Chapter 14: Federal and Teaching

Hospitals’ Services Management

FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH 1
 Section 1 Learning Objectives

 Section 2 Introduction
 Section 3 Operational Standards
 Section 4 Implementation Guidance
 Section 5 Implementation Monitoring

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Learning Objectives
 At the end of this presentation participants will be
able to understand;

◦ the benefits of integration of patient care, teaching

and research.

◦ need to orient students/interns/residents on hospitals

policy before clinical attachments
◦ importance of maintaining patients’ dignity and
quality of care during teaching activities

◦ principles related to morning meeting sessions and

community and field visit practices

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Introduction
 Currently, teaching hospitals are expected to
integrate patient care, teaching and research
activities.

 It requires having shared vision, collaborative

strategic planning, and accountability among these
functions .

 These three main functions are led by a single CED

and a common overarching governing board.

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Introduction…
 In such hospitals bedsides, rounds and community
filed activities have always been the cornerstone of
clinical teaching activities.

 The clinical teacher needs to be responsible not

just for the students but of the welfare and health
outcome of the patients.

 Teaching and research activities must be practiced

in a way that maximize patients’/communities’
benefit.

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Operational Standards
1. The hospital has established functional
management and governance structure that
integrates patient care, medical education and
research.

2. The hospital implements an orientation

programme for students/interns/residents on
hospital policies and procedures prior to clinical
attachments.

3. The hospital has established system to ensure

care provided and students’ practice maintains
patients’ confidentiality and privacy at all times.

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Operational Standards (cont’d)
4. The hospital has established protocols/policies
and procedures for ward rounds and bedside
students’ teaching to maximise patients’ benefit.

5. The hospital ensures students/interns/residents’

patient care provided is supervised by their
respective teachers/hospital based instructors at
all times.

6. The hospital has established guidelines,

memoranda of understanding and procedures for
affiliation with other teaching institutions,
communities and field activities.
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Implementation Guidance

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Federal and Teaching Hospitals’ management structure

 Integration of the three main functions;

◦ patient care, teaching and research

 Full organizational integration under unified

leadership and governance makes sense for a
number of reasons.
◦ Enables strategic focus.

◦ Facilitates efficient utilization of both financial and human

resources.

◦ Provides researchers the opportunity to focus on local

problems and patients

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Federal and Teaching Hospitals’ management structure…

 According to ‘Guidelines for the Management of

Federal Hospitals in Ethiopia’ teaching hospitals;
◦ Should to stablish their own board

◦ Led by a Chief Executive Director (CED)

◦ Direct report to the CED-Clinical Director, Chief

Academic and Research Affairs Director and Chief
Administration and Business Affairs Director.
◦ An executive management committee under the CED
and composed of all chief directors

◦ Senior Management Team composed of clinical

directors and heads of relevant departments

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Students/interns/residents’ orientation

 All new students /interns/residents should receive

an orientation on hospital policies and procedures
prior to any clinical attachment.

 This enables the new students/interns/residents to

become familiar with the entire organization and
attachment areas/departments.

 The orientation should include at least;

◦ IPPS practices, patients’/clients’ information
documentation, communication with patient and staff,
teamwork, patient confidentiality and privacy, professional
code of conducts and other related knowledges and skills
needed to perform activities.

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Ward round and bedside student teaching related
patients’ dignity and quality of care concerns
 The hospital should develop and implement a
written protocol/policy for ward rounds and
bedside student teaching.

 Such written protocol/policy should also include

information about patient/family/carer involvement
and access to information about their care

 All teaching and research practice should maintain

patents’ dignity, confidentiality and privacy, as well
as, ensure the best clinical outcomes for patients.

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Protecting confidentiality and dignity
 All members of the ward round team should be
aware of the immediate environment when
conducting bedside and rounds.
 Recommended guidelines are;
◦ Choose language that sets the tone for partnership

◦ Common courtesy: ask the patient for permission and

introduce teacher, learners and the proposed activity,

◦ Physical examinations and procedures are performed and

practiced with appropriate explanation.

◦ Conversations are made in a way that the patient is

included and understands.

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Protecting confidentiality and dignity…
 Recommended guidelines are…;
◦ Ask the patient for feedback on staff (clinicians and
students) communication and clinical skills, attitudes, and
bedside manners.
◦ Ask the patient after the session whether they have any
questions, since sensitive issues may have been raised.

◦ Ensure that students respect the confidentiality of all

information relating to patients.

