annualreport20 11 08. - osieec.osakidetza.eus · 155 annualreport2011...

annual report 2011

08.Organisation and Systems

GURUTZETAKO UNIBERTSITATE OSPITALEAHOSPITAL UNIVERSITARIO CRUCES

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08. Organisation and Systems


In 1997, Osakidetza decided that the Biscay DataProcessing Centre (DPC), one of the organisation's fourlarge DPCs, would be installed at the Cruces HospitalInformation Technology Service.

Since then, this service has been responsible forhousing, maintaining and managing all the DPC Biscaycorporate servers, making it possible to ensure continuouscorporate IT support for the healthcare activity in all theBiscayan hospitals.

Following the EFQM model, Cruces University Hospitalincludes the Information Systems process in its processmap.

The mission of this process is to manage theinformation and the knowledge in our organisation,making the necessary Information Systems available to allof our professionals in order to fulfil our patients´healthcare needs.

The Information Technology Service is responsible forproviding the services related to information andcommunication technologies to all the professionals atCruces University Hospital.

Among these services, the following are worthmentioning due to their importance and volume:

• Managing the Hospital's LAN network, supervisingits operation, improving its topology andguaranteeing permanent connectivity

• Maintaining and managing all the corporateservers of the Biscay Data Processing Centre inorder to ensure continuous corporate IT supportfor the healthcare activity in Biscayanhospitals

• Maintaining and managing Cruces UniversityHospital's servers that guarantee the technologicalsupport for carrying out those activities withoutcorporate support

• Managing the corporate applications(implementation, corrective and developmentalmaintenance, …)

• Managing the hospital's applications (development,implementation and maintenance)

• Integrating the hospital's information systems so thatthey may be used to facilitate decision making

• Making available microcomputing systems and thecorresponding technical support for users

• Managing incidents (User Support Centre)

• Evaluating and adding new technologies(Wikipedia, eLearning, etc.)

• Localisation for urgent incidents

The Information Systems process identifies thefollowing sub-processes:

User Support Centre (CAU) Sub-Process

Its mission is to address the doubts, calls and anyother request medium for all the Hospital´s professionals,in this way assisting the continuous support and makingthe necessary IT tools available in order to carry out theirhealthcare work.

The CAU provides service to more than 5,000potential users and received 37,500 calls in 2011. TheCAU resolved 96 % of the incidents received. Theremaining 4% were derived to and resolved by other sub-processes.

08.1 INFORMATION TECHNOLOGY

PROCESS

Requests

Processes andOutput

User Impact(CAU)

Systems

Microcomputing

Development andImplementation

Maintenance andDevelopment of

Web Site

14061310

961378

313173

0 200 400 600 800 1000 1200 1400 1600

ATTENDED INCIDENTS

Web SiteSystems

MicrocomputingInt. DevelopmentExt. DevelopmentCAU Coordination

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Incident hours of operation:• Monday to Friday, 8:00 to 21:00• Saturday, 8:00 to 15:00

Outside of these hours, urgent incidents that entail ageneral IT failure will be attended, as well as thoseconsidered necessary by specialist doctors and supervisorson call.

Since 2008, all of the hospital´s employees are giventhe option of having a personal e-mail account.

In 2011, 2,582 new e-mail accounts were created,with a total of 720 users who access their e-mail via theInternet

Microcomputing Sub-Process

The mission of this sub-process is:

• To manage computer equipment: assignment,configuration, installation and maintenance

• To manage connections t the hospital´s LAN network

In 2011, 121 access points to the LAN network wereinstalled, 20 points were transferred, and 1 verification wasperformed.

The project to renew all the computers that were atleast four years old began in February. This project hasallowed to implement the Osabide Global application sinceits requirements were not met by the computers that werereplaced, and also to migrate to Windows 7.

Another project to highlight from 2011 is theconfiguration and installation of advanced viewing stations.These are computers that have a second screen with alarger size and resolution for viewing radiology images.They are used in Outpatient Consultations, the EmergencyRoom, the ICU and operating theatres.

The WiFi map is currently as follows:

* General Emergencies → Examination and EvolutionPaediatric Emergencies

305

322

106

49

64

202

0 100 200 300 400 500

PCH

e-osabide

Infogen/SIB

Zaineri

Global.Net

Osabide Global

ATTENDED INCIDENTS BY APPLICATION

500

700

900

1100

1300

1500

1700

1900

2100

2000 01 02 03 04 05 06 07 08 09 10 2011

No. DEVICES

Date Number of e-mail accountsYear 2011 6.479Year 2010 3.897Year 2009 3.457Year 2008 2.253

12º

11º

10º

9º

8º

Sot. -1º C*

Baja E

1ºA 1ºB 1ºD 1º E

2ºA 2ºB 2ºD 2º E

3ºA 3ºB 3ºC 3º E

4ºA 4ºB 4º E

5ºD 5º E

6ºB 6ºD 6º E

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Systems Sub-Process

The Systems sub-process has provided support andtechnical service to the following projects:

• Pharmacy: Medication information for patients(INFOWIN)

• Hospital:Storing security camera images along withcontrol pointsInternal applications developmentContingency plan for medical orders

• Warehouse: Stock control system (STOCKEY)

• Laboratory: Changes to the server infrastructure

• Outpatient Consultations: Queue managementsystem

Most of these projects have entailed the creation andconfiguration of virtual servers. There are currently 36virtualised servers.

