By Michael Maron, CRUDEM President and Holy Name Medical Center CEO & President
It is often said time moves with us or without us, never looking back to see if we have kept pace. In many ways I find it hard to believe that it has been over a year and a half since Holy Name Medical Center has been fully engaged in supporting CRUDEM and Hôpital Sacré Coeur. It has been a contradiction of time, often feeling like no time has passed at all and we are still the neophytes trying to figure this all out; and other times, feeling like we have been totally immersed for a lifetime in a long struggle with no end in sight.
My intention of this communication is to provide an update of progress made to date, why certain projects and initiatives have advanced, as well as some insight to the vision we have for the future. Despite the challenges, I am more convinced than ever that a realistic and sustainable healthcare solution can be developed here. In order to be successful, however, we need your support. Holy Name alone cannot carry this mission.
Positive momentum has started to grow, the flywheel of change is turning, and we need all the financial assistance we can get to nurture this movement, clear the hurdles and position Hôpital Sacré Coeur for a bright and sustainable future.
While the long-term solution for Hôpital Sacré Coeur is a new facility – and concrete steps have been taken to make this a reality, we have a growing hospital to run and that requires an investment of resources now – investments that can be leveraged today and in the future. Our principal goals for investing at this site are threefold: One, to engage the employees by building trust, confidence and a sense of security. Two, to strengthen our position and reputation for providing quality healthcare in northern Haiti; and three, to test new building material, computer systems, operating processes, staffing and care delivery models to ultimately be deployed in the new facility.
We started by building an employee lounge. At first glance, this project might not seem to be a critical priority, but in my meetings with Dr. Prévil, Hôpital Sacré Coeur’s CEO and his management staff, it became clear this had been a priority for his people for many years, and would test our commitment to listening, partnering and engaging the employees. It also provided an opportunity to test new building materials and contractors on a reasonable and cost effective scale. The building was completed on time and under budget in just several weeks of construction. So far, it has surpassed our expectation on both counts. Employee morale and engagement is at an all-time high and the physical building is performing beautifully in terms of durability, efficiency, and cleanliness.
New Outpatient Clinic
We are now using the same material and contractor to complete an expanded outpatient clinic and emergency department. This project will be completed during the second quarter of 2014 and provides an opportunity to design new and efficient outpatient care delivery models, staffing models and care coordination, related to almost every service we offer. The building component itself is more complex than the employee lounge because we are also renovating existing space and connecting the new space to the renovated space. The principle objectives of this project are to consolidate all outpatient clinical services in one area, controlling patient flow, enhance clinical efficiency and improve quality of care.
This new space will accommodate a new 10 bed emergency room, two new dental rooms, large orthopedic exam and casting room, ophthalmology room, OB / GYN and general exam rooms. In addition HIV, TB, Cardiology and other specialty clinics will all be incorporated in this space. Radiology and Pharmacy will be relocated, upgraded and integrated into this area as well. All in all we will have more than tripled our outpatient clinic exam capabilities with this. The new hospital design will follow many of the same functional aspects of this clinic space and this gives us a perfect opportunity to test and amend both physical building design as well as staffing and care models. For example, all patients, regardless of service will now have their vital signs taken and documented in one area, before they proceed to their designated exam room. We will also use the new design to test different components of security and crowd control, limiting access only to identified patients and their families.
Patient Registration System
Since access to the hospital is currently congested and difficult to regulate, we will close the existing entrance and open a new one upon completion of the clinic space. The new entrance will be off Rue Républicaine on the south side of the hospital (where the rarely used vehicular entrance is now).
The new entrance will have an expanded waiting area and a functional patient registration system. We anticipate deploying a patient registration system to include:
1. Computerized registration and patient index
2. Patient ID bands
3. Foundation for charging, billing and collecting revenue
4. Accumulating accurate daily statistics
5. Enhanced security of patient flow through the campus
6. Foundation for supply chain management needs
Designing, testing and modifying these systems now on the existing campus will go a long way in assisting for a smooth and orderly transition to a new hospital design, patient flow and care models.
Financial Reporting and Accountability
Improving financial reporting and accountability is also a major priority at Hôpital Sacré Coeur. Last year, we reached the conclusion that the current financial system could not be made to work reliably. Accordingly, we invested in a new system for the finance office that is now tied to a central server, backed up multiple times a day, and locked down so that only authorized use and approved applications can be installed and run on these computers. As we seek to obtain support from individual donors, foundations, corporations and government agencies, it will be imperative to demonstrate sound financial controls and meaningful accountability. As part of this effort, and to improve oversight, we will relocate the cashier’s office from the hospital building to the existing dental space, which is just in front of the accounting office. Cash management and revenue cycle systems are being developed to accommodate tighter controls and better forecasting. These enhanced systems will rely on a new approach to patient registration. Patients will be registered on arrival at the new entrance, receive an ID band, once called they will proceed to the clinic exam room they are assigned. Staff will complete an exam charge master, the patient will then take this to the cashier’s office, pay and use the receipt as proof to receive drugs, supplies or any other items our policies require advanced payment for. The systems are somewhat more complicated than I have described, but this gives you a sense of our commitment to improved financial management, better accountability and tighter controls.
