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					   Catalan Health Institute (ICS)

Modernisation of the main public
 health institution of Catalonia
                                              Modernisation of the main
                                         public health institution of Catalonia

                                                                                     Improvement Actions
                                                       ICS in figures

                                                                                              Primary Care
                  The ICS
                                                                                             Hospital Care
                  Organisation Chart
                                                                                         Human Resources
                  Health Centres
                                                                                         Legal Assessment
                  Health Care, teaching and research
                                                                                      Communication Office
                  Human resources: distribution
                                                                         Economy, Organisation and Finance
                  Budget 2004
                                                                                         Investments 2005
                  Health-care activity (2004)
                  Waiting lists (2004)
                  Quality                                                              ICS challenges
                  Pharmacy
                                                                                     Diagnosis Organisation
                  Administration work
                                                                                 Background to the Reform
                  Communication
                                                                                            Driving change
                  Infrastructures
                                                                                     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

                                                                                   Technical
                       Human Resource Management
                                                                                     Office
                     Economic, Organisational and
                        Financial Management                                       Communication Office
                                                                                      And User Service

                      Infrastructure and Technical
                          Services Management                                      Legal Assessment




                               Hospital Care Division                             Primary Care Division




                                  8 hospital managements                    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.
                                                                                    5,488,092 of the assigned population (equal to that of the
                                                                                    Community of Madrid).
                        30 Primary Care
                           Services                                                 9 call centers with a monthly average of 240,000 calls.

                                          +    Laboratories
                                                                                    Action Plan in the Primary Care Centres with the greatest demand,
                          464 Service                                               reducing excessive health pressure, and including 133 professionals
                             Units                                                  and 62 new centres, in 2004.
                                                   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                Improvement Actions                             ICS challenges

                  HEALTH CENTRES: HOSPITAL CARE


                                                                                                                             8 Hospitals




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




                                                                                                                 Offices
                                                                                          Operating theatres
                                                                                 Beds                           query
                                                                                                               Outpatient
                                        County H.    H. Viladecans                  104                   4             23
                                     Reference H.     H. Verge de la Cinta          222                   6             54
                                     Reference H.     H. U. Arnau de Vilanova       432                  11             53
                                     Reference H.    H. U. Joan XXIII               325                   8             61
                                     Reference H.     H. U. Dr. Josep Trueta        372                  11             50
                                High-technology H. H. U. Germans Trias i Pujol      613                  15             63
                                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




Institut Català
de la Salut                                                                                                                                    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                                             TEACHING
                      It has 80% of the primary care centres.            It provides more than 40% of the scientific           Undergraduate and post-Graduate training
                                                                           output of Catalonia.                                   supplies 56% of the medicine graduates and
                      It provides 32% of total hospitalisation beds
                                                                          Its centres are among the most productive in           66% of the specialists trained in Catalonia.
                       plus 50% of tertiary beds.
                                                                           Spain (documents can be cited):                       There are 39 professors of medicine.
                      It is the main transplant performer (2004):
                                                                                no. 2 H. Vall de Hebron.
                            100% Lung.                                                                                          More than 1,500 MIR (residents) are trained
                                                                                no. 3 H. Bellvitge.                              in ICS centres.
                            46% Kidney.
                                                                                no. 13 H. Trias i Pujol.
                            27% Heart.                                                                                          More than 4,300 under-graduates:
                                                                          Its research publications have great scientific
                            62% Liver.                                                                                                2,300 in medicine.
                                                                           value (total impact factor of 2.8 for 2004).
                                                                                                                                       2,000 in nursing.
                                                                          More than 303 research projects (2004).




Institut Català
de la Salut                                                                                                                                                           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:
                                                          „    20 morning operating theatres

                                                          „    4 afternoon operating theatres

                                                          „    One-day hospitalisation unit (Major Ambulatory Surgery).