Development Sub-Process

Its mission is to make all the applications available tothe Hospital´s professions that are necessary for theiractivity, helping it reach its mission.

Within this sub-process, two lines of work may bedifferentiated:

• Internal Development: Applications developed by theInformation Technology Service, which is alsoresponsible for their implementation andmaintenance. These applications cover the hospital´sneeds.

• External Development: Corporate applicationsoutsourced by Osakidetza to external companies. Inthis case, the external company is responsible fordevelopment, and the Information Technology Serviceis responsible for implementing, maintaining andpromoting these applications that make it possible tocarry out healthcare and management activities.

A. Internal Development:

These are applications thathave been developed in the ITservice during 2011.

InterconsultationsWeb tool that allowsOsakidetza physicians torequest interconsultations fromthe hospital's HomeHospitalisation service,replacing the previously usedpaper request system.

Resident ManagementApplication used bythe Medical TeachingUnit to manage thehospital's database forresident medicalinterns.

Periodic access controlsAutomated periodic access control to healthcareapplications, which provides a final report with the result ofany anomalies that were detected and the actions carriedout to resolve them.

DIETOOLS.User managementTool that allows theNursing Departmentto independentlyadminister the userswho access the dietsapplication(Dietools).

Using a web interface, this application allows the NursingDepartment user to assign/unassign nursing units tonurses and nurse assistants, as well as to create newDietools users, activate deactivated users and resetpasswords.

Technological evolution of existing applicationsContinuing with the process of technologically evolvingexisting platforms towards more up to date platforms, thefollowing tools have been migrated to a web platform:

RegistryRegistry of incoming and outgoing documentation involvingrequests, documents and messages aimed at varioushospital departments, Osakidetza or external companies.

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Orderly SupplyTool used by orderlysupply staff to register,assign and monitorrequests received fromthe various hospitalservices.

B. External Development:

The most important projects in 2011:

• e-osabide:• Billing and Program Contract• Integration with Global Clinic, Zaineri Berria and SIB

• OSABIDE GLOBAL in Hospitalisation andOutpatient ConsultationsOsabide Global is the application that provides accessto the single Osakidetza digital medical history. It iscentred on patients, favours stronger relations andcollaborations between healthcare levels, andsignificantly improves clinical security.

Osabide Global began to be implemented at the Hospitalin March 2011 in the Thoracic Surgery, Pulmonologyand Neurosurgery services. By the end of the year, it hadbeen implemented in nearly all the hospital's services forthe hospitalisation and outpatient consultations areas.

The professionals who have used the project highlightits functionality, access to information from allprofessionalcategories andimproved patientcare since it providesa global vision.

WEB Sub-Process

Our website is an important communication tool, bothon an internal level for the more than 5,000 Hospitalworkers, as well as on an external level (patients,professionals, media). So much that it is in constantevolution so that we may adapt to changes and address theneeds of our professionals.

Position in Global Hospital Ranking

In the January 2012 edition of the Global Hospital WebRanking, Cruces University Hospital's website moved upone position in the Spanish ranking to become the 5th bestSpanish hospital website.

Global Position: 338European Position: 90Position compared to other hospitals in Spain: 5

In terms of the number of website visits, there has alsobeen a growing progression compared to last year:

Date Global European Positionposition position compared

to otherhospitalsin Spain

January 2009 2513 >32July 2009 879 326 13January 2010 930 258 7July 2010 497 133 7January 2011 289 83 6January 2012 338 90 5

Evolution of VISITS TO THE HOSPITAL WEBSITE - www.hospitalcruces.com

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2009 62.972 77.605 81.803 78.666 73.172 72.918 90.094 87.528 91.001 77.2002010 83.508 90.963 98.013 91.792 103.097 100.946 87.216 79.174 96.301 92.419 98.331 82.0622011 92.268 102.937 121.369 98.864 116.417 113.006 89.108 74.991 78.081 72.193 79.482 68.174

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New Improvements

�Popup that can be activated for specialcampaigns or news to be highlightedduring a specific period of time

�New "Prevention-Advice" section in thewebsite's "Health" section

New functionality that gives fullautonomy to the editors responsible formaintaining the webpage that containsthe hospital's service catalogueupdated.

