Roadmap for the development of an Integrated University Hospital Network

Strategic Development of the KazNMU United University Hospital Network

A Roadmap to develop an Integrated University Network

Hospital

“Different institutes in a United University Network”

“A roadmap to create an Integrated University Hospital Network”

Kazakh National Medical University named after S.D. Asfendiyarov The Educational and Clinical Center UNIclinic KazNMU Dental Institute New upcoming KazNMU Hospital New affiliated UHS institutions New in franchising UHS institutions

How to use this document This document is a continuum of “The Vision for the Academic Health Science Centre of Kazakh National Medical University”. It describes the sequence of actions that have to be undertaken to reach the creation of the Integrated University Hospital Network fulfilling the UNIclinic Vision and Mission. It provides the fundamental steps and deadlines for the development of such Network.

This document is meant to be a fluid and to adapt thanks to the updating to the new upcoming needs during the future years. It should also light up the way that all the institutions within the University network should follow to achieve the set goals.

It will be followed by the three to five-year strategy plans of the other components of the Integrated University Hospital Network, which will adapt to collaborate establishing University level goals and identify how to achieve them, particularly within the University’s stated specialties.

Foreword Since the end of the XVII century the system of medical education and science is based on the model of university hospitals all over the world. These clinics have their own peculiar philosophy, bringing together a trinity of education, science and clinical practice. The educational process is inseparably connected to the research, development and introduction of new medical technologies for the benefit of patients. Up today in our country, the system of medical education does not assume that University may have its own clinic. For practical training of students we send them to the city hospitals and national health institutions, which are often not ready and, in general, are not designed to meet the needs of the educational process. This limits the access to the patient not only for students, but also for faculty members.

The new competence-oriented education model of KazNMU needs the creation of its own hospitals network in order to develop all the competencies in students, like practical, legal and communication skills. This direction is a completely new for Kazakhstan. For this reason best teaching hospitals of Germany, Italy and Lithuania were taken as an example.

At the end of 2012, under my direct supervision, a group of young researchers (Sukhrab Zhaparov, Madina Temirkhanova, Natalia Kushpeleva, Karina Zhangireyeva, Ainur Kumar, Aigul Aibasova, Vakhtang Zhangireyev, Maiya Zhumanova, Alia Tokusheva) started to develop this new Concept of the University Hospital in collaboration with Prof. Filippo Bartoccioni (Italy) and Prof.

Tilek Meimanaliev (Kyrgyz Republic). I would like to thank not only them but also several areas of the University that were involved and participate suggesting ideas and offering to actively participate in the project like, just to make few examples, the Communication Skills Center, Educational Department and the Faculty of Pharmacy.

The roadmap to create an integrated University Hospital Network represents a new concept in Kazakhstan. This Roadmap defines the basic principles, steps, goals and directions of the creation of the network. Base on this roadmap detailed orders for actions will be elaborated with the use of all resources (human, financial, academic, scientific, etc.) of the University.

This is not a stand-alone project but it is the offspring of the University, that will become a platform for the implementation of the most bold and creative ideas.

Good luck to all of us in this new start!

Rector, Prof. Aikan Akanov

Foreword The Strategic Development of the KazNMU United University Hospital Network is a key part of reconfiguration of the actual hospital services principally to ensure that integrated, high quality and safe services can be delivered into the future within resources available. Over the next period, the KazNMU will have to meet new regulations and licensing requirements including international standards and National Directives.

It is important to recognize that the reconfiguration programme is a proactive process being undertaken by the KazNMU, to enable the organization to reshape the roles of the hospitals system to ensure to meet these challenges and deliver the type and quality of services required to meet the needs of the local communities been served, in line with international best practice. This becomes even more important with the current world financial challenges faced in this era.

I am delighted to present to you the reconfiguration Roadmap to create an integrated University hospital network system within the KazNMU. The Roadmap outlines a clear and vital role for each institution and the key roles in the system.

The role of each hospital will be unique and not a duplication of services in other hospitals. While the focus of this Roadmap is the services delivered in the hospitals increasing importance of General Practice, Primary Care Teams and Multidisciplinary Clinical Teams is highlighted. Great emphasis is placed on improving the interface between the hospitals and the University activities like education and research. I underline the key leadership role played by the Faculty Members and the Clinicians in the work of the reconfiguration subgroups. Developing and strengthening clinical leadership continues to be a feature of the evolution of the KazNMU. Clinical Directors now play a vital role in the day to day management of hospitals. Work has already commenced and a variety of initiatives are underway and it is important that we acknowledge the work that is underway and the staff at all levels that involved in it.

The priority now is, for everyone who works in the hospital systems, to play their part in implementing these programmes of change. It is vital that reconfiguration is seen by everyone as part of their role and not the sole responsibility of any one group.

This Reconfiguration Roadmap for the KazNMU University System is both challenging and exciting and will involve comprehensive change to health care delivery in this region. I fully acknowledge that the change will be challenging for those involved in delivering healthcare services and for the service users as the process go through, however, I do believe that if everybody strives to implement this Roadmap it will create a better health care system within the KazNMU Health Delivery System.

The implementation of this strategic planning for the KazNMU Integrated University Hospital will make a highly significant contribution to the design and delivery of health services in the region and will mark a significant landmark in the history of Kazakh health service.

Prof. Filippo Bartoccioni, M.D. of Health Technology Assessment International Public Health Advisor Cardiac surgeon April 2013

Acknowledgement

I would like to express my deepest appreciation for the leadership role of Rector Prof.

Aikan Akanov and to thank him for the energy, commitment and vision that he has brought to this project. I would like to thank him for believing in me and in this project since the first day.

Without his encouragement and guidance this project would not have materialized and without his vision and wise support will not be possible to realize any part of this project and in his expert hands and on his reliable staff now I consign its implementation.

I would like to express my special gratitude and thanks to all those who provided me the possibility to complete this report. It would not have been possible without the sharing of the ideas of many individuals within the KazNMU such as Prof. Meimanaliev T.S., Prof.

Myrzabekov O.M., Prof. Duisekeyev A.D., Prof. Izmukhambetov T.A., Prof. Balmukhanova A.V., Prof. Tulebayev K.A., Prof. Kurakbayev, Dr. Abirova M.A., Prof. Assimov M.A., Prof. Datkhayev U.M., As.Prof. Sholpabayeva A.R., Mrs. Gubaidullina Z.A., Ramazanova B.A., Prof. Devyatko V.N., As.Prof. Ivanchenko N.N., Prof. Mrs. Kalmenova Z., Mrs. Ainabekova P.D. and Mrs. Abrasheva D.M. A special gratitude I give to all the management team of the UNIclinic, Dr. Zhaparov S.A., Mr. Akanov Z.A., Mukasheva K.U., Kumar A., Tokusheva A., Zhangireyev V., Zhumanova M., Aibassova A., Tailakova D., and the chiefs of the departments of UNIclinic whose contribution in stimulating suggestions and encouragement helped me to coordinate this project.

A special thank goes to my team mates Temirkhanova M., Zhangireyeva K. and Kushpeleva N., who helped me out with their abilities to assemble the parts of this projects and especially in writing this document and gave me always the suggestions and inspirations and never left me alone during this entire project guiding, me through the Kazakh environment and helping me to understand the beauty of the Kazakh mentality.

I would like to express my gratitude towards Professor Ricciardi, a real “Guru” in the medical management and source of inspiration and motivation, without his vision all these achievements would never been possible. I can’t say thank you enough to all the staff of the Institute of Public Health and Hygiene of the Catholic University in Rome, which helped my arrival in Kazakhstan and taught me all the methodologies here used and inspired me to integrate always new methodologies in this field.

I would like to extend my sincere thanks to Professor Morrone and Doctor Amoddeo that with their permission and kind support allow me to come in Kazakhstan to create this project.

Last but not least, I would like to extend my sincere thanks to Miss Mihaela Dubinski, president of HTAcamp, the IT University and all Rotary and Rotaract members that supported the evolution of this project giving me such attention and time.

Table of Contents Acronyms ............................................................................................. 2 Executive Summary ............................................................................. 3 Need and problem assessment ............................................................... 3 The background of the current system .................................................... 3 Analysis of the current system ............................................................... 3 Risks of the current situation ................................................................. 5 Data of the current situation .................................................................. 5 The new prospective ............................................................................. 6 Summary of the Goals .......................................................................... 7 Summary of the actions to Undertake ..................................................... 8 Essential Key Figures and Responsibilities ...............................................14 Network analysis on actions and relative key figures ...............................17 ROADMAP to KazNMU Integrated University Hospital Network ..........19 Annexes ............................................................................................ 112

Acronyms CG TEAM

Clinical Governance Team

CMT

Common Management Team

ECC

The Educational and Clinical Center

ENHR

Essential National Health Research and Priority Setting

EPRB ExB

External Supervisory Peer Review Board Executive Board of KazNMU Integrated University Hospital Network

HNA

Health Needs Assessment

HTA TEAM

Health Technology Assessment Team

IUHN

Integrated University Hospital Network

KazNMU

Kazakh National Medical University

MCTs

Multidisciplinary Clinical Teams

NGO

Non-governmental organization

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Executive Summary Need and problem assessment Up today the Kazakh National Medical University (KazNMU) activities such as research, education and clinical practices are fragmented in different University and non University institutions. The coordination and organization structure at the moment is not enough integrated to permit optimal results in these fields. This forces the University staff and students to spread in different city hospitals and health care facilities not allowing to focus in one system with a common goal. Logistic problems are wide spread but also waste resources are clearly visible.

The background of the current system The Educational and Clinical Center (ECC), did not accomplish during these last years a real integration with the University. The research, education and clinical activities were often in parallel but not really integrated within the system. It looks very much like the other hospitals in the city but run by the University.

To solve the problem a new hospital was opened but it faced in the first months several management problems due to the bigger size and the inexperience of the management team to run an academic health research center. For these reasons, the University drastically changed the entire management of the new hospital. The goal was to use new techniques and methodologies to upgrade the level of this healthcare facility first to a national and then to an international level.

The new management showed rapidly sign of improvements but also faced several critical issues. The new approved vision of the UNIclinic showed these issues and set as one of the goals to overcome them thanks to a reconfiguration of the structure within the University itself and the previous existing clinic creating the new concept of Integrated University Hospital Network (IUHN).

Up today the involvement of the University activities in the two clinics is very limited.

This is not due to the hospital management team but is due to the poor coordination between the University and the two structures and it is due to the poor motivation in moving the activities in these two hospitals. Today the responsibility to attract the University research and clinical activities is based on entice of the two health facilities.

The two institutions, at the moment, can survive but cannot win the competition with the other city hospitals well tested in the system.

Analysis of the current system Today a temporary solution is in place. To support the new management team in the UNIclinic a bridge group was created. This common management team is today supported economically by the two hospitals and consists of the previous manager of ECC and a residual from the past failing management UNIclinic and 2 young clinical doctors.

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None of these figures is in charge of the research or the educational process. There is no integration or figures responsible for this integration in the common management but only informal communications between the University activities and the management of the two hospitals.

There is no clear mandate in the University to create an interface between the University and the clinical activities. As well there is no mandate to create an interface to coordinate the research activities, programs and economical resources between the University and the clinics. Any contact is able only through informal communication or personal contacts.

Up today there is no formal document that can force all the professors to be involved, even just partially, in the activities of the clinics. The motivation to participate is lacking. The Management of the clinics is delegated to the two clinics common management team (CMT) that is too apart from the University activities and is felt something out of reach. Up today there is no formal document on the results of meetings of this group and their decision making. This is not an accountable way to take decisions. For example in the end of February, a document for the reorganization of the salaries was created without a clear discussion of the risks that this new reorganization order could cause. The results were serious unhappiness within the staff of the UNIclinic and strikes in the nurse and cleaning lady services.

The University owns a solid structure to coordinate research and education but nobody is actually integrating this inside the clinics activity.

The two hospitals managements are working actively and with knowledge to fill the gaps but without a proper shared planning it is impossible to create a solid structure for research and education. Everything is run on emergency base and on reaction to events.

The system that was in the beginning of the year unstable for the loss of the new hospital now is getting more and more stable. The real risk is the new upcoming institute with a bigger size, almost double, than the other two hospitals together.

Who will coordinate the activities there? How will it be connected with the University and the other clinics? Is it possible the integration of new affiliated institution in the system?

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Risks of the current situation It is critical to solve these issues not only to proper start an academic health research center in the UNIclinic in a short time frame but also to avoid a big failure of the system with the new upcoming huge health structure in the near future.

The system is still stable up today but it can become very unstable with the opening of the new University institute. If the organization will be not ready, reconfigured and prepared to integrate it in the Integrated University Hospital Network the inefficiencies and the new costs will be so huge to drain most of the University economic resources creating an economic collapse.

Data of the current situation Today the electronic data to describe the process between the University and the clinics are not present or there are few traces. It is not clear, just to make some small examples, on an accountable base to know the number of trials active in the clinics today or the quality of clinical practice teaching in the clinics or the effective presence of students, residents, masters or University staff in the clinics. There is no available data on the multidisciplinary activity between specialties and on the education to clinical cooperation and multidisciplinarity.

These responsibilities should be located in the University. The departments of education have to be involved and similar should be for the research and human resources. The responsibility should not be only on the hospital management teams. The role of these teams should be to facilitate and report the activities and the results to the specific departments and together, University and hospital management teams should plan and review the activities to improve it to its best.

The accountability of the clinical activities of the two clinics is not available for the public, like in other countries but it is also difficult to understand or impossible to collect even for the insiders. It is difficult, for example, to know how many patients with a specific comorbidities are actually visited in the clinics. The collection of the data is delegated to the good will of the single physicians. To build in the UNIclinic a reliable database, from paper records, to study and plan clinical governance activities and a pharmacy establishment in the UNIclinic took more than 3 months.

These activities usually are done in collaboration with the public health department that defines the fields of interest and use these data to improve the clinical service or to study the health needs of the population.

This situation is forgivable for the recent empowerment of the management in the UNIclinic but this and other severe gaps are not understandable in a clinic that is running from several years like ECC. In every University hospital in the western countries there is a medical director that supports the general director. The medical director is a medical doctor usually with a public health background with the critical function to follow the clinical activity and the healthcare workers. This figure is absent or delegated to clinical physician. This aspect is solved only in the UNIclinic where most of the management team has a medical degree and the ward managers figures widely cover this gap and actually create a more clinical awareness.

Thanks to this figures in the UNIclinic the data collection not only started but a long work on reconstructing the past has been done. Up today the ward managers of the UNIclinic are able to say the comorbidities of the patients, their risk factors and conditions of risk and Roadmap to IUHN

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this is really important for the creation of the new pharmacy and the accountability of each department.

The hard work of these months rewards the UNIclinic management team that has the chance to start a quality control over its activity.

The new prospective The new vision adopted by the KazNMU for the UNIclinic and the new agreements done to include in the Integrated University Hospital Network a new upcoming structure or integrate old ones like the Dental Institute, requires a reconfiguration of the responsibilities and duties within the system.

For this reasons, the Reconfiguration Plan of the KazNMU Health Services and its coordination with the educational and research activities is needed. Crucial is to improve the trust in the integrated leadership and management. This can be done only through clear definitions of the goals, the deadlines and the responsibilities within the integration process.

An emotional meaning have also to be understood. Working within the Integrated University Hospital Network will also force an increase in accountability and a stricter monitor of the activities of the students and the University staff. In single person self interest the changing does not have any appeal, especially when is required to move in a poor area of the city like it is for the UNIclinic. The University interest of course is completely different, is indeed to create an integrated health network where the education and research activities can bring new strength to the clinical practice and to work with the poor population.

The University is giving today its biggest value, the human resources, to other institutions for free. In the economic expenditure list of any business the human resources are the most valuable kind of resource. The education of these resources is critical and very expensive. Today the University is offering and even begging other institutions to host these very well educated resources for free.

The new organization of the Integrated University Hospital Network naturally will create opponents and wide spread conflict of interests also inside the University itself. For these reason the commitment and the strong input to shift and move the University activities in the two and in the future more structures can only come from the University Central Coordination itself.

Only the highest in rank key coordination University figures supported by a reliable integration of leaderships can accomplish this transfer to a new system. It is unthinkable that the single dislocated hospital management teams can assure alone this evolution shift.

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Summary of the Goals These are the fundamental changes that will drive the reconfiguration of the KazNMU Hospital Services. The delivering of the following goals will give the integrated hospital network its defining characteristics. Each objective contains its own recommendations and measurable outcomes with their own deadlines that are explained in details in the second part of this document.

