modernisation of the main public health institution of catalonia catalan health institute (ics)
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Modernisation of the main public health institution of Catalonia
Catalan Health Institute (ICS)
Pág. 2
Institut Catalàde la Salut
ICS in figures
The ICS
Organisation Chart
Health Centres
Health Care, teaching and research
Human resources: distribution
Budget 2004
Health-care activity (2004)
Waiting lists (2004)
Quality
Pharmacy
Administration work
Communication
Infrastructures
The ICS
Organisation Chart
Health Centres
Health Care, teaching and research
Human resources: distribution
Budget 2004
Health-care activity (2004)
Waiting lists (2004)
Quality
Pharmacy
Administration work
Communication
Infrastructures
Primary Care
Hospital Care
Human Resources
Legal Assessment
Communication Office
Economy, Organisation and Finance
Investments 2005
Primary Care
Hospital Care
Human Resources
Legal Assessment
Communication Office
Economy, Organisation and Finance
Investments 2005
Improvement Actions
Diagnosis Organisation
Background to the Reform
Driving change
Modernisation Strategy
Law of the ICS
Diagnosis Organisation
Background to the Reform
Driving change
Modernisation Strategy
Law of the ICS
ICS challenges
Modernisation of the mainpublic health institution of Catalonia
Pág. 3
Institut Catalàde la Salut
The ICS is the main public institution in Catalonia. More than 35,000 professionals carry out more than 50 million health-care interventions at its 8 hospitals and 271 Health Centres.
The ICS is the main public institution in Catalonia. More than 35,000 professionals carry out more than 50 million health-care interventions at its 8 hospitals and 271 Health Centres.
The ICS reports to the Department of Health. Its budget is approved on a yearly basis by the Parliament of Catalonia.
It works to standardise the contractual relationship between the CatSalut and the ICS and the relationship between the CatSalut and the other health-care centres of the XHUP (Public Hospital Network).
The ICS reports to the Department of Health. Its budget is approved on a yearly basis by the Parliament of Catalonia.
It works to standardise the contractual relationship between the CatSalut and the ICS and the relationship between the CatSalut and the other health-care centres of the XHUP (Public Hospital Network).
Improvement Actions ICS challengesICS in figures
Other CatSalut providers
Hiring
Pág. 4
Institut Catalàde la Salut
Human Resource Management
Economic, Organisational and Financial Management
Infrastructure and Technical Services Management
Communication Office
And User Service
Legal Assessment
Technical
Office
Hospital Care Division
8 hospital managements
Primary Care Division
8 Primary Care level managements
30 Primary Care services
Improvement Actions ICS challengesICS in figures
ORGANISATIONAL CHART
Managing Director
Pág. 5
Institut Catalàde la Salut
Primary Care areas Service units
+
+
Pharmacy U.
Laboratories
Care to 83% of the population of Catalonia.
5,488,092 of the assigned population (equal to that of the Community of Madrid).
9 call centers with a monthly average of 240,000 calls.
Action Plan in the Primary Care Centres with the greatest demand, reducing excessive health pressure, and including 133 professionals and 62 new centres, in 2004.
8
464 ServiceUnits
30 Primary CareServices
8 Areas
Improvement ActionsICS in figures
1. Lleida
2. Tarragona- Terres de l’Ebre
3. The city of Barcelona
4. Girona
5. Costa de Ponent
6. Barcelonès nord i Maresme
7. Centre
HEALTH CENTRES: PRIMARY CARE
ICS challenges
Pág. 6
Institut Catalàde la Salut
8 Hospitals
32% of the beds of the Public Hospital Network (XHUP)
Improvement Actions ICS challengesICS in figures
Beds Operating theatres
Officesquery
Outpatient
H. Viladecans 104 4 23
H. Verge de la Cinta 222 6 54
H. U. Arnau de Vilanova 432 11 53
H. U. Joan XXIII 325 8 61
H. U. Dr. Josep Trueta 372 11 50
H. U. Germans Trias i Pujol
613 15 63
H. U. Bellvitge 792 27 119
H. U. Vall d'Hebron 1,265 44 213
TOTAL 4,125 126 636
County H.
