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INDIGO

associate
Kanthicha | Kingkomon | Natthanun |
Sasi | Thippayaporn | Thitiporn |
Overview of Ramathibodi Hospital
One of the famous public hospital in Thailand & One of two medical schools within Mahidol University

Company Background Vision, Value and Missions

Vision Missions

Established in 1969 following the Second To educate and generate


National Economic and Social To become a leading medical graduates and
Development Plan guide for national health specialists to meet high
advocacy and one of
international standards.
the foremost academic
His Majesty King Bhumibol Adulyadej institutions in Thailand To provide high quality of
conferred upon the name of with an established medical care with modern
"Ramathibodi" international reputation.
facilities and technology to
the public.
Value
The Hospital has been fully equipped and To be the research center for
“To be a Learning
has provided medical education and medical innovations and
Organization with
research facilities to the public
Integrity and Quality” public healthcare services.

Organizational overview Situational analysis Problem 1 Problem 2


Ramathibodi service framework

Ramathibodi hospital must follow conceptual framework to keep up with the expectation of patients

Conceptual framework of Hospital service Implemented Technology

Expectation of patients Online medical record


Confidential level/ credibility Fast and accessible service
a. Proper and standard treatment a. Prolong time of service
b. Be able to make appointment Automatic packaging
c. Variety of service channels and labeling medicine
Understandable explanations system
a. Friendly Staffs
b. Caring Staffs Good service
c. Efficient communication a. Attentive Staffs
b. Response to customers
Telecar System

Places and facilities


a. Enough resting space
Clear guiding sign
Curing all diseases
b.
a. Professional doctors and staffs Analysis and result in
c. Enough parking lots Pathology System
d. Food courts and convenient store b. Innovative tools
c. Efficient treatment

Appropriate price/ privileges Appointment queues


a. Cheap and appropriated service system

Organizational overview Situational analysis Problem 1 Problem 2


Ramathibodi Hospital Structure
Ramathibodi is one of the division in Faculty of Medicine Ramathibodi Hospital in Mahidol University

Organization Structure

Faculty of Medicine Ramathibodi Hospital of Mahidol


University

Academic Department Nursing Hospitals Dean Educational Chakri Other 6


Pediatrics
School - Rama hospital Office Office Divisions
- Naruebodin
- Ophthalmology - Queen Sirikit
- Pathology Medical Center
ra Medical
- Orthopedic - Somdech Phra Institute
- Other 14 depart. Debaratana
Medical Center

Patient Department Nursing Nutrition Pharmacy Dental Other 12


- Outpatient Depart (OPD) Department Department Department Department depart.
- Inpatient Depart (IPD)

Organizational overview Situational analysis Problem 1 Problem 2


Somdech Phra
Debaratana
Medical Center

Orthopedic clinic
Orthopedic Department: Organizational hierarchy & Human resource

Orthopedic department have xxx doctors and xxxx nurses

Internal hierarchy of orthopedic department Human resources

Doctors
Orthopedics department
Regular 32
General Support
Administration Regular Senior 2
Main mission support
Specialties 2
Sub-specialty
Hospitalist and 4
SDMC
Fellow 8

Orthopedic Spine Tumor Sport Trauma Hip & Housing doctor 35


Medicine Knee
4 specialist 4 specialist 3 specialist 4 specialist Total 84
3 specialist 3 specialist

Foot &
Head & Pediatric
Ankle
Nurses หาข้ อมูลพยาบาลไม่ได้
Microsurgery Orthopedic

5 specialist 2 specialist
4 specialist

Organizational overview Situational analysis Problem 1 Problem 2


Orthopedic clinic: Number of staff and estimated capacity

Orthopedic clinic can serve xxx no of patients per day

Internal Staff Management Estimated capacity


• Scope of Service
# of patients / 365 =
> Diagnosis and treatment service #/day
- Normal Clinic : Mon-Fri (7.00am- 4.00 pm) all doc
- After hours clinic : Mon-Fri (4.00 pm- Avg 20 ???
8.00pm), Sat(4.00pm-8.00pm), หมอใช้ เวลาตรวจคนไข้ นานเท่าไหร่ ลงตรวจรอบนึงกี่คน?
Sun(7.00am-12.00pm)
- Daoruang clinic : 5.00 pm-12.00pm (for Capacity = out/in สามารถ service คนไข้ ได้ กี่คนต่อวัน
only patient with severe symptom)
Out patients Working hr Doctor
>Tertiary Care
In Doctor Show the calculation Patients per day
>Education and Research
Patient/ 1 Doc Avg hr/ patients
Normal Clinic: 8 doctors > avg. 8 • Start the first lot of patient at 9am (The patient
hours/day +OT should come at least 30 minutes in advance of
the appointed time)
Premium Clinic: 12 doctors > avg. 12
hours/day
หาข้ อมูลพยาบาลไม่ได้
Limitation of appointment: 15-20patients • The professors take about 30 minutes to
Limitation of walk-in : 5 patients diagnose each patients
กะ หมอ พยาบาล ที่เข้ ามาในคลีนิค //
lock ไว้ กี่คน / วัน (หรื อกะ)

