42 Promote low-cost, high-quality care utilising QI techniques and strategies in paediatric inpatients

Background Most high-income countries are concerned about healthcare expenses. Gartner suggests that hospitals can decrease expenses by up to 15% just by analysing, arranging, and controlling the purchase and utilisation of supplies. With this scheme, it can appreciate up to a 7% growth in profit margin. The challenge is that few organisations have the supply chain talent and leadership necessary to make this possible.¹ In paediatric inpatients, we haven’t focused on the costs associated with providing services as most payments derive from government funding, some from insurance. Our supplies come from the supply chain through internal requests in an Oracle Database, without close monitoring of costs, potentially leading to inefficiencies, overspending, overstocking, and waste. We started the National Value Improvement Collaborative (NVIC) with 8-week baseline data, the estimated supply cost per patient day was QAR 87. We aimed to reduce the supply cost per patient day from QAR 87 to QAR 74 by December 2022, an estimated reduction of 15%.³

Methods The Plan-Do-Study-Act (PDSA) cycle methodology as part of the Institute for Healthcare Improvement (IHI) Model of Improvement guided multiple strategies,² such as adapting the IHI Waste Identification Tool, utilising the five S method in the store arrangement (figure 2), and using LEAN methodology to reduce waste and improve efficiency.

Results A cost reduction from QAR 87 to QAR 74 per patient day was achieved by December 2022 (figure 1). Our results indicate achievement of a 15% reduction in supply costs overall. The reduction during the initiative was being maintained despite the expanded bed capacity in 2022 and sustained through to mid-2023.

Conclusion We managed to cut costs while preserving high-quality treatment, then eliminate waste by making the most use of available resources, optimising store procedures, and utilising technology to facilitate efficient workflow. Spreading this accomplishment to the Paediatric Division units will be the next stage.

References

1. Abdulsalam Y, Schneller E. Hospital supply expenses: an important ingredient in health services research. Medical Care Research and Review [Internet]. 2019 Jul 24;76(2):240–52. Available from: https://journals.sagepub.com/doi/10.1177/1077558717719928

2. Pennic J. 5 Ways Supply Chain Can Reduce Rising Healthcare Costs [Internet]. Hitconsultant.net. 2014. Available from: https://hitconsultant.net/2013/05/13/5-ways-supply-chain-can-reduce-rising-healthcare-costs/

3. Sharek PJ, Parry G, Goldmann D, Bones K, Hackbarth A, Resar R, et al. Performance characteristics of a methodology to quantify adverse events over time in hospitalized patients. Health Services Research [Internet]. 2010 Aug 16;46(2):654–78. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2010.01156.

Ethical Approval/IRB Statement Approved by Hamad Medical Corporation as Quality Improvement project.

Disclosures and Acknowledgments The authors have nothing to disclose. We acknowledge the Paediatric Division team for their commitment to improvement and to the Executive Leadership for their support to facilitate the project.