Institut Català
de la Salut                                                                                                                                      Pág. 8
                                                              ICS in figures                  Improvement Actions              ICS challenges

                   HEALTH-CARE OFFER

                                          HOSPITAL BEDS                                                      PRIMARY CARE CENTRES

                                                                               300
                  70,0%
                                                             64,7%                   269

                  60,0%                                                        250



                  50,0%
                                                                               200


                  40,0%
                                             32,8%                             150

                  30,0%

                                                                               100
                  20,0%
                                                                                               60

                                                                               50                                              40
                  10,0%                                                                                          35                    32
                             2,5%                                                                       15             15                       8

                  0,0%                                                           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                Improvement Actions              ICS challenges

                  PROFESSIONAL TEAM
                                            The ICS has more than 35,000 professionals
                        WORK FORCE BY TYPE OF CONTRACT 2004                                WORK FORCE BY CARE AREA 2004



                                           MIR / LLIR                                 Corporate C
                                                  5%      Civil servants                  2%
                                                                     2%
                   Non health
                         25%                                         Work
                                                                        0%




                                                                Doctors
                                                                    25%



                                                                                      Primary C                           Hospital care
                                                                                        52%                                  46%
                           Sanitary
                               43%
                   MIR: Interns

                                  Lleida                                      1.115      H. Viladecans                              432
                                  Girona                                      1.498      H. Verge de la Cinta                       683
                                  Tarragona-Terres de l'Ebre                  1.747      H. U. Arnau de Vilanova                  1.247
                                  Barcelonès Nord i Maresme                   2.147      H. U. Joan XXIII                         1.159
                                  Costa de Ponent                             3.856      H. U. Dr.Josep Trueta                    1.263
                                                                                         H. U. Germans Trias i Pujol              2.039
                                  Centre                                      3.567
                                                                                         H. U. Bellvitge                          3.289
                                  City of Barcelona                           4.643
                                                                                         H. U. Vall d'Hebron                      6.252
                                  Total                                      18.573      Total                                  16.364

Institut Català
de la Salut                                                                                                                        Pág. 10
                                                          ICS in figures                    Improvement Actions                    ICS challenges

                  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:

                                                                                        Hospitals            Primary
                                                               Doctors                     758                 829           1.587
                                                               DUI (Nursing)             2.261               1.904           4.165
                   MANAGEMENT BY OBJECTIVES:                                            3.019               2.733

                        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                Improvement Actions                   ICS challenges

                   BUDGET 2004
                                                                              53.3




                   Total ICS                                                                     863.7
                                                                                                           Million €
                         2,022                      1,105.9

                                                                                                                 Primary Care
                                                                                                                 Hospital Care
                  Data in million €
                                                                                                                 Corporate Centre


                           HOSPITAL CARE: Distribution by chapters
                                                                                               PRIMARY CARE: Distribution by chapters
                                                     0.03%
                      100%                            1.4%                                                                       0.04%
                                                                                       100%                                      0.8%
                       90%
                                                                                        90%                                      14.7%

                       80%
                                                     40.4%                              80%
                       70%
                                                                                        70%
                                                                 Chap. VIII
                       60%
                                                                 Chap. VI               60%
                       50%                                       Chap. II
                                                                                        50%
                                                                 Chap. I
                       40%                                                                                                       84.4%
                                                                                        40%

                       30%                           58.1%                              30%

                       20%                                                              20%

                       10%                                                              10%

                         0%                                                              0%
Institut Català                             1                                                                          1
de la Salut                                                                                                                             Pág. 12
                                         ICS in figures                 Improvement Actions                      ICS challenges