�Complete redesign of the HealthSciences Library section

Citizen´s Forum

Evolution:Throughout 2011, forum messagesreached 339,446 readings and visitorscreated 352 messages (133 new topicsand 219 responses to existing topics.

�Digital Newsletter

Throughout 2011, there have been atotal of 657 registered subscribers.23 newsletters have been sent tosubscribers via email (up toNO. 122)

Extranet

After the additions in 2011, there arenow 26 Hospital services that have andmanage their own webpage.

Teaching and Training

Some training needs are detectedthrough the CAU. We publish usermanuals in the IT Service´s extranet.

The implementation of newapplications or functionalities alwaysinvolves user training.

In 2011, we participated in thecourses provided for Global Clinic.We have also continued participating ininternship training for ProfessionalEducation students. The ConfederaciónEmpresarial Vasca (ConfeBask, BasqueBusiness Confederation) stated theirrecognition and appreciation for thiseffort of the Information TechnologyService, as well as the satisfactionexpressed by the young individuals andeducational centres that participated.

0

20000

40000

60000

80000

100000

120000

140000

2009

2010

2011

EVOLUTION OF VISITS TO THE HOSPITAL WEBSITE

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

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The Quality Unit's Mission

To facilitate the development and implementation oftools that streamline the organisation's progress towardsExcellence.

Service Portfolio

The Quality Unit´s management project has twoobjectives:

1. To improve management quality2. To improve service quality

Each of the Unit´s objectives is carried out in workareas. The first objective includes eight work areas(Strategy, Leadership, Patients, People, Processes,Information Technology (IT), Relationships and Alliances,and the Evaluation of Results).

The second objective (service quality) includes twowork areas (Accessibility and Safety). SAFETY has beenincluded recently in most quality improvement projects ofthe various administrations (state and the regionalcommunities).

Activities carried out to reach the objectiveof Improved Management Quality

1. PATIENT work area.We have prepared reports about results and priorityareas of improvement based on surveys of patients thathave been treated in Psychiatry, Major OutpatientSurgery, Outpatient Consultations and GeneralHospitalisation. Results reports are prepared forManagement and for each of the Service/Section Chiefsand Unit Supervisors of the affected areas.

2. PEOPLE work area.Completion of an accredited course (3.8 credits) onmanaging the hospitalisation process. One course hasbeen provided this year. Training activities have beenexpanded and as of this year will include consulting forimplementing the process in clinical practices.

3. PROCESSES work area.We participate in assessing other organisations that aimto manage their activities according to the EFQMExcellence Model. We provide consulting and auditservices for healthcare processes certified with the ISO9001:2010 Standard.

Activities carried out to reach the objectiveof Improved Service Quality

1. SAFETY work area.a. Incident Notification Monitoring.Incidents notified using the Hospital's computer toolare monitored daily. The individuals responsible forteam safety are notified of incidents, as well as Unit andService supervisors, when applicable.

b. Development of the Incident Notification tool.Two computer applications (in Excel and Access) havebeen created in order to analyse and investigate thecauses of notified incidents. The tools have beenprovided to the individuals responsible for safety inservices and units.

c. Incident Investigation Training.Completion of two accredited courses (4.7 credits) onclinical incident investigation for investigation teams.

d. Application of risk management tools.A risk management project has been carried outinvolving professionals from the Pharmacy area, led bya chemist, with the objective of minimising the risksassociated to medication errors.We work together with the nursing department to preparedatabases and reports aimed at minimising the risks ofhaving pressure ulcers and nosocomial infections appear.

e. Collaboration in training workshops.Together with the Nursing Department, to providetraining for all Hospital personnel in pressure ulcers,preventing infections associated to catheters andcatheters.

f. Analysis of safety improvement activities.We work together with the Medical Department inverifying the degree of implementation and complianceof the Surgical Verification List in the interventionscarried out in the hospital's operating theatres.

We disseminate projects and activities in two settings:the annual conference of the Sociedad Española deCalidad Asistencial (SECA, the Spanish Healthcare QualitySociety), with the presentation of four projects, and theGrupo Nacional para el Estudio y Asesoramiento deÚlceras por Presión y Heridas Crónicas (GNEAUPP, theNational Group for Studying and Advising on PressureUlcers and Chronic Wounds), where we form part of thesteering committee.

