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Increasing Collaboration in Health
Services Management and Delivery
in the Dutch-Caribbean
Prof. dr. A.J. Duits
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NOBEL PRIZE LITERATURE 2016 24051941
1964
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Red Cross Blood Bank Foundation Bonaire 251016
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PROGRESSION FREE:
83.2% vs 60.1%
After 1 year
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Zika Infection May Bring Future Immunity: Study
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Red Cross Blood Bank Foundation Bonaire 251016
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Red Cross Blood Bank Foundation Bonaire 251016 Red Cross Blood Bank Foundation ISBT 050916
Approved by the Inspectorate of Health
01-02-2016: 800 platelet units pooled
(pools of 4).
• Curacao
• Aruba
• Sint Maarten
• Bonaire
Hemovigilance:
• No adverse effects reported
• Neonatal/UV treatment
• Pediatric Tx
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Dutch Caribbean
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BES
CAS
AFTER 10-10-2010
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Aruba: 100.000
Sint Maarten: 40.000
Curacao: 150.000
Bonaire: 17.000
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ZIEKENHUIS:
FACILITEREND
OFICINA’S
WETGEVING
HONORARIUM:
FEEFORSERVICE
ONDERNEMERSRISICO
HUISARTSEN
ZIEKENHUIS:
GMSB/WERKGEVER
OFICINA’S
WETGEVING+BIG
+DECLARATIEWET
HONORARIUM:
BUDGET
GEEN
ONDERNEMERSRISICO
PRIMAIREENSECUNDAIREARBEIDSVOORWAARDEN
WERKOMSTANDIGHEDENENINFRASTRUCTUUR
MEDISCHESPECIALISTEN
HNO
WET
FINAN
CIEN
FTE
AGE
WORK
GMN
CHV
VMSC
MS
SEHOS
SVB
CBV
PAT
USONA
V
B
H
C
V
B
H
C
ADVENT
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Increasing Collaboration in Health
Services Management and Delivery
in the Dutch-Caribbean
Sounds of Success
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Red Cross Blood Bank Foundation Bonaire 251016
RED CROSS BLOOD BANK FOUNDATION
DONORS: 100% VOLUNTARY NON-REMUNERATED
BLOOD PRODUCTS: 100% LEUKOREDUCED
IDT: SEROLOGY (HIV, HCV, HTLV, SYPH, HBV)
NAT (HIV,HCV,HBV) WNV
QUALITY: GMP (EU/AABB)
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SUSTAINABLE SMALL SCALE BLOOD BANKS
COMPLYING WITH EU QUALITY NORMS
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Dutch Caribbean labile blood provision
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PAHO TRAINING GEORGETOWN GUYANA 19-21/09/2016
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PREVENTION OF TRANSMISSION
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CHARACTERISTICS OF HIV INFECTED POPULATION IN CURAÇAO
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"The HIV-1 Epidemic Amongst Men Having Sex
With Men in the Netherlands is Dispersed
Amongst a Large Number of Self-sustaining and
Persistent Transmission Clusters: A Combined
Mathematical and Phylogenetic Study on
Observational Data" (PMEDICINE-
D-14-01427R3) by Daniela Bezemer, Ph.D.; Anne Cori; Oliver Ratmann; Ard van Sighem; Gonneke Hermanides; Bas E. Dutilh; Luuk Gras; Nuno
Rodrigues Faria; Rob van den Hengel; Ashley Duits; Peter Reiss; Frank de Wolf; Christophe Fraser
Accepted for publication
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Red Cross Blood Bank Foundation Bonaire 251016
HIV:
• SHM (Netherlands)
• SRKB/SEHOS (Curacao)
• FMD (Bonaire)
Treating physicians/infectiologists:
- SXM/Aruba/Bonaire/Curacao
- DATA sharing!
- Training personnel
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Red Cross Blood Bank Foundation Bonaire 251016
Neurosurgery (Aruba and Curacao)
Intensive care (Bonaire and Aruba)
NICU (Curacao, Bonaire and Aruba)
Oncology (Curacao, Bonaire, Sint Maarten)
Rheumatology (Curacao, Bonaire)
Infectious Diseases (Curacao, Aruba, Bonaire)
Public Health (Curacao, Bonaire)
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GLOBAL HEALTH: LOCAL PUBLIC HEALTH
• DISEASES
• MULTI-CULTURAL SOCIETY
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Infectious disease monitoring
Globalization has intensified cross-border health threats, leading to a situation of health interdependence — the
notion that no nation or organization is able to address
single-handedly the health threats it face but instead
must rely to some degree on others to mount an effective
response.