                  HEALTH-CARE ACTIVITY

                         HOSPITAL CARE                                    Hospital Care 2004                             %v2003
                                                    Conventional Discharges                                174,270         2.0%
                                                    CMA Discharges                                          32,814         3.0%
                                                 Total Discharges                                        207,084           2.2%
                                                    Scheduled surgery                                       51,105         1.6%
                                                    Emergency Surgery                                       21,720         2.7%
                                                 Total surgical activity                                 105,639           2.2%
                                                 Emergencies                                             805,623          -0.6%
                                                 Pressure emergencies                                           60.90%    0.00%
                                                     First visits                                          800,636         4.2%
                                                    Index of repetition                                         3.09     -1.60%
                                                  Total Outpatient                                     2,111,700           2.9%
                                                  Day Hospital                                           154,855          10.2%
                                                  Hosp. Diagnostic tests                                 134,360




                                                                          Primary Care 2004                              %v2003
                         PRIMARY CARE
                                                     Family Medicine Visit                             18,477,209          9.1%
                                                     Paediatric Visit                                   3,489,335          7.5%
                                                     Nursing visit                                     10,613,775          1.2%
                                                 Total visits EAP                                    32,854,132            6.2%
                                                     Home Family Medicine                                  248,980        -45.6%
                                                     Home Paediatrics                                           4,686     -71.6%
                                                     Home Nursing                                          226,539        -60.4%
                                                  Total visits home EAP                                   480,205        -54.1%
                                                  Total visits EAP                                   36,586,567
                                                  Specialised Visits extrahosp.                        1,006,525
                                                     Lab tests ICS centres                             17,724,102          6.8%
                                                     Radio diagnostic explorations                      1,396,359          -2.3%
                                                  Diagnostic explorations                            19,120,461

                                                                               EAP: Primary Care Team.
                                                                               CMA: Major Ambulatory Surgery.
Institut Català
de la Salut                                                                                                                 Pág. 13
                                                            ICS in figures                      Improvement Actions           ICS challenges

                  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)              % variation vs 2003
                                   Patients on waiting list                           148,683                         -0.6%
                                   Delay (days)                                           44                          -5.0%




Institut Català
de la Salut                                                                                                                             Pág. 14
                                                                                   ICS in figures                  Improvement Actions                      ICS challenges

                  HIGH COST PROCEDURES




                                                                                                                   8,030
                                                                                                           7,364
                                                           9,000                                                                                              2003

                                                                                                                                                              2004




                          Number of high-cost procedures
                                                           7,500

                                                           6,000




                                                                                                 3,877
                                                                                         3,753
                                                                           3,171
                                                                   2,971
                                                           4,500

                                                           3,000




                                                                                                                                 524


                                                                                                                                       614




                                                                                                                                                            316
                                                                                                                                                     267
                                                           1,500

                                                            -
                                                                      Heart              Orthopaedic       Haemodynamic            Vascular   Others (Implants
                                                                     surgery               surgery                                 surgery     cochlear, LCR
                                                                                                                                                    valves,
                                                                                                                                              Neurotransmitters)




                                                                                                                           Difference 2004 vs 2003
                                                                                                                                                             Increase
                                                                                        2003             2004                N                %            expense 2004

                       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 €

Institut Català
de la Salut                                                                                                                                                               Pág. 15
                                                        ICS in figures                 Improvement Actions                ICS challenges

                   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         04

                            PERCENTAGE READMISSIONS 1996-2004                                      GROSS MEAN STAY 1996-2004

                                                                                 10
                  12   11.1
                                                                                      8.9               8.8
                  10              9.4                                             9          8.7              8.7   8.6
                                                                                                                           8.38          -8.4%
                                                                                                                                  8.07
                  8
                                                                                  8




                                                                          days
                                                                                                                                           7.39
                  6
                                            4.61        4.3                       7
                  4                                                3.08

                  2                                                               6


                  0                                                               5
                       96         00        02          03         04                 96     97         98    99    00     02     03       04

Institut Català
de la Salut                                                                                                                         Pág. 16
                                                                    ICS in figures                       Improvement Actions                   ICS challenges

                  CASE MIX: CASE MIX
                                                                 The 10 most frequent GRD accumulate 20.4% of the total of the
                                                                               of ICS hospital discharges in 2004

