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

Catalan Health Institute (ICS)
Modernisation of the main public
health institution of Catalonia
Modernisation of the main
public health institution of Catalonia
ICS in figures
The ICS
Organisation Chart
Health Centres
Health Care, teaching and research
Human resources: distribution
Budget 2004
Health-care activity (2004)
Improvement Actions
Primary Care
Hospital Care
Human Resources
Legal Assessment
Communication Office
Economy, Organisation and Finance
Investments 2005
Waiting lists (2004)
Quality
Pharmacy
Administration work
Communication
Infrastructures
ICS challenges
Diagnosis Organisation
Background to the Reform
Driving change
Modernisation Strategy
Law of the ICS
Institut Català
de la Salut
Pág. 2
ICS in figures
Improvement Actions
ICS challenges
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.
Hiring
Other CatSalut providers
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).
Institut Català
de la Salut
Pág. 3
ICS in figures
Improvement Actions
ICS challenges
ORGANISATIONAL CHART
Managing Director
Human Resource Management
Technical
Office
Economic, Organisational and
Financial Management
Communication Office
And User Service
Infrastructure and Technical
Services Management
Hospital Care Division
8 hospital managements
Legal Assessment
Primary Care Division
8 Primary Care level managements
30 Primary Care services
Institut Català
de la Salut
Pág. 4
ICS in figures
Improvement Actions
ICS challenges
HEALTH CENTRES: PRIMARY CARE
Care to 83% of the population of Catalonia.
8 Areas
+
Pharmacy U.
30 Primary Care
Services
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.
+
Laboratories
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.
464 Service
Units
8
Service units
Primary Care areas
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
Institut Català
de la Salut
Pág. 5
ICS in figures
ICS challenges
Improvement Actions
HEALTH CENTRES: HOSPITAL CARE
8 Hospitals
32% of the beds of the Public
Hospital Network (XHUP)
Beds
Offices
query
Outpatient
104
4
23
H. Verge de la Cinta
222
6
54
H. U. Arnau de Vilanova
432
11
53
325
8
61
H. U. Dr. Josep Trueta
372
11
50
High-technology H. H. U. Germans Trias i Pujol
613
15
63
County H.
Reference H.
Reference H.
Reference H.
Reference H.
Institut Català
de la Salut
Operating theatres
H. Viladecans
H. U. Joan XXIII
High-technology H.
H. U. Bellvitge
792
27
119
High-technology H.
H. U. Vall d'Hebron
1,265
44
213
TOTAL
4,125
126
636
Pág. 6
ICS in figures
Improvement Actions
ICS challenges
HEALTH CARE, TEACHING AND RESEARCH
The ICS is a pioneer in its three basic lines of activity: Health Care, Research and Teaching.
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.
CARE
RESEARCH

It has 80% of the primary care centres.


It provides 32% of total hospitalisation beds plus
50% of tertiary beds.
It provides more than 40% of the scientific output of
Catalonia.

Its centres are among the most productive in Spain
(documents can be cited):

It is the main transplant performer (2004):
 100% Lung.
 27% Heart.
 62% Liver.
Institut Català
de la Salut

Undergraduate and post-Graduate training supplies
56% of the medicine graduates and 66% of the
specialists trained in Catalonia.

 no. 2 H. Vall de Hebron.
There are 39 professors of medicine.

 no. 13 H. Trias i Pujol.
More than 1,500 MIR (residents) are trained in ICS
centres.

More than 4,300 under-graduates:
 no. 3 H. Bellvitge.
 46% Kidney.
TEACHING

Its research publications have great scientific value
(total impact factor of 2.8 for 2004).