Organizational overview Situational analysis Problem 1 Problem 2


Orthopedic clinic: Service demand and estimated capacity

Orthopedic clinic can serve xxx no of patients per day

Actual service demands Estimated capacity

According to statistics in 2015 to 2017, Capacity = out/in


Out patients Working hr Doctor
the average annual visits are 118,533
In Doctor Patients per day
Patient/ 1 Doc Avg hr/ patients
Total number of patients is
approximately 350 persons per day
หยก กดลบกราฟไป เพราะกดผิด และอันดูไม่ได้ คือกราฟ ผูป่ วยต่อปี ควร
Walk-in 60-80 visit per day ใส่มยั ้ คือไม่ร้ ูอา่
Show the calculation
คานวณมาได้ คนไข้ ประมาณ 325 คน ต่อวัน คือ ใช้ เลข 350 หรื อ 325
Problems Avg 20 ???
เดี๋ยวมาทาต่อให้ เด้ อ
หมอใช้ เวลาตรวจคนไข้ นานเท่าไหร่ ลงตรวจรอบนึงกี่คน?
Many walk-in patients came to the
hospital but can’t get the สามารถ service คนไข้ ได้ กี่คนต่อวัน
treatment/diagnosis:
• Time slot
• The overflowing of patients
ได้ เลขบางอันแล้ ว เด่ะมาต่อออจ้ า กุง่วงมากกก // หยกเอง ~~~~

Organizational overview Situational analysis Problem 1 Problem 2


Orthopedic clinic: Internal operation

In depth analysis of orthopedic clinic operation >> มีปัญหาอะไรบ้ าง เอา ปห มาใส่ใน tag line

Operation and workflows

Case ใส่ service flow chart ลงตรงนี ้ใส่ทงหน้


ั ้ า >> แล้ ว
duplicate หน้ านี ้ออกแล้ วบอกว่า มี NVA ตรงไหน
Emergency
Normal >> Reserve before

เดี๋ยวมานะจ้ ะ

• Start the first lot of patient at 9am (The patient


should come at least 30 minutes in advance of
the appointed time)

• Limitation of resident with appointment: around


15-20 people and 5 for walk-in case

• The professors take about 30 minutes to


diagnose each patients

Organizational overview Situational analysis Problem 1 Problem 2


Key question
How can we maximize the service
satisfaction of patient with the
limited capacity?
Organizational overview Situational analysis Problem 1 Problem 2
Executive summary

Objective Problems Suggested solution

Waiting patient

Large average non-


value added wait time
in front of the clinic
To maximize the
service
satisfaction of
patients with
limited capacity Pre-operative
assessment clinic
Dissatisfaction between
both doctors, nurses
and patients during the
process.
Process of pre-operation assessment clinic: Flow chart

Using flow chart to determine the most problematic area in the process

4 OPD
Refer to Specialist doctors Doctor
other Case
appointed surgery as a type Concerns
hospital treatment plan Specialist Resident
No
IPD
2 • Resident and nurse
Patient Give out brief date
have hard time
go to Patient get to Resident determine Yes
admit at admit or not the operation date
Emergency? dealing with patients
Yes 1 and explaining the
the ward Resident talk to
No patients about the risk involve with the
Nurse book the details and assign operation
bed for admit for pre-operation
Record is 3 test • There are cases
held for Patient sign
doctor
The nurse Doctor when there are not
clarify and document to Patients sign
to approve the
appoint for Nurse give out the enough capacity to
give some pre-op clinic the documents take in another
consider operation additional details to
Yes additional and go home
No Yes patients and clarify patients as the
details and
Record is held No details to patients doctor need to deal
Operation? expense bills Operation? Doctors held
for doctor to
conference
with the emergency
consider
case first
Patients No Patients go home
Consult and receive
Doctor check up receive Resident call to
medicine / operation on the
document for Abnormality? patents for
anesthesia date specified
appointment blood test
Pre-op clinic department Yes
of pre-op clinic