                                                     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%          0.903
                  209 Pq lower extremity, reinsertions/replace. major articul.                          3663          1.8%               12.78%          2.078
                  127 Heart failure and shock                                                           3198          1.6%               14.35%          1.004
                  359 Pq uterus/adnexa, non-malign, w/c                                                 2767          1.4%               15.70%          0.835
                  014 Intracranial haemorrhage and ictus with infarct                                   2737          1.3%               17.04%          1.294
                  187 Tooth extractions/repairs                                                         2597          1.3%               18.32%          0.867
                  035 Another nervous system disorders w/c                                              2135          1.0%               19.36%          0.639
                  371 Caesarean section w/c                                                             2131          1.0%               20.41%          0.675

                    Total disch.                                                                     204.132                                             1.183



                                             Rate of standard operation                                                          0.958




                                             % replacement of major ambulatory surgery                                           63.9%




                                            % of emergency readmissions in the same GRD (in                                      1.2 %
                                            less than 30 days)




Institut Català
de la Salut                                                                                                                                                Pág. 17
                                                   ICS in figures            Improvement Actions           ICS challenges

                  CONTROL OF PHARMACEUTICAL EXPENDITURE


                    13
                                                                                           12.15 12.24
                    12

                    11           10.69
                         10.57
                                                                           9.89
                    10                                                            9.54

                     9

                                                           7.93
                     8                   7.52   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                                              Improvement Actions                                                      ICS challenges

                   PHARMACEUTICAL EXPENDITURE BY AA (AUTONOMOUS COMMUNITIES)

                  12



                  10



                  8
                                                                    6.75%
                  6

                                         4.6%
                  4



                  2



                  0




                                                                                                                                                                                                               Extremadura
                                                                                                                                                                         Castilla- La Mancha




                                                                                                                                                                                                                                                          Ceuta
                                                                                                                                                                                                                             Madrid

                                                                                                                                                                                                                                      Murcia
                                         Catalán




                                                                                                                                                                                                                                                                  Melilla
                                                                                                                                                                                                                                               La Rioja
                                                                                                                                                          Cantabria
                                                                     S. Gallego




                                                                                                           S. Canario




                                                                                                                                                                                               Castilla-León
                                                                                  S. Navarrés




                                                                                                                                               Baleares
                                                                                                                           Aragón
                                                                                                S.Vasco
                                                    S. Valenciano




                                                                                                                                    Asturias
                            S. Andaluz




                       12
                                                   10.96%                                                      10.16% (*)
                       10
                                                                                                                        4.73%                                         Catalonia is 2.15 per cent below the national average
                       8
                                                                                                                                                                      (2004)
                       6
                                                                                                                                                                      The ICS has generated savings of 63.5 million € corresponding to
                       4
                                                                                                                                                                      the Order of Reference Prices.
                                                                                                                        5.43%
                       2                                                                                                                                              Real savings have been higher than expected.

                       0
                                                       02/03                                                             03/04

                               (*) Theoretical growth without the effect of the Reference Prices


Institut Català
de la Salut                                                                                                                                                                                                                                                       Pág. 19
                                                         ICS in figures               Improvement Actions                 ICS challenges

                  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

                                                                                                                         MBO: Management by objectives.
Institut Català
de la Salut                                                                                                                              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


                  3.000                                                                        Negative
                                                                                                15%

                  2.000

                                                     1.079
                  1.000           763


                   -
                                Corporate          Primary Care            Hospital
                                 Centre                                    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
                                  70                                                                                           Work                  881
                                                                                                                               Total               1.602
                                  60
                                                                                                                                       Annual average
                                  50                                                                                           Equipment               22
                                                                                                                               Installations           26
                                                                                                                               Work                    59
                                  40
                      Million €




                                                                                                                               Total                  107

                                  30                                                                                                     In million euros


                                  20

                                  10

                                   0
                                       1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003


                                                   Interventions          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 €.

