Modernisation of the main public health institution of Catalonia Catalan Health Institute (ICS)

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


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


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


Human Resource Management

Economic, Organisational and Financial Management

Infrastructure and Technical Services Management


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


ORGANISATIONAL CHART

Managing Director

Pág. 5


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


8 Hospitals

32% of the beds of the Public Hospital Network (XHUP)


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


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.


HEALTH CARE, TEACHING AND RESEARCH

Pág. 8



• 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


PRIMARY CARE CENTRESHOSPITAL BEDS


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


WORK FORCE BY TYPE OF CONTRACT 2004

WORK FORCE BY CARE AREA 2004


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



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


2,022

Data in million €

Total ICS


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



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


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



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


HOSPITAL DISCHARGES 1996-2004

GROSS MEAN STAY 1996-2004PERCENTAGE READMISSIONS 1996-2004


-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



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



% 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


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.


PHARMACEUTICAL EXPENDITURE BY AA (AUTONOMOUS COMMUNITIES)

Pág. 20


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


MBO: Management by objectives.

ADMINISTRATIVE PROCEDURES

Pág. 21


The ICS appeared 7,159 times in the mass media in 2004


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


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


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


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.


Pág. 25


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



• 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



• 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


• 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


• 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).


HUMAN RESOURCE MANAGEMENT

Pág. 30


• 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


Pág. 31


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


301 Primary Care Centers: 473.318 m2

8 hospitals: 593.727 m2

Pág. 32


• 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


• 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.


COMMUNICATION OFFICE

Pág. 34


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


• 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

Pág. 35


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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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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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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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

Modernisation of the main public health institution of Catalonia Catalan Health Institute (ICS)

Documents

Transcript of Modernisation of the main public health institution of Catalonia Catalan Health Institute (ICS)