Objective A: Reorganization of the structure Objective B: Unification of the strategic plans Objective C: Implementation of the information system and benchmarking with national and international institutions Objective D: Increase the research activity within the Integrated University Hospital Network Objective E: Excellency in research Objective F:

Increase the practical educational experience for all the learners

Objective G: Empowerment of the residents and the increase the residency experience Objective H: Foster the health improvement of the population understanding their health needs with low economic expenditure Objective I:

360 degree healthcare coverage

Objective J:

Implementation of clinical governance

Objective K: Productivity and critical mass for service Objective L:

Increasing the quality of care to the international level

Objective M: National and international Accreditation Objective N: Increasing the patient satisfaction Objective O: Increasing the patient accessibility Objective P: Monitor and increase the health workers satisfaction Objective Q: Increasing the patient and health workers safety Objective R: Economic sustainability Objective S: Eco-sustainability Objective T: Increase and coordination of the intra-University network for an integrated leadership and management within the IUHN Objective U: Creation of a franchising network and affiliated institutions Objective V: Optimization of the IUHN infrastructure and service network Objective W: Increase Networking Objective X: Develop a 2.0 collaborative social IUHN Objective Y: Development of a creative and innovative IUHN Objective Z: Redefinition of internal structure of the IUHN hospitals Roadmap to IUHN

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Summary of the actions to undertake The actions summarized here, are explained in details in the second part of this document and the complete Gantt Project is attached in the annexes.

Urgent actions to start in the short terms within the first month (July 2013)

Action A1: Define the relations and the responsibility Action A2: Approval of the Program by the Scientific Council.

Action C9: Indicator review Action A3: Design and preparation of "prikaz" for the program implementation identifying the responsible key figures Action Q2: Implementation of 24h emergency resuscitation team Action C1: Creation of reliable system of data collection at the IUHN level (Phase 1) Action R2: Prevention of economic collapse or crisis Action S1: Supervision of the eco-friendly status and eco-impact on environment Action S2: Participation in the educational and prevention projects related with environment and pollution.

Action T1: Increasing and monitoring the growth of the participation of the University areas within the IUHN. Action Y2: Bring the new ideas and projects into practice

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Actions to start in the short terms within 3 months (before September 2013)

Action A4: Creation and approval of the Executive Board of KazNMU Integrated University Hospital Network (ExB) Action A6: Creation of multidisciplinary chair Action W3: Creation of an intra-University communication strategy plan Action W4: Creation of a communication and marketing strategy plan Action V1: Define the space within the structures and monitoring its appropriate use Action F3: Measuring human resources presence and activity Action N1: Pain free hospital Action W6: National and international collaborations Action X1: Creating value in IUHN thanks to the voluntary and social activities Action A5: Creation of External Supervisory Peer Review Board (EPRB) Action A8: Creation of health technology assessment team (HTA TEAM) Action A9: Creation of clinical governance team (CG TEAM) Action B1: Vision and strategic plan development of ECC Action B3: Vision and strategic plan development of KazNMU Dental Institute Action G1: Reconfiguration of the residents activities based on the national law.

Action J6: Review of the international literature for the implementation of measures for risk management Action J7: Review of the international literature for the implementation of measures for waste management Action Z1: Redefinition of internal structure and responsibilities within the UNIclinic Action B2: Vision and strategic plan development of Future University Clinic Roadmap to IUHN

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Action N2: Reducing the waiting list time Action O1: Increase accessibility for disabled population Action O2: Implementation of IUHN web portal Action O8: Improvement of the viability for the IUHN hospital network Action L3: Select a flexible functional structure of disciplines to implement in the IUHN Action A7: Creation and monitoring of Multidisciplinary Clinical Teams (MCTs) Action E5: Opening the educational and research processes to the singularity approach

Actions to start in the intermediate terms within 6 months (before December 2013) Action C3: Upgrade of the data collection system to adapt to the national benchmarking and to match accreditation requirements (Phase 2) Action C5: Design of IUHN indicators Action G2: Creating a working space and an appropriate environment dedicated to residents Action I5: Planning the IUHN call center Action I11: Planning home care service Action J9: Data analysis for most common drugs used in the IUHN Action U1: Creation of the policies for the affiliating and in franchising clinics Action Z2: Redefinition of internal structure and responsibilities in ECC Action L1: Increase accessibility to the shared knowledge Action Q1: Implantation of Risk Management guidelines and identification of responsible figures in each hospital Action C2: Implementation of the information system.

Action J8: Health technology assessment implementation Action V2: Define network a synergic work within the IUHN

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Action L2: Implementing clinical governance methodologies within the IUHN Action F1: Reconfiguration of the activity for different kinds of students Action D1: Select and approve the new research projects Action F2: Monitoring of Quality, Performance and Satisfaction of the clinical practice Action F4: Integration between the educational coordinator with multidisciplinary chair and the MCTs Action Z3: Redefinition of internal structure and responsibilities in the KazNMU Dental Institute Action G3: Education and preparation of the residents to their new activities Action K1: Monitor production activity of the departments Action N3: Improving the doctor-patient communication and empathy Action N4: Developing emotional intelligence and social sensitivity in the IUHN Action P1: Assessment of the workers satisfaction Action Q3: Monitoring and reducing of hospital acquired infections Action W1: Monitoring of the networking activities Action Z4: Identification, definition, planning and monitoring of the use of available resources.

Action C6: Design indicators on the national level Action H1: Select and create the new prevention and screening projects.

Action I7: Planning the IUHN pharmacy Action C4: Upgrade of reliable data collection system to adapt to international benchmarking and to match international quality standards (Phase 3) Action I6: Developing the IUHN call center Action I12: Developing home care service education Action I14: Developing hospice care Action C8: Continuous real time monitoring Action E1: Alignment between research and clinical practice Action E2: Health Technology Assessment into the selected research activities Roadmap to IUHN

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Action E3: Implementation and monitoring the increase of multidisciplinary approach in research Action E4:Optimization of Data collection for accountability in quality and quantity of the research activity and its results Action J1: Data analysis for most common diseases and comorbidities detection in each hospital of the IUHN Action K2: Preventive and corrective measures to increase or to optimize the production Action U2: Vision and strategic plan of new affiliating or in franchising clinical healthcare institutions development Action W2: Analysis of the networking activities Action W5: Communication and marketing activities Action T3: Emergency and critical care plans Action I8: Developing IUHN pharmacy Action F6: Creation of an under-post graduate health management academy Action I2: Developing primary care centers Action I3: Developing different kinds of secondary care Action I4: Developing tertiary care centers Action D2: Monitoring and statistical analysis on the research activity and international accountability Action F5: Starting online teaching and support for students Action H2: Coordinate the activities of the residents with the implementation of new prevention and screening projects in accordance with the National planning.

Action J2: Search and assessment of evidence based literature for creation or upgrading clinical pathways and protocols in clinics.

Action M1: Monitor the required fields for accreditation Action T2: Plan, monitor and implement the flexibility of the IUHN through the MCTs. Action U3: Revocation of the IUHN membership affiliation

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Actions to start in the long terms after 6 months (from December 2013)

Action I1: Planning of the activities reducing the waste of resources and duplications within the IUHN. Action O7: Implementation of online health records access Action I15: Integration of the working network and traceability of the patients within the IUHN institutions Action M2: Preventive and corrective measures to increase or to optimize the efficiency in the required areas for accreditation Action C7: Design indicators on the international level Action T4: Public Health Emergencies and Modern Disaster Response Planning Action O3: Implementation of the telemedicine Action I13: Developing home care Action C10: Publication of indicator dashboard in the website Action H3: Monitoring and statistical analysis on the prevention and screening projects implemented Action H4: Integration of the prevention and screening projects implemented with the research activities

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Action J3: Creating clinical pathways and protocols.

Action K3: Closure of a department Action N5: Increase the national and international appeal of the IUHN Action Y1: Involving the IUHN and University in the evolution of the IUHN Action X2: Creation of web 2.0 tools to communicate with the population Action J4: Implementation of clinical pathways and protocols Action D3: Publication of the research results Action J5: Monitoring clinical pathways and protocols and their efficacy and the implementation quality Action O4: Implementation of Online Booking Action O5: Implementation of online educational materials for the population and the patients Action O6: Implementation of web 2.0 services and online health applications Action R1: Monitoring and public reporting Action M3: Obtain international recognition of research publication Action I9: Planning first aid emergency center Action I10: Developing first aid emergency center

Essential Key Figures and Responsibilities The Key Figures are centered mainly in the Executive Board of KazNMU Integrated University Hospital Network (ExB). This is to improve their communications and to introduce multidisciplinarity in the management of the IUHN. The communication between these figures is crucial and essential. Of course these figures have to collaborate with the figures within the hospitals and with the specific department of the University such as the one in education, research and administrative areas. Some other figures are important to peer review the activity of the system to assure the accountability like the External Supervisory Peer Review Board (EPRB).

The following lists show the main key figures and their responsibilities. 

Rector as facilitator of the entire process and as ExB coordinator



Within the Executive Board of KazNMU Integrated University Hospital Network (ExB): o

Responsible for the legal aspects. The following responsibilities are explicative examples: patient rights compliance, corruption, realization plan violation, social sustainability, legal issues to support in decision making, review of memorandum of agreement or contracts, support other ExB coordinators in their activities regarding the legal aspects and the respect of the national regulations etc.

o

Responsible for the economic aspects: responsible for the creation of an accountable and transparent system on investments, balance (incomes, expenses and profit) and use of recourses available. A due duty will be to submit monthly reports on the activity Roadmap to IUHN

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o

Coordinator for educational processes: responsible for the integration of the undergraduate and postgraduate education in the IUHN: timetables for theoretical and practical classes, etc. A due duty will be to submit quarterly reports on the activity.

o

Coordinator for clinical practice (multidisciplinary chair): responsible for practice and integration of learners (students, interns, residents, masters, PhD students) into the multidisciplinary clinical teams (MCTs). A due duty will be to submit monthly reports on the activity.

o

Coordinator for clinical governance: responsible for defining, selecting and monitoring clinical disciplines, which will be based in the clinics. A due duty will be to submit monthly reports on their activity.

o

Coordinator for human resources: responsible for the plan and monitoring of attendance and performance of all the University staff within the IUHN. A due duty will be to submit monthly reports on the activity.

o

Coordinator for scientific-research process: responsible for research activities of MCTs, number and situation on current clinical trials and research programs in the clinics. A due duty will be to submit monthly reports on the activity.

o

Coordinator for the internal and external communication and marketing issues: responsible for all the internal and external communication and marketing issues. A due duty will be to submit monthly reports on the number of collaborations and internal and external network. Its activity will go from patients and health workers satisfaction level to the assessment of marketing activities including.

o

Coordinator for public health issues: responsible on the epidemiological analysis, assessment of health care needs, clinical governance and monitoring and implementation of clinical guidelines through clinical pathways and the review of all the clinical protocols. A due duty will be to submit monthly reports on the activity.

o

Coordinator for strategic planning and IUHN development: responsible for the participation of the University departments within the IUHN and their integration. A due duty will be to submit monthly reports on the activity.

o

Coordinator for the health technology assessment: responsible for the creation of reports in the health technology assessment for any request of investments.

Reports must be delivered within 30 days from the request. A due duty will be to submit monthly reports on the activity.

o

All directors of the clinics within the IUHN such as ECC, UNIclinic, and other future clinic and affiliated health care institutions 

Head of ECC: responsible for decisions integration and implementation in the clinic made by the ExB. A due duty will be to submit monthly reports on the following directions: quality, performance, clinical outcomes, implementation stage of the approved projects. Collecting and providing required information for the ExB coordinators.



Head of UNIclinic: responsible for decisions integration and implementation in the clinic made by the ExB. A due duty will be to submit monthly reports on the following directions: quality, performance,

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clinical outcomes, implementation stage of the approved projects.

Collecting and providing required information for the ExB coordinators. 







Head of future clinics: planning and preparation for the future integration and actions implementation in the clinic made by ExB. Responsible for decisions integration and implementation in the clinic made by the ExB. A due duty will be to submit monthly reports on the following directions: quality, performance, clinical outcomes, implementation stage of the approved projects. Collecting and providing required information for the ExB coordinators.

Within the External Supervisory Peer Review Board (EPRB): They will review the ExB decisions and activities. To assure a reliable accountable system an external peer review of the system is needed. These key figures must be external to the University and hospitals standard salary to permit an external point of view free for any conflict of interest. The fields of review like scientific research, clinical activity, hospital management will be similar but the approach will be different. The commission has to include tree main figures: o

Responsible for reviewing ethics and deontology within the IUHN

o

Responsible for reviewing clinical governance and health technology assessment within the IUHN

o

Responsible for reviewing policy and economic balance within the IUHN

Within the Hospital Clinics of the IUHN to support the directors to run the hospital and to supervise the clinical and research activity and the management of the wards: o

Directors of the departments

o

Hospital Management Teams

o

MCTs and their directors

o

Area Managers

Within the University to facilitate the changing process: o

University Chairs

o

University Faculties

o

University Specific Centers

o

Different and specific department within the University for education, research, clinical practice and administration.

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Network analysis on actions and relative key figures The network analysis is been used to evaluate the interconnections between the key figures and the actions (fig 1).

Thanks to this kind of analysis is possible to understand the figures that are more involved in the processes (high degree out) and that have to be very active like the hospital directors (HD) (fig 2) and which are the most involved figures in the interconnectivity of the system (high betweenness centrality) (fig 3) and which actions require more interdisciplinary approach (high degree in) and consequently a better integration of leaderships (fig 4).

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From the analysis is possible to notice that are 4 main groups (fig 5) (actions + figures), these group where selected by the computer based on the inter correlations within the network: “University Group” (green circle), that includes the Rector, Scientific Council and other University figures; the “Healthcare Facility Group” (pink square) in that includes hospital directors, area managers, the clinical governance activity (CG-ExB), MCTs and other healthcare activities in the Hospitals; the “Coordination Group” (orange triangle) that includes most of the ExB like coordinator for strategic planning and IUHN development (SPD-ExB), HTA activity (HTA-ExB), Human Resources (HR-ExB) and others; “Stakeholder Oriented Group” (blue square) that includes Public Health activities (PH-ExB) communication and marketing actions (Com-ExB).

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ROADMAP to Kazakh National Medical Integrated University Hospital Network

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Objective A: Reorganization of the structure Description The most urgent and important goal in the short term is to define relations and responsibilities and key responsible figures within the IUHN and get the approval from the University Scientific Council. The creation of order (prikaz) to define the new functional structure and several plans on the use of available resources is very important to define a global strategic plan. The creation of an Executive Board (ExB) is the starting point of all the sequential actions of the project and only through its creation will be possible to achieve all the set goals. The creation of the first operative MCTs will permit to start the multidisciplinary and research activity.

Action A1: Define the relations and the responsibility Description The development of strategic program that will be approved by the University Scientific Council is very useful to agree on the future steps that have to be taken. The definition of relations and responsibilities in the University and between the different clinics is mandatory as well as an integration of the different visions.

Expected results Development of program and implementation plan submitted for approval to the Scientific Council.

Starting Date

May 11, 2013

Ending Date

May 27, 2013

Responsible Prof. Filippo Bartoccioni Indicators The paper version of the program and the plan that will be discussed at the University Scientific Council

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Action A2: Approval of the Program by the Scientific Council.

Description The Program have to be discussed implementation of the strategic program.

and

approved

to

permit

the

Expected results The approval of the program.

Starting Date

May 28, 2013

Ending Date

May 28, 2013

Responsible Scientific Council Indicators Approval by the Scientific Council

Action A3: Design and preparation of order (prikaz) for the program implementation identifying the responsible key figures Description Following the approval of the Scientific Council, Rector will define the responsible figures for the preparation and development of orders (prikazes) on activities in the different directions with the aim of reorganizing the structure, described in the program.