More than 303 research projects (2004).
 2,300 in medicine.
 2,000 in nursing.
Pág. 7
ICS in figures
Improvement Actions
ICS challenges
REFERENCE SERVICES IN THE HOSPITAL CENTRES
• 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:
Institut Català
de la Salut
•
20 morning operating theatres
•
4 afternoon operating theatres
•
One-day hospitalisation unit (Major Ambulatory Surgery).
Pág. 8
ICS in figures
ICS challenges
Improvement Actions
HEALTH-CARE OFFER
HOSPITAL BEDS
70,0%
PRIMARY CARE CENTRES
64,7%
60,0%
300
269
250
50,0%
200
40,0%
32,8%
150
30,0%
100
20,0%
60
50
10,0%
2,5%
15
0,0%
40
35
32
15
8
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.
Institut Català
de la Salut
Pág. 9
ICS in figures
PROFESSIONAL TEAM
Improvement Actions
ICS challenges
The ICS has more than 35,000 professionals
WORK FORCE BY TYPE OF CONTRACT 2004
MIR / LLIR
5%
WORK FORCE BY CARE AREA 2004
Corporate C
Civil servants
2%
2%
Non health
25%
Work
0%
Doctors
25%
Primary C
52%
Sanitary
43%
Hospital care
46%
MIR: Interns
Lleida
Girona
Tarragona-Terres de l'Ebre
Barcelonès Nord i Maresme
Costa de Ponent
Centre
City of Barcelona
Total
Institut Català
de la Salut
1.115
1.498
1.747
2.147
3.856
3.567
4.643
18.573
H. Viladecans
H. Verge de la Cinta
H. U. Arnau de Vilanova
H. U. Joan XXIII
H. U. Dr.Josep Trueta
H. U. Germans Trias i Pujol
H. U. Bellvitge
H. U. Vall d'Hebron
Total
432
683
1.247
1.159
1.263
2.039
3.289
6.252
16.364
Pág. 10
ICS in figures
ICS challenges
Improvement Actions
MODERN MANAGEMENT OF HUMAN RESOURCES
 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:
Doctors
DUI (Nursing)
Hospitals
758
2.261
3.019
Primary
829
1.904
2.733
1.587
4.165
 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).
Institut Català
de la Salut
Pág. 11
ICS in figures
ICS challenges
Improvement Actions
BUDGET 2004
53.3
Total ICS
863.7
2,022
Million €
1,105.9
Primary Care
Hospital Care
Data in million €
Corporate Centre
HOSPITAL CARE: Distribution by chapters
100%
1.4%
0.04%
100%
90%
0.8%
14.7%
90%
80%
40.4%
80%
70%
Chap. VIII
Chap. VI
Chap. II
Chap. I
60%
50%
40%
70%
60%
50%
84.4%
40%
30%
58.1%
30%
20%
20%
10%
10%
0%
0%
Institut Català
de la Salut
PRIMARY CARE: Distribution by chapters
0.03%
1
1
Pág. 12
ICS in figures
ICS challenges
Improvement Actions
HEALTH-CARE ACTIVITY
HOSPITAL CARE
Hospital Care 2004
%v2003
Conventional Discharges
174,270
32,814
3.0%
Total Discharges
207,084
2.2%
51,105
21,720
1.6%
2.7%
Scheduled surgery
Emergency Surgery
Total surgical activity
105,639
2.2%
Emergencies
805,623
-0.6%
Pressure emergencies
60.90%
First visits
4.2%
3.09
-1.60%
2,111,700
2.9%
Day Hospital
154,855
10.2%
Hosp. Diagnostic tests
134,360
Total Outpatient
Primary Care 2004
Family Medicine Visit
Paediatric Visit
Nursing visit
Total visits EAP
%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%
Home Family Medicine
Home Paediatrics
Home Nursing
Total visits home EAP
Total visits EAP
Lab tests ICS centres
Radio diagnostic explorations
Diagnostic explorations
226,539
-60.4%
480,205
-54.1%
36,586,567
Specialised Visits extrahosp.
Institut Català
de la Salut
0.00%
800,636
Index of repetition
PRIMARY CARE
2.0%
CMA Discharges
1,006,525
17,724,102
6.8%
1,396,359
-2.3%
19,120,461
EAP: Primary Care Team.
CMA: Major Ambulatory Surgery.
Pág. 13
ICS in figures
ICS challenges
Improvement Actions
WAITING LISTS
HOSPITAL CARE
Surgery waiting list for the 14 procedures monitored by the CatSalut.
n (2004)
% variation vs 2003
Patients on waiting list
13,720
-10.8%
Surgery performed on the
waiting list
28,216
-0.6%
Resolution time (months)
5.8
-10.8%
PRIMARY CARE
