary Catheter Infection Rate In Appropriate Hand Hygiene Facilities And Poor Hand Hygiene Increased Blood Stream Compliance Infection Rate

Inadequate Personal Increased Surgical Site Protective Equipment Infection Rate Increased Incidence Of Inappropriate Bio-Medical Pressure Ulcer Waste Management Increased Rate Of Poor Infection Control Thrombophlebitis Practices

GLOBAL HEALTHCARE CONFERENCE LACK OF CHANGE – DEEMED TO DIE

Hospital Board Met In 1999

Voted to CLOSE THE HOSPITAL

Run Nursing College in Existing Hospital Building

GLOBAL HEALTHCARE CONFERENCE THE CHALLENGE OF TRANSFORMATION – Change Management

Dr. M.S Jeremiah, Founder President & CEO, Metas Group of Institutions

GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE Focus On Achievements

7 6 Expanded Scope Of Services Appointed Super 5 Specialty Doctors 4 Introduction Of Formation Of Advanced 3 Equipment & Tie-up With New Depts & 2 Renovation Of Technology- 2007 Initiated Well- Known Hospital-2006 1 Marketing Companies - Joined As A Strategies - 2005 Associate Vice- president -1999 2001 GLOBAL HEALTHCARE CONFERENCE Marketing Strategies

General Camps Free eye surgeries Diabetes Rally

GLOBAL HEALTHCARE CONFERENCE Tie-Up with Well- Known Companies - 2005

GLOBAL HEALTHCARE CONFERENCE Tie-Up with Well- Known Companies - 2005

GLOBAL HEALTHCARE CONFERENCE Formation of New Departments

Customer Care -2001 Dialysis Unit-2011 Intensive Care Unit

VIP Room-2013 Microbiology

GLOBAL HEALTHCARE CONFERENCE Formation of New Departments

Medical Records Department Blood Storage Unit Pathology

Airport Medical Center Imaging Home Care

GLOBAL HEALTHCARE CONFERENCE Introduction of Advanced Equipment - 2007

Storz Endoscopy -2008 Siemens C-arm - 2009 Surgident LED lights-2012 Class 100 Theatres with Hepa filters

Olympus Operating Surgical Microscope RupsPlasma sterilizer - 2014 J &J Vessel sealer-2015 ETO - 2017

GLOBAL HEALTHCARE CONFERENCE Expanded Scope of Services

• General Medicine

• General Surgery

• Orthopedics'

• Neurology

• Neurosurgery

• Ophthalmology

• Gastroenterology

• General Medicine

• General Surgery

• Internal Medicine

• Minimal Access Surgery

• Nephrology

• Nero-Surgery

• Obstetrics & Genecology

GLOBAL HEALTHCARE CONFERENCE Expanded Scope of Services

• Oncology Services available in Diagnostics Imaging • Onco Surgery • C T Scan • Ophthalmology • Sonography • Orthopedic • X-ray • Pediatrics • Plastic Surgery • 2D echo • Psychiatric • TMT • Urology • PFT Round the Clock Services • Pharmacy • Emergency with Ambulance • Intensive Critical Care Unit • Operation Theater • Pathology • Hemo Dialysis • Blood banking

GLOBAL HEALTHCARE CONFERENCE Medical Evangelism

S.No Practices Percentage

1 Prayer with each patient at bedside 80% 2 Play Soft music in the whole hospital facility 100% 3 Pray before commencement of every shift 82%

4 Prayer in the nursing station by all the staff 86%

5 Prayer at the bedside for the assigned patients by each staff before the duty starts 81%

6 Prayer in the OT before taking inside for surgery 89%

7 Prayer in the OT before taking inside for surgery 90%

8 Mid day prayer at 12 noon 95%

9 Bedside Singing bands in the weekends 60%

GLOBAL HEALTHCARE CONFERENCE MEDICAL EVANGELISM

GLOBAL HEALTHCARE CONFERENCE NEW CHURCHES ESTABLISHED

S.No Church Language Area District

1 S D A church English Athwalines Surat .Gujarat

2 S D A church Gujarati Athwalines Surat .Gujarat

3 S D A church Telugu Limbayat Surat .Gujarat

4 S D A church Tamil Pandesara Surat .Gujarat

5 S D A church Gujarati Sayon Surat .Gujarat

6 S D A church Telugu Bhatar Surat .Gujarat

7 S D A church Gujarati Surat .Gujarat

GLOBAL HEALTHCARE CONFERENCE NEW CHURCHES ESTABLISHED

S.N Church Language Area District S.N Church Language Area District o o 8 S D A Gujarati Madvi .Gujarat 15 S D A church Gujarati Lakholi Songagh .Gujarat church