Expected results The creation of “Prikaz” and the selection of the names of the key figures Starting Date

June 3, 2013

Ending Date

July 1, 2013

Responsible Responsible figures determined by the Rector Indicators Approval of “prikazes” on various directions activities with the aim of reorganizing structure, described in the program

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Action A4: Creation and approval of the Executive Board of KazNMU Integrated University Hospital Network (ExB) Description The Executive Board will be an organ responsible for implementing policy and programs within the KazNMU Integrated University Hospital Network. It will be created by the Rector as a multidisciplinary organ. Thus, this Commission will be authorized to make decisions on the most critical issues, like educational, scientific-research, clinical planning, hospitals organization and networking, economical issues, human resources, ethic, communication and marketing, as well as issues concerning the accountability and transparency within the public health objectives (assessment of epidemiological situation and health care needs). In the commission there must be one responsible for each area of interest. This ExB will be the critical interface between the University activities and their implementation in the clinic. For achieving the set goals the commission will also include the heads of existing clinics and of the future ones. The ExB will also evaluate new healthcare institutions affiliation and will supervise the admission requirements and fees in case of franchising activity.

The compulsory members of the Executive Board are: 

Rector as the ExB coordinator



Responsible for the legal aspects. The following responsibilities are explicative examples: patient rights compliance, corruption, realization plan violation, social sustainability, legal issues to support in decision making, review of memorandum of agreement or contracts, support other ExB coordinators in their activities regarding the legal aspects etc.



Responsible for the economic aspects: responsible for the creation of an accountable and transparent system on investments, balance (incomes, expenses and profit) and use of recourses available. A due duty will be to submit monthly reports on the activity



Coordinator for educational processes: responsible for the integration of the undergraduate and postgraduate education in the IUHN like timetables for theoretical and practical classes, etc. A due duty will be to submit quarterly reports on the activity.

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

Coordinator for clinical practice (multidisciplinary chair): responsible for practice and integration of learners (students, interns, residents, masters, PhD students) into the multidisciplinary clinical teams (MCTs). A due duty will be to submit monthly reports on the activity.



Coordinator for clinical governance: responsible for defining, selecting and monitoring clinical disciplines, which will be based in the clinics. A due duty will be to submit monthly reports on their activity.



Coordinator for human resources: responsible for the plan and monitoring of attendance and performance of all the University staff within the IUHN. A due duty will be to submit monthly reports on the activity.



Coordinator for scientific-research process: responsible for research activities of MCTs, number and situation on current clinical trials and research programs in the clinics. A due duty will be to submit monthly reports on the activity.



Coordinator for the internal and external communication and marketing issues: responsible for all the internal and external communication and marketing issues. A due duty will be to submit monthly reports on the number of collaborations and internal and external network. Its activity will go from patients and health workers satisfaction level to the assessment of marketing activities.



Coordinator for public health issues: responsible on the epidemiological analysis, assessment of health care needs, clinical governance and monitoring and implementation of clinical guidelines through clinical pathways and the review of all the clinical protocols. A due duty will be to submit monthly reports on the activity.



Coordinator for strategic planning and IUHN development: responsible for the participation of the University departments within the IUHN and their integration. A due duty will be to submit monthly reports on the activity.



Coordinator for the health technology assessment: responsible for the creation of reports in the health technology assessment for any request of investments. Reports must be delivered within 30 days from the request. A due duty will be to submit monthly reports on the activity.



All directors of the clinics within the IUHN such as ECC, UNIclinic, and other future clinics and affiliated health care institutions o

Head of ECC: responsible for decisions integration and implementation in the clinic made by the ExB. A due duty will be to submit monthly reports on the following directions: quality, performance, clinical outcomes, implementation stage of the approved projects. Collecting and providing required information for the ExB coordinators.

o

Head of UNIclinic: responsible for decisions integration and implementation in the clinic made by the ExB. A due duty will be to submit monthly reports on the following directions: quality, performance, clinical outcomes, implementation stage of the approved projects. Collecting and providing required information for the ExB coordinators.

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o

Head of future clinics: planning and preparation for the future integration and actions implementation in the clinic made by ExB. Responsible for decisions integration and implementation in the clinic made by the ExB. A due duty will be to submit monthly reports on the following directions: quality, performance, clinical outcomes, implementation stage of the approved projects. Collecting and providing required information for the ExB coordinators.

o

A representative of the each current and future affiliated institutions within the IUHN: decisions integration and implementation in the clinic made by ExB. A due duty will be to submit monthly reports on the following directions: quality, performance, clinical outcomes, implementation stage of the approved projects.

Collecting and providing required information for the ExB coordinators.

If it is necessary, additional members can be included in ExB. The ExB will gather once a month. No members from ExB can cover more than one position and no members from ExB, except the heads of the clinics, can be employed in the IUHN clinics to avoid conflict of interest.

Expected results The creation of an Executive Board with clear and defined responsibilities will permit an integration of leadership and management within the IUHN. The EPRB will permit a more accountable activity of the ExB. Starting Date

July 1, 2013

Ending Date

August 1, 2013

Responsible Rector Indicators “Prikaz” on the creation of ExB defining its members and “polozhenie” on ExB members’ activity and responsibilities.

Action A5: Creation of External Supervisory Peer Review Board (EPRB) Description The External Supervisory Peer Review Board (EPRB) will review the ExB decisions and activities. To assure a reliable accountable system an external peer review of the system is needed. These key figures must be external to the University and hospitals standard salary to permit an external point of view free for any conflict of interest. At least 3 key guarantor figures with a permanent mandate, at least 2 years, have to review periodically the job done by the ExB. The time frame can be different but cannot exceed a maximal 6 months interval. The fields of review like scientific research, clinical activity and hospital management will be similar but the approach

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will be different. The commission should be done by an odd numbers of members and has to include tree main figures: o

Responsible for reviewing ethics and deontology within the IUHN

o

Responsible for reviewing clinical governance and health technology assessment within the IUHN

o

Responsible for reviewing policy and economic balance within the IUHN

Expected results Assure a reliable accountable system thanks to an external peer review of the system.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible Rector and the ExB Indicators “Prikaz” on the creation of EPRB. Documentation of the periodical review of the ExB activity.

Action A6: Creation of multidisciplinary chair Description A multidisciplinary chair for creation of multidisciplinary approach in research and in the clinical practice should be established. This chair will focus its activity on education, research and clinical practice. It will be in charge of planning and organizing educational and practical activities and to monitor the under and post graduate learners’ skills improvement. It will coordinate with the MCTs to support their activities and to verify the acquisition of the proper skills of the learners during their participation in the MCTs activities.

Expected results Creation and establishment of a new chair and the following decrease of educational and clinical fragmentation.

Starting Date

July 1, 2013

Ending Date

September 1, 2013

Responsible Rector, Scientific departments.

Council

in

collaboration

with

different

University

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Indicators Deadlines respect for the required documentation on the creation of such chair.

Action A7: Creation and monitoring of Multidisciplinary Clinical Teams (MCTs) Description MCTs in collaboration with the new multidisciplinary chair will be the key elements for the multidisciplinary activity of the clinic.

They will be implementing research and prevention programs. They will be main effective main figures in translational researches. MCTs will be created after their strategic and business plans approval

by ExB. MCTs will consist of: researchers, doctors, public health expert in biostatistics and epidemiology, learners on under and post graduate levels. They will have to report monthly to the coordinator on scientific activity about performance, results and economical expenses. Their main aim is the interdisciplinary approach in research, health prevention and screening programs.

Their activity will be monitored basing on the multidisciplinary meetings done and on others “ad hoc” indicators. Different levels learners will be integrated to learn how to do these kinds of activities and to support the group work in a stable manner. Their activities will also be agreed and planned with the multidisciplinary chair and with the heads of the hosting departments. The ExB will approve their creation approving the project after the evidence based and economical sustainability assessment, but also supervising their activities in time. The MCTs have to be intended as flexible and temporary. The temporary existence will be based on the time length of the project and their dismissing or procrastination, at the end of their specific and limited goal, will be approved by the ExB. Expected results Creation and implementation of multidisciplinary approach into education, research and healthcare. Rapid increase of the research activity level but in an accountable manner. A proper redistribution of resources following the international research guidelines like for example “Essential National Health Research and Priority Setting” to select the most appropriate research and do it in an accountable way.

Starting Date

August 1, 2013

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Ending Date

June 1, 2023

Responsible ExB in coordination with coordinators of scientific-research process, for strategic planning and IUHN development, for clinical practice and for public health issues Indicators Their activity will be monitored based on the multidisciplinary meetings done and on others “ad hoc� indicators.

Action A8: Creation of health technology assessment team (HTA TEAM) Description Health technology assessment is a multi-disciplinary field of policy analysis that examines the medical, economic, social and ethical implications of the incremental value, diffusion and use of a medical technology in health care. It is intended to provide a bridge between the world of research and the world of decision-making. Health technology assessment is an active field internationally and has seen continued growth fostered by the need to support management, clinical, and policy decisions. It has also been advanced by the evolution of evaluative methods in the social and applied sciences, including clinical epidemiology and health economics. Health policy decisions are becoming increasingly important as the opportunity costs from making wrong decisions continue to grow. Health technology can be defined broadly as any intervention that may be used to promote health, to prevent, diagnose or treat disease or for rehabilitation or long-term care. This includes the pharmaceuticals, devices, procedures and organizational systems used in health care. The implementation of the HTA activity in the IUHN is essential. The activity has to have follow a multidisciplinary approach and for this reason a HTA Team across the IUHN has to be created. The Team will be lead by the ExB coordinator for the health technology assessment and has to work across the IUHN. Have to be in the team different figures like medical doctors, public health experts, biomedical engineers, health economists, sociologists, pharmacists, statisticians, law experts and others. The HTA Team has to focus not only on new technologies but also on the already implemented ones checking their appropriate use and eventually evaluate their disinvestment.

Expected results Implement the HTA methodologies within the IUHN improving the investments and supporting with evidence the decision makers. HTA reports on new technologies to buy and old technologies to dismiss.

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Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible ExB for the creation of HTA Team and the coordinator for the health technology assessment to lead the team.

Indicators Frequent reporting through HTA reports

Action A9: Creation of clinical governance team (CG TEAM) Description Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system. A framework through which IUHN organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. It is intended to embody three key attributes: recognizably high standards of care, transparent responsibility and accountability for those standards, and a constant dynamic of improvement.

This team will work under the lead of the ExB coordinator for clinical governance and will work across the all IUHN. This team will be involved in the selection of guidelines, creation of indicators, implementation of quality dashboards; its activity will go from risk management to clinical pathways to waste management. They will monitor the accountability of the entire system promoting actions to improve the quality in the IUHN to the decisions makers like the hospital directors and the ExB. The team should include different figures like medical doctors, public health experts, process engineers, pharmacists, health economists, sociologists, statisticians and law experts. Frequent reporting is essential.

Expected results Implement the clinical government methodologies within the IUHN will create a more accountable and governable health Network . The presence of the CG Team will also permit to obtain a faster accreditation at the national and international levels.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible ExB for the creation of the CG Team and the coordinator for clinical governance to lead the team.

Indicators Creation and maintenance of quality dashboard is essential as well as frequent reporting to the ExB.

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Objective B: Unification of the strategic plans Description Each clinic in the IUHN or in franchising or affiliated and the University itself needs to have a vision and strategic plan to propose the integration and to decide future individual actions and goals. ExB will assess these visions and strategic plans and will discuss with the aim of proficient integration of goals and actions.

Action B1: Vision and strategic plan development of ECC Description Document explaining vision and future direction of the ECC for its integration in the IUHN. In the document, which will be then approved by the ExB, the clinical activity has to be described for the upcoming years.

Expected results Creation of a document which will allow an integrated and unified vision and strategic plan.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible The director of ECC and its management team Indicators Document approved by the Scientific Council

Action B2: Vision and strategic plan development of Future University Clinic Description Document explaining vision and the direction of the future clinic for its integration in the IUHN. In the document approved by the ExB, the clinical activity has to be described for the upcoming years.

Expected results Creation of a document which will allow an integrated and unified vision and strategic plan.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible The director of the future upcoming clinic and its management team Indicators Document approved by the Scientific Council Roadmap to IUHN

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Action B3: Vision and strategic plan development of KazNMU Dental Institute Description Document explaining vision and future direction of the KazNMU Dental Institute for its integration in the IUHN. In the document, which will be then approved by the ExB, the clinical activity has to be described for the upcoming years.

Expected results Creation of a document which will allow an integrated and unified vision and strategic plan.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible The director of KazNMU Dental Institute and its management team Indicators Document approved by the Scientific Council

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Objective C: Implementation of the information system and benchmarking with national and international institutions Description To confirm the quality, performance and outcomes within the IUHN a complete set of indicators is required. These indicators should be monitored in real time; the types of indicators should include those used by others national and international institutions. The benchmarking activity will identify which areas need to be improved and to determine the national and international rating of the clinic. Critical for this step is to create a reliable system of data collection.

Action C1: Creation of reliable system of data collection at the IUHN level (Phase 1) Description Database will include and integrate following areas: economical, educational, clinical, research, quality and performance for the clinics’ activity to permit benchmarking between the institutions in the IUHN before starting the national and international benchmarking. This activity is also important to permit the evaluation of eventual dismissing of institutions from franchising or affiliation if their performance in these fields is insufficient.

Expected results Reliable and integrated data within the IUHN. Starting Date

June 3, 2013

Ending Date

September 1, 2013

Responsible Each director of the clinic will be responsible for the quality and completeness of their data and data collection. The type of data to collect can be discussed with different coordinators within the ExB. Indicators Creation of common IUHN indicators on quality and performance in the following areas: economical, clinical, research, educational, management, etc.

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Action C2: Implementation of the information system.

Description Obtain and implement a reliable information system in each clinic of the IUHN. Expected results Optimization of data collection with integrations in the clinics to obtain a real time monitoring and integration of compatible data.

Starting Date

September 1, 2013

Ending Date

December 1, 2013

Responsible Hospital directors and the ExB coordinator for the health technology assessment.

Indicators Proper collection and flow of integrated data in real time.

Action C3: Upgrade of the data collection system to adapt to the national benchmarking and to match accreditation requirements (Phase 2) Description Database will include and integrate following areas: economical, educational, clinical, research, quality and performance for the clinics’ activity to allow benchmarking between the institutions to permit government accreditation and national benchmarking. This activity is also important to permit the evaluation of eventual areas of improvement in the clinics within the IUHN. Expected results Reliable and integrated data for the accreditation and the national benchmarking.

Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible Each director of the clinic will be responsible for the quality and completeness of their data and data collection. The type of data to collect can be discussed with different coordinators within the ExB.

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Indicators Creation of common indicators on quality and performance in the following areas: economical, clinical, research, educational, management, etc.

Action C4: Upgrade of reliable data collection system to adapt to international benchmarking and to match international quality standards (Phase 3) Description Data base will include and integrate following areas: economical, clinical, research, quality and performance for the clinic’s activity benchmarking on the level of international.

Expected results Reliable integrated data in the international level Starting Date

October 1, 2013

Ending Date

January 1, 2014

Responsible Each director of the clinic will be responsible for the quality and completeness of their data and data collection. The type of data to collect can be discussed with different coordinators within the ExB. Indicators Creation of common indicators on quality and performance in the following areas: economical, clinical, research, educational, management, etc.

Action C5: Design of IUHN indicators Description Indicators must be common for the IUHN clinics and will be defined and approved by ExB. Indicators will be used to support the decision making and future activity. They have to cover all the healthcare areas, the educational process and the research activities and achievements. The indicators will need to cover at least: patient and healthcare workers satisfaction, discovering of new knowledge and its fast implementation, productivity, effectiveness multidisciplinary approach, target population, educational activity, accessibility and welcoming etc.

Expected results Increase of accountability and transparency of the activity in the clinics.

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dashboard and its publication on the website will permit to increase the trust of the population and of the stakeholders on the system.

Starting Date

September 1, 2013

End

October 1, 2013

Responsible Specific coordinators within the ExB Indicators Creation of a clear dashboard to monitor.

Action C6: Design indicators on the national level Description Indicators must be common for the IUHN clinics and will be defined and approved by ExB according to the accreditation requirements and will have to match to the national indicators of hospital activity. Indicators will be used to support the decision making and future activity and will be used in the involvement on the accreditation process and in clinic ranking at national level. They have to cover all the healthcare areas, the educational process and the research activities and achievements. The indicators will need to cover at least: patient and healthcare workers satisfaction, discovering of new knowledge and its fast implementation, productivity, effectiveness multidisciplinary approach, target population, educational activity, accessibility and welcoming etc.

Expected results Increase of accountability and transparency of the activity in the clinics.

Creation of a reliable support for decision making. Creation of a transparent dashboard and its publication on the website will permit to increase the trust of the population and of the stakeholders on the system. This will permit the ranking of the clinic and make benchmarking with other national medical institutions, as well as allow to participate in the accreditation processes.