Delay, defined as 20% of free spaces by specialist agenda
n (2004)
Patients on waiting list
Delay (days)
Institut Català
de la Salut
148,683
44
% variation vs 2003
-0.6%
-5.0%
Pág. 14
ICS in figures
ICS challenges
Improvement Actions
2003
2004
3,877
4,500
3,171
6,000
3,753
7,500
2,971
Heart
surgery
Orthopaedic
surgery
Haemodynamic
Vascular
surgery
Others (Implants
cochlear, LCR
valves,
Neurotransmitters)
Difference 2004 vs 2003
2003
Heart surgery
Orthopaedic surgery
Haemodynamics
Vascular Surgery
2004
N
%
2,971
3,753
7,364
524
3,171
3,877
8,030
614
200
124
666
90
valves Neurotransmitters)
267
316
49
14,879
16,008
1,129
Increase
expense 2004
6.7%
781,990 €
3.3%
392,523 €
9.0% 1,029,370 €
17.2%
231,399 €
Others (Implants cochlear, LCR
Institut Català
de la Salut
316
267
1,500
614
3,000
524
Number of high-cost procedures
9,000
8,030
7,364
HIGH COST PROCEDURES
18.4%
280,240 €
10% 2,715,522 €
Pág. 15
ICS in figures
ICS challenges
Improvement Actions
EFFICIENCY OF HEALTH-CARE ACTIVITY
HOSPITAL DISCHARGES 1996-2004
176,704
172,688
6.5%
168,672
164,656
160,640
156,624
152,608
148,592
96
97
98
99
00
03
PERCENTAGE READMISSIONS 1996-2004
12
GROSS MEAN STAY 1996-2004
10
11.1
9
9.4
10
8.9
8.7
8.8
8.7
8.6
8.38
8.07
8
-8.4%
4.61
days
8
6
4.3
4
7.39
7
3.08
6
2
0
96
Institut Català
de la Salut
04
00
02
03
04
5
96
97
98
99
00
02
03
04
Pág. 16
ICS in figures
ICS challenges
Improvement Actions
CASE MIX: CASE MIX
The 10 most frequent GRD accumulate 20.4% of the total of the
of ICS hospital discharges in 2004
GRD
373 Vaginal partum without complication diagnosis
039 Crystalline pg with ¢ without vitrectomy
088 Chronic obstructive pulmonary disease
209 Pq lower extremity, reinsertions/replace. major articul.
127 Heart failure and shock
359 Pq uterus/adnexa, non-malign, w/c
014 Intracranial haemorrhage and ictus with infarct
187 Tooth extractions/repairs
035 Another nervous system disorders w/c
371 Caesarean section w/c
Total disch.
Disch.
% Disch
9494
9103
3832
3663
3198
2767
2737
2597
2135
2131
4.7%
4.5%
1.9%
1.8%
1.6%
1.4%
1.3%
1.3%
1.0%
1.0%
4.65%
9.11%
10.99%
12.78%
14.35%
15.70%
17.04%
18.32%
19.36%
20.41%
204.132
Rate of standard operation
% replacement of major ambulatory surgery
% of emergency readmissions in the same GRD (in less than 30
days)
Institut Català
de la Salut
% accum. disch. Relative weight
0.393
0.594
0.903
2.078
1.004
0.835
1.294
0.867
0.639
0.675
1.183
0.958
63.9%
1.2 %
Pág. 17
ICS in figures
ICS challenges
Improvement Actions
CONTROL OF PHARMACEUTICAL EXPENDITURE
13
12.15 12.24
12
11
10.57
10.69
9.89
10
9.54
9
8
7.52
7.93
7.49
7
6.4
6
5.64
5
4.6
4
1999
2000
2001
2002
2003
2004
% Increase expenditure Catalonia
% Increase expenditure Spain
Institut Català
de la Salut
Pág. 18
ICS in figures
ICS challenges
Improvement Actions
PHARMACEUTICAL EXPENDITURE BY AA (AUTONOMOUS COMMUNITIES)
12
10
8
6.75%
6
4.6%
4
12
10.96%
Melilla
Ceuta
La Rioja
Murcia
Madrid
Extremadura
Castilla-León
Cantabria
Baleares
Asturias
Aragón
S. Canario
S.Vasco
S. Navarrés
S. Gallego
S. Valenciano
Catalán
S. Andaluz
0
Castilla- La Mancha
2
10.16% (*)
10
8
4.73%
Catalonia is 2.15 per cent below the national average (2004)
5.43%
The ICS has generated savings of 63.5 million € corresponding to the
Order of Reference Prices.
Real savings have been higher than expected.
6
4
2
0
02/03
03/04
(*) Theoretical growth without the effect of the Reference Prices
Institut Català
de la Salut
Pág. 19
ICS in figures
ICS challenges
Improvement Actions
ADMINISTRATIVE PROCEDURES
HUMAN RESOURCE AREA
 Personnel management (licences, authorisation,...)
196,000 formalities