9 S D A Gujarati Areth Vyara .Gujarat 16 S D A church Gujarati Junvan Songagh .Gujarat church

10 S D A Gujarati Anthoroli Vyara .Gujarat 17 S D A church Gujarati Ghodchit Songagh .Gujarat church

11 S D A Gujarati Kantowow Vyara .Gujarat 18 S D A church Gujarati Ghutwel Songagh .Gujarat church

12 S D A Gujarati Sarkui Vyara .Gujarat 19 S D A church Gujarati Vazarda Songagh .Gujarat church

13 S D A Gujarati Vyara Vyara .Gujarat 20 S D A church Gujarati Tadkua Songagh .Gujarat church Tichakpura

14 S D A Gujarati Balpur Vyara .Gujarat 21 S D A church Gujarati Gunsadh Songagh .Gujarat church

GLOBAL HEALTHCARE CONFERENCE NEW CHURCHES ESTABLISHED

S.N Church Language Area District o

22 S D A church Gujarati Pakhari ,.Gujarat

23 S D A church Gujarati Don Songadh ,.Gujarat

24 S D A church Gujarati Khoksha Songadh ,.Gujarat

25 S D A church Gujarati Medhsingi Songadh ,.Gujarat

26 S D A church Gujarati Lauehali Songadh ,.Gujarat

GLOBAL HEALTHCARE CONFERENCE Transformation of Hospital Since 1920 2018

2006

2001 1999 1920

GLOBAL HEALTHCARE CONFERENCE Need for Quality- Embracing Change: Building Today's Leaders!

GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE Journey in 2009-2010 Quality Adaptation Initiated Employee Meetings 5 & Departmental Conferences Formulated Hospital Standard Operating Procedures, Policies & Manuals 4 Initiated Departmental Rankings Adapted ISQUA Standards 3 Recruited of Young & Conducted Self & Energetic Employees 2 Cross Audits Introduction of Advanced Initiated Quality Technology Improvement 1 Projects

Formation Of Super Specialty Services

GLOBAL HEALTHCARE CONFERENCE Quality Team

Dr Anil Kumar CH Quality Head

Mrs Ruth Mohan P Quality Manager

Quality Infection Nurse Clinical Coordinators Control Nurse Educators Auditors

Mrs Shweta Mr Samjaisheel Samson Mr Pramod Nirmal Dr Ann Santosh Preetam Mrs Jeevana Sunidhar Mrs Sujatha Ashok Dr Neha Sinha

GLOBAL HEALTHCARE CONFERENCE Journey in 2009-2010

GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE Infection Control Indicators 1999 - 2018

1999 2009 2012 2015 2018

Urinary Tract Infection 40.0 40.2 17 11.5 3.2 Respiratory Tract Infections 39.7 33.3 26.2 21.5 5 Surgical Site Infections 17.3 14.2 10.4 9.5 3.1 Hand Hygiene Compliance 52 69 75 85 90 Incidences of 234 211 175 164 61 Thrombophlebitis Pressure Ulcer Hospital 26 18 14 10 2 Acquired

GLOBAL HEALTHCARE CONFERENCE Infection Control Indicators 1999 - 2018

250 234

211

200

175 164

150 1999 2009 2012 2015 100 90 85 2018 75 69 61 52 50 40 40.2 39.7 33.3 26.2 26 21.5 18 17 17.314.2 14 11.5 10.4 9.5 10 3.2 5 3.1 2 0 Urinary Tract Infection Respiratory Tract Infections Surgical Site Infections Hand Hygiene Compliance Incidences of Pressure Ulcer Hospital Thrombophlebitis Acquired

GLOBAL HEALTHCARE CONFERENCE Journey in 2011

GLOBAL HEALTHCARE CONFERENCE Training & Development Programs

S.No Type Of training & Development No.of trainings per Achieved in year percentage 10 In House Research activities 86 QIP/year 100%

11 Journal club association 3 articles/year 100% ( www. Metas.. 12 Departmental Key performance 351 KPIs/month 100% indicators 13 Performance appraisal 351 employees/month 100% 14 Departmental competency assessmnet 58 assessments/year 100%

15 Quiz competitions related to health 65 /Year 100% 16 Need based trainings (KPI, incidents As Per Need 100% with CAPA, feedback, grievance….)

