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: sept, 2022
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
haramaya general Hospital cluster 1st Q report prp by HA
 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 Sept 11, 2022 to March 30, 2023 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
Shortage of clinicians Products and services
knowledge
& training of
workforce Shortage of pharmaceutical expenditure
Lack of resource
Absence of Low FTE of GP that spent with patient
Inappropriate payment systems

employee
of Shortage of hospital budget
$$
engagemen Source inefficiency in
t health system our hospital
Inappropriate hospital
size with services Poor communication Poor mgt, Rx and Dx
and poorly managed of disease
patient flow
Unnecessary admission and
unnecessary referrals to specialists
Poor infrastructure
Low bed density

Lack of equipment and Inapproppriate ALS and low BORs

inappropriate use of technology

Environment/technology/ 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
Needs-based assessment and
training; revise remuneration
policies; flexible contracts;
performance-related pay
Improve quality of
Enhance monitoring and clinical
care and decrease medical error,
improve hospital size, improve audit; improve continuity of care
admission/length of stay
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,
knowledge about efficient admission practice
investigations and
equipment
Reform incentive, revenue and
payment structures (e.g. capitation)
Improve use generic drug, rational Improve drug regulation and
quality control; carry out product
use of drugs
testing
improve prescribing guidance,
information, training and develop
active purchasing; reduce
mark-ups, raise public awareness
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
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
Aim Change Balancing
Outcome measure Process measures measures
state ideas
ment
Indicator Numerator Denominator

Indicator Improve worker .

productivity
Improving efficiency of health care system in our

Numerator Improve
quality of care

Denominat Improve
hospital
or products and
services

Data HMIS report,

register,
hospital

Source satisfaction
pation
 P of PDSA
Aim Improving efficiency of health care system in our hospital
S What Process Measure Wher Who How(descriptio When (time table ) Remar
No.
(Change e(ser (responsible n how to deliver k
ideas) vice body) activities Start date End date
area)
1 Improve worker Increase staff motivation, prepare Harama ➢HR, QI team and ➢Attendance, survey Nov 1, 2022 July 30, 2023
appropriate incentive, reward and
productivity appraisal system, prepare
ya SMT and guideline
awareness and training, using work hospital
measurement and time system

2 Improve quality Develop and implement evidence Harama ❖QI team, SMT ❖CA, HMIS report, Nov 1, 2022 July 30, 2023
based clinical care guideline, ❖# Beds, #modified
of care undertake more clinical audits,
ya
monitoring , improve hospital room/unit
admission/length of stay,
modifying hospital size,
✓Pharm Dep’t, ✓Value of purchased drugs,
3 Improve hospital Improve pharmaceutical expenditure,
prepare appropriate payment system, stocked drugs, drugs
Nov 1, 2022 July 30, 2023
products and improve, improve use of Rx and Dx
Finance, QI team,
supplied, consumption of
services in imaging and Lab, improve use in SMT specific drug and Share of
generic drug and rational drug use generics in market,
4
P of PDSA…
Measurement Plan /data collection plan
AIM/Out Come Data source Data collection Time Responsible
Indicator (Where) method (how) (When) for
Improve efficiency Haramaya G HMIS report, Nov 1, 2022, to QI team, SMT
of health care system July 30, 2023
Hospital Clinical Audit,
in hospital survey, FGD,
observation,
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)