Starting Date

October 1, 2013

End

November 1, 2013

Responsible Specific coordinators within the ExB Indicators Creation of a clear dashboard to monitor.

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Action C7: Design indicators on the international level Description Indicators must be common for the IUHN clinics and will be defined and approved by ExB according to the international accreditation requirements and will have to match to the international indicators of hospital activity.

Indicators will be used to support the decision making and future activity and will be used in the involvement on the accreditation process and in clinic ranking at national level. They have to cover all the healthcare areas, the educational process and the research activities and achievements. The indicators will need to cover at least: patient and healthcare workers satisfaction, discovering of new knowledge and it fast implementation, productivity, effectiveness multidisciplinary approach, target population, educational activity, accessibility and welcoming etc.

Expected results Increase of accountability and transparency of the activity in the clinics.

Creation of a reliable support of the decision making. Creation of a transparent dashboard and its publication on the website will permit to increase the trust of the population and of the stakeholders on the system.

This will permit the ranking of the clinic and make benchmarking with other international medical institutions, as well as allow to participate in the international accreditation processes.

Starting Date

January 1, 2014

End

February 1, 2014

Responsible Specific coordinators within the ExB Indicators Creation of a clear dashboard to monitor.

Action C8: Continuous real time monitoring Description The monitoring of all indicators will permit the regular discussion of updated data, which will support ExB in decision making. Responsible for monitoring will be the directors of the clinics together with specific coordinators within the ExB. Expected results Support a better decision making of the ExB and increase of accountability and transparency in the IUHN activity.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

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Responsible Directors of the clinics together with specific coordinators within the ExB Indicators Updated indicators in the dashboard and presence of updated data in the specific ExB coordinator reports.

Action C9: Indicator review Description ExB annually will review the indicator dashboard to remove unnecessary indicators and introduce new ones.

Expected results Increase of accountability and transparency in the clinic’s activity and decision making support.

Starting Date

June 1, 2014

Ending Date

June 1, 2023

Responsible The ExB Indicators Documents of ExB, motivating the removal or the introduction of new indicators.

Action C10: Publication of indicators dashboard in the website Description Publication of indicators dashboard will increase transparency of the clinic activity and trust of the population in the IUHN. It will be done on the single clinic website and in the IUHN website permitting and supporting the ranking of the clinics at national and international levels showing the progress of the ranking position in time.

Expected results Increase of transparency in the clinic’s activity and trust of the population to IUHN. Starting Date

January 1, 2014

Ending Date

June 1, 2023

Responsible Directors of the clinics together with specific coordinators within the ExB Indicators Publication of updated indicators dashboard on internet and intranet.

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Objective D: Increase the research activity within the Integrated University Hospital Network Description The research is a fundamental area for the University and for the entire IUHN. The quantity and quality of new trials started will define the future University scientific publications. The aim is to concentrate as much as possible these activities within the Integrated University Hospital Network without dispersing the energies and the resources in health centers different from the University one.

Action D1: Select and approve the new research projects Description Several good ideas do not end in successful research projects. The aim of this phase is to select, every 6 months, the best and more achievable research programs based on the possible available resources. The selection has to be done with clear definition of the necessary characteristics to be chosen, their relevance and with an accountable international approved methodology like the ENHR (Essential National Health Research and Priority Setting) strategy.

Expected result Increasing number of new projects and trials selected in an accountable and transparent way.

Starting Date

September 1,2013

Ending Date

June 1, 2013

Responsible The ExB coordinator for scientific-research process, for public health, for the health technology assessment, for strategic planning and IUHN development, for clinical governance, the MCTs and the ExB for approval.

Indicators New trials or research projects/6 months.

Action D2: Monitoring and statistical analysis on the research activity and international accountability Description The subscription of the trials in the proper international websites and the subsequent monitoring and results analysis of the ongoing project are mandatory. This will be done with the creation of a dashboard to compare the clinical outcomes but also the economical sustainability of the process.

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These will also permit to use the collected data for research and epidemiological studies for international publication activity.

Expected result Increase of accountability in the creation of research and epidemiological studies. This is the base to increase the international literature publishing activity. New approved trials accepted at international level.

Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for scientific-research process, for public health, the MCTs and the ExB for approval.

Indicators Creation of a dashboard with approved international indicators for quality control and outcomes. Periodical report to the Scientific Council with honorary appointment of the MCTs groups.

Action D3: Publication of the research results Description The publication of the results have to be done after the approval of the ExB. The final goal is to bring in to practice the research and to obtain a better ranking in national and international research community.

Expected result Increase the international publishing activity. Increase of accountability and the creation of research and epidemiological studies.

Starting Date

March 1, 2014

Ending Date

June 1, 2023

Responsible The ExB coordinator for scientific-research process, for public health, the MCTs and the ExB for approval Indicators Creation of a dashboard with approved international trials indicators for quality control and outcomes.

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Objective E: Excellency in research Description To obtain research excellence a strong alignment of research and clinical practice has to exist. Evidence based literature and the international approved clinical trials are mandatory. The development of health technology assessment culture for basic and innovative research is needed. The creation of knowledge has to expand from new type of care to new techniques and an evaluation of the results in both quality and quantity and an optimal record keeping has to be obtained. The multidisciplinary approach in scientific research has to be mandatory and described, including in the process not only different medical specialties but also disciplines like health related branches of economy, engineering and others. The integration of the singularity approach to education linked to research need to be started and increased overtime. The projects that will focus on the integration of new technologies and methodologies need to supported and realized through the adaptation of the educational system.

Action E1: Alignment between research and clinical practice Description The aligning of research and clinical practice increases the effectiveness and improves the success of the research activity. This alignment has to be fostered by specific figure such as the coordinator of scientific-research process, of clinical governance, for clinical practice, public health issues. This alignment will permit also a fast implementation of the discovered knowledge but also to increase the population study in the research projects giving more reliable results and increasing the chance of publication.

Expected result Synergic results of this alignment and more reliable results, increasing the chance of publication and fast implementation of the discovered knowledge.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for scientific-research process, for clinical governance, for clinical practice, public health issues and the MCTs Indicators Reports of the MCTs and of the ExB coordinator for scientific-research process.

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Action E2: Health Technology Assessment into the selected research activities Description The HTA activity will permit a better selection of the technology to study and the HTA methodology can be useful to monitor the best research project and the one with a higher change of cost/effective results.

Expected result Clear supervision of the research and the evaluation research projects cost/efficiency.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for the health technology assessment Indicators HTA reports before the approval of new projects by ExB. Periodic reports of the progress of the research projects evaluating the cost/efficacy of the projects

Action E3: Implementation and monitoring the increase of multidisciplinary approach in research Description The multidisciplinary approach has been demonstrated that it is the most effective way to achieve new and innovative results in research.

Implementing it is not easy and the coordination is very delicate. The multidisciplinary approach should be not only related to medical specialty but also to affine disciplines. Often this approach reduces the cost of the research as well.

Expected result Increase the results, improve the ideation of new research programs, increase the interfaculty collaborations and reduce the costs of research.

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Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator of scientific-research process, for the internal and external communication and marketing issues, for clinical practice, for clinical governance and for strategic planning and IUHN development Indicators “Ad hoc� indicators to monitor multidisciplinarity in the research process

Action E4: Optimization of Data collection for accountability in quality and quantity of the research activity and its results Description The data collection and data reporting thought the subscription of the new trials in the proper international websites; the subsequent monitoring and the results analysis of the ongoing project is mandatory. The data and the statistical analysis have to be reliable and of high quality. The optimization of these data collection depends on the human recourses involved, the technology and information technology used in the process. The optimization has to follow the technological updating in a proper and assessed way.

Expected result Use the best and proper ways to collect the data in research with the minimal weight on the costs of the project.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinators for the health technology assessment, for strategic planning and IUHN development and for scientific-research process Indicators Number of data optimization interventions reported/year

Action E5: Opening the educational and research processes to the singularity approach Description Thanks to the coordination and integrated leadership between research and education will be permitted to all the learners including residents and students even in the early stage to integrate or replace some of the classical Roadmap to IUHN

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practical trainings or subjects with singularity approved activities. This will be easily possible thanks to the educational credit system, in areas where credit system is not active yet a special permission will be issue by the ExB. A learner will be able to have a different activity program more connected to research that will be fully recognize in the educational curriculum instead of classical practical or theoretical activity. The main aim is to recognize the creative activity of the young minds and permit them to have the proper time and support to create innovation in the system. This will permit to look in to the future trying to combine and adapt recent knowledge, technologies and methodologies to the classical educational system. This will cause the propulsion of the university into the future creating competitive new figures for the job market and it will attract the best students and best professors even at the international level. Selected visiting professor can indeed be associated into in these kinds of activities. Thanks to these activities, the innovation will be highly increased and consequently the research activity and the numbers of publications. In case of publication of the results at the end of the activity the credit bonus will be increased to reward the commitment and the diligence but also to increase the motivation of young minds to innovation. Multiple fields will be included from clinical practice to management as long as the integration of innovation is been verified and approved by the research and educational ExB coordinators.

Expected result Creation of new type of professionals with high knowledge on the new innovative evolutions, ready to adapt to the technological singularity.

Starting Date

August 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinators for strategic planning and IUHN development, educational processes, for the health technology assessment and for scientific-research process Indicators Number of learners included in the projects/year; report of the result of the project 6 months.

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Objective F: Increase the practical educational experience for all the learners Description The international literature is showing how important is the clinical practice and the direct experience in the learning process. The direct experience and the gradual load of responsibility is the key to produce serious and self-confident future professionals. A clear goal of the IUHN is to provide to the students of different courses and different stages of education, the best quality practice possible. This can be accomplished thanks to the increasing of clinical activity in the IUHN but it must be very well planned and organized. The involvement of several key figures in the University cannot be ignored. The ExB and especially the educational coordinator and the new multidisciplinary chair need to be the main promoters of this activity and to plan in detail the activities beforehand. It is crucial to identify the responsible persons basing on the activities. Also for this reason the new multidisciplinary chair must be created. Crucial is the monitoring of these activities and a severe control on the quality and the results of this clinical practice has to be done and the recording will be helpful for transparency.

All these things will increase also the trust in the University System and create better professionals in the future. Indicators of these goals are very important and should measure the sharing of the knowledge and the diffusion of best practice and best innovations and their implementation. The word “learners” should be understood in the wider way possible, including not only medical or nursing students but students from all health related disciplines and should not be limited to undergraduate but should include different kind of post graduate education like residents, PhD and master students. Very important is the inclusion in the educational activities the “Care Givers” education. The indicators should show and reflect different aspects of this. They should measure space and time dedicated to education for confidence and responsibility acquired by the learners and should measure the real empowerment in the working alone activities in all the areas like administrative, clinical and technological with clear goals and measures. Other data monitoring is necessary to evaluate the international and national exchange activity and collaboration in this process.

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Action F1: Reconfiguration of the activity for different kinds of students Description A reconfiguration is needed to regulate the new activities, schedule and limits of the experience. This job should be done by the new multidisciplinary chair in collaboration with the educational coordinator of ExB and the different University key figures for education.

Expected result Increase the performance and the transparency of the educational process integrating the multidisciplinary approach in the educational process.

Starting Date

September 1, 2013

Ending Date

September 1, 2014

Responsible the ExB coordinator for educational processes and for clinical practice.

Indicators The creation of clear plans and lists of activities which every student has to do to in the clinical area where the multidisciplinary activity and approach are clearly highlighted.

Action F2: Monitoring of Quality, Performance and Satisfaction of the clinical practice Description A monitoring of the education quality and teaching methodologies performance is mandatory. A clear feedback can come directly from the students through periodic “ad hoc� survey on the experience.

Expected result Increase of the information on the educational process with clear results to have a base to increase the educational experience of the learners.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible ExB responsible for educational processes, the directors of the hospitals, Communication Skills Center. ExB for supervision the activity.

Indicators The presence of a clear and complete dashboard including surveys results on the educational process.

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Action F3: Measuring human resources presence and activity Description In dislocated educational process is crucial to monitor the presence and activity. The presence monitoring has to be done every day to assure the presence at work of the educational workers and of the students. The monitoring of the management has to be organized in a digital database to create analysis and statistics that will support decision making in the future.

Obviously the support of the hospital in the monitoring is crucial and has to be accountable not only in the presence but also in defining tutors and activities were the people are involved showing the activity done day by day from each person that the University sends to the practical field.

Expected result More accountable and reliable system on the educational process and on the localization of the human resources.

Starting Date

July 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for strategic planning and IUHN development, for human resources, for educational processes, for clinical practice and the hospital directors.

Indicators Clear dashboard to understand the presence and activity of each educational workers or learners in the IUHN.

Action F4: Integration between the educational coordinator with multidisciplinary chair and the MCTs Description The leadership and management integration is the linking point to reach the set goals. The key figures for the educational activity need to meet and discuss and revaluate weekly the process to understand how to improve it and adjust it to obtain the best performance and results. They will report to the ExB all the problems found and the possible solutions to solve them permitting a quick decision making.

Expected result A coordinated network of activities.

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Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible ExB Coordinator for educational processes, for clinical practice and the directors of MCTs. Indicators The weekly meetings and the report on problems found and solved.

Action F5: Starting online teaching and support for students Description Creating an online platform for teaching will allow to support students and residents over time and over distance.

The platform can support an easy storage of the knowledge, and easy sharing and it can be integrated with web 2.0 tools for online consultation between students-tutors or studentsprofessors. Such kind of platform will permit the support of the students, postgraduates or young professionals in their work even in remote areas and will create a never ending link between the University and the ex-students.. The establishment of such platform is needed to improve the knowledge sharing and the activity control of learners and professors but requires a proper infrastructure.

Expected result Implementation of the online learning platform and statistics on the learners and teacher educational activities.

Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for strategic planning and IUHN development, for the health technology assessment, for human resources, for educational processes, for clinical practice and the directors of the hospitals.

Indicators Statistics on the online platform usage and feedback of learners and teacher educational activities.

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Action F6: Creation management academy

of

an

under-post

graduate

health

Description Following the Kazakh National Program for the future years is clear the importance of a new management and the need of a more monitored health care. These activities are duties of the management. The lack of these figures is a gap to be filled and as soon as possible. A new health management academy is recommended to teach in the undergraduate and post graduate learners this critical activity. This education is useful for both future managers but also for future physicians. Looking the structure of the future IUHN this chair should be located in a central position in the network to coordinate the system. It should not concentrate its activity in one institution but should allow the students to see the different strategies of different hospitals in the IUHN. Different hospitals indeed have different roles, functions and goals and this reflects different internal structure and strategy. The director of this academy should assess the different strategies put in place by the different hospitals within the IUHN and compare with other national and international institutions. The director of such academy should be like a scientist in a laboratory in a neutral position to study the evolution and the strategy and should not be involved at all in the hospital management or in the ExB but should be invited as a consultant if needed by the ExB. This director should report and coordinate the activities with the ExB for educational processes and for clinical governance.

Expected result The creation of an organized educational structure that will teach and evaluate the management in the IUHN and assess the different strategies put in place by the different hospitals and compare them with other national and international institutions.

Starting Date

November 1, 2013

Ending Date

March 1, 2014

Responsible Rector, Scientific Council in collaboration with different University departments and the ExB coordinator for strategic planning and IUHN development Indicators The creation of the academy and the beginning of its educational activities, like courses and the creation of periodic assessment reports of the strategies of the different clinics within the IUHN.

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Objective G: Empowerment of the residents and the increase the residency experience Description The residents are recognized doctors and professionals. Up today the residents have to work, following the law, 54 hours/week.

These hours, according to the law, have to be spent (2/3) 36 hours with their tutors and (1/3) 18 hours working alone in the same specialty in which they are specializing. At the moment, the residents only rarely are really working alone and if they are doing it then in structures that are not University ones like city hospitals etc. A reconfiguration of these hours can unleash a great University power and can improve the residency experience. Creating a special environment for them, creating protected opportunity and specific courses to improve their working alone activities can make a big difference in their education and preparation for the real competitive working world today. The focusing of all these working hours of all these young doctors in health prevention programs, with a salary already paid by the government, can make huge difference for the health of the population in accordance with the Kazakh National Prevention Plan. The activities of the screening and prevention projects made by the residents can produce a huge beneficial impact especially on the poor populations. Residents are doctors and the law permits them to work 18 hours a week also as specialists, if the University can really sustain them with space and professor knowledge support in case of any problem, this can really create the perfect environment for their empowerment.

Action G1: Reconfiguration of the residents activities based on the national law.