GLOBAL HEALTHCARE CONFERENCE HOSPITAL COMMITTEES

Journey in 2012 METAS OF SEVENTH DAY ADVENTIST HOSPITAL, Surat COMMITTEE TRACKERS -2018

SNO Trackers Monthly Twice in a month

THE MANAGEMENT REVIEW & QUALITY STEERING COMMITTEE 1 PHARMACY & THERAPEUTICS COMMITTEE 2 THE SAFETY ,RISK MANAGEMENT & EMERGENCY PREPAREDNESS COMMITTEE 3 INFECTION CONTROL & HOSPITAL WASTE MANAGEMENT COMMITTEE 4

5 ICU & OPERATING ROOM USERS COMMITTEE 6 ANTI HARASSMENT COMMITTEE GRIEVANCE & DISCIPLINARY COMMITTEE 7 THE HEALTH INFORMATION MANAGEMENT & MEDICAL RECORDS COMMITTEE 8 CODEBLUE REVIEW COMMITTEE 9

MORTALITY RATE REVIEW 10

11 DIAGNOSTIC REVIEW COMMITTEE

GLOBAL HEALTHCARE CONFERENCE Journey in 2012 Audits

Internal Audits External Audits . Outsource Departments Audit .Departmental Audits . Department Audit by External .Quality Audits Assessors .Nursing Audits . Audits by Local Governing .Infection Control Audit Bodies .Budget Audits . Audits by Adventist Governing Bodies

GLOBAL HEALTHCARE CONFERENCE Journey in 2013 Disaster management »Cyclones & Floods »Earth quake »Fire »Out breaks »Riots »Terrorism »Bomb threat

GLOBAL HEALTHCARE CONFERENCE Journey in 2013

Emergency Code Red Evacuation

Code Triage Blue Management Code Black

GLOBAL HEALTHCARE CONFERENCE GLOBAL HEALTHCARE CONFERENCE Quality Improvement Programme Journey in 2014

GLOBAL HEALTHCARE CONFERENCE Good Practices

Journey S.No Good practices Implementation Acheived % in 2014 1. TNAI Activities 2016 82% 2 Employee Appreciation 2017 96% 3 Medical Evangelism with full time chaplain 2017 75% 4 Mortality review meeting (every Thursday) 2016 80% 5 Inter – department Meeting (every Tuesday) 2016 100% 6 Employee/Nurses Meeting (every Wednesday) 2016 70% 7 Cleaning Day (every Thursday) 2016 75% 8 Ward Conferences 2017 86% 9 Journal Club discussion with new trends in nursing 2018 50% 10 Performance Appraisal 2015 100%

11 Ranking 2018 Employee Ranking 60-70% Departmental Ranking

12 Blood donation, conducting rallys 2013 100%

GLOBAL HEALTHCARE CONFERENCE Evolution of Qualitative Need-Based Training

Journey in 2014

Patient Employee Key Incident Performance Medication Training Satisfaction Feedback & Performance Reports Appraisal Errors Analysis Survey Grievance Indicators (Post Test ) Need Based Training

Need Based Training

Initiation of Quality Standards

GLOBAL HEALTHCARE CONFERENCE How We Achieved ? Success Tools for Quality Standards

Exposed Staff to NABH/JCI Accredited Hospitals for training Self & Cross Audits Job Description Formation of SOP’s & Policies

Formulation of Departmental Manuals Sponsored staff to attend Workshops & Conferences Continuous In-service Education With Pre & Post Tests Employee Participation in CME & CNE Formation of In-House Journal club Quality Improvement Programme Departmental Induction

60 GLOBAL HEALTHCARE CONFERENCE How We Achieved ? Success Tools for Quality Standards

Initiated Good Practices for Quality Improvement

Standard Operating Procedure Trainings

Incentives to Employees

Regular Mock Drills as Formation of Quality Team per Trackers Installation of Safety tools in the Hospital Visited other Hospitals for Training Budget Plan done for 10 years 1999-2009

