Improving Medical Care Service Through Collaborative Networks Watana Navacharoen, M.D. Maharaj Nakorn Chiang Mai Hospital Faculty of Medicine, Chiang Mai U.,Thailand Watana Navacharoen, M.D. Maharaj Nakorn Chiang Mai Hospital Faculty of Medicine, Chiang Mai U.,Thailand 1

Our Work Load 1,000,000 visit / yr 47,000 admission / yr 1,000,000 visit / yr 47,000 admission / yr ProvinceNo. of cases Chiang Mai 89,165 Lamphun 20,852 Chiang Rai 19,393 Phayao 11,134 Lampang 7,360 Mae Hong Son 7,215 Phrae 4,876 Nan 4,702 Tak 3,018 Sukhothai 1,547 Uttaradit 1,518 Kamphaeng Phet 396 Phitsanulok 293 Nakhon Sawan 120 Phetchaboon 112 Pichit 112 Uthai Thani 5 Total171,818 No. of Referred Cases in

Our Service include Population in 17 provinces in the North of Thailand Minority groups - Hill tribe - Migrate people Population in 17 provinces in the North of Thailand Minority groups - Hill tribe - Migrate people Covered population 12 millions 3

Improving Delivery of Service Lean and seamless - One stop service Information technology - Medical information system (SMI) - Barcode & stickers identification - OPD card scanning - IPD card scanning - Prescribing medicine in SMI - Internet consultation - Internet OR setting Lean and seamless - One stop service Information technology - Medical information system (SMI) - Barcode & stickers identification - OPD card scanning - IPD card scanning - Prescribing medicine in SMI - Internet consultation - Internet OR setting 4

Key Indicators of Quality Service Delivery 5

1. Waiting time 6

2. Customer satisfaction 7

3. Customer satisfaction for palliative care 8

4. Pain management 9

Indicator Length of stay Death rate Death rate of acute MI Death rate of stroke Maternal birth2,4202,0131,8571,993 Maternal mortality2310 Life birth2,4632,0581,8742,082 Perinatal death Others clinical indicators 10

Medical Collaborative Networks Problems 1.Too many number of patients requiring medical services 2. Patients did not received appropriate medical care before coming to the hospitals. 3. The lack of community hospitals’ competency treatment 4. Lacking medication and up-to-date monitoring equipment Problems 1.Too many number of patients requiring medical services 2. Patients did not received appropriate medical care before coming to the hospitals. 3. The lack of community hospitals’ competency treatment 4. Lacking medication and up-to-date monitoring equipment 11

Collaborative Networks Acute coronary syndrome network Trauma center Stroke network Campaign against raw pork consumption (Streptococcus Suis infection) Acute coronary syndrome network Trauma center Stroke network Campaign against raw pork consumption (Streptococcus Suis infection) Team setup Education, Training Supplied equipments, medicine Internet referring, SMS, Facsimile Team setup Education, Training Supplied equipments, medicine Internet referring, SMS, Facsimile 12

KPI: AMI fast track admission time Pre40 Post74 Door to needle time Pre70 Post4032 Door to balloon time Pre130 Post Dead rate

Year trimester 2 trimester 3 trimester 4 trimester Response time: Trauma team Response time: Neurosurgery Response time: Orthopedics KPI: Trauma fast track 14

TargetResult rt-PA within 2 hr % Door to drug time min Symptomatic ICH after rt-PA<7%0 (28.5% HF) Patients’ independence at 3 months after rt-PA 50%57.1% Note: rt-PA, recombinant tissue plasminogen activator KPI: Stroke Fast Track 15

Change the Culture Public campaign against raw pork consumption to decrease morbidity and mortality rates from Streptococcus Suis infection Public campaign against raw pork consumption to decrease morbidity and mortality rates from Streptococcus Suis infection Organized 65 campaign activities and message through mass media during past 3 years 16

With strong streamline and seamless collaborative networks cover all hospitals in the north of Thailand With strong streamline and seamless collaborative networks cover all hospitals in the north of Thailand Conclusion “All hospitals in the north is the only one big hospital” “All hospitals in the north is the only one big hospital” 17

Thank you for the prestigious award that will strengthen our conviction to continuously improve the quality of health care for our people. 18