Reference H.Reference H.Reference H.Reference H.High-technology H.High-technology H.High-technology H.
HEALTH CENTRES: HOSPITAL CARE
Pág. 7
Institut Catalàde la Salut
Undergraduate and post-Graduate training supplies 56% of the medicine graduates and 66% of the specialists trained in Catalonia.
There are 39 professors of medicine.
More than 1,500 MIR (residents) are trained in ICS centres.
More than 4,300 under-graduates:
2,300 in medicine.2,000 in nursing.
TEACHING
It provides more than 40% of the scientific output of Catalonia.
Its centres are among the most productive in Spain (documents can be cited):
no. 2 H. Vall de Hebron.no. 3 H. Bellvitge.no. 13 H. Trias i Pujol.
Its research publications have great scientific value (total impact factor of 2.8 for 2004).
More than 303 research projects (2004).
RESEARCH
It has 80% of the primary care centres.
It provides 32% of total hospitalisation beds plus 50% of tertiary beds.
It is the main transplant performer (2004):
100% Lung.46% Kidney.27% Heart.62% Liver.
CARE
It is the main health-care supplier of the CatSalut, and its centres, renowned for their quality, are among the most scientifically productive in Spain. It provides a large part of the medical and nursing graduates trained in Catalonia.
The ICS is a pioneer in its three basic lines of activity: Health Care, Research and Teaching.
Improvement Actions ICS challengesICS in figures
HEALTH CARE, TEACHING AND RESEARCH
Pág. 8
Institut Catalàde la Salut
Improvement Actions ICS challengesICS in figures
• Hospital Universitari Germans Trias i Pujol AIDS patient care Unit.
• Hospital Universitari Vall de Hebron Burns Unit and Lung Transplant Unit: both are reference hospitals for the whole of Catalonia.
• Hospital Universitari Vall de Hebron Digestive Apparatus Service: Crohn's
chronic digestive disease that affects 20 out of every 100,000 citizens of
Catalonia.
• Hospital Universitari Vall de Hebron Fetal Surgery and Paediatric Surgery
Unit.
• Hospital Universitari Bellvitge Heart Surgery with post-heart surgery
reanimation unit.
• Hospital Universitari Bellvitge Anorexia and Bulimia Unit.
• Hospital Universitari Bellvitge Liver Transplant Programme.
Groundbreaking in Spain since 1984. Facilities:
• 20 morning operating theatres
• 4 afternoon operating theatres
• One-day hospitalisation unit (Major Ambulatory
Surgery).
REFERENCE SERVICES IN THE HOSPITAL CENTRES
Pág. 9
Institut Catalàde la Salut
PRIMARY CARE CENTRESHOSPITAL BEDS
Improvement Actions ICS challengesICS in figures
60
35
15
4032
269
815
0
50
100
150
200
250
300
2,5%
32,8%
64,7%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
Basic General Reference High technology
EAP: Primary Care Teams.
Other services (emergencies, occupational health)
Rehabilitation.
PASSIR: Sexual and Reproductive Health Care.
PADES: Home Care Programme, Support Teams.
Other specialities.
SPDI: Imaging Diagnosis Services.
Laboratories.
HEALTH-CARE OFFER
Pág. 10
Institut Catalàde la Salut
WORK FORCE BY TYPE OF CONTRACT 2004
WORK FORCE BY CARE AREA 2004
Improvement Actions ICS challengesICS in figures
The ICS has more than 35,000 professionals
MIR: Interns
H. Viladecans 432H. Verge de la Cinta 683H. U. Arnau de Vilanova 1.247H. U. Joan XXIII 1.159
H. U. Dr.Josep Trueta 1.263H. U. Germans Trias i Pujol 2.039H. U. Bellvitge 3.289H. U. Vall d'Hebron 6.252Total 16.364
Corporate C2%
Hospital care46%
Primary C52%
PROFESSIONAL TEAM
Sanitary43%
Civil servants2%
Non health25%
Doctors25%
Work0%
MIR / LLIR5%
Lleida 1.115
Girona 1.498
Tarragona-Terres de l'Ebre 1.747
Barcelonès Nord i Maresme 2.147
Costa de Ponent 3.856
Centre 3.567
City of Barcelona 4.643
Total 18.573
Pág. 11
Institut Catalàde la Salut
Improvement Actions ICS challengesICS in figures
PROFESSIONAL CAREER: Retributive model for medical personnel, nursing and other voluntary access
diploma holders.