Description A reconfiguration is needed to allow the empowerment of the residents. This reconfiguration need to regulate the new activities, schedule and limits of the job of the residents. This job should be done in collaboration with the new multidisciplinary chair created.

Expected result Clear empowerment of the residents in the work alone activities following the Kazakhstan law.

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Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible The ExB coordinator for the legal area, for educational processes, for clinical practice, for human resources Indicators ‘Ad hoc” indicators to monitor the effects of the reconfiguration.

Action G2: Creating a working space environment dedicated to residents

and

an

appropriate

Description To permit the new empowerment of the residents’ activities a special University area and environment have to be created. New medical cabinets have to be arranged for their practice. The creation of a well organized system within the IUHN coordinated by the Multidisciplinary Chair in accordance with the director of the Hospitals and the approval of the ExB is necessary. The institutions should also give support and incentivize the resident private remunerated activity within the IUHN. This will permit them to test their marketing skills in a protected and environment.

Expected result Creation of a clear schedule of the working alone activity and the creation of the appropriate environment that permits the easy access to the support of professors.

Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible Hospital directors, the ExB Coordinator for clinical practice, for the legal aspects, for strategic planning and IUHN development and the directors of different chairs in the University.

Indicators The presence of a clear schedule, organization plan and the opening of a dedicated area

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Action G3: Education and preparation of the residents to their new activities Description Courses are necessary to teach the residents how to manage their new activities and function. Courses of self management, quick patient assessment and health marketing are necessary to create a proper functioning system.

Expected result Educated human resources ready to enter the competitive health market and ready to “work alone� in the screening prevention programs.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible Director of the hospital management academy, the ExB Coordinator for clinical practice, for educational processes.

Indicators Number of courses for residents on the self management, quick patient assessment and health marketing and others management skills courses.

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Objective H: Foster the health improvement of the population understanding their health needs with low economic expenditure Description Creating a special environment for the residents and creating protected opportunities and specific courses to improve residents “working alone” activities can make a big difference in the education and preparation for them but also for the health of the population. The focusing of all these working hours of all these young doctors in health prevention programs, with a salary already paid by the government, can create a huge difference in the health of the population in accordance with the Kazakh National Prevention Plan. Residents are doctors and the law permits them to work 18 hours a week also as specialists. If the University can sustain them with space and professors knowledge support in case of any problem arise, this can create the perfect environment. The costs of these activities will be reduced at the minimum thanks to the use of “already paid well educated human resources”. The activities of the screening and prevention projects made by the residents can produce a huge beneficial impact especially on the poor populations.

Action H1: Select and create the new prevention and screening projects.

Description The new screening and prevention projects have to selected and organized on the epidemiological base and health need assessment (HNA) studies. This activity need to be done using all the recent methodologies for epidemiology and public health. Epidemiological Literature have to merge with national and area data and to be evaluated though the health needs assessment analysis and these kind of reports have to be done to support the ExB decision making before planning any action. An accountable way of selecting the activities have to be done, showing the section process in a transparent way using the most updated guidelines on health needs assessment.

Expected result To select the most appropriate screening and prevention programs and projects in accordance with the National Plans.

Starting Date

October 1, 2013

Ending Date

November 1, 2013

Responsible The ExB coordinator for public health and the public health department. The ExB for the decision making.

Indicators Transparent periodical HNA reports on the population needs.

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Action H2: Coordinate the activities of the residents with the implementation of new prevention and screening projects in accordance with the National planning.

Description The coordination of these two activities is critical and crucial for evolution of the Integrated University Hospital Network . It is a very new and delicate job and has to be done through a leadership and management integration. The new projects can be done with the support of the government level thanks to the funds for the prevention and screening national programs. The participation on the government tenders is crucial and this responsibility should be of the ExB coordinator for public health issues and for the legal aspects Expected result The begin of prevention and screening projects with only a minimal economical expenditure. High revenues are expected thank to the support of the government and its funds for the prevention and screening national programs. Increase the education and the health of the populations.

Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for public health issues, for the legal aspects, for scientific-research process, for clinical practice, the hospital directors and the MCTs directors.

Indicators Number of screening programs and projects/month; number of resident involved in each project/month; number of national tender for screening and prevention participation/year; number of national tender for screening and prevention won/year.

Action H3: Monitoring and statistical analysis on the prevention and screening projects implemented Description The monitoring and analysis on the results of the ongoing project are mandatory. This will be done with the creation of a dashboard to compare the clinical outcomes but also the economical sustainability of the process.

These will also permit to use the collected data for research and epidemiological studies.

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Expected result Increase of accountability and the creation of research and epidemiological studies.

Starting Date

January 1, 2014

Ending Date

June 1, 2023

Responsible The ExB coordinator for public health issues, for clinical governance, for clinical practice, the hospital directors and the MCTs directors.

Indicators Creation and monitoring activity of “ad hoc� indicators for the different projects.

Action H4: Integration of the prevention and screening projects implemented with the research activities Description The screening of the population will bring a lot of opportunities for the research. Often the main problem for the research studies is the small population number, with these activities will be possible to increase exponentially the base population of the research studies. This integration is based on the good will and integration of different figures.

Expected result Integration of the research studies with the screening and prevention activities.

Starting Date

January 1, 2014

Ending Date

June 1, 2023

Responsible The ExB coordinator for public health issues, for clinical governance, for scientific-research process, for clinical practice, the hospital directors and the MCTs directors.

Indicators Number of new research collaborations connected with the prevention and screening projects/year.

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Objective I: 360 degree healthcare coverage Description

The IUHN goal is to create a 360 degree health coverage with the integration of the educational process and the research process. The IUHN will organize the network to cover primary, secondary and tertiary healthcare. The ExB will decide where within the IUHN to develop screening or prevention programs in which institutions the different specialties for secondary care will be located and where the rehabilitation centers and activities will be placed. The development of the primary care and tertiary care will be the most delicate part but also strategic areas. The Kazakhstan has indeed a great demand for such kind of care. Thanks to IUHN network the healthcare will focus on all kinds of pathologies and comorbidities from Oncology to Degenerative diseases, from patient life style modification to care giver education. Main aim of the IUHN is to study and support the poor population thanks to the involvement of all its human resources. The IUHN will do this by deploying high number of residents at service of the poor areas and making free consultations for this kind of population. The 360 degree approach means also to support the patients in emergency, in the post care phase when administrating the drug at home or adjusting its dosage or answer quick health question to dispel doubts. Selling drugs within the hospital and post discharge at a lower price is part of the 360 degree care too.

Action I1: Planning of the activities reducing the waste of resources and duplications within the IUHN. Description The integration of all these healthcare activities can be achieved only through a complete and careful planning of the activities based on reliable epidemiological and IUHN data. Responsible for the original plan and its updated editions are different key figures within the ExB and the approval of such plans is a responsibility of the ExB. A correct plan will allow to diminish the resources waste and to optimize the system reducing duplications within the IUHN. Expected result A complete strategic plan with the aim to diminish the resources waste and to optimize the system reducing duplications within the IUHN. Reduce of costs and increase of performance within the IUHN. Starting Date

December 1, 2013

Ending Date

March 1, 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues, for clinical governance, for human resources, for the economic aspects and hospital directors.

Indicators The creation of clear plans stating the clear involvement of each University department in the IUHN. Roadmap to IUHN

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Action I2: Developing primary care centers Description Special attention is required in developing a modern primary care. The Kazakh National Program is clear on the importance of this kind of activity.

The IUHN cannot ignore this and have to create new centers to develop these activities. This activity can be centered mainly where most of the needs are but should also be spread everywhere in the system.

Expected result Increase of prevention and screening activity in all the IUHN. Starting Date

November 1, 2013

Ending Date

June , 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues and hospital directors.

Indicators The creation of the strategic plan and the start of the activities in an accountable and regulated manner.

Action I3: Developing different kinds of secondary care Description Day Hospital and Day service as well as the ambulatory care will be developed and encouraged to permit a reducing of the costs and a more appropriate use of the resources. Most of the western countries are now forcing the shift from stationary care to day hospital and ambulatory care.

Short stationary length and high bed turn over are becoming mandatory and under strict control. The day hospital and day surgery permits also to the patient to go back in a warm environment like their own home with their own relatives. “Week hospital” and “week surgery” activities will be implemented in the IUHN. Expected result Shifting the clinical activities to day hospital and day surgery regimens. The implantation of week surgery and week hospital kind of management.

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Starting Date

November 1, 2013

Ending Date

June , 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for clinical governance, area managers and hospital directors.

Indicators The creation of the strategic plan and the start of the activities in an accountable and regulated manner.

Action I4: Developing tertiary care centers Description Special attention is required in developing a modern tertiary care. The Kazakh National Program is clear on the importance of this kind of activity.

The IUHN cannot ignore this and has to create or affiliate new centers develop them. This activity should be located mainly where most of the needs are but also it should be strongly connected with the secondary care and the follow up activity.

Expected result Increase of coordinated rehabilitation activities within all the IUHN. Starting Date

November 1, 2013

Ending Date

June , 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues and hospital directors.

Indicators The creation of the strategic plan and the start of the activities in an accountable and regulated manner.

Action I5: Planning the IUHN call center Description Every patient has usually questions and doubts that have to be dispelled.

Creating a support call center will allow the hospital to keep in touch with all the patients and increase the trust in the system. It will also increase the Roadmap to IUHN

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number of people that will start to connect with the system increasing the number of patients in the future. This way the IUHN call center will become a gateway for all the new patients. This activity has to be planned carefully in accordance with the ExB coordinators supervision and the final ExB approval.

Expected result Obtain a strategic plan to evaluate the feasibility of the IUHN call center opening.

Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible The ExB coordinators for strategic planning and IUHN development, for the internal and external communication and marketing issues, for public health issues and hospital directors. ExB for approval.

Indicators Creation of the strategic plan for opening a IUHN call center

Action center

I6:

Developing

the

IUHN

call

Description The call canter will work 24/7 and it will eventually integrate in the future with the first aid/emergency center. Thanks to this action the IUHN will make a further step to become a system always open to any patient health requests. This activity has to be developed carefully in accordance with the ExB coordinators supervision and the final ExB approval. This activity can be linked to telemedicine activities.

Expected result Opening and developing the IUHN call center. Increase of trust in the IUHN and increase of the support for population especially the poor one.

Starting Date

October 1, 2013

Ending Date

January 1, 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for the internal and external communication and marketing issues, for public health issues and hospital directors. ExB for approval.

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Indicators Creation of the call center and the increasing number of incoming call/month.

Action I7: Planning the IUHN pharmacy Description The planning of such an important service has to be supported by economic, clinical and epidemiological data. An integrated management is necessary.

Special attention is required in developing a modern centralized pharmacy in the IUHN. This activity has to be planned carefully in accordance with the ExB coordinators supervision and the final ExB approval.

Expected result Obtain a strategic plan on the advances of a centralized pharmacy opening and define the correct location and infrastructure.

Starting Date

October 1, 2013

Ending Date

November 1, 2013

Responsible The ExB coordinators for strategic planning and IUHN development, for the legal aspects, for public health issues, for the internal and external communication and marketing issues, hospital directors and the University Pharmacy faculty and departments. ExB for approval.

Indicators Creation of the strategic plan for opening the IUHN centralized pharmacy.

Action I8: Developing IUHN pharmacy Description Special attention is required in developing a modern centralized pharmacy in the IUHN. Offering the general population and the hospital population a 24/7 pharmacy service is a part of the 360 degree took in charge of the patient. Thanks to this action the IUHN will make a further step to become a system always open to any patient’s health requests. The development of the centralized pharmacy will also allow a more strict control on the drug expenditure and on more appropriate prescription but also will affect the costs of the single drugs because of the increase of the stock Roadmap to IUHN

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quantity obtaining better deals on purchasing. This activity has to be planned carefully in accordance with the ExB coordinators supervision and the final ExB approval.

Expected result Obtain a strategic plan and then opening of a centralized pharmacy that will serve the general population but also all the hospitals within the IUHN. Starting Date

November 1, 2013

Ending Date

February 1, 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues, hospital directors and the University Pharmacy faculty and departments. ExB for approval.

Indicators Opening of the IUHN pharmacy and then starting of the activities in an accountable and regulated manner.

Action I9: Planning first aid emergency center Description Up today the IUHN does not have the infrastructure for emergency service but in the evolving of the system will be helpful to plan and develop directly or through affiliated or in franchising institutions one or more first aid/emergency center. This activity has to be planned carefully in accordance with the ExB coordinators supervision and the final ExB approval.

Expected result Obtain a strategic plan for first aid/emergency center that will serve the general population and will be connected in a proficient network activity with the rest of the IUHN institutes.

Starting Date

September 1, 2018

Ending Date

March 1, 2019

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues, hospital directors. ExB for approval.

Indicators The creation of the strategic plan to evaluate the opening of a first aid/emergency service.

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Action I10: Developing first aid emergency center Description In case the strategic planning is showing the feasibility and the opportunity to open a first aid/emergency service the IUHN should start to develop such kind of service for the health of the population and to attract also the emergency cases. The individuation of the proper infrastructure is essential.

This activity should be carefully supervised by the ExB coordinators.

Expected result Opening first aid/emergency center that will serve the general population and will be connected in a proficient network activity with the rest of the IUHN institutes will be a very important strategic step of the IUHN. Starting Date

March 1, 2019

Ending Date

September 1, 2019

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues and hospital directors.

Indicators Start of the activities to create the service in an accountable and regulated manner.

Action I11: Planning home care service Description Home care, also referred to as domiciliary care or social care, is a health care or supportive care provided in the patient's home by licensed healthcare professionals. It is often referred to as home health care or formal care. Often, the term “home health care� is used to distinguish it from non-medical care or custodial care, which is care that is provided by persons who are not nurses, doctors, or other licensed medical personnel.

Licensed personnel and others who assist the individual may be referred to as caregivers. Caregivers may help the individual with such daily tasks as bathing, eating, cleaning the home and preparing meals. For terminally ill patients, home care may include hospice care. For patients recovering from surgery or illness, home care may include rehabilitative assistance. The support of the patients at home is one of the most important future goals of the western healthcare systems. Supporting the patients at home reduces Roadmap to IUHN

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the cost of the healthcare and will permit a more comfortable place for patients. The admission to the hospital of elderly patients usually causes them disorientation or even more serious mental problems. Several activities can be moved from day hospital and ambulatory care to home care. Instead of moving the patient to the hospital the hospital staff will move to the patients. Education of care givers and team of nurses are essential to promote this kind of specific activities.

Expected result Obtain a strategic plan and then opening the home care service; start care givers education and evaluate hospice service for terminally ill patients. All these kinds of service have to be highly connected in a proficient network activity with the rest of the IUHN institutes.

Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible The ExB coordinators for strategic planning and IUHN development, for educational processes, for public health issues, for legal issues, for the internal and external communication and marketing issues, hospital directors. ExB for approval.

Indicators The creation of the strategic plan and the start of the activities in an accountable and regulated manner.

Action I12: Developing home care service education Description This step has to be in accordance with the strategic planning. The University has to support the IUHN creating specific courses for caregivers and home care as described in the previous action.

Expected result Creation of specific courses for caregivers and home care professionals.

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Starting Date

October 1, 2013

Ending Date

January 1, 2014

Responsible The ExB coordinators for strategic planning and IUHN development, for educational processes, for public health issues, for legal issues, for the internal and external communication and marketing issues, hospital directors. ExB for approval.

Indicators The creation of the strategic plan and the start of the activities in an accountable and regulated manner.

Action I13: Developing home care Description The development of this activity should be done only after the strategic planning and developing the educational support. This will permit to create an organized system of home care without risking the life of the patients.

This activity can be linked to telemedicine. All these kinds of service have to be highly connected in a proficient network activity with the rest of the IUHN institutes.

Expected result Opening the home care service and starting care givers education; evaluation of some “home hospice service� for terminally ill patients.

Starting Date

January 1, 2014

Ending Date

January 1, 2016

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues, hospital directors. ExB for approval.

Indicators The beginning of the home care activities in an accountable and regulated manner.

Action I14: Developing hospice care Description Hospice care is a type and philosophy of care that focuses on the palliative care of a terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional Roadmap to IUHN

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and spiritual needs. Within the United States the term is largely defined by the practices of the Medicare system and other health insurance providers, which make hospice care available, either in an inpatient facility or at the patient's home, to patients with a terminal prognosis who are medically certified to have less than six months to live. Outside the United States, the term hospice tends to be primarily associated with the particular buildings or institutions that specialize in such care (although so-called "hospice at home" services may also be available). Outside the United States such institutions may similarly mostly provide care in an end-of-life setting; but they may also be available for patients with other specific palliative care needs. In cooperation and with the support of the home care service new or affiliated institutes of the IUHN can develop such kind of hospice activities.

