Haramaya General Hospital
PROJECT TITLE፡ IMPROVING HEALTH SYSTEM EFFICIENCY IN
PROCUREMENT, HUMAN RESOURCE AND SUPPLY CHAIN
REGION: OROMIA
HEALTH FACILITY: HARAMAYA GENERAL HOSPITAL
PRP BY HARIF A(M.SC.)
DATE: JAN, 2023
haramaya general Hospital cluster 1st Q report prp by HA
Background of Haramaya General Hospital
❑Haramaya Hospital is found in East Hararghe;
Oromia National Regional state; 507Km from
Finfinne and 18 km from Harar town
• It is established in 2005 Ethiopia calendar.
• It was upgraded from health centre
❑Then in 2009 it was expanded to a zonal
hospital by the Regional Health Bureau.
haramaya general Hospital cluster 1st Q report prp by HA
Cont…
• Now the Hospital have more than 172 beds and
giving health service for two towns and four
districts for more than 1.4 million people and
also there is 27 Health centers in the catchment
and two lead health centre
• It has 340 employees; 186 health Professionals
and the rest supportive staff
haramaya general Hospital cluster 1st Q report prp by HA
Cont…
• On averages Daily 320-460 patients visit OPD
• It has specialty in psychiatry, eye, ART clinic, Youth
friendly service ,ophthalmic clinic, and TBL among
other services and also four referral clinic
• To promote quality service effectively the hospital has
fully utilized all health reform core processes, namely
BPR,BSC, HCF, HMIS/DHIS2/HPMI, EHSTG, SaLTS,
CaTCH-IT, HSTQ, IPD initiatives and EHAQ/EBC
Organization’s Mission, Vision, Scope of Service
• Mission
Haramaya General Hospital plays a basic role to reduce morbidity, mortality and disability and
improve the health status of Haramaya hospital catchment population through providing and
regulating a comprehensive package of preventive, promotive, rehabilitative and basic curative
health services via a decentralized and democratized health system.
• Vision
To see healthy, productive, and prosperous Haramaya Hospital catchment population
Problem statement (prioritized for improvement)
• Us we assessed in our hospital there is sources of inefficiency in procurement, human
resource for health and supply chain
Aim Statement
• The Aim of these project is to improving efficiency in health system in our Haramaya
General Hospital start from January 11, 2023 to Feb 28, 2024 for evidence based
decision making.
Methodologies of the project
Model for Improvement
What are we trying to accomplish?
What change can we make that will
result in improvement?
How will we know that a change
is an improvement?
Act
Plan
Study
Do
Fishbone Diagram
workforce
Inadequate
knowledge
& training of
workforce
Products and services
Shortage of clinicians
Lack of resource
Absence of
employee
of
$$
engagemen
t
Inappropriate hospital
size with services
Shortage of pharmaceutical expenditure
Inappropriate payment systems
Low FTE of GP that spent with patient
Shortage of hospital budget
Source inefficiency in
health system our hospital
Poor communication
and poorly managed
patient flow
Poor infrastructure
Poor mgt, Rx and Dx
of disease
Unnecessary admission and
unnecessary referrals to specialists
Low bed density
Lack of equipment and
inappropriate use of technology
Environment/technology/
Inapproppriate ALS and low BORs
Services delivery
Aim
Primary Drivers
Secondary Drivers
By what, by when
What must be present to achieve our aim 1
What must be present to deliver each
driver
Turnover and Recruitment
Premium Pay Work Days Lost Due to
Injury or Illness Staffing Efficiency
Improve staff efficiency
Improve quality of
care and decrease medical error,
improve hospital size, improve
admission/length of stay
Needs-based assessment and
training; revise remuneration
policies; flexible contracts;
performance-related pay
Enhance monitoring and clinical
audit; improve continuity of care
Use input-output data to plan, match managerial
capacity to size; raise occupancy
provide alternative care (e.g. day care); alter
incentives to hospital providers; raise
Improve use of procedures,
investigations and
equipment
knowledge about efficient admission practice
Reform incentive, revenue and
payment structures (e.g. capitation)
Change Ideas
Increase staff motivation, Introducing
performance-based payments
Use appropriate incentive, reward and
appraisal systems
Raising workforce awareness and training
workforce
Using work measurement and time
management techniques
Develop and implement guidelines
clinical
undertake more clinical audits; monitor
hospital performance
Modifying hospital size: selecting an efficient
size and
preventing hospital overdevelopmen
Improving workforce, equipment, and beds
based on
evidence
Modifying hospital budget structures and Improve
regulation/governanc
management techniques and methods of
economic analysis
Improve use generic drug, rational
use of drugs
Improve drug regulation and
quality control; carry out product
testing
improve prescribing guidance,
information, training and develop
active purchasing; reduce
mark-ups, raise public awareness
Developing appropriate tariff and payment systems
Value of purchased drugs, Value of stocked drugs
Value of drugs supplied, Volume of consumption of
specific drug and Share of generics in market
-Use of cost analysis and DEA model and other efficiency
measurement
A flowchart for the selection of policy tools for improving allocative efficiency
Measures/Indicators
Improving efficiency of health care system in
our hospital
Aim
state
ment
Outcome measure
Change
ideas
Indicator
Indicator
Improve
worker
productivity
Numerato
r
Improve
quality of
care
Denomin
ator
Improve
hospital
products and
services
Data
Source
HMIS report,
register,
satisfaction
pation
Balancing
measures
Process measures
Numerator
Denominator
.
P of PDSA
Aim Improving efficiency of health care system in our hospital
S
No
.
What
(Change
ideas)
1
Improve
worker
productivity
2
3
4
Process Measure
Wher Who
e(ser (responsible
vice body)
area)
How(descripti When (time table )
on how to
Start date
End date
deliver
activities
Increase staff motivation,
prepare appropriate incentive,
reward and appraisal system,
prepare awareness and
training, using work
measurement and time system
Harama ➢HR, QI team and
ya
SMT
hospital
➢Attendance, survey Feb 1, 2023
and guideline
Dec 30, 2023
Improve
quality of care
Develop and implement
evidence based clinical care
guideline, undertake more
clinical audits, monitoring ,
improve admission/length of
stay, modifying hospital size,
Harama ❖QI team, SMT
ya
hospital
❖CA, HMIS report,
❖# Beds, #modified
room/unit
Feb 1, 2023
Dec 30, 2023
Improve
hospital
products and
services
Improve pharmaceutical
expenditure, prepare
appropriate payment system,
improve, improve use of Rx and
Dx in imaging and Lab, improve
use in generic drug and rational
drug use
✓Value of purchased
drugs, stocked drugs,
drugs supplied,
consumption of specific
drug and Share of
generics in market,
Feb 1, 2023
Dec 30, 2023
✓Pharm Dep’t,
Finance, QI team,
SMT
Rema
rk
P of PDSA…
Measurement Plan /data collection plan
AIM/Out Come Data source
Indicator
(Where)
Data collection
method (how)
Time
Improve efficiency
of health care
system in hospital
HMIS report,
Clinical Audit,
survey, FGD,
observation,
Feb 1, 2023, to
dec 30, 2023
Haramaya G
Hospital
(When)
Responsible
for
QI team, SMT
Do
• Test your change ideas one at a time
• Use Run chart to monitor your QI project over time.
Study
• Describe the measured results and how they compared to the predictions and
baseline
Act
• Here describe what modifications to the plan will be made for the next cycle
from what you learned (Adapt, Adopt, Abandon)