Area of development (MBO, claims,...)
50,000 formalities

Occupational hazards (queries, planning,...)
30,000 formalities
265,000 formalities
LEGAL ASSESSMENT
 Legal defence, reports, hiring and contracting, agreements...
8,000 formalities
SHORT-TERM CONTRACTS
 Recorded in the primary care division in the centres
36,000 contracts
Institut Català
de la Salut
MBO: Management by objectives.
Pág. 20
ICS in figures
Improvement Actions
ICS challenges
MASS MEDIA
MEDIA IMPACT 2004
6.000
5.317
5.000
ASSESSMENT OF IMPACT 2004
4.000
Negative
15%
3.000
2.000
1.000
763
1.079
Corporate
Centre
Primary Care
Hospital
Care
The ICS appeared 7,159 times in the mass media in 2004
Positive
85%
Institut Català
de la Salut
Pág. 21
ICS in figures
Improvement Actions
ICS challenges
INFRASTRUCTURES


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 €.
Period 2005-2019
Equipment
326
Installations
395
Work
881
Total
1.602
70
60
Annual average
Equipment
22
Installations
26
Work
59
Total
107
Million €
50
40
In million euros
30
20
10
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Interventions

Institut Català
de la Salut
Need inves
Mean inves
The calculation of needs to recover from the historic decapitalisation for the 2005-2019 period stands at an annual investment rate of 107 million €.
Pág. 22
ICS in figures
ICS challenges
Improvement Actions
USER SATISFACTION (Primary Care)