Instruments for identifying and stimulating professional careers in line with the objectives of the ICS.
Five-tier structure according to years of employment and professional merits, measured through health-care activity, training, commitment, teaching and research.
Results 2004:
MANAGEMENT BY OBJECTIVES: Variable productivity bonus for accomplishing pre-established goals measured
using standard indicators.
The professional's individual goals are linked to the organisation they
guarantee organisational consistency.
• Median accomplishment of 80.9% in primary care (3,431 doctors).• Median accomplishment of 79.0% in hospitals (2,013 doctors).
MODERN MANAGEMENT OF HUMAN RESOURCES
Hospitals PrimaryDoctors 758 829 1.587 DUI (Nursing) 2.261 1.904 4.165
3.019 2.733
Pág. 12
Institut Catalàde la Salut
2,022
Data in million €
Total ICS
Improvement Actions ICS challengesICS in figures
Million €
Primary Care
Hospital Care
Corporate Centre
BUDGET 2004
HOSPITAL CARE: Distribution by chapters
58.1%
40.4%
1.4%
0.03%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1
Chap. VIIIChap. VIChap. IIChap. I
PRIMARY CARE: Distribution by chapters
84.4%
14.7%
0.8%
0.04%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1
53.3
863.7
1,105.9
Pág. 13
Institut Catalàde la Salut
Improvement Actions ICS challengesICS in figures
EAP: Primary Care Team.CMA: Major Ambulatory Surgery.
HOSPITAL CARE
PRIMARY CARE
HEALTH-CARE ACTIVITY
%v2003
174,270 2.0%
32,814 3.0%
207,084 2.2%
51,105 1.6%
21,720 2.7%
105,639 2.2%
805,623 -0.6%
60.90% 0.00%
800,636 4.2%
Index of repetition 3.09 -1.60%
2,111,700 2.9%
154,855 10.2%
134,360
Hospital Care 2004
Total Outpatient
Day Hospital
Pressure emergencies
First visits
Conventional Discharges
CMA Discharges
Scheduled surgery
Emergency Surgery
Total Discharges
Total surgical activity
Emergencies
Hosp. Diagnostic tests
%v2003
18,477,209 9.1%
3,489,335 7.5%
10,613,775 1.2%
32,854,132 6.2%
248,980 -45.6%
4,686 -71.6%
226,539 -60.4%
480,205 -54.1%
36,586,567
1,006,525
Lab tests ICS centres 17,724,102 6.8%
Radio diagnostic explorations 1,396,359 -2.3%
19,120,461
Primary Care 2004
Specialised Visits extrahosp.
Total visits EAP
Total visits home EAP
Nursing visit
Home Paediatrics
Diagnostic explorations
Home Nursing
Total visits EAP
Paediatric Visit
Family Medicine Visit
Home Family Medicine
Pág. 14
Institut Catalàde la Salut
HOSPITAL CARE
PRIMARY CARE
ICS in figures
Surgery waiting list for the 14 procedures monitored by the CatSalut.