Organizational overview Situational analysis Problem 1 Problem 2


Problems at pre-operation assessment clinic: Fish bone diagram

Digging down to the major root cause of the problem using fish bone diagram

Doctors Nurse Concerns

Have large amount • Resident and nurse


Many documents to deal with
of workload have hard time
dealing with patients
and explaining the
Need to take care of Have large amount
of workload risk involve with the
emergency case Problems at operation
pre-operation
assessment • There are cases
when there are not
Went through many process clinic
but cannot get operation enough capacity to
Emergency take in another
Large amount of patients case patients as the
doctor need to deal
Not enough with the emergency
Could be picky and
capacity for patient case first
demanding
to admit at IPD
Patients Externalities

Organizational overview Situational analysis Problem 1 Problem 2


Key question
How can we increase the effectiveness of the
operation and deal with externalities more
effectively to satisfy of both patients and staff?
Key issue to be address

Tackling the root cause and underlying problem to solve problems in long term

Issues Questions Solutions

Reorder
How can we deal with • Introduce the emergency track
uncontrollable
emergency operation • Ensure that the residents schedule the possible
There are many emergency case? operation for emergency case to slot in
cases that making the operation
schedule changes, making the
patient unable to receive
operation at the appointed time. Deliver
• Infographic to inform patients before
operation

How can ensure that • Training for staff on how to deal with picky
both staff and patient patients (especially for the resident that have
can communicate to deal with pre-op clinic)
Patients could be better?
demanding and staff have to
inform them many time. • Introduce knowledge management system on
how to deal with picky patients

Organizational overview Situational analysis Problem 1 Problem 2


Solution 1: Reorder

Reorganizing the fast track for smooth admission of emergency cases

Current capacity for IPD Ward Implementation of fast track

6 operation room 6 operation room


Normal operation – 5 rooms
Emergency – 1 room
In the case there
are no emergency
case (which is
40 post-op unlikely)
40 post-op
admission space admission space
The resident should
Normal operation – 39 bed arrange the
Emergency – 1 bed
schedule for
normal operation
instead.

Organizational overview Situational analysis Problem 1 Problem 2


Solution 1: Reorder

Reorganizing the fast track for smooth admission of emergency cases

Implementation of fast track


To ensure the smooth implementation

6 operation room
• Ensure that the Normal operation – 5 rooms
residents schedule Emergency – 1 room
the possible In the case there
operation for are no emergency
emergency case to case (which is
slot in unlikely)
40 post-op
admission space
The resident should
• Arrange a group of Normal operation – 39 bed arrange the
patients who can Emergency – 1 bed
schedule for
come for the normal operation
operation within the instead.
short period of time,
in the case that the
space is vacant.

Organizational overview Situational analysis Problem 1 Problem 2


Solution 2: Deliver

There are large noise in the communication between patients and doctors / nurse

Patients Doctors & Nurse


Encode / decode

Noises

Encode / decode

• Demanding and picky • Large amount of workload

• Need clarified information • Dissatisfaction from dealing with


picky patients
• Large amount of patients
• Getting bored from telling the
same thing over and over again

The communication between patients and staff are not effective.

Organizational overview Situational analysis Problem 1 Problem 2


Solution 2: Deliver

To reduce the noise on patient side we should introduce the media for patients to read by them selves

Objective To ensure the smooth implementation


Patients To give clarified information

Content
Give out infographic regarding
1 the repetitive information that Doctors and nurse must
doctor needed to inform along meet up to determine
with the existing booklet the content

Redirect the from infographic


2 to interactive web-board to fit
Leverage
• Demanding and picky in information in addition to
infographic
The making of
• Need clarified information interactive web board
and infographic can
Large amount of patients Introduce FAQ section on the

3 booklet, infographic, and web
be leverage on the
board current existing media
and IT team

Organizational overview Situational analysis Problem 1 Problem 2


Solution 2: Deliver

Objective
To ensure that the information is Doctors & Nurse
1. On the Job given effectively
training Rationale
Using on the on the job
training to train resident how • Doctors and nurses are skilled in
to communicate and deal their area however, they may not
with very picky patients know how to communicate or
deal with picky patients in certain
scenario

Staff can reduce their stress by


2. Knowledge •
sharing their experience in the
• Large amount of workload

management KMS
• Dissatisfaction from dealing with
• Ortho DBMC can retain the picky patients
Let staff share their expertise / expertise in the area of dealing
working experience on how to with patients • Getting bored from telling the
communicate and deal with same thing over and over again
patients

Organizational overview Situational analysis Problem 1 Problem 2


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