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.
Does your centre solve your normal health
(disease) problems?
2.1%
5.2%
7.9%
25.98%
58.8%
Never
Institut Català
de la Salut
Rarely
Often
Alm. always
Always
Pág. 23
ICS in figures
Improvement Actions
ICS challenges
PRIMARY CARE DIVISION
Improvement Actions
•
Accessibility:
•
Opening of new services that will facilitate access by citizens to the system:
•
•
•
•
•
•
Institut Català
de la Salut
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.
•
•
•
Pilot test: emergency home care vehicles.
Improvement of emergency services: CAP Sant Félix, CAP Guell, Alta Ribagorça, Terres de l’Ebre and
Hospitalet.
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. 24
ICS in figures
Improvement Actions
ICS challenges
PRIMARY CARE DIVISION
•
Health-care quality:
•
Increase problem-solving capacity of health centres:
•
•
•
Management Training.
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:
•
Institut Català
de la Salut
By e-learning: More than 8,000 workers and a decentralised training offer.
Increased diagnostic capacity:
•
•
Extension of OAT control in primary CARE.
Training:
•
•
•
Give all health centres: spirometers and pulse meters, defibrillators, Doppler and non-mydriatic cameras.
European environmental certification (EMAS).
Pág. 25
ICS in figures
Improvement Actions
ICS challenges
HOSPITAL CARE DIVISION
•
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:
•
•
•
Institut Català
de la Salut
New integrated management plans.
Improved information systems and circuits.
Project to reduce knee replacement and heart surgery waiting time.
Pág. 26
ICS in figures
Improvement Actions
ICS challenges
HOSPITAL CARE DIVISION
•
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.
Institut Català
de la Salut
Pág. 27
ICS in figures
Improvement Actions
ICS challenges
HUMAN RESOURCE MANAGEMENT
• 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:
•
460 GPs.
•
180 Nursing Staff.
•
120 Paediatricians.
•
45 Midwives.
• 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...)
Institut Català
de la Salut
Pág. 28
ICS in figures
Improvement Actions
ICS challenges
HUMAN RESOURCE MANAGEMENT
• 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).
Institut Català
de la Salut
Pág. 29
ICS in figures
Improvement Actions
ICS challenges
ECONOMIC AND FINANCIAL MANAGEMENT
• 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.
Institut Català
de la Salut
•
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.
Pág. 30
ICS in figures
Improvement Actions
ICS challenges
INFRASTRUCTURE AND TECHNICAL SERVICES MANAGEMENT
301 Primary Care Centers: 473.318 m2
8 hospitals: 593.727 m2
• 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:
Institut Català
de la Salut
•
Ascertain the value of its assets
•
Ascertain the average service life of the equipment.
•
Pre-empt electro medical equipment replacement needs.
Pág. 31
ICS in figures
Improvement Actions
ICS challenges
LEGAL ASSESSMENT
• 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:
•
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.
• 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.
Institut Català
de la Salut
Pág. 32
ICS in figures
Improvement Actions
ICS challenges
COMMUNICATION OFFICE
• Corporate web of the ICS
•
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.
• 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.
Institut Català
de la Salut
Pág. 33
ICS in figures
Improvement actions
ICS challenges
INVESTMENTS 2005
Hospital care: 77 million €*  85 Works and 38 projects
Work:
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
Projects:
most relevant
• 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.
Primary care: 48 million €*  71 Works and 124 projects
Work:
most relevant
• 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.
Institut Català
de la Salut
Projects:
most relevant
• CAP Eixample de Lleida: extension.
•
•
•
•
•
•
•
•
CAP
CAP
CAP
CAP
CAP
CAP
CAP
CAP
Bages: extension.
Deltebre: extension.
Vilanova del Vallés: new centre.
Sant Andreu: new floors.
Sant Martí: reform.
Manresa IV: new centre.
Riudarenes: new centre.
Just Oliveras: reform.
* Total sources of funding
Pág. 34
ICS in figures
Improvement Actions
ICS challenges
The process of modernisation of the
Institut 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.
Institut Català
de la Salut
Pág. 35
ICS in figures
Improvement Actions
ICS challenges
SOME BRIEF BACKGROUND

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).
Institut Català
de la Salut

1991  Approval of the LOSC

2005  Process of Modernisation of the Law of the ICS.
Pág. 36
ICS in figures
Improvement Actions
ICS challenges
REASONS FOR CHANGE
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.
PRINCIPLES: INDEPENDENT MANAGEMENT AND DECENTRALISATION
5.
New organisational legal solution with a view to improving efficiency.
6.
Incorporation of business criteria.
CREATION OF A PUBLIC COMPANY
Institut Català
de la Salut
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.
Pág. 37
ICS in figures
Improvement Actions
ICS para
challenges
Retos
el ICS
MAIN ISSUES SOLVED
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.
Institut Català
de la Salut
Pág. 38