Other Facility Related Projects Underway:
1. Oxygen generator: completing a business plan for consideration of large scale O2 sales.
2. Incinerator installation: Combined with a recycling and waste management program we are installing a new high intensity incinerator.
3. Information Technology:
a. E-MAIL System
b. Phone system
c. PACs system for radiology images
d. Reliable Teleconference Capabilities.
4. New Library and teaching space for Sr. Maureen at the CRUDEM compound
5. New Volunteer lounge at the CRUDEM compound
6. Water supply: well heads, pumps and automated chlorination system
7. Converting the half built nutrition center into housing for families who regularly sleep on the ground in the evenings.
On top off all this we are embarking on an energy conservation program. There are no public utilities serving Milot and Hôpital Sacré Coeur relies entirely on its own generators. One of the first projects we at Holy Name engaged in was the installation of two new large Caterpillar generators and one smaller one. We currently have 4 generators with different output capacities at our disposal. Fuel is the second highest operating expense we have next to salaries. Timers and other load management strategies are currently being deployed at the hospital. But it is critical that we educate hospital staff on energy conservation and enforce appropriate rules concerning electrical consumption. This will reduce costs and prolong the life of the generators. Managing our energy consumption better will go along way toward making Hôpital Sacré Coeur a sustainable operation.
Supply Chain Management
Enhanced supply Chain management is also under development at Hôpital Sacré Coeur. Our supply and drug procurement process, shipping process, storage and requisitioning process are all in need of an improvement. Staff at Holy Name and CRUDEM have been working diligently with Hôpital Sacré Coeur to identify new partners and new systems for the entire supply chain management process. Our philosophy is to limit inventory of medications and supplies in Milot to only the essential items, keeping a limited and manageable quantity on hand with a more reliable requisitioning and shipping process from the US and abroad.
The Bon Samaritan property, just behind our pediatric pavilion and connected to the main hospital campus by two separate gates, was also recently re-acquired. We need to secure the outside wall along the canal first and will then develop plans for the building to include expanded pediatric clinic space as well as food distribution for malnourished patients and people in the community.
New Clinical Models
It has become very apparent that we need to invest in and improve the level of nursing care and the nursing models at the hospital. Dr. Prévil and his team are working with us to explore moving to 12 hour shifts for nursing staff, limiting the number of nursing students who rotate through at any one time and requiring candidates to pass an HSC developed and administered competency exam before they are approved to come to Hôpital Sacré Coeur. We anticipate developing and administering a similar competency exam for all of our nursing staff.
We are developing a plan for two service lines to serve as pilots for a new patient care model and a new leadership team accountability model. Each service line has a physician leader and a nurse manager leader but the concept of working as a team, holding each other accountable is uncommon in Haiti. We look to change that perspective through a consistent regiment of education coupled with bedside implementation, so that the practicum immediately reinforces classroom work. This is a departure for Hôpital Sacré Coeur, but we are optimistic that it will have a lasting impact.
CRUDEM, thanks to the tireless work and vision of Dr. Joni Paterson, has significantly enhanced its fund raising performance in 2013 and projections for 2014. Our Give a Life! Campaign provides an opportunity to directly sponsor the salary costs of one our Haitian colleagues. Salaries are the single largest operating expense we have, this program allows the employees in Milot, who earn a fraction of their American counterparts to feel connected, trusted and appreciated by their sponsors. It not only helps offset operating costs it enhances morale and the spirit of the people we need to be fully engaged to make their future better.
Hôpital Sacré Coeur, under Dr. Prévil’s able leadership, has responded to the stimulus and energy created by the partnership between Holy Name and CRUDEM. Hôpital Sacré Coeur staff at all levels is engaging, improving, questioning and challenging old stereotypes. They recognize the need to improve patient care and, indeed, all facets of hospital operation. As a result of this awareness, our colleagues in Milot understand that support from Holy Name and CRUDEM will not be fleeting, but will endure long into the future.
Serving the Community
Sr. Ann Crawley and Sr. Maureen Boggins continue to bless us with their unwavering spirit and dedication to the people of Milot. Working with both Sisters of St. Joseph of Peace we are improving housing for those in need, developing better and more effective ways to feed the hungry and building state of the art classroom spaces to assist teaching English as a second language and providing other educational opportunities.
“The future belongs to those who believe in the beauty of their dreams.”
Please help us build the beautiful dream for the people of Milot so their future will be bright.