Delay, defined as 20% of free spaces by specialist agenda
Improvement Actions ICS challenges
WAITING LISTS
n (2004) % variation vs 2003Patients on waiting list 13,720 -10.8%
Surgery performed on the waiting list 28,216 -0.6%
Resolution time (months) 5.8 -10.8%
n (2004) % variation vs 2003
Patients on waiting list 148,683 -0.6%
Delay (days) 44 -5.0%
Pág. 15
Institut Catalàde la Salut
Improvement Actions ICS challengesICS in figures
HIGH COST PROCEDURES
26
7
52
4
3,7
53
2,9
71
7,3
64
31
6
61
4
3,8
77
3,1
71
8,0
30
-
1,500
3,000
4,500
6,000
7,500
9,000
Heart surgery
Orthopaedic surgery
Haemodynamic Vascular surgery
Others (Implants cochlear, LCR
valves,
Neurotransmitters)
Nu
mb
er
of
hig
h-c
ost
pro
ced
ure
s
2003
2004
2003 2004 N %
Heart surgery 2,971 3,171 200 6.7% 781,990 € Orthopaedic surgery 3,753 3,877 124 3.3% 392,523 € Haemodynamics 7,364 8,030 666 9.0% 1,029,370 € Vascular Surgery 524 614 90 17.2% 231,399 €
Others (Implants cochlear, LCR valves Neurotransmitters) 267 316 49 18.4% 280,240 €
14,879 16,008 1,129 10% 2,715,522 €
Difference 2004 vs 2003Increase
expense 2004
Pág. 16
Institut Catalàde la Salut
HOSPITAL DISCHARGES 1996-2004
GROSS MEAN STAY 1996-2004PERCENTAGE READMISSIONS 1996-2004
Improvement Actions ICS challengesICS in figures
-8.4%
6.5%
EFFICIENCY OF HEALTH-CARE ACTIVITY
148,592
152,608
156,624
160,640
164,656
168,672
172,688
176,704
96 97 98 99 00 03 04
11.1
9.4
4.61 4.3
3.08
0
2
4
6
8
10
12
96 00 02 03 04
8.98.7 8.8 8.7 8.6
8.388.07
7.39
5
6
7
8
9
10
96 97 98 99 00 02 03 04
days
Pág. 17
Institut Catalàde la Salut
Improvement Actions ICS challengesICS in figures
Rate of standard operation
% replacement of major ambulatory surgery
% of emergency readmissions in the same GRD (in less than 30 days)
0.958
63.9%
1.2 %
The 10 most frequent GRD accumulate 20.4% of the total of the
of ICS hospital discharges in 2004
CASE MIX: CASE MIX
GRD Disch. % Disch % accum. disch. Relative weight
373 Vaginal partum without complication diagnosis 9494 4.7% 4.65% 0.393 039 Crystalline pg with ¢ without vitrectomy 9103 4.5% 9.11% 0.594
088 Chronic obstructive pulmonary disease 3832 1.9% 10.99% 0.903209 Pq lower extremity, reinsertions/replace. major articul. 3663 1.8% 12.78% 2.078127 Heart failure and shock 3198 1.6% 14.35% 1.004359 Pq uterus/adnexa, non-malign, w/c 2767 1.4% 15.70% 0.835014 Intracranial haemorrhage and ictus with infarct 2737 1.3% 17.04% 1.294187 Tooth extractions/repairs 2597 1.3% 18.32% 0.867035 Another nervous system disorders w/c 2135 1.0% 19.36% 0.639371 Caesarean section w/c 2131 1.0% 20.41% 0.675
Total disch. 204.132 1.183
Pág. 18
Institut Catalàde la Salut
Improvement Actions ICS challengesICS in figures
% Increase expenditure Catalonia
% Increase expenditure Spain
CONTROL OF PHARMACEUTICAL EXPENDITURE
10.57
7.527.93
9.89
12.15
6.4
10.69
7.49
5.64
9.54
12.24
4.6
4
5
6
7
8
9
10
11
12
13
1999 2000 2001 2002 2003 2004
Pág. 19
Institut Catalàde la Salut
0
2
4
6
8
10
12
S. A
ndalu
z
Cata
lán
S. V
ale
ncia
no
S. G
allego
S. N
avarrés
S.V
asco
S. C
anario
Aragón
Astu
ria
s
Bale
ares
Canta
bria
Castilla- L
a M
ancha
Castilla-León
Extr
em
adura
Madrid
Murcia
La R
ioja
Ceuta
Melilla
4.6%
6.75%
Catalonia is 2.15 per cent below the national average (2004)
0
2
4
6
8
10
12
02/03 03/04
10.96%
5.43%
4.73%
10.16% (*)
(*) Theoretical growth without the effect of the Reference Prices
The ICS has generated savings of 63.5 million € corresponding to the Order of Reference Prices. Real savings have been higher than expected.