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GP medical center/Surveillance center
INNOVATIVE EARLY WARNING SYSTEM
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Education
• Residents
• Interns
• Nurses
• Medical
Specialists
• Medical
professionals
TEACHING HOSPITAL UMCG AFFILIATE
Curacao, Aruba,
Bonaire,
Sint Maarten
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Increasing Collaboration in Health
Services Management and Delivery
in the Dutch-Caribbean
Under construction/design
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HEALTHCARE SERVICES
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CURAÇAO HEALTH CARE SYSTEM
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BES
CAS
The Hague
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BEFORE 10-10-2010:
• Healthcare: island
responsibility
AFTER 10-10-2010:
• CAS: Healthcare: island
responsibility
• BES: Healthcare: Holland responsibility
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Red Cross Blood Bank Foundation Bonaire 251016
CARIBBEAN PERSPECTIVE
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ESSENTIAL = TRUST
• OPEN COMMUNICATION
• SHARING RELEVANT DATA/INFORMATION
• SHARED VISION
• LESSONS LEARNED SUCCESSFULL COLLABORATIONS
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Transport knowledge and skills
Not patients!
Redundancy and backup
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Shared
infrastructure:
Volume, quality
and costs
• Dedicated
facilities
• Single Island
Hospital
location
EP
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FACILITIES:
• Redundant • Cooperation in teams!
• Patient population
• Costs
• Volume
• Availability
CP
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CP/EP
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MYTHS DEBUNKED
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Relationship between volume and quality in
healthcare
2012
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Policy of collaborative efforts should focus on
quality optimization of organization and
delivery of healthcare and not focus
unilaterally on a so-called sufficient quantity of
patients
Increasing Collaboration in Health Services
Management and Delivery in the Dutch-Caribbean
For high-risk complicated surgical
interventions volume-quality rate influenced
by:
• surgical expertise
• Support by the hospital organization
• Multidisciplinary collaboration
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Red Cross Blood Bank Foundation Bonaire 251016
Increasing Collaboration in Health Services
Management and Delivery in the Dutch-Caribbean
Other factors:
• Diagnostic and supporting service teams
• Staff composition
• Information system supporting pre- and postoperative processes
Other crucial factor:
* Obtaining and maintaining expertise of medical professionals
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Volume-quality debate:
• Different evaluation criteria from different perspectives
• Society perspective
• Organizational perspective
• Professional’ perspective
• Patient’ perspective
Increasing Collaboration in Health Services
Management and Delivery in the Dutch-Caribbean
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Society perspective:
- Volume initiatives contribute to quality, accessibility
and affordability healthcare
Organizational perspective:
- Efficient organization of healthcare, strategic
positioning, collaboration and competition
Professional perspective:
- Sufficient expertise
- Multidisciplinary collaboration
- Career development
Patient perspective:
- Individual results
- Freedom of choice
- Geographical accessible care
Increasing Collaboration in Health Services
Management and Delivery in the Dutch-Caribbean
LEAST DISCUSSED!
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Red Cross Blood Bank Foundation Bonaire 251016
Increasing Collaboration in Health Services
Management and Delivery in the Dutch-Caribbean
Results: hernia, obstetrics, bariatric surgery, breast cancer and
hemophilia
*organizational and professional perspective
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YOUR MONEY OR
YOUR LIFE
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ZZ
MK
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COLLABORATION IN HEALTH SERVICES
• SHARED RESPONSIBILITY • SHARED OPPORTUNITY
• SCIENTISTS/PROFESSIONALS/INSTITUTES
COLLABORATE
• GOVERNMENTS/ SHOULD FURTHER FACILITATE
(IMPROVEMENT)
4 perspectives:
• Society
• Organizational
• Professional
• Patient
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HEALTHY LIFESTYLE: CURACAO & BONAIRE
INFECTIOUS DISEASES:
CURACAO & ARUBA
CLINICAL GENETICS:
CURACAO & ARUBA
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EPO: 50x more expensive!
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YOUR MONEY OR
YOUR LIFE
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Red Cross Blood Bank Foundation Bonaire 251016
Increasing Collaboration in Health
Services Management and Delivery
in the Dutch-Caribbean
Prof. dr. A.J. Duits