1. Improving Medical Care Service Through Collaborative Networks Watana Navacharoen, M.D. Maharaj Nakorn Chiang Mai Hospital Faculty of Medicine, Chiang Mai U.,Thailand Watana Navacharoen, M.D. Maharaj Nakorn Chiang Mai Hospital Faculty of Medicine, Chiang Mai U.,Thailand 1

2. Our Work Load 1,000,000 visit / yr 47,000 admission / yr 1,000,000 visit / yr 47,000 admission / yr ProvinceNo. of cases Chiang Mai 89,165 Lamphun 20,852 Chiang Rai 19,393 Phayao 11,134 Lampang 7,360 Mae Hong Son 7,215 Phrae 4,876 Nan 4,702 Tak 3,018 Sukhothai 1,547 Uttaradit 1,518 Kamphaeng Phet 396 Phitsanulok 293 Nakhon Sawan 120 Phetchaboon 112 Pichit 112 Uthai Thani 5 Total171,818 No. of Referred Cases in 2008 2

3. Our Service include Population in 17 provinces in the North of Thailand Minority groups - Hill tribe - Migrate people Population in 17 provinces in the North of Thailand Minority groups - Hill tribe - Migrate people Covered population 12 millions 3

4. Improving Delivery of Service Lean and seamless - One stop service Information technology - Medical information system (SMI) - Barcode & stickers identification - OPD card scanning - IPD card scanning - Prescribing medicine in SMI - Internet consultation - Internet OR setting Lean and seamless - One stop service Information technology - Medical information system (SMI) - Barcode & stickers identification - OPD card scanning - IPD card scanning - Prescribing medicine in SMI - Internet consultation - Internet OR setting 4

5. Key Indicators of Quality Service Delivery 5

6. 1. Waiting time 6

7. 2. Customer satisfaction 7

8. 3. Customer satisfaction for palliative care 8

9. 4. Pain management 9

10. Indicator2005200620072008 Length of stay8.4 8.57.9 Death rate2.32.121.9 Death rate of acute MI14.513.09.39.8 Death rate of stroke12.210.310.18.9 Maternal birth2,4202,0131,8571,993 Maternal mortality2310 Life birth2,4632,0581,8742,082 Perinatal death66615948 5. Others clinical indicators 10

11. Medical Collaborative Networks Problems 1.Too many number of patients requiring medical services 2. Patients did not received appropriate medical care before coming to the hospitals. 3. The lack of community hospitals’ competency treatment 4. Lacking medication and up-to-date monitoring equipment Problems 1.Too many number of patients requiring medical services 2. Patients did not received appropriate medical care before coming to the hospitals. 3. The lack of community hospitals’ competency treatment 4. Lacking medication and up-to-date monitoring equipment 11

12. Collaborative Networks Acute coronary syndrome network Trauma center Stroke network Campaign against raw pork consumption (Streptococcus Suis infection) Acute coronary syndrome network Trauma center Stroke network Campaign against raw pork consumption (Streptococcus Suis infection) Team setup Education, Training Supplied equipments, medicine Internet referring, SMS, Facsimile Team setup Education, Training Supplied equipments, medicine Internet referring, SMS, Facsimile 12

13. KPI: AMI fast track admission time 20072008 Pre40 Post74 Door to needle time 20072008 Pre70 Post4032 Door to balloon time 20072008 Pre130 Post95 2005200620072008 Dead rate14.613.09.39.8 13

14. Year 20081 trimester 2 trimester 3 trimester 4 trimester Response time: Trauma team7.18.77.97.0 Response time: Neurosurgery14.211.412.212.1 Response time: Orthopedics10.713.211.610.5 KPI: Trauma fast track 14

15. TargetResult rt-PA within 2 hr.10088 % Door to drug time6088.3 min Symptomatic ICH after rt-PA<7%0 (28.5% HF) Patients’ independence at 3 months after rt-PA 50%57.1% Note: rt-PA, recombinant tissue plasminogen activator KPI: Stroke Fast Track 15

16. Change the Culture Public campaign against raw pork consumption to decrease morbidity and mortality rates from Streptococcus Suis infection Public campaign against raw pork consumption to decrease morbidity and mortality rates from Streptococcus Suis infection Organized 65 campaign activities and message through mass media during past 3 years 16

17. With strong streamline and seamless collaborative networks cover all hospitals in the north of Thailand With strong streamline and seamless collaborative networks cover all hospitals in the north of Thailand Conclusion “All hospitals in the north is the only one big hospital” “All hospitals in the north is the only one big hospital” 17

18. Thank you for the prestigious award that will strengthen our conviction to continuously improve the quality of health care for our people. 18