Journal: SunText Review of Economics & Business
DOI: 10.51737/2766-4775.2020.003
Download PDFIn this work is described a practical experience related a
managerial performance related hospital gas management System. After an
introduction related some normative rules involved are provided a description
of activities. Then an analyses of results obtained is reported. Result fined:
related this specific experience of 5 years all endpoint was obtained:
clinical, economic and risk.
The management of
hospital medicinal gas system need various management skills. This kind of
speciality need to respect various normative rules: European, Italian,
regionals, technical and safety prescription as well as economic budget law oblige.
The medical gases are under medicinal rules, medical devices rules or galenic
ones. The pharmacopeia European and Italian: provide prescription of quality
but also many other technical normative (ISO – EN- UNI international, European,
or Italian) are involved in. So the management of this complex world for assure
oxygen-therapy of patient, ventilation in ICU or for imaging, med lab or for
some kind of surgery need a high level of managerial competencies. This
managerial competencies are also required to directors of complex healthcare
structure in hospital and to do this is necessary to add management basis
courses and a project work related. The basis management course for
directorship of health complex structure in Italy must cover this [1-17].
This
courses must follow: Active
didactics methodology, frontal lessons, practical cases discussion, incident
analysis, role playing, simulations, analysis of data, focus groups. At the end
it must be presented a written related project work. According this rules it is
submitted a project work named involved in hospital medicinal gases management.
With and prospected (
from 2015 to 20120 ) and observational ( in retrospective way from 2020 to 2015
) way many data related medicinal gas management in pc hospital was recorded to
produce completive data for the final analyse.
Source of data
Official applicative program of hospital,
database, albo praetorian for economic data, regional healthcare data for gas
product use.
Location- settings
PC AREA 3 public
hospital and 2 other structure linked in the same provincial network. About
more then700 beds.
Organization
Departmental, wards,
complex units, simple units
Central organization
General Director,
health directors, administrative director HR director, other technical office,
SPP prevention protection service.
Staff:
ICT, budget control, Economy buying office and other
Many wards: Emergencies, ICU, medical and surgical, ambulatory
Different kind of medical speciality: Surgery, nematology, oncology,
infectious disease, cardiology, nephrology Obstetrics- gynaecology,
paediatrics, - trauma orthopaedic, neurology, psychiatry, Otorino, oculist,
allergology, imaging, med lab and, addictions services and many other Also
transplant are performed. (Staminal cells- molecular biology and other).
Time of observation: From 2015-2020
Kind of service managed: Public hospital gas management
Position observed: hospital pharmacist involved officially in medicinal
gas management
Role:
Execution director of hospital medical
gases contract with external provider- quality control of
medical gases officially-pharmacist responsible for gas management
Title
of observed position: Applied pharmacologist,
ward clinical pharmacist university title, hospital pharmacist manager, director of execution contract
Dec: medical gases providing system and Dec for contract internal transport of
mobile container of gases.
Qualified as: hospital pharmacist and territorial manager level,
complex structure directorship level (idoneita alle funzioni) 2020 public
selection Cremona hosp.
Updating and formative management courses followed during
2015-2020
Several courses relate management topics like: strategic management project management,
TQM, Risk management, MBO, problem solving, time management, budget analysis,
economic and financier, Healthcare economy, pharmacy-economy, economic
analysis, ICT, gas medical management-regional level courses), communication
technique, team building topics, SWOT analysis, DATA management and many other.
Risk analysis: In the observed period from 2014-2020 NO adverse
event or incident or other relevant was observed.
Cost analyse: During the period 2016-2020 the medical gases budget
was approved by general manager, and monitoring of the amount ordered was
performed and no overload of ordered products. The cost of medicinal gases was
according the rules accepted in official buying procedure of area vista. No any
kind of official contrast between hospitals direction ship and external private
gas Provider Company.
Clinical results: In the observed period no any clinical adverse event
was observed and registered about medicinal gases used in this hospital.
Quality control: In the observed period no any periodic analysis on
quality of gases provided was out of official Italian pharmacopeia specific.
Only 1 cases related medical air due to also pre-analytical problem but solved
in few time.
Control of documentation: In the observed period all documentation for
archive was done Certificate of analysis, written memorandum, contract, recall,
communications and all related.
Revision of documentation: During this period was introduced DGO
operative gestational document or medicinal gases system (in collaboration with
technical office and prevention protection system office and medical directors)
officially adopted on going the producing of other related procedure but cited
in the DGO.
Emergency management: Related covid-19 emergency it was needed to increase
the availability of medical gases like oxygen introducing other new tank near
the poli-chirurgic of the hospital and to add to the central system various
packs units. All this measure added to a great increase in provided medical
gases mobile container and liquid oxygen or concentrators make possible to
overcome the great emergencies.
Description of role observed: according Italian rule named codice degli appalti there is a
specific position named Dec execution director of contracts that have a
substantial project manager role. This figure is a real link between the extern
provider of medical gases and the hospital management. This figure must execute
the official contract with the winner of the buying procedure of area vasta (an
association of various provincial hospital). All this according principle of
transparency, equal condition, celerity, under economic and risk evaluation
with the aim to keep the continuity of patient therapy for their need of
medical gases and oxygen therapy. This figure is related so whit buying office,
the hospital general managers, directors of clinical units, technical offices,
prevention protection service and external provider. Other function officially
played: quality control of provided gases. Periodic analysis was performed
every 6 month for oxygen and medical air and azote. The sample was sanded to
officially recognized laboratory and the final report was accepted and then
under archive procedure.
