Reorganization Technical Services Clinical hospital Sibiu, Romania
PROJECT
Preface
For quite some time now, the Urgenta Foundation has been involved with the University Hospital in Sibiu. Numerous contacts between the hospital and the foundation have developed throughout the years into a tight bond of friendship and mutual trust. At the moment a very ambitious board of directors is in control. They started a more contemporary management with emphasis on the future. External help is provided by a number of western medical practitioners who play an advisory role in restructuring the hospital in the strictly medical field. This way, the hospital is little by little developing into a, medically spoken, modern hospital.
However, the Facility Services of the hospital, consisting of the Purchase Department, miscellaneous services and Technical Services, is lagging behind. As you can imagine, the Facility Services are of great importance to any hospital, especially when a modernization has to be carried out.
The hospital board has indicated that the focus has to be set on Facility Services also and that they are in need of an external consultant who can play an advisory role the same way as the western medical practioners are doing in the medical field. As it happens the Urgenta Foundation has a member of the board, Mr. A. van Rijn, at its disposal who is an expert in this line of work. He gained the necessary experience in restructuring the University Medical Center (UMC) a few years ago. Mr. Van Rijn has been personally asked by the hospital board and, after some time to think the matter over, decided to gladly take the task upon him. Since Mr. Van Rijn is currently employed by FNV Bouw (trades union for construction workers) as manager accommodation control, he can not just leave for three months. Therefore the hospital board has sent a letter to FNV Bouw to inquire if it is possible to relieve Mr. Van Rijn of his duties for three months. This way he will be able to bring the project to a favorable conclusion.
Clinical Hospital Spitalul Judetean Sibiu
Medical Managing Director: Mr. Dr. Cotarla Liviu
Economical Managing Director: Mrs. Ec. Burnete Doina
The University Hospital of Sibiu obtained its academic status in the nineties. This of course is of great importance to the hospital and the city of Sibiu. The changes are being made at great pace, the construction of the Faculty Building, at which doctors as well as students will be located, has already been started, but due to financial problems the construction site has temporarily been shut down. Therefore the hospital is under a lot of pressure, since all lectures are taught there now. The hospital has a capacity of 1.700 beds in total. Not all of them are situated at the main hospital though, some of them are located at several auxiliary buildings across the city of Sibiu.
The short-term objective is to expand this hospital into a prominent national university hospital. In time an international reputation is something to strive for.
After a period of just consolidating and a lot of changes in personnel, the hospital has finally started -partly due to the changed political situation in Romania- the process of changing and improving the basic medical activities which are desperately needed in order to improve the standard of medical care at the hospital.
All across the country, and consequently at the hospital, the Western European influences are noticeable. The wish to join the EU is getting stronger. Romania is at the beginning of a long and difficult process to achieve its goals but a start has been made.
OBJECTIVE IMPROVEMENTS TECHNICAL SERVICES
Preface
As mentioned before the hospital is trying to alter and improve its organizational structure and therefore its management to rule out bureaucracy and the related low pace at which changes can be made. The hospital and especially the patients should benefit from these alterations and improvements.
Medically, a lot of work is being done at the moment. On the one hand by letting physicians attend lectures and seminars abroad, on the other hand by restructuring the organization aided by befriended foreign medical practitioners. As a result of this, intense arguments may occur between the hospital board and the physicians about, for example, organizational changes or acquisitions to be made. The hospital board does not have all the answers to these problems, mainly because many regulations issued by the government are not always clear or not even issued at all. This is one of the consequences of the present developments in Romania.
The budgets, still ruled and provided for by the government in Bucharest, are hardly sufficient to bear the costs of the changes needed. This is mainly due to a shortage of any long-term vision and the lack of a modern budgetary system.
Technical Services
The Technical Services, consisting of several different departments, provide for the general maintenance of buildings, installations and furnishings. Adjustments, renewals and innovation projects are managed by Technical Services on its own. Sometimes external building contractors and installers are hired to put parts of these projects into effect.
The following departments belong to the Technical Services:
- Construction: carpenters, plumbers, bricklayers, upholsterers.
- Electrical engineering: electricians.
- Mechanical engineering: fitters, c.h. mechanics, refrigeration engineers, air conditioning engineers, medical gasses engineers.
- Instrumentation Services: instrumentation/control engineers (mechanics/electronics ).
- Parks department: garden keepers.
- Additional staff: manager of Technical Services, project planners, clerical staff.
Currently, seventy people are employed by the Technical Services, under direct control of the manager of Technical Services. Teams of mechanical engineers are put on round the clock shifts to keep miscellaneous installations and medicinal gas equipment in operation. If problems should occur they can solve these themselves or ask engineers who are not on duty for help.
The Technical Services' organizational structure is such that all activities are directed straight from the manager of Technical Services. This originates from the old days when hierarchy was imposed from the top.
Considering the number of employees, the size of the hospital as well as the increasing technical complexities this can no longer be sustained (according to us this situation was unworkable even in the old days). The manager of Technical Services justifies his actions to the economical manager director. The economical manager director is, in addition to being responsible for Technical Services, also responsible for the divisions Purchase, Food Services, General Maintenance, Transport, Security and Bookkeeping.
Objective definition
Technical Services must be transparent, short-circuited and with responsibilities in their right place.
The hospital has asked, on the authority of the board of directors, to look over Technical Services, to report on its findings and submit them to the board. This, alongside with a first conclusion and a recommendation as to how, following the consultant's advise, things can be changed into a better and more efficient Technical Services.
The regulations issued by the government, healthcare, as well as the limited available social laws must be accounted for. In each separate case discussions must be held with local authorities and representatives of the trades union movement.
After having determined the conclusions and recommendations, the ways in which changes will be made are agreed upon mutually. The consultant who has set up these conclusions and recommendations will be asked to give further suggestions. The manager of Technical Services and the consultant will take care of the implementation.
Every week accomplishments resulting from the implementation will be reflected upon in meetings with the board. All possible bottlenecks will be discussed and solutions and adaptations will be sought out.
The implementation will take longer than the planned three months during which the consultant will be present. To conclude his three months stay, the consultant will hand over a written report to the board of directors, in which an evaluation will have been made. Hopefully the consultant will include complementary recommendations.
Follow-ups done by the consultant in question will be much appreciated, preferably by means of periodical visits in the years to come.
TIME SPAN
For the first step, to look over Technical Services, a period of four weeks is recommendable. During the implementation and progress of the alterations much time and personal contact with all personnel in question is required. People are not used to being directed and will certainly be critical about this at first. However, with the consultant's input, which can rely on much regard and trust among employees, the board of directors is of the opinion that this project can be a great success.
COSTS
The main question is in what way the project can be covered financially. The Urgenta Foundation does not have access to financial means. It is not possible for the consultant to do without income during these three months.
Matters such as payments, healthcare costs, pensions, transport and expenses for board and lodging are a necessity. The Urgenta Foundation has taken the initiative to ask for financial aid at the NCDO in Amsterdam. The exact amount of money is hard to calculate and also depends on how much the employer, the FNV Bouw, is willing to contribute. The hospital in Sibiu is prepared to make a modest donation as well. This requires further agreements to be made.
An estimate has been made at about €13,000