Institut Català
de la Salut                                                                                                                                                 Pág. 22
                                                        ICS in figures                   Improvement Actions                 ICS challenges

                  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          Rarely            Often            Alm. always             Always


Institut Català
de la Salut                                                                                                                               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:
                                               „ 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.




Institut Català
de la Salut                                                                                                                                 Pág. 24
                                                             ICS in figures                   Improvement Actions                ICS challenges

                  PRIMARY CARE DIVISION


                  „   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).




Institut Català
de la Salut                                                                                                                                  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:
                                       „    New integrated management plans.
                                       „    Improved information systems and circuits.
                                       „    Project to reduce knee replacement and heart surgery waiting time.




Institut Català
de la Salut                                                                                                                              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.
                                  „ Social action 45 Midwives.
                                           „      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.

                                     „   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.




Institut Català
de la Salut                                                                                                                                 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:




                                        „    Ascertain the value of its assets

                                        „    Ascertain the average service life of the equipment.

                                        „    Pre-empt electro medical equipment replacement needs.
Institut Català
de la Salut                                                                                                                       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.




                  „    Intranet Portal
                                         „   Management of the implementation project
                                         „   Development of instruments of participation and debate: Forum, weblog,   videoconference.




                  „    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:                                                               Projects:
                  most relevant                                                       most relevant

                    • H. Bellvitge: Phase I-II new building.                            • H. Vall d’Hebron: Emergencies (General),
                    • H. Vall d’Hebron: Surgery block general area and traumatology     paediatric ICU (Maternity/children’s) and
                      area..                                                            Emergencies (Traumatology H).
                    • H. Germans Tries i Pujol: Research and teaching                   • H. Germans Tries i Pujol: Emergencies and
                      laboratory.                                                       reform of Hospitalisation floors.
                    • H. Josep Trueta: New safety/security systems.                     • H. Josep Trueta: New ambulatory building.
                    • H. Verge de la Cinta: ICU and sterilisation                       • H. Arnau de Vilanova: Reform emergencies.
                    • H. Joan XXIII: extension of the CT and                            • H. Joan XXIII: Reform of the emergency
                      densitometry.                                                     service and the 3rd hospitalisation floor.
                    • H. Arnau de Vilanova: Linear accelerator and                      • H. Verge de la Cinta: Surgery block and 1st
                      replacement of CT and its area.                                   hospitalisation floor.
                    • H. Viladecans: development of the car park                        • H. Viladecans: new surgery block.


                  Primary care: 48 million €*  71 Works and 124 projects

                    Work:                                                                 Projects:
                    most relevant                                                         most relevant

                      • CAP Martorell: reform.                                                • CAP Eixample de Lleida: extension.
                      • CAP Sant Feliu de Guíxols: reform.                                    •   CAP     Bages: extension.
                      • CAP Mollerussa: extension.                                            •   CAP     Deltebre: extension.
                      • CAP Sant Pere y Sant Pau: extension.                                  •   CAP     Vilanova del Vallés: new centre.
                      • CAP Montcada y Reixac-2:new centre.                                   •   CAP     Sant Andreu: new floors.
                      • Centre de Diagnòstic Ràpid de l‘Hospitalet.                           •   CAP     Sant Martí: reform.
                      • CAP Rambla de Sabadell: new centre.                                   •   CAP     Manresa IV: new centre.
                      • CAP Alcanar: new centre.                                              •   CAP     Riudarenes: new centre.
                      • CAP Santa Perpetua de la Mogoda:                                      •   CAP     Just Oliveras: reform.
                      extension.


                     * Total sources of funding
Institut Català
de la Salut                                                                                                                            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).

                       1991  Approval of the LOSC

                       2005  Process of Modernisation of the Law of the ICS.




Institut Català
de la Salut                                                                                                                     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

                  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.



Institut Català
de la Salut                                                                                                                                     Pág. 37
                                                              ICS in figures                    Improvement Actions                  ICS challenges
                                                                                                                                   Retos para 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

				
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