Organized Recreational Activities Process Mapping for Staff

61 GLOBAL HEALTHCARE CONFERENCE Journey in 2016-2017 Conducted Workshops & Conferences - 2016 & 2017

GLOBAL HEALTHCARE CONFERENCE Journey in 2016 1st Hospital in Southern Asia to Achieve National Accreditation - NABH

GLOBAL HEALTHCARE CONFERENCE FUTURE GOALS

GLOBAL HEALTHCARE CONFERENCE JCI ACCREDITATION

During the Process of Achievement of National Accreditation-

METAS Adventist Hospital Implemented 80% of JCI Standards

Due to Financial Constraints – $ 0.5 – 1 million

100% Achievement was not possible

OUR VISION

JCI ACCREDITATION

GLOBAL HEALTHCARE CONFERENCE 5 Years - Strategic Plan Pillars

GLOBAL HEALTHCARE CONFERENCE Strategic Action Plan

2016 2017 2018 2019 2020

Strategic area 1 : NABH RRT Journal club NABH JCI QIP Reduction in Hospital NABL CLINICAL EXCELLENCE AND QA Reduce in no of Attack rates Research and Nursing Excellence QUALITY OF CARE Formation of Code blue incidence NABH Accreditation publications IMPROVEMENTS Committees application for Nuzvid NABH Clinical Audits Hospital Accreditation for Patient safety Ranchi Hospital Checklists & Audits

Strategic area 2 : Bariatric/Neuro/ Uro Introduction of Increase in OPD Radiation Cosmetic Surgery surgeries advanced patient Registrations Oncology CONFIDENCE IN CARE safety devices De-addiction Day care /strategies Increase in IPD Mobile Clinics centre Admissions Outreach programs Free Eye Surgeries Telemedicine Satellite units Increase in patient Home care services Health Checkups satisfaction Liver Transplant

Free Surgeries Diet Counselling Increase in patient care quality Renal Transplant Centre Corneal Transplant

GLOBAL HEALTHCARE CONFERENCE Strategic Action Plan

2016 2017 2018 2019 2020

Strategic area 3: -Training & development --Performance evaluation --DNB --CPS – Pathology --Diploma --KPI -TNAI Activities --RCA & CAPA analysis --CPS – Gynecology --CPS – Anesthesia --Paramedical Hospital ORGANIZATIONAL -Welfare activities --Medical evangelism Based Courses PARTNERSHIP --BLS & ACLS ISCCM --CPS – Orthopedics DEVELOPMENT -Employee Appreciation Certification -Insurance and corporate Indo Australian Critical DNB-Orthopedics Care Course empanelment DNB - Gynaecology -Mock drills

Strategic area 4: Fire alarm system Expansion of New departments Modernization of OT MRI centre departments In house Laundry Disaster Mngt; Wheelchair Belts Radiology HVAC systems PATIENT ENVIRONMENT AND for Safety Hospital Gate Bone Marrow Transplant INFRASTRUCTURE Pathology Modernization of ENHANCEMENT Expansion of Oncology unit Cardiology Unit Brain & Spine Unit Cafeteria Life Style Health Checkup Lounge IVF Unit

Strategic area 5: Internal Marketing New Companies Enrolled Government schemes Target Based Marketing Revamp Revenue Cycle External Marketing – 11/71 Package system Free camps & surgeries DPCO/ GST International Marketing Centralize Vendor Mngt STRENGTHEN FINANCIAL Charity Restored Blacklisted Rural Marketing HEALTH Cost Studies Insurance 7/10 90 Day Credit Reduce Employee Cost Vendor Negotiations Energy Saving Front Office Mngt Employee Insurance

GLOBAL HEALTHCARE CONFERENCE Outcomes Of Embracing Change

90

80 Quality 70 Improvement 60

50

40 Quality 30 improvement 20 church Growth

10 Revenue

0 Medical Evangelism

GLOBAL HEALTHCARE CONFERENCE A Message for Young Leaders

For Initiation of Quality in an Organisation we need Leaders who

Can Take Initiatives Have The Ability To Manage People Have Courage to Take Risks Have Capability to Generate Innovative Ideas Have Long Term Vision Have Willingness to Embrace Change

GLOBAL HEALTHCARE CONFERENCE Disclosure of Conflict of Interest

I do not have any relevant financial relationships with any commercial interests. Questions