Improvement Actions ICS challengesICS in figures
PHARMACEUTICAL EXPENDITURE BY AA (AUTONOMOUS COMMUNITIES)
Pág. 20
Institut Catalàde la Salut
LEGAL ASSESSMENT
8,000 formalities
Legal defence, reports, hiring and contracting, agreements...
265,000 formalities
HUMAN RESOURCE AREA
36,000 contracts
Recorded in the primary care division in the centres
SHORT-TERM CONTRACTS
Personnel management (licences,
authorisation,...)
Area of development (MBO, claims,...)
Occupational hazards (queries, planning,...)
196,000 formalities
50,000 formalities
30,000 formalities
Improvement Actions ICS challengesICS in figures
MBO: Management by objectives.
ADMINISTRATIVE PROCEDURES
Pág. 21
Institut Catalàde la Salut
The ICS appeared 7,159 times in the mass media in 2004
Improvement Actions ICS challengesICS in figures
MEDIA IMPACT 2004
ASSESSMENT OF IMPACT 2004
MASS MEDIA
763 1.079
5.317
-
1.000
2.000
3.000
4.000
5.000
6.000
CorporateCentre
Primary Care HospitalCare
Negative15%
Positive85%
Pág. 22
Institut Catalàde la Salut
The lack of investment has led to a major decapitalisation in the ICS's infrastructure.
Over the last few years a major investment deficit has accumulated: the minimal annual investment need was 63 million € (calculated from 4% of the updated construction value), while average investment between 1991 and 2003 was 41 million €.
The calculation of needs to recover from the historic decapitalisation for the 2005-
2019 period stands at an annual investment rate of 107 million €.
ICS challengesICS in figures
In million euros
Improvement Actions
INFRASTRUCTURES
Equipment 326Installations 395Work 881Total 1.602
Period 2005-2019
Equipment 22Installations 26Work 59Total 107
Annual average
0
10
20
30
40
50
60
70
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Mill
ion
€
Interventions Need inves Mean inves
Pág. 23
Institut Catalàde la Salut
Improvement in overall satisfaction with the Primary Care Teams of the ICS. Score of 7,84 out of 10 in 2004 (outperforming the 7.51 of 2003).
Three (3) out of every 4 Catalans perceived care as excellent, good or very good.
88,6% of the population has been seen a health professional at least once this year.
The rating of the feeling of being in good hands was 8.06. Satisfaction with medical care is 8.19, with care for disease standing at 8.25
and satisfaction with installations at 8.25. 92% of users would recommend their centre to friends.
ICS in figures Improvement Actions ICS challenges
USER SATISFACTION (Primary Care)
Does your centre solve your normal health(disease) problems?
5.2%
7.9%
25.98%58.8%
2.1%
Never Rarely Often Alm. always Always
Pág. 24
Institut Catalàde la Salut
Improvement Actions
PRIMARY CARE DIVISION
ICS in figures
• Accessibility:
• Opening of new services that will facilitate access by citizens to the system:
• Telemedicine services: Primary Care Area of the Pyrenees.
• Care Services to Travellers in Osona and El Baix Llobregat.
• Rehabilitation service in Viladecans and Tarragona.
• Health Programme and the School: provide health care in schools.
• Improved ongoing and emergency care:
• Creation of 5 Primary Care Emergency Centres: Cornellà, Matarò, Manso, Cerdanyola and Lleida.
• Improvement of emergency services: CAP Sant Félix, CAP Guell, Alta Ribagorça, Terres de l’Ebre and Hospitalet.
• Pilot test: emergency home care vehicles.
• Coordination devices with reference hospitals.
• New equipment for ongoing care centres.
• Call centres: Streamlining of resources through a single telephone number
for scheduling all visits.
Improvement Actions ICS challenges
Pág. 25
Institut Catalàde la Salut
ICS in figures
• Health-care quality:
• Increase problem-solving capacity of health centres:
• Give all health centres: spirometers and pulse meters, defibrillators, Doppler and non-mydriatic cameras.
• Extension of OAT control in primary CARE.
• Training:
• By e-learning: More than 8,000 workers and a decentralised training offer.