The opportunity has to be evaluated in the future by the ExB coordinators and approved by the ExB. Expected result Opening or affiliation of such structures for palliative care of a terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs to support can complete the 360 degree health service of the IUHN. Starting Date

October 1, 2013

Ending Date

January 1, 2016

Responsible The ExB coordinators for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues, hospital directors. ExB for approval.

Indicators The beginning of the hospice care activity in an accountable and regulated manner.

Action I15: Integration of the working network and traceability of the patients within the IUHN institutions Description The traceability of the patient trough the IUHN is a goal that will need a lot of efforts and the development of an integrated information system within the IUHN. This is the future of the health system and the national government is aiming on this.

Investing in this area in advance will not only increase the health of the population but also increase the performance of the IUHN. Having Roadmap to IUHN

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the electronic medical records merged in the electronic health records will permit to follow patients from practice to practice and allow for things like data exchange and messaging between physicians. Crucial is the activity of coordinator for the legal aspects to preserve the patient privacy and rights.

Expected result Drive the patients within the IUHN and permit a 360 degree integrated care, reducing bureaucracy and avoiding losing the connection with patients during his care. Follow patients from practice to practice and allow for data exchange and messaging between physicians.

Starting Date

December 1, 2013

Ending Date

June 1, 2023

Responsible The coordinator for strategic planning and IUHN development, for the legal aspects, for the health technology assessment, for the internal and external communication and marketing issues, for clinical governance and hospital directors.

Indicators A complete database and dashboard to follow patients through an integrated information system but also through the person network based on multidisciplinarity.

What's the difference between EMR and EHR? The terms electronic medical record (EMR) and electronic health record (EHR) are often used interchangeably. Technically, there is a distinction, but it's one that's been blurred by common usage. At a minimum, EMR systems replicate all aspects of medical paper charting. They are designed to facilitate all the documentation the doctor does in the office already—lab results, visit notes, diagnostic test results, insurance information, demographics, health histories, medication information, and more. EHRs, on the other hand, are essentially EMRs with the capacity for greater electronic exchange; that is, they may be able to follow patients from practice to practice and allow for things like data. exchange and messaging between physicians

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Objective J: Implementation of clinical governance Description Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system. A framework through which IUHN organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. It is intended to embody three key attributes: recognizably high standards of care, transparent responsibility and accountability for those standards, and a constant dynamic of improvement.

The Clinical Pathways are the best methodology to implement the clinical guidelines in the local framework. Thanks to their implementation the quality in the system increases. They can identify processes within the IUHN, showing the gaps and the weaknesses, they create rules and connect all the protocols together forcing to review them. They are also the best method to start a risk management activity because they show the interfaces between the procedures and they identify the responsible figure for every step in the path. Clinical pathways and protocols will be designed in accordance with international evidence based literature and guidelines. For their design up-to-date methods of clinical management will be used. The collaboration between the ExB coordinators for clinical governance, hospital directors and MCTs and departments directors is very important.

Action J1: Data analysis for most common diseases comorbidities detection in each hospital of the IUHN

and

Description An analysis has to be done basing on the data collected in each clinic for the detection of the most common pathologies. This will permit identify a search for the most useful and needed clinical pathways and further look for appropriate evidence based literature and recommendations with the aim of following adaptation into the clinical process. Like in an industry it is very important to understand what kind of products are made, which processes are involved and who is actually involved in these processes. This is the only way to optimize the production system and adapt it to the needs of the population. This activity will permit to choose the most appropriate new MCTs to create. For this action, complete and reliable health records in the clinics are needed.

Expected results Detailed information on kind of patient and population that pertains to each clinic. In order to identify the patients needs to improve the service. This will permit to select clinical pathways, which will have then to be designed.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

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Responsible The ExB coordinator for public health issues, for clinical governance, area managers, statistical managers, hospital directors, MCTs directors.

Indicators Creation of 6 months analysis report.

Action J2: Search and assessment of evidence based literature for creation or upgrading clinical pathways and protocols in clinics Description According to the results of the analysis done, there will be conducted a search of evidence based literature and guidelines, their assessment and selection to create clinical pathways. The most updated clinical governance methodologies must be used in this process.

Expected results Obtain the best evidence based literature and guidelines to implement in the IUHN clinical pathways.

Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for public health issues, for clinical governance, area managers, statistical managers, hospital directors, MCTs directors.

Indicators Indicators to assess the proper methodologies of the selection process and bibliographic research.

Action J3: Creating clinical pathways and protocols.

Description Information resulting from the data collection, the literature search and its assessment will be used to review, improve and update the existing clinical pathways and protocols. This information will be useful to identify new clinical pathways and protocols to implement in the IUHN. Expected results Clinical pathways and protocols approved by ExB. Increase of quality, safety, accountability and performance in the IUHN. Starting Date

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Ending Date

June 1, 2023

Responsible The ExB coordinator for public health issues, for clinical governance, area managers, statistical managers, hospital directors, MCTs directors.

Indicators Number of approved clinical pathways/month; number of protocols/month; number of clinical pathways reviewed/month

approved

Action J4: Implementation of clinical pathways and protocols Description The developed clinical pathways and protocols, after the approval of the ExB, will be introduced in clinics by area managers, MCTs and heads of departments.

The implementation is one of the crucial points to finalize all the job done. The use of proper implementation techniques is very important.

Expected results Increase of quality, safety, accountability and performance in the IUHN. Starting Date

February 1, 2014

Ending Date

June 1, 2023

Responsible Hospital directors, MCTs directors, area managers, the ExB coordinator for public health issues, for clinical governance, statistical managers.

Indicators Indicators monitoring the improvement of the quality and productivity within the departments and the application of the multidisciplinary approach.

Action J5: Monitoring clinical pathways and protocols and their efficacy and the implementation quality Description The monitoring and updating of the job done creating the protocols and the clinical pathways have to be continuous. This step is mandatory to see if the job is only on papers or it is really implemented in the system.

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Expected results A consistently high level of provided medical care through continuously updated dashboard that will permit to make interventions to improve the IUHN over time.

Starting Date

March 1, 2014

Ending Date

June 1, 2023

Responsible Hospital directors, MCTs directors, area managers, the ExB coordinator for public health issues, for clinical governance, statistical managers.

Indicators Creation of constantly updated indicators dashboard

Action J6: Review of the international literature implementation of measures for risk management

for

the

Description Risk management is the identification, assessment, and prioritization of risks (defined in ISO 31000 as the effect of uncertainty on objectives, whether positive or negative) followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events. Risk management is an integral aspect of quality. The study of international literature on risk management will permit to implement all of the techniques and methods to reduce the risks and hopefully to prevent and avoid adverse events for the patients and the health workers. Risk management implementation is an essential element for accreditation.

Expected results Reduce the risks and hopefully to prevent and avoid adverse events for the patients and the health workers. Improving the quality of the clinic and permitting the accreditation.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible Hospital directors, MCTs directors, area managers, the ExB coordinator for public health issues, for clinical governance, statistical managers.

Indicators Creation and monitoring of risk management indicators

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Action J7: Review of the international literature implementation of measures for waste management

for

the

Description Medical waste, otherwise known as clinical waste, normally refers to waste products that cannot be considered general waste, produced from healthcare premises, such as hospitals, clinics, doctors’ offices and labs. Waste management is the collection, transport, processing or disposal, managing and monitoring of waste materials and it is a very important especially for medical and hospital framework. There are national and international standards to respect to obtain the accreditation but the main reason is to prevent and avoid accidents and also to reduce the impact of the environment. The economic balance and the costs will be also affected; a proper waste management can indeed reduce the costs of hospital significantly.

Expected results Reduce the risks and hopefully to prevent and avoid adverse events for the patients and the health workers. Reduce the impact on the environment.

Reduce the cost and promote recycling. Improving the quality of the clinic and permitting the accreditation.

Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible Hospital directors, MCTs directors, area managers, the ExB coordinator for public health issues, for clinical governance, statistical managers.

Indicators Creation and monitoring of waste management indicators

Action J8: Health technology assessment implementation Description The aim is the creation of health technology assessment reports before any investment and further follow up on the appropriate use of the technologies.

This activity will go across the institutions of the IUHN and will follow the activity of the research, clinical practice and education. Health technology assessment is a multi-disciplinary field of policy analysis that examines the medical, economic, social and ethical implications of the incremental value, diffusion and use of a medical technology in health care. It is intended to provide a bridge between the world of research and the world of decisionmaking. Health policy decisions are becoming increasingly important as the opportunity costs from making wrong decisions continue to grow. Health technology can be defined broadly as any intervention that may be used to promote health, to prevent, diagnose or treat disease or for rehabilitation or long-term care. This includes the pharmaceuticals, devices, educational tools, procedures and organizational systems used in health care. The Roadmap to IUHN

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implementation of the HTA activity in the IUHN is essential. Responsible for these activities will be the ExB coordinator for the health technology assessment and the HTA team.

Expected results Support on decision making to choose the best investments disinvestments with great benefits in economic and clinical results.

Starting Date

September 1, 2013

Ending Date

January 1, 2014

and

Responsible ExB coordinator for the health technology assessment and the HTA team with the collaboration of the hospital directors.

Indicators Number of HTA reports/month; “ad hoc� indicators to show the impact of this activity on quality.

Action J9: Data analysis for most common drugs used in the IUHN Description An analysis has to be done based on the data collected in each clinic for the detection of the most common drugs used. This will permit to review the appropriateness of the drug use but also will permit to optimize the process to create a centralized pharmacy. This will permit to optimize the system of drugs redistribution within the IUHN and to forecast the right needed quantity. Needed, for this action, are complete and reliable health records in the clinics.

Expected results Detailed information on drug prescriptions and consumes population in each clinic and in the entire IUHN. Better increase of prescription appropriateness and reduction of the the drugs. Detailed data to plan the opening and the support new centralized pharmacy.

Starting Date

September 1, 2013

Ending Date

October 1, 2013

of the hospital drug selection, costs related to the work of the

Responsible ExB coordinator for the health technology assessment, for clinical governance, for the economic aspects, for public health issues and the hospital directors.

Indicators Creation of 6 months analysis report.

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Objective K: Productivity and critical mass for service Description The international literature shows clearly that only structure with a defined quantity of patients can assure a proper quality and safety. This is especially true for surgery but all the clinical branches are influenced. The critical mass is necessary to get the sufficient experience for the physicians but is crucial in educational environment. The productivity is crucial not only for the economic balance but affects directly the outcomes and the safety of the patients. The benchmarking to select the appropriate level of activity can be done through the evidence based literature and accountable websites. The productivity quantity influences also the educational process and it has to be evaluated carefully in the planning of the educational activity.

Action K1: Monitor production activity of the departments Description To improve the productivity to reach the critical mass first a monitoring of the system is required. The production has to be not the total number of patients in departments but the number should be divided for single pathologies. Every single pathology has to be monitored to understand the critical mass for each subspecialty. If a department of oncology has a lot of patients for example, it does not mean that it has enough critical mass for every specific oncologic specialty as for example pheochromocytoma. This activity has to force the system to evaluate sending the patient to a more appropriate institution with a bigger experience on this kind of pathology or to improve in the future MCTs for these specific cases.

Expected result To monitor the specific clinical activity to assure a sufficient quality of care for patients.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for clinical governance Indicators Indicators dashboard on quantity and quality of the clinical activity in each subspecialty.

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Action K2: Preventive and corrective measures to increase or to optimize the production Description Thanks to the monitoring the ExB can decide on corrective measures to increase or to optimize the production.

Expected result Increasing or optimization of the production to assure the sufficient quality in the healthcare.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for clinical governance, for clinical practice, for educational processes, hospital directors and MCTs directors Indicators Multidisciplinary approach to solve critical production issues and adoption of preventive measures.

Action K3: Closure of a department Description In case of not respecting the minimal requirements for patient safety or performance of the care a department can be closed or the director can be changed. If the quality or the quantities of the treated or diagnosed patients are not enough, then the patient safety has to prevail on other kind of interests. This activity has also to prevent the waste of resources in field or structure that are not anymore useful for the population and the IUHN. Expected result Set a minimum requirement for the accreditation within the IUHN. Starting Date

January 1, 2014

Ending Date

June 1, 2023

Responsible The ExB Indicators Number of closed departments/time

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Objective L: Increasing the quality of care to the international level Description To benchmark the hospitals activity with the national and international level a reliable database and a complex dashboard of indicators are needed. The dashboard will show the real situation and the weak points within the system, this way new actions can be done to improve outcomes and performance. A new culture of education and healthcare has to develop within the IUHN to be comparable with the rest of the world. The cultural change is mandatory and it has to be guided by the evidence based medicine. The evidence based medicine is the instrument to obtain this goal. It can be done only through an easy access for doctors and students to the world shared knowledge. Making the access to the information more effective has to be connected with a culture of finding and selecting the right information using reliable sources. This can be done only through a clinical governance approach. The implementation of this knowledge has to involve every level of the IUHN, from nurses to doctors and from students to professors. The change, to be really effective, has to involve all the hospital areas and activities. A culture of risk management and health technology assessment is crucial as is essential for the creation of clinical pathways that are the implementation of the merging international guidelines and the local framework. The creation of indicators on quality and performance is mandatory to find the problems and the risks and to correct or prevent them.

Crucial, to implement this cultural change and to maintain it, is the lifelong education approach.

Action L1: Increase accessibility to the shared knowledge Description The access to knowledge cannot be ignored but has to be increased bringing the knowledge to the point of care and to the “bed of the patient�. The online connection with the library or the online evidence based sources and the connections between students and teachers need to be a priority.

Sharing knowledge is the key for a better education and a better clinical practice. Increase the sharing of the knowledge assuring high quality internet connections can change dramatically the learning experience and at the same time increase the chance to expose learners and health workers to new useful information increasing their self confidence.

Expected result Increase workers

of knowledge and students

in health thanks to

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knowledge delivery at the point of care thanks to a reliable fast internet connection and to platforms of educational material.

Starting Date

September 1, 2013

Ending Date

November 1, 2013

Responsible Hospital directors and the ExB coordinator for strategic planning and IUHN development.

Indicators Reliable fast internet connection and a proper monitoring of the activity over the network.

Action L2: Implementing within the IUHN

clinical

governance

methodologies

Description The previous point about data collection and data monitoring have to finalize in a correct clinical government culture implementation. Through accountability it is possible to improve the IUHN and start the benchmarking at national and international level trying to obtain the best results improving day by day thanks to the implementation of the evidence based medicine.

The indicators have to be compatible and align with the IUHN policies, national and international guidelines.

Expected result Increase the global quality of the IUHN implementing the evidence based medicine.

Starting Date

September 1, 2013

Ending Date

March 1, 2014

Responsible The ExB coordinator for clinical governance, for educational processes, for strategic planning and IUHN development, for public health issues, hospital directors and the area managers.

Indicators The presence of a clear and complete dashboard. The implementation of clinical guidelines and protocols, creation of clinical pathways.

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Action L3: Select a flexible functional structure of disciplines to implement in the IUHN Description The selection of the disciplines has to prepare the hospital to be flexible to the changing needs of the population. The care for the social activities, epidemiology, health needs assessment and clinical governance activity are basic steps to understand the direction of activities. Waste of resources and duplications within the IUHN should be avoided however activities can be duplicated following the population needs. The planning has to be done thanks to the collaborative thinking activity of several key figures.

Expected result Proper and accountable selection of activities and disciplines in the IUHN. Starting Date

August 1, 2013

Ending Date

August 1, 2016

Responsible The ExB coordinator for strategic planning and IUHN development, for educational processes, for public health issues, for human resources, for scientific-research process, for clinical governance, for clinical practice and hospital directors.

Indicators Document describing the strategic plan and selection process approved by ExB.

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Objective M: National and international Accreditation Description Due goals of the IUHN are to obtain national and international recognition for the quality of the health services. This is only possible in an accountable health system that cares about reducing the acquired infections, about reducing waiting lists, fulfill the staff and structure requirements. It is impossible to forget about subjects like quality perception and safety of the patient. The accountability on efficiency and financial resources for clinical, educational and research activities is vital as well.