◦ Use bedside curtains and protect visual privacy, and

auditory privacy.

◦ Establish a policy and procedure for that determines

student to patient ratio

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Use of Skills Lab and Simulator Centres

 Skills labs and simulation centres are safe ways of

teaching heath care students.

 These methods are designed to acquaint the

clinical skills prior to their application on actual
patients.

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Ward rounds/bedside teaching and quality of care
 Ward rounds and bedside teaching are an integral
part of inpatient care

 Quality of care, positive patients’ experience and

safety should be at the centre of all ward rounds.

 Mistakes are more likely in a complex, chaotic

environment such as in a teaching hospital wards

 Establishing, promoting and sustaining culture

change in relation to ward rounds and bedside
teaching require strong clinical leadership and
commitment

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Ward rounds/bedside teaching and quality of care...
 The recommendations are;
◦ The maximum time for bedside teaching and ward
rounds in a given patient should not exceed more
than ONE hour.

◦ Whenever teaching rounds are not conducted,

regular rounds should be conducted DAILY

◦ Mechanisms should be in place to ensure

seniors/consultants’ recommendations are
implemented

◦ On duty medical officers should visit ALL inpatients

at least, and as a minimum, ONCE

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Ward rounds/bedside teaching and quality of care…
 The recommendations are;...

◦ Critically ill patients should be routinely monitored

by the on-duty Medical officer and specialist

◦ Inpatient medications should ONLY be changed

with prior consultation and advice from the on-duty
doctor

◦ All referrals and consultations should be

communicated to the on-duty doctor and to the
specialist

◦ All documentations should be accurate and legible.

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Multidisciplinary Morning Meeting Sessions
 This is a forum for a short time to review patients’
cases prior to the commencement of the day’s
routine activities.
 Such meeting sessions are also used to discuss
cross cutting acute and emerging administrative
issues.
 One drawback of these sessions is the length of
time it takes, resulting in increased patients’
waiting time.
 The duration for such sessions should not exceed
30 minutes.

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Record keeping
 Proper recording ensures completeness in case of
medico-legal issues that may arise.
 All key decisions and actions made on the ward
round should be clearly documented.
 All documents should be legible including name
and signature of the person writing.
 Patient’s records should be kept centrally to
promote effective communication and team
working.

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Medical certificate and death certificate

 Medical and death certificates are legal documents

provided to the patient.

 This official medical document should only be

written by qualified hospital personnel.

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Skills lab and Simulation center

 Skills labs and simulation center are upcoming

ways of teaching heath care students.

 These methods are designed to acquaint the

student with clinical skills prior to applying them
on the actual patient.

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Community practice and field visits
 Community practice and field visits are important
activities of the teaching and learning process.
◦ These could be in health facilities or in the community

 Signed MoU among the receiving/hosting facility

and the relevant community health authority.
 The recommends are;
◦ Students should always be accompanied by their
instructors.
◦ Orientations should be given on roles and responsibilities
in the community.
◦ Necessary information about the socio-cultural structure,
values before deployment

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Implementation monitoring

 Checklist & Indicators to measure attainment

of each Operational Standard.

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 Assessment Tool for Operational Standards
Verification method
S# Standards Met Unmet

The hospital has established functional  Check the membership and functionality of the governing
management and governance structure that board
integrates patient care, medical education  View the organogram of the hospital
1. and research to bring better results.  View the JD of CED, CARD,CCD,CAD
 View minutes of the executive committee, SMT
 Strategic and annual plan

2. The hospital ensures  View the orientation guidelines

students/interns/residents are oriented on  Interview five students/interns/residents randomly to check if
the hospital polices and producers before they have taken the orientation before clinical attachments.
clinical attachments and are comply with  Interview department head and ward head nurses for
them. students/interns/residents compliance on policies and
procedures

3. The hospital has established system to  View protocols for conducting teaching on patients.
ensure care provided and students’ practice  Interview 10 patient from different wards on their privacy,
maintains patients’ confidentiality, privacy confidentiality and their involvement on the care process.
and at all times.  Observe patient care areas
 check presence of sill labs and simulation centers

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Indicators
Indicator Formula Frequency Comments

1. 1Number of Board meetings in reporting Total number of board Quarterly

period meetings in the reporting
period

2. Number of executive committee meetings in Total number of executive Quarterly

reporting period committee meetings in the
reporting period

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 END

Thank You

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