08.2 QUALITY UNIT

MANAGEMENT QUALITY SERVICE QUALITYData management: Satisfaction:database creation, Customer surveyspresentation and statisticalanalysis of resultsManagement of Safety: Failure Mode EffectImprovement Projects Analysis (FMEA), Incident

Notification System,Cause Analysis(London Protocol)

Process Management; Accessibility:Hospitalisation Care Recommended actionsSelf-evaluation accordingto the EFQM model5S ToolDashboardsLeadership and MotivationMeeting ManagementQuality Management Systems

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08.3 INFORMATION UNIT

Information Unit Activity

1. Non-healthcare services for patients hospitalised inthe Emergency RoomLocating family members of patients. Accompanyingpatient family members in Restricted Areas.

2. Attending foreigners receiving care in the CentreLocating family members of all the foreigners who visitthe Emergency Room Service due to illness, traffic orworkplace accidents, as well as providing the non-healthcare information they may need.

3. Hospital Information ServiceThere are three information centres that are located atthe main entrance, the Emergency Room, andOutpatient Consultations. Here, the questions made bythe centre´s patients and visitors are resolved. Most arerelated to the location of Outpatient Consultations andHospital Services, as well as locating patients.

4. Lost and Found

5. Room telephone numbers

6. ClaimsWithin the Information Unit, there is a work group thathandles, among other functions, collecting, processingand resolving (whenever possible) any claims madeoutside of the operating hours of Patient CustomerService.

7. Procedure for abused women

8. Providing service to and accompanying familymembers of hospitalised patients, especially those ofU.R.P., who due to disability or age, may requireassistance in the hospital area.

Most frequent information unit access according to emergency room hospitalisation reasons

Reason Annual volume Information Unit Care (%)Traffic Accidents 3.403 70Workplace Accidents 1227 50School, Sports, and Other Accidents 563 30Assaults 407 30Deaths or DOA in the Emergency Room Service 362 100Foreigners 592 100

Activity volume

Family Members Located 230

Activity Daily Monthly %Weekday Sat-Sun

Customer Support Activity• Outpatient Consultations 312 6.165 5,6%• Additional Tests 749 15.095 13,7%• Emergency Room 2.509 2.305 74.713 67,8%

Telephone Consultations• General Area 282 135 5.763 5,2%• Emergency Room 270 276 8.465 7,7%

Total 4.123 2.716 110.201 100,0%

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08.4 COMMUNICATIONS OFFICE

Internal Communication

• Editing and preparing the Cruces Hospital Newspaper• Preparing the Berriak with information of general interest• Participating in the tribute for retirees, children´s party

and the Christmas tree lighting• Participating in "Cartas Domiciliadas" letters that contain

relevant information about objectives and actions• Layout and editing of the Annual Report• The Communication Office´s extranet page• Image bank• PowerPoint presentations assistant• Webpage maintenance• Informative electronic newsletters• Management Objectives Presentation: editing the

PowerPoint presentation

External Communication

• Promoting the publication of healthcare actions inspecialised and general news media (Diario Médico, ElCorreo, etc.)

• Updating social networks (Facebook, Twitter)• Daily newspaper dossier• Organising coverage to the external information

demanded by the news media• Supporting the Conferences and Events organised by

the Hospital´s services, in those items related to mediacoverage

• Structured collaboration with NGOs and PatientAssociations

• Designing and preparing informative sheets andbrochures aimed at patients, family members orpersonnel

• Maintaining informative spaces in the Hospital's website

Other tasks

3.1. Publications:• "Handling the Secondary Effects from Treating Hepatitis

C with Pegylated Interferon and Ribavirin," Pharmacy• "Multidisciplinary Unit for the Treatment of Diabetic

Foot: Structure and Operation"• "Handling Sever Sepsis and Septic Shock in

Emergencies 2011"• "Insulinisation Protocol." Endocrinology Service• "Application Manual for the WHO Surgery Safety

Verification List." Medical Sub Office of SurgicalServices

• "Painful Shoulder." Rehabilitation Service• "Breech Birth and External Cephalic Version."

Obstetrics and Gynaecology Service• "Action Protocol for Joint Prosthesis Infections."

Infectious Unit• "Home Hospitalisation Manual"• Emergency Room brochure

3.2. Poster• "Caring for chronic patients: the same quality at a lower

cost"• "Improving the care of chronic patients"• Informative session about waste management and

environmental protection

3.3. Support• Conference: 2011 Research Diabetes• Biocruces Clinical Sessions: From the Laboratory to

Clinical Practice• Conference: YES, IT'S LUPUS! Questions and answers

about Systemic Lupus Erythematosus• Exhibit: "New Haiti, the Right to Health and Education"• General Clinical Sessions• Inauguration Building A• Participation in the 3rd Conference on Chronic Patients.

San Sebastian• Presentation of the Department of Culture programme:

"Bularretik Mintzora"• Merging with the Biocruces project• Inauguration of the Emergency Room and the Heliport

annualreport20 11 08. - osieec.osakidetza.eus · 155 annualreport2011...

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