• Management Training.
• Increased diagnostic capacity:
• New radiology, CT and ultrasound equipment: Osona, Hospitalet, Vilanova i la Geltrú, Gavà, Nou Barris, Granollers and CAP Manso.
• Comfort and safety:
• Air-conditioning of health centres:
• All health centres completely air-conditioned.
• Environmental audits:
• European environmental certification (EMAS).
Improvement Actions
PRIMARY CARE DIVISION
ICS challenges
Pág. 26
Institut Catalàde la Salut
ICS challengesICS in figures
• Accessibility:
• Project for the improvement of emergency care:
• Professionalisation of the classification and selection of emergencies.
• More emergency health-care professionals: 32 new arrivals.
• Project for computerised patient reception and electronic medicine prescription.
• PISA Project: Prevention of emergency department crowding in the winter.
• Cancer care programme:
• Implementation of quick-diagnosis circuits.
• Daytime cancer consultation.
• New oncology service and linear accelerator in H.Arnau de Vilanova.
• Waiting lists:
• New integrated management plans.
• Improved information systems and circuits.
• Project to reduce knee replacement and heart surgery waiting time.
Improvement Actions
HOSPITAL CARE DIVISION
Pág. 27
Institut Catalàde la Salut
ICS challengesICS in figures
• Health-care quality:
• Replanning of services:
• Critical and semi critical hospital patients: Germans Trias i Pujol, Josep Trueta, Viladecans and Arnau de Vilanova.
• Gynaecology, obstetrics and paediatric Hospitals: Arnau de Vilanova and Josep Trueta.
• Promote alternatives to hospitalisation:
• Major Ambulatory Surgery.
• Day Hospital.
• Unit for integrated patient support throughout the health-care process.
• Collaboration between hospitals:
• Hospital Vall de Hebron/Arnau de Vilanova: oncology and neonatology.
• Hospital Josep Trueta/Germans Trias i Pujol: heart surgery.
• Genetic and molecular medicine service (H. Vall de Hebron) and acute psychiatry
care in collaboration with CAP San Rafael.
• High-cost and highly-complex procedures and emergency conditions 1 million €
earmarked to increase coronary stents in the following Hospitals: Germans Trias i
Pujol, Bellvitge and Vall de Hebron.
Improvement Actions
HOSPITAL CARE DIVISION
Pág. 28
Institut Catalàde la Salut
• Implementation of the “Framework Statute” Law of statutory personnel:
• Establishment of maximum number of working days and planning of
work time.
• Determination of professional categories and their functional
content.
• Reform of the primary care contingency staff from 2.5 to 6 hours,
affecting:
• Social action funds (additional non-economic resource funds to
improve the working conditions of statutory personnel: nurseries,
food)
• New regulation of permission and licences adapted to the Framework
Statute (for studying, marriage, leaves of absence...)
• 460 GPs.
• 180 Nursing Staff.
• 120 Paediatricians.
• 45 Midwives.
ICS challengesICS in figures Improvement Actions
HUMAN RESOURCE MANAGEMENT
Pág. 29
Institut Catalàde la Salut
• Completion of the implementation of the Agreement on working
conditions of 29 October, 2002; improved development of MBO
(management by Objectives) and of professional career process:
• 2,734 professionals may be included in the professional career levels I, II,
III.
• 4,138 professionals may be included in professional career level IV.
• Undertake recruitment processes to stabilise the workforce of the ICS
and implement policies that promote the employment of workers with
disabilities.
• Design and implementation of a human resource information system for
the whole ICS, complementing the existing personnel management
system.
• Implement an occupational hazard prevention plan and continue with
work already done in the area of psychosocial risk (physical and psychic
aggressions, mobbing).
ICS challengesICS in figures Improvement Actions
HUMAN RESOURCE MANAGEMENT
Pág. 30
Institut Catalàde la Salut
• Improvement of Information systems, expanding the SAP project to the
economic and financial levels of management and planning. The
medium-term objective is to implement the SAP project in the
management of ICS hospital patients.
• Rendering of logistics and warehousing services in primary care via a
single company: Logaritme. The supply, storage and distribution of
consumable material requires an ideal location, with modern,
computerised and automated structures to leverage efficiency.