Action M1: Monitor the required fields for accreditation Description Within the dashboards the indicators that will permit the national accreditation has to be monitored and optimized. The checking of these indicators have to be continuous. It does not have to be in a form of an exam but a routine check of the system. Frequent internal and external audit activity is needed.

Expected result Optimal measures in the accreditation key point on the entire year.

Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for clinical governance and hospital directors Indicators All the required accreditation indicators at national and international level.

Action M2: Preventive and corrective measures to increase or to optimize the efficiency in the required areas for accreditation.

Description It is duty of the hospital managers with the support of the ExB coordinator for clinical governance to work to correct the problems optimizing the efficiency in the poor performing areas.

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Expected result To prevent and correct problems to avoid failing to match the accreditation requirements.

Starting Date

December 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for clinical governance and hospital directors Indicators Number of preventive measures or corrective action/year.

Action M3: publication

Obtain

international

recognition

of

research

Description The research can in some cases neglect the publication step. Crucial is to obtain international recognition to adapt the research methodologies to the international guidelines and requirement and publish the trial before starting the research activity and to update the information in the proper way.

Expected result Increase the international journal publication activity.

Starting Date

January 1, 2015

Ending Date

June 1, 2023

Responsible The ExB coordinator for scientific-research process Indicators Number of trials published on dedicated website following the international rules before starting the research program/month.

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Objective N: Increasing the patient satisfaction Description Today the patient satisfaction is one of most used measures of health service quality. Several institutions and website record and analyze it. The competitive market is one of the reasons of this attention to the patient satisfaction. This is not the only reason to work on this field. The access to healthcare facility is always connected with emotional stress. This is especially true for the elderly population and those with the fear for pain and suffering. Today there are advanced technologies and drugs, but also organizational methodologies to reduce this kind of fear and stress and to create in the patient positive feels about visiting the hospital. All the healthcare facilities are focusing on the patient satisfaction. The feedbacks, often surveys, are recorded and used to improve the hospital experience. This empathic approach is very useful to build a solid trust within the health care system. The quality of the life inside the hospital is becoming a bigger concern and new approach like the “pain free hospital” or the luxury hospital are an example. The rights of the patient have to respected in all the structures within the IUHN and the informed consent is the first basic step.

Action N1: Pain free hospital Description Nowadays it is possible to reduce the pain and the suffering of the patient thanks to new drugs and technologies. What is necessary is more attention to the patient needs and an organizational support. The nurse and the anesthesiologist are the main columns of this kind of practice. Frequent assessing and monitoring especially in post surgery or oncologic patients are the first steps and have to be done by the nurse or the psychologist using recognized methodologies and scales. The support of the anesthesiologist is necessary in several kinds of patients. The control of this good practice is the responsibility of the area manager, the hospital director and the ExB coordinator for clinical governance. New MCTs can be created to approach the most complex cases.

Expected result Reduce at minimum the suffering of the patients.

Starting Date

July 1, 2013

Ending Date

June 1, 2023

Responsible Area managers, MCTs, anesthesiologist, hospital director and the ExB coordinator for clinical governance.

Indicators “Ad hoc” indicators to assess the implementation of this good practice.

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Action N2: Reducing the waiting list time Description Nobody especially when they are medical exam or a consultation. waiting list to reduce the waiting used for the high performance hospitals.

worried or sick wants to wait to get an Very important is the monitoring of the time. These kinds of indicators are often and management organization in the

Expected result Reduce to the minimum the waiting time of the patients.

Starting Date

August 1, 2013

Ending Date

January 1, 2014

Responsible Area managers, hospital directors and the ExB coordinator for clinical governance.

Indicators “Ad hoc” indicators to assess the implementation of this good practice.

Action N3: Improving the doctor-patient communication and empathy Description The KazNMU has a Communication Skills Center to teach the methodologies to improve this important aspect. What should be done is to involve this University center in the hospital activities to measure the effects of these kinds of methodologies and to study appropriate solution in case of communication problems.

Expected result Increase the doctor-patient empathy increasing the medical communication skills.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible Communication Skills Center, Area managers, hospital directors and the ExB coordinator for educational processes.

Indicators “Ad hoc” indicators to assess the implementation of this good practice.

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Action N4: Developing sensitivity in the IUHN

emotional

intelligence

and

social

Description The development of emotional intelligence and social sensitivity in health care is crucial for the quality of the services delivered. In the principle, the project will have an impact on the quality of personal and professional life of the health care professionals and, by extent, to the quality of life of the people they care for in the long run. To reach this objective, the IUHN intends to raise awareness on the importance of developing emotional intelligence and social sensitivity in the health sector.

Expected result Raised awareness on the importance of developing emotional intelligence and social sensitivity in the health sector.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible Communication Skills Center, Area managers, hospital directors and the ExB coordinator for educational processes.

Indicators “Ad hoc” indicators to assess the implementation of this good practice.

Action N5: Increase the national and international appeal of the IUHN Description The good practice and the high quality like the multidisciplinary approach or the publication of the indicators are for sure good examples to increase the trust and the appeal for IUHN. New ways to increase the satisfaction and the hospital experience has to be searched and found. Responsible for this activity is the ExB coordinator for the internal and external communication and marketing issues.

Expected result Increase the IUHN appeal at national and international level.

Starting Date

January 1, 2014

Ending Date

June 1, 2023

Responsible The ExB coordinator for the internal and external communication and marketing issues Indicators “Ad hoc” indicators to assess the implementation of this good practice.

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Objective O: Increasing the patient accessibility Description The accessibility and welcoming of all kinds of patients are the main aim of the IUHN. The IUHN wants to be open without religion, nationality, social or economical background, current location barriers. The IUHN has to be accessible or ready to respond to request 24/7. The target population will cover poor and not poor population; male and female, all different age stage with a special attention to elderly and fragile patients.

Action O1: Increase accessibility for disabled population Description The IUHN will carefully plan easier access for disabled population and their handling inside the structures. All the affiliated structures will be evaluated on this kind of requirements before being accepted in the IUHN. Expected result Assure an optimal IUHN accessibility for the disabled population.

Starting Date

August 1, 2013

Ending Date

January 1, 2014

Responsible The hospital directors. The ExB for approval.

Indicators Documentation on disable accessibility.

Action O2: Implementation of IUHN web portal Description The IUHN needs to be presented on the web. This will permit the publication of information, data, indicators but also to start new activities to connect it with the population such as, just to make some examples, the online booking, marketing actions, health educational section for patients etc.

Expected result Opening of IUHN web portal.

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Starting Date

August 1, 2013

Ending Date

January 1, 2014

Responsible The ExB coordinator for the health technology assessment, for strategic planning and IUHN development, for the internal and external communication and marketing issues, for the legal aspects and hospital directors.

Indicators Opening of a modern and completely functional website.

Action O3: Implementation of the telemedicine Description Telemedicine is the use of telecommunication and infor mation technologies in order to provide clinical health care at a distance. The implementation of the telemedicine is clear goal of the IUHN. Through this activity it is possible to follow patients even in remote areas and this is very useful in a country like Kazakhstan that has huge quantity of desolated lands.

Several activities can be started in the near future. It helps to eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It can also be used to save lives in critical care and emergency situations. Videotelephony, advanced diagnostic methods supported by distributed client/server applications, and additionally with telemedical devices are all good examples. This activity can be integrated with the “in-home care�.

Expected result Activation of several telemedical activities and increase of accessibility to remote areas of the country.

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Starting Date

August 1, 2013

Ending Date

October 1, 2014

Responsible The ExB coordinator for the health technology assessment, for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues.

Indicators The number of IUHN new telemedicine services opened to the public.

Action O4: Implementation of Online Booking Description The online booking is a modern way to connect with the population and it will automate most of the booking activities making them more reliable.

People will be able to see the waiting time in different institution of the IUHN choosing where to be treated.

They will be able to see the availability of different professors and to book the slot in real time paying by credit card.

Expected result The developing of the online booking.

Starting Date

January 1, 2014

Ending Date

January 1, 2015

Responsible The ExB coordinator for the internal and external communication and marketing issues, for the health technology assessment, for human resources, for strategic planning and IUHN development, for clinical practice, for the legal aspects, for the economic aspects and hospital directors.

Indicators Numbers of Online Booking/month

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Action O5: Implementation of online educational materials for the population and the patients Description The IUHN web portal wants to become the reference point for the general population and the patients with the medical knowledge. The IUHN will publish patient hands out and evidence based medical information on pathologies and symptoms. Internet today is full of information but the accessibility or the reliability of this is poor. The IUHN wants to support the population with reliable information and advices for their health. This process will be part of the educational and preventive projects. The educational material will be at least in Kazakh and Russian languages. The involvement of the University chairs trough the coordination of the ExB and the faculty of KazNMU will be mandatory.

Expected result Becoming a reference center of health and the educational and reliable source of information center for the Kazakh population.

Starting Date

October 1, 2014

Ending Date

February 1, 2015

Responsible The ExB coordinator for the internal and external communication and marketing issues, for clinical governance, for public health issues, for strategic planning and IUHN development, for the health technology assessment, for educational processes, all the educational chairs and departments of the KazNMU. Indicators Number of online visitors/month and similar.

Action O6: Implementation of web 2.0 services and online health applications Description The web portal will be the center of the online activity and from it will be possible to offer reliable online health applications, open discussion forum, answer questions and download phone health applications and develop new web 2.0 services. The involvement of the University chairs trough the coordination of the ExB and the faculty of KazNMU will be mandatory.

Expected result Becoming a reference center for healthcare and an educational and reliable source of information center for the Kazakhstan population.

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Starting Date

October 1, 2014

Ending Date

February 1, 2015

Responsible The ExB coordinator for the internal and external communication and marketing issues, for clinical governance, for public health issues, for strategic planning and IUHN development, for the health technology assessment, for educational processes, all the educational chairs and departments of the KazNMU. Indicators Use of the online application and web 2.0 services.

Action O7: Implementation of online health records access Description Most of the patients have paper health records and exam reports. This over time will become impossible to store correctly and to bring to the doctors for a complete evaluation. The IUHN thanks to the implementation of the Electronic Health Records will permit to store and give free access to the patients to their documentation on line at anytime. This will permit not only to share these kinds of information within the IUHN but also with other health institutions even abroad. Special attention will be on the privacy rights of the patients and for the security of such delicate kind of data.

Expected result Online access to Electronic Health Records.

Starting Date

December 1, 2013

Ending Date

December 1, 2014

Responsible The ExB coordinator for the internal and external communication and marketing issues, for the health technology assessment, for strategic planning and IUHN development, for clinical governance, for the legal aspects, for the economic aspects and hospital directors.

Indicators Quantity and quality indicators on the online Electronic Health Records service.

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Action O8: Improvement of the viability for the IUHN hospital network Description The viability is a crucial point for the IUHN. Often the responsibility of it is outside the IUHN but the coordinator for the internal and external communication and marketing issues and the hospital directors cannot forget about this essential point. Public transportation, street maintenance, parking and other viability problems have to be discussed with the right figures in the municipality to improve and adapt the viability increasing the accessibility to the health structures for all kinds of patients.

Expected result Increase the IUHN viability to achieve and easier access to the health institutions for all kinds of patients.

Starting Date

August 1, 2013

Ending Date

December 1, 2014

Responsible The ExB coordinator for the internal and external communication and marketing issues and the hospital directors.

Indicators “Ad hoc� indicators to assess the implementation of this good practice.

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Objective P: Monitor and increase the health workers satisfaction Description The respect for the work of every health worker within the IUHN is crucial from every point of view. It is important not only for ethic, deontology but also for the well performing of the structure. A more motivated and happy worker reflects into the health care delivery. The creation of a stimulating environment not only with high wages is essential.

Action P1: Assessment of the workers satisfaction Description Surveys to investigate the satisfaction and the communication problems within the health institution have to be done periodically.

Expected result Estimate the health workers satisfaction and problems to solve them rapidly.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible Hospital directors, coordinator for human resources and communication skills center.

Indicators Frequent audit to assess the health workers satisfaction.

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Objective Q: Increasing the patient and health workers safety Description The safety of the patient and the health workers have to be a priority. It is not possible to forgive unawareness of such kind of problems up today with the international and national guidelines available. Responsible figures for risk management have to be indentified in each structure of the IUHN. The emergencies system to prevent the life loss of the patients has to be mandatory. Reanimation teams have to be active and present in the hospitals 24/7 and they need to have all the law required safety material for such practice. Any hospital within the IUHN has to fulfill these requirements before applying for affiliation or franchising. The responsibility of this is on the hospital directors but also on specific ExB key figures. Similar attention has to be on monitoring and reducing of hospital acquired infections.

Action Q1: Implantation of Risk Management guidelines and identification of responsible figures in each hospital Description Responsible figures for risk management have to be indentified in each structure of the IUHN. Frequent audit have to done to assess the sufficient quality of this activity.

Expected result Implantation of Risk Management guidelines and identification of responsible figures in each hospital.

Starting Date

September 1, 2013

Ending Date

November 1, 2013

Responsible Hospital directors, coordinator for clinical governance and for human resources.

Indicators Frequent audit to assess the quality of this activity.

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Action Q2: Implementation of 24h emergency resuscitation team Description Each hospital needs to have 24h emergency resuscitation service. This can be obtained through intensive care department or resuscitation teams. This activity needs to be integrated in an internal emergency network for different level of severity cases within the IUHN. Expected result 24h emergency resuscitation service in each hospital.

Starting Date

June 3, 2013

Ending Date

July 1, 2013

Responsible Hospital directors, coordinator for clinical governance, for strategic planning and IUHN development, for the internal and external communication and marketing issues.

Indicators Indicators on emergency resuscitation service activity over time.

Action Q3: infections

Monitoring

and

reducing

of

hospital

acquired

Description The monitoring of the hospital acquired infections has to be done periodically. Responsible figures have to be identified within the hospitals but also in the IUHN to create external audit activity.

Expected result Reduction of hospital acquired infections.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible Hospital directors, governance.

area

managers,

the

ExB

coordinator

for

clinical

Indicators Frequent audit to assess the quality of this activity.

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Objective R: Economic sustainability Description The economic sustainability is very important for the future and investment of the IUHN. The responsible figure for this is the ExB responsible for the economic aspects. This function has to be integrated within most of the activity of the ExB. The participation has to be active and transparent and accountable. Frequent reports and statistical analysis easy to understand and freely accessible for transparency are needed. The transparency will permit to strengthen trust of the stakeholders permitting a faster evolution of the IUHN and to build more solid collaborations.

The economic sustainability and transparency is part of the accreditation process and can compromise the future of the entire IUHN.

Action R1: Monitoring and public reporting Description The transparency and the accountability on the economic expenditure and performance are important in public institution and it is a mandatory goal in all the western public institutions. The results and data have to be public on the website or at least in the intranet. Basic indicators are: detailed incomes, detailed expenses, profit or loss, eventual evaluation reports on diversification of funding, growing or decreasing of revenues and investment expenditure with health technology assessment report before investing and reports monitoring the use and cost of maintenance of such technology.

Expected result Transparency in monitoring, clear responsibilities and publication of reports and data.

Starting Date

October 1, 2014

Ending Date

June 1, 2023

Responsible The ExB responsible for the economic aspects and hospital directors Indicators Indicators such as: income, expenses, profit, investments and similar indicators.

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Action R2: Prevention of economic collapse or crisis Description The Prevention of economic collapse or crisis is a duty of the ExB responsible for the economic aspects. All the measures to prevent such catastrophic events have to be organized, planned and described through periodical reports to the ExB. Expected result Prevention of economic collapse or crisis.

Starting Date

June 3, 2013

Ending Date

June 1, 2023

Responsible The ExB responsible for the economic aspects, for strategic planning and IUHN development and hospital directors Indicators Periodical economical reports

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Objective S: Eco-sustainability Description Today all the best hospitals in the world as most of the companies are becoming ecofriendly. The environment is one of the most important factors for the health of the population and it cannot be ignored. This is especially true for healthcare facilities. A responsible key figure is needed to evaluate over time the respect of the environmental statements and the adoption of the best updated methodologies to reduce the environmental impact.

Action S1: Supervision of the eco-friendly status and eco-impact on environment Description The supervision and monitoring on the eco-sustainability of the hospital is required to be part of the IUHN. A responsible figure has to be identified by the ExB in the IUHN and this figure has to report periodically at the ExB. This figure will need to collaborate with the public health department and the directors of the clinic on the waste management and recycling and with the health technology assessment coordinator for the new investments and acquisitions.

