Rene Domingo, a professor from the Asian Institute of Management in the Philippines, authored ‘Quality Means Survival’ and served as a technical consultant with the World Health Organization – Western Pacific Region on hospital management. He has assisted hospitals in improving customer service, patient flow and patient safety.
Hospital Insider spoke to Professor Domingo on the major challenges in hospitals across the Asia Pacific and the importance of improving efficiency and productivity for better patient outcomes.
What are the major hospital challenges that you see in Asia Pacific?
The biggest challenge for hospitals, especially those from developing countries in Asia, is overcrowding in public hospitals. This is due to the acute shortage of beds and staff, as well as the rising costs of healthcare that is shifting demand from private to public hospitals, which are more affordable.
Public hospitals in the region find it difficult to expand and upgrade to meet the increasing demand due to limited financial resources and access to funds.
Overcrowding also leads to poorer patient outcomes and a higher risk of medical errors, which will eventually pose additional challenges for these hospitals.
What do you think can be done to address these and improve patient outcomes?
Improving the productivity of doctors, nurses and other healthcare professionals will allow them to serve more patients and address the issue of manpower shortages. The demand for labour will decrease; this will help hospitals cut costs as manpower accounts for 60% of their operating costs. The nursing staff, the largest group of employees, accounts for 25.5% of hospital expenditure.
Cutting inefficiencies and wastefulness from hospital systems and procedures – for instance, patient flow management, supply management and facility management – will also greatly reduce operating costs.
How can international guidelines, benchmarketing, technology and other innovations play a role?
Hospitals can use technologies including e-health, telemedicine, EMRs and other electronic solutions to boost the capacity and reach of their limited resources – skilled manpower in particular. By replacing manual tasks such as documentation and transport with electronic means, medical staff can spend more time on direct patient care.
Hospitals can also benchmark with the 4:1 world class standard ratio of direct labour to indirect labour. The principle is that the higher the percentage of manpower resources are devoted to direct labour or direct patient care in the case of a hospital, the higher its operating efficiency and service effectiveness.
What is one tool or technique that particularly interests you?
To address the problems of overcrowding, long patient waiting times and high costs, I believe that the lean approach, as practiced by Toyota, can help hospitals spot and reduce wastefulness. They will be able to improve internal efficiencies and capacities to serve better and serve more patients.
Hospitals can also adapt and adopt the lean technique of mistake-proofing, or pokayoke, to prevent and stop medical and medication errors.
Is there any hospital practice you would like to see featured during this year’s Hospital Management Asia?
At the upcoming Hospital Management Asia, I shall be speaking on “How Non-Value Added Work Affects the Productivity of Healthcare Professionals”. I will share how hospitals can improve the efficiency and capacity of their limited human resources by identifying and eliminating all forms of waste (“muda”) or Non Value Added work using the lean approach.
What do you think will be the ‘next big thing’ in healthcare?
Smart technologies, IoTs and other real-time tracking technologies to monitor efficiency and outcomes will help hospital managers improve performance, patient safety, and patient satisfaction.