• Single Call Centre for all the citizens of Catalonia.
• Increase the rendering of the aggregated purchase of intermediate
products (complementary tests). Move towards the ICS centres taking
over all intermediate products.
• 86.9% of the remaining tests will be allocated by calls for tenders,
generating savings of 3.6%.
• 13.5% of tests undertaken are expected to be taken over by ICS
centres.
ICS in figures
ECONOMIC AND FINANCIAL MANAGEMENT
Improvement Actions ICS challenges
Pág. 31
Institut Catalàde la Salut
ICS challenges
• Implementation of solar energy for the sanitary hot water network
(ACS).
• Implementation of phase II of air-conditioning in primary centres.
• Environmental management project (EMAS) in three ICS hospitals and
in 30 Primary Care Centres (CAP).
• Implementation of the first phase of the electro medical equipment
plan.
• Preparation of guides for responsibility in destruction of confidential
information and protocols to analyse the critical areas of hospitals.
• Promote global and homogeneous inventorying of all electro medical
equipment in ICS centres to:
• Ascertain the value of its assets
• Ascertain the average service life of the equipment.
• Pre-empt electro medical equipment replacement needs.
INFRASTRUCTURE AND TECHNICAL SERVICES MANAGEMENT
Improvement ActionsICS in figures
301 Primary Care Centers: 473.318 m2
8 hospitals: 593.727 m2
Pág. 32
Institut Catalàde la Salut
• Maintain the levels of activity recorded in 2004 and optimise resources
and results
• Approval of the Law of the ICS and the decrees submitted in the
course of 2004:
• Develop the Insurance Brokerage function for the asset liability policy.
• Extension of Legal Assessment in Tarragona and Lleida (new offices).
• Install a new “on-line” data base of Legal Assessment in Girona,
Tarragona and Lleida: Achieve the paperless office.
• Reorganisation of Legal Assessment: prioritising by-topic/subject
specialisation of lawyers.
• Decree for the Modernisation of the ICS (along with HR).
• Decree regulating organisations that participate in hospital centres.
• Decree on prevention of and action against aggressions.
ICS challenges
LEGAL ASSESSMENT
ICS in figures Improvement Actions
Pág. 33
Institut Catalàde la Salut
• Corporate web of the ICS
• Intranet Portal
• Harmonisation of contents, webs and publications of the ICS and Health.
Hosting of webs in the domain of the Autonomous Government of Catalonia.
• Promote digital publications targeting professionals and increase the number
of publications, on paper and on-line, for users.
• Develop the scheduling of nursing/infirmary appointments.
• Sexual and reproductive health Web in the framework of the Health and School programme.
• Management of the implementation project.
• Management of the implementation project
• Development of instruments of participation and debate: Forum, weblog, videoconference.
ICS challengesICS in figures Improvement Actions
COMMUNICATION OFFICE
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Institut Catalàde la Salut
Primary care: 48 million €* 71 Works and 124 projects
Projects:most relevantProjects:most relevant
Work:most relevantWork:most relevant
Hospital care: 77 million €* 85 Works and 38 projects
* Total sources of funding
Work:most relevantWork:most relevant
Projects:most relevantProjects:most relevant
ICS challengesICS in figures
• H. Bellvitge: Phase I-II new building.• H. Vall d’Hebron: Surgery block general area
and traumatology area..• H. Germans Tries i Pujol: Research and
teaching laboratory.• H. Josep Trueta: New safety/security systems.• H. Verge de la Cinta: ICU and sterilisation• H. Joan XXIII: extension of the CT and
densitometry.• H. Arnau de Vilanova: Linear accelerator and
replacement of CT and its area.• H. Viladecans: development of the car park
• H. Vall d’Hebron: Emergencies (General), paediatric ICU (Maternity/children’s) and Emergencies (Traumatology H).• H. Germans Tries i Pujol: Emergencies and reform of Hospitalisation floors.• H. Josep Trueta: New ambulatory building.• H. Arnau de Vilanova: Reform emergencies.• H. Joan XXIII: Reform of the emergency service and the 3rd hospitalisation floor.• H. Verge de la Cinta: Surgery block and 1st hospitalisation floor.• H. Viladecans: new surgery block.