Updating procedure: It was organized a first course for top managers of hospital
Related medicinal gases management
(co-organized whit technical office engineer and director of prevention protection
system). This future also performed as: hospital pharmacist manager responsible
for medicinal gases. (Ordering procedure, buying procedure, internal transport
of mobile tanks of oxygen recall, tracing system of mobile tanks and other
related activity). In the first phase of this last contract of providing gases
it was needed to change all the big tanks of cryogenic oxygen in the 3
principal hospital. It was officially assigned an engineer to Dec medical gases
as technical support for system problems. After this complex change procedure
was written and signed officially a report for central office of hospital. To
adequately manage this systems it was needed and 24/24 hours every day and for
all the year to cover the emergencies. A rapid communication system was adopted
to communicate with all the players.
Control activities
During this period was centrally
and peripherally controlled the amount of gases provides also using informatics
on distance system named telemetry: in this way by remote was possible to
verify the data about the tank level added.
Day by day activity: Contacts with clinical wards, external provider, buying
office, medical ventral office, technical office and other related. Verify or
ADR adverse event reaction due by medical gases before sends it to pharmacology-vigilance
center of the hospital. Recall activity according the alert provided by
authorities or by manufactures industries.
Official visit: Activity
with written report to verify correct condition of stoking of mobile containers.
In wards and in central storage.
Cost managed: About
350.000 euro by year related cost of provide gases (1.750 .000 euros by 5
years), about more the 50.000 euro by year for internal transport by year of
mobile container other service managed as DEC mobile tanks verify and
expiration data for 2020 about 40.000 euros. Total costs managed in 5 year:
about 2.200.000 euro but it must be added also cost avoided due by a safety use
of medical gases management system without risks (explosion, burn and other are
very expensive and difficult to evaluate before).
Gases managed: Oxygen
(compressed, liquid and cryogenic), Medical air (produced inside hospital with
compressor, azote liquid, argon, CO2, NO, helio.
Kind of physical gases: Compressed for mobile tanks for acute therapy or transport
liquid for chronic therapy
Congenic: For
central system of providing
Use: : Therapeutic
(oxygen, no, medical air) , imaging helio for RM, laboratory co2 ,
surgery (argon), crio conservation of sample n2, mixture of gases
for otorino and spirometry, oxygen therapy, ventilation in ICU diagnostic and
surgery procedure (cryosurgery, laparoscopic procedure) motor gases for
instruments to refrigerate magnate resonance medicine laboratory
For all this activates was used various managerial techniques
like
·
Project
management
·
Time
management
·
HR
management
·
Budget
analyst
·
Risk
analysis
·
ICT
management
·
MBO
·
TQM
·
Soft
Skills management
·
Communication
management
And many management techniques:
like problem solving, brainstorming, what if analysis, zero vision Eisenhower
matrix, FMECA, ishikawa diagram, critical path methods. Using not also an
historic way but also a prospectic approach.
Financier aspect: This practical experience is related a public setting of a
provincial hospital PC AREA and related other presidium so the patient involved
are under the cover of public financial providing.
Reimbursement policy
According national Italian rules a
national system regulate LEA essential level of cure for all patient and then
from national level was decide level of financier cost reimbursed to the single
regions. The regional institution provide to the local hospital the amount
needed of money.
Monitoring activity
During observed period was
performed various activity
·
Monitoring
of amount provided of gases
·
Monitoring
of quality of gases
·
Monitoring
of total costs of gases- economic evaluation- budget impact
·
Monitoring
of ADR
·
Monitoring
of recall and non-conformity
·
Monitoring
of official documents
·
Monitoring
of revision of procedure
·
Monitoring
of official data flux for region
·
Monitoring
of correct informatics codify of products
·
Reimbursement
procedure
Periodic management evaluation
In the global period observe every year positive evaluated by the
central hospital management of HR the budged for medicinal
gases was respected. No any controversy with external providers. No any written report
related ADR on near miss event and other.
The experience presented cover a
long period of time like 5 year and during this period all end points was
obtained. (Clinical, economic, risk) The continuity of cure was guaranteed.
Risk was controlled no ADR, near miss event or other (only 1 cases related
expiration time for some mobile tanks linked to the central pipeline-tertiary
source, rapidly resolved). No controversy between external provider and
hospital management. No problems of security with patient, healthcare
professionals, technical and caregivers. In the first phase of this was necessary to create a team
multi-professional and for this reason many managerial technique was used. In
emergency settings was introduced a task force multi-professional to manage it.
All communication activity was correctly performed.
Risk analysis was performed for all activity with prevention protection
service. Actually under evaluation also the new BIG TANKS for cryogenic oxygen
introduced during emergency covid 19.
USING correctly deep management
techniques was obtained all kind of endpoint in the period observed.
Signed
the original version by the author value
This project work is produced to be submitted for international
evaluation for basis course of management of health care complex unit
directorship.