• CAP Martorell: reform.• CAP Sant Feliu de Guíxols: reform.• CAP Mollerussa: extension.• CAP Sant Pere y Sant Pau: extension.• CAP Montcada y Reixac-2:new centre.• Centre de Diagnòstic Ràpid de l‘Hospitalet.• CAP Rambla de Sabadell: new centre.• CAP Alcanar: new centre.• CAP Santa Perpetua de la Mogoda: extension.
• CAP Eixample de Lleida: extension.• CAP Bages: extension.• CAP Deltebre: extension.• CAP Vilanova del Vallés: new centre.• CAP Sant Andreu: new floors.• CAP Sant Martí: reform.• CAP Manresa IV: new centre.• CAP Riudarenes: new centre.• CAP Just Oliveras: reform.
Improvement actions
INVESTMENTS 2005
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Institut Catalàde la Salut
ICS challengesImprovement ActionsICS in figures
The process of modernisation of theInstitut Català de la Salut
The Law of modernisation of the ICS will make it possible to provide new health-care and
organisational solutions geared towards increasing the degree of efficiency of the public health system of
Catalonia and to bringing in business management criteria based on the removal of red tape, more
flexible economic management and decentralisation in decision-making at centres and in services.
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Institut Catalàde la Salut
Improvement ActionsICS in figures
1981 Transfer of Health powers (health and social centres and services) to
Catalonia.
1981-1983 Beginning of the management and implementation of the
health map of Catalonia: accreditation of centres and first order of
agreements.
1983 The basis for the model was established: creation of the ICS,
managing organisation of the health services of the Social Security.
1983-1989 The Public Hospital Network was created, the reform of primary
care was undertaken and hospital care was replanned and management
decentralised.
1989-1991 Beginning of the separation of the funding and provision with
the creation of the General Board of Economic Resources of the Social
Security (DGRESS).
1991 Approval of the LOSC
2005 Process of Modernisation of the Law of the ICS.
ICS challenges
SOME BRIEF BACKGROUND
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Institut Catalàde la Salut
Improvement ActionsICS in figures
1. Institutional normalisation: The ICS must find its own space within the institutional reality of Catalonia, expanding the vision of what the managing organisation of the Social Security is.
2. Governing Board: creation of the governing board as a management organ of the ICS and in charge of setting the major goals and accountability..
3. New human resource model.
4. New economic operation model: own treasury, permanent instead of preliminary financial control, own assets and securing of credits within the limits established by the Autonomous Government of Catalonia.
5. New organisational legal solution with a view to improving efficiency.
6. Incorporation of business criteria.
PRINCIPLES: INDEPENDENT MANAGEMENT AND DECENTRALISATION
7. Simple law to make it easier to understand.
8. ICS as an organisation with its own legal status and reporting to the Autonomous Government of Catalonia.
9. Basis for developing future company statutes.
CREATION OF A PUBLIC COMPANY
ICS challenges
REASONS FOR CHANGE
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Institut Catalàde la Salut
Retos para el ICSImprovement ActionsICS in figures
1. Gives major powers and responsibility to the governing board to set targets and approve the programme.
2. Global organisational reengineering: redefinition of the role of the corporate centre, simplification of the organisation and modernisation of processes and systems.
3. It retains the critical powers needed to govern the ICS, develop the backbone policies of the Department of Health and its portfolio, as well as the budget strategy.
4. It retains the essential powers: As an economic and human resource model, shared services and general framework to prepare the regulations pertaining to how its management units are structured and operate.
EXAMPLES OF IMPROVEMENT
All new investments (excluding replacement) ultimately depend on the Servei Català de la Salut with execution via GISA or through other channels.
The execution of the ICS's infrastructure budgets will be approved by the governing board.
At the moment, the Autonomous Government of Catalonia invoices third parties (other organisations, people or companies).
Invoicing to third parties will depend on the ICS, thus generating greater income.
ICS challenges
MAIN ISSUES SOLVED