Expected result Monitoring of the eco-sustainability of the IUHN. Starting Date

June 3, 2013

Ending Date

June 1, 2023

Responsible The hospital directors and the ExB through a specific figure Indicators Creation of “ad hoc� indicators dashboard.

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Action S2: Participation in the educational and prevention projects related with environment and pollution.

Description The IUHN care for the environment can be integrated with other clinical and educational programs and this can be done on co-participation with other NGOs or governmental projects. The monitoring of the environment should be one of the future fields of action of the IUHN. Expected result Participation to environmental monitoring activities and educational and prevention projects.

Starting Date

June 3, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for strategic planning and IUHN development, for public health issues, for the internal and external communication and marketing issues and hospital directors.

Indicators Creation of new projects and collaboration in time

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Objective T: Increase and coordination of the intraUniversity network for an integrated leadership and management within the IUHN Description The network between the University chairs and the IUHN is crucial and a responsible key figure that follow and coordinate these activities needs to be identified. This key figure has to overcome singular conflict of interest or frictions for the good of the IUHN. The promotion of the involvement of the chair in the IUHN is a critical issue that has to be addressed. This activity has to connect and involve in the IUHN evolution educational, research and healthcare activities. Its function will be to accelerate as an enzyme every intra-University activity.

Action T1: Increasing and monitoring the growth participation of the University areas within the IUHN.

of

the

Description The University involvement in the IUHN is central. This involvement has to be motivated and even forced if not justifiable. It is unimaginable that the University departments and chairs do not participate actively in the IUHN. The responsibility of this involvement is on the ExB coordinator for the internal and external communication and marketing issues and for strategic planning and IUHN development. Other figures will be involved in the process like the coordinator for scientific-research process and for educational processes. The ExB has to monitor carefully this and require interventions in case of poor participation or denial.

Expected result Full participation of the University area in the IUHN activity.

Starting Date

June 3, 2013

Ending Date

June 1, 2023

Responsible The coordinator for the internal and external communication and marketing issues, strategic planning and IUHN development, coordinator for scientificresearch process and for educational processes.

Indicators The creation of clear plans with lists of collaboration type that every department and activity area of the University is doing in the IUHN. The creation of a monthly report on these kinds of collaboration will show real involvement of every figure of the University in the IUHN.

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Action T2: Plan, monitor and implement the flexibility of the IUHN through the MCTs. Description In a rapid changing world with evolving needs is fundamental to be ready to adapt to these new needs. Thanks to the continuous health need assessment new adaptation plans and projects will be created and implemented. The MCTs will offer already a high flexibility of the system but a continuous integration of leadership and management is needed.

Expected result High flexibility and adaptation of the IUHN to the population health needs.

Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The coordinator for strategic planning and IUHN development, public health coordinator and hospital directors.

Indicators Documentation of flexibility planning and actions done to adapt to the population health needs

Action T3: Emergency and critical care plans Description Hospitalized patients can become critical rapidly and resuscitation or critical care can become necessary in few minutes. The development of resuscitation team is necessary but crucial for these kinds of patients is the post resuscitation treatment. Smaller hospital should be able to transfer, according to defined emergency plan, the patient within an hour to a bigger and better equipped hospital within the IUHN or external to the IUHN. Such kind of plans have to be developed in advance and agreed with written documentation and organized through clinical pathways taking care of the transportation methodologies, reserved and preferential accessibility and the support needed.

Expected result Development of emergency and critical care plans within the IUHN and with external health care facilities for each hospital.

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Starting Date

November 1, 2013

Ending Date

January 1, 2014

Responsible The coordinator for strategic planning and IUHN development, for the internal and external communication and marketing issues and hospital directors.

Indicators The creation of the of emergency and critical care plans for each hospital.

Action T4: Public Health Emergencies and Modern Disaster Response Planning Description A modern IUHN cannot ignore the risk of climate and natural disasters or conflict-based disasters, human systems or technological failures and the direct and indirect consequences of these disasters. Plans have to be done and prepared before when the need is not visible. All these possible events have to be tough and emergency plans and emergency network have to be prepared. This will involve the different structures within the IUHN and their communication. Almaty still has the scars of natural disasters events.

Planning ahead of such kind of possibilities and the communication to the population where to go before and during this catastrophic events in needed.

The redistribution of patients based on severity has to be planned ahead.

Specific international guidelines are available and should be implemented in the IUHN. Expected result Public Health Emergencies and Modern Disaster Response Planning to save human life during such kind of events.

Starting Date

January 1, 2014

Ending Date

June 1, 2014

Responsible The coordinator for strategic planning and IUHN development, public health coordinator and director of the clinics within the IUHN. Indicators Creation of Public Health Emergencies and Modern Disaster Response Planning

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Objective U: Creation of a franchising network and affiliated institutions Description The creation of network made by franchising and affiliating health structures within the IUHN will result in more accountable and regulated network for educational and clinical purpose of the University. The definition of clear requirements and policies to be integrated in the IUHN network is mandatory as well as the revoking parameters. These policies will force the institutions to a more accountable use of both economic and human University resources. The franchising activity can impose measure of quality and quantity level of activity required to be an educational or practice center connected with the University. This kind of activity can also bring new economic resources in the IUHN for its future evolution.

Action U1: Creation of the policies for the affiliating and in franchising clinics Description To integrate and accept different healthcare and research institutions as affiliated or in franchising documentation on duties and responsibilities needs to be prepared. These documents need to state the minimal requirements to be accredited as affiliated or in franchising structure within the IUHN. Such delicate process has to be clear and accountable and transparent. Such kinds of documents need to be reviewed carefully before the approval by the ExB by the ExB responsible for the legal aspects. The requirements need to cover healthcare quality, infrastructure but also educational and research processes accountability. These documents need also to be used as guidelines for the IUHN accreditation pathway for the future applying institutions.

Expected results An accountable and regulated process to accept in the IUHN new research and healthcare institutions.

Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible ExB in coordination with coordinator for scientific-research process, for strategic planning and IUHN development, for clinical practice and for public health issues.

Indicators Their activity will be monitored based on the multidisciplinary meetings and on others “ad hoc� indicators.

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Action U2: Vision and strategic plan of new affiliating or in franchising clinical healthcare institutions development Description Document explaining vision and the strategic plan of the requesting clinic for the integration in the IUHN. In the document approved by the ExB, the clinical activities and the modality of integration, areas of action, responsibilities, duties and rights have to be described for the upcoming years.

Expected results Creation of a document which will allow an integrated and unified vision and strategic plan.

Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The director of the applying clinic for affiliation and its management team Indicators Document approved by the Scientific Council

Action U3: Revocation of the IUHN membership affiliation Description In case of not respect to ExB prefixed parameters from the affiliated or in franchising institution or in case other severe actions that can damage the image of the IUHN or the University the affiliation can be removed or suspended. The parameters should be decided for all the appliers by the ExB but they need to include educational parameters, indicators of performance, quality and quantity to assure a proper service within the IUHN. Expected result To plan the possibility of the affiliation revoking for preserving the good image and quality of the IUHN. Starting Date

November 1, 2013

Ending Date

June 1, 2023

Responsible The ExB Indicators Number of discussions in the ExB to remove affiliated or in franchising institutions.

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Objective V: Optimization of the IUHN infrastructure and service network Description The optimization of the infrastructure is crucial to reach the set goals. The adaptation has to be rapid and guided by an integrated leadership that can base its decision on reliable data. The main areas that need to be monitored and adapted are the working space usage. The plan has to focus on the needs of education, clinical practice and research. Fundamental is the support to the knowledge flow and on the knowledge sharing. The infrastructure has to take care of the heath workers and the students but of course also about the patients and their needs from admission, service provision assuring quality of care and quality of life in the hospital facilities. The IUHN has to create a complete 360 degree around the patient needs covering primary, secondary and tertiary care but also organize to follow the patient at home, thank to telemedicine and in time thanks to a strict follow up.

Action V1: Define the space within the structures and monitoring its appropriate use Description The healthcare facilities should be optimized for the clinical practice and for the care of the patients. Even if it is a University system the formal lessons should be done in the University classrooms. Of course debriefing rooms to discuss the clinical activities have to present but the high costly structure of the hospital should be optimized for the clinical activity reducing the number of desks to increase the number of beds for the patients. The number of beds influences the number of patients and the number of patients influences the volume of activity, the educational process and the patient care quality and safety.

Expected result Optimization of the space for clinical and education purposes.

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Starting Date

July 1, 2013

Ending Date

January 1, 2014

Responsible Hospital directors, MCTs directors, the ExB coordinator for strategic planning and IUHN development, for clinical practice and for educational processes.

Indicators Map of room and space usage within the IUHN.

Action V2: Define network a synergic work within the IUHN Description Clear function of each institution within the IUHN has to be stated. The definition of the network responsibilities have to be planned and agreed. This will permit a synergic effect increasing the efficacy of the IUHN. The network documentation rules must include not only the healthcare facilities but also every single department of the University. These policies have to be approved by the ExB and the Scientific Council.

Expected result Clear documentation on the network responsibilities.

Starting Date

September 1, 2013

Ending Date

January 1, 2014

Responsible The ExB coordinator for strategic planning and IUHN development and hospital directors. ExB and Scientific Council for approval.

Indicators The approval of the document on the network responsibilities.

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Objective W: Increase Networking Description The Networking activity is a crucial area for the survival and the evolution of the project. It is fundamental to monitor and increase the network activity within the University departments and areas but also outside the University area. The networking can bring new opportunities and new valuable resources. The main objective is to monitor carefully the growing of the network and analyze it through a social network analysis regularly and take new decisions and actions on the data and to improve the network itself but also to improve and support the ExB. The Network coverage should include intra-University and other health care and educational institutions and also national and international level NGOs.

Action W1: Monitoring of the networking activities Description The monitoring has to be continuous and planned ahead. It has to use the modern methodologies to monitor it like the new software for social network analysis.

Expected result The creation of a database for the social network analysis.

Starting Date

September 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for the internal and external communication and marketing issues and communication skills center Indicators The presence of a regularly updated database

Action W2: Analysis of the networking activities Description The analysis has to be regular and planned ahead. It has to use the modern methodologies and software for social network analysis like NodeXL or others. A report on these activities has to be produced regularly to discuss new strategies within the ExB. Expected result Increase of the strategic planning and support of the evolution of the marketing activities.

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Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for the internal and external communication and marketing issues and communication skills center Indicators The presence of a regularly updated report

Action W3: Creation strategy plan

of

an

intra-University

communication

Description An intra-University communication strategy plan is needed to involve all the figures of the University in the IUHN and to keep all these figures united as a whole team.

Mapping of their role and the activity is central in the IUHN reorganization process.

Expected result Increase the effectiveness of this crucial area for the project.

Starting Date

July 1, 2013

Ending Date

October 1, 2013

Responsible The ExB coordinator for the internal and external communication and marketing issues Indicators The presence of a regularly updated plan with the different University figures involvement in the IUHN.

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Action W4: Creation of a communication and marketing strategy plan Description The monitoring and the analysis will naturally evolve in a regularly updated communication and marketing plan that has to be discussed with the ExB and put in to action.

Expected result The strategic planning of the communication and marketing actions will increase the effectiveness of this crucial area for the project.

Starting Date

July 1, 2013

Ending Date

October 1, 2013

Responsible The ExB coordinator for the internal and external communication and marketing issues Indicators The presence of a regularly updated communication and marketing plan and the regularly discussion of it in the ExB meeting.

Action W5: Communication and marketing activities Description The activities have to be carried out and reported regularly. New collaborations have to start and new ways to communicate with the population and the patient have to be found and developed. New projects need to be started in collaboration with other institutions and companies.

Communication with the stakeholders will evolve in an increase of trust in the IUHN thanks to the transparency and the accountability of the system.

Needed collaborations will include but do not limit to NGOs, Government branches, education, healthcare and research institutes and mass media.

Expected result Increase the visibility of the IUHN and the trust of the population and the stakeholders in the system. Crucial the creation of new join projects with new companies and new institutions.

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Starting Date

October 1, 2013

Ending Date

June 1, 2023

Responsible The ExB The ExB coordinator for the internal and external communication and marketing issues, for the legal aspects, for strategic planning and IUHN development. The ExB for approval.

Indicators Number of new communication activities/month; number of new join projects/month; number of new memorandum of agreement signed/month.

Action W6: National and international collaborations Description The national and international collaborations are important to introduce new ideas and new methodologies in the system. Exchange programs should start for research, clinical practice, management, clinical governance, health technology assessment and education.

Expected result Increase of international and national collaborations.

Starting Date

July 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for the internal and external communication and marketing issues, for strategic planning and IUHN development, for educational processes and the University international office.

Indicators New collaborations with national partners/6 month; new collaborations with international partners/6 month.

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Objective X: Develop a 2.0 collaborative social IUHN Description The involvement of the population in the IUHN is a new and icebreaking idea. In the social era the value is created involving the population to collaborate in the projects.

The involvement has to be fostered, incentivized and facilitated.

The participation of the population to assess the system or to propose change or simply to make voluntary programs is a strong propulsive energy that cannot be ignored in the social era. This energy has to be conveyed in strong propulsion for the IUHN.

Action X1: Creating value in IUHN thanks to the voluntary and social activities Description A responsible figure and area on the web have to be created. This figure has to be active in involving and listening to the population proposals and has to covey this proposal into plans and then to action. The coordination of this strong propulsion is a very delicate subject and has to be monitored continuously for the risk to create adverse effect. The collaboration of NGOs for social activities can bring new and innovative ideas for the future kind of healthcare.

Expected result Increase the involvement of the population in the IUHN in regulated and controlled manner.

Starting Date

July 1, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for the internal and external communication and marketing issues and for strategic planning and IUHN development Indicators The presence of a regularly updated report on new ideas and proposition from the population

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Action X2: Creation of web 2.0 tools to communicate with the population Description New online tools can be implemented to increase the participation of the population in finding new future visions and collecting new ideas for IUHN. Examples are discussion forum and blogs or other social network activities.

Expected result Increase the involvement of the population in the IUHN in regulated and controlled manner.

Starting Date

February 1, 2013

Ending Date

June 1, 2014

Responsible The ExB coordinator for the internal and external communication and marketing issues and for strategic planning and IUHN development Indicators Indicator on the online activity and social participation.

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Objective Y: Development of a creative and innovative IUHN Description The IUHN has to create a new way for the health workers, researchers and students to propose new projects. This will permit the IUHN to be updated with the current time and to evolve and renew itself in time.

Action Y1: Involving the IUHN and University in the evolution of the IUHN Description The IUHN have to stimulate continuously the IUHN and University environments to obtain new ideas and projects.

The organization of competitions for projects and find the financial support of the winners is just one of the several ways to involve in changing and in the improving process the people that are part of these institutions.

Through this activity new opportunities will arise. Examples are research projects or new MCTs creation.

Expected result Collection of new ideas bottom-up in periodical and organized manner.

Starting Date

January 1, 2014

Ending Date

June 1, 2023

Responsible The ExB coordinator for the internal and external communication and marketing issues Indicators Number of new projects bottom up/6 month

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Action Y2: Bring the new ideas and projects into practice Description Bringing the best ideas and projects in to practice has to be easy and not too bureaucratic to avoid losing the enthusiasm momentum. A planned pathway to bring ideas into practice has to be defined and monitored. Fund raising for this activities has to be organized by a dedicated team.

Expected result Quick development of the ideas and projects through a dedicated supportive team.

Starting Date

June 5, 2013

Ending Date

June 1, 2023

Responsible The ExB coordinator for strategic planning and IUHN development Indicators Number of new projects bottom up developed/6 month

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Objective Z: Redefinition of internal structure of the IUHN hospitals Description To adapt to the new structure and needs of the IUHN the hospitals within the IUHN will need to redefine their structure and new roles and responsibilities. The mapping of the available resources such as human, technological and economic is mandatory.

Action Z1: Redefinition of internal structure and responsibilities within the UNIclinic Description A review of the staff and their positions with the introduction of new strategic program will be needed. The revision will affect staff salaries, responsibilities with the determination of urgent and emergency priorities for UNIclinic.

The following key figures should be included in the revision process: area managers, clinical governance manager, statistical manager, nurse manager, clinical pharmacist and research managers. The reorganization of the clinical internal structure should be based on clinical areas type of clinical care and not anymore on clinical departments.

Expected results A regulatory documentation specific for the UNIclinic functional structure Starting Date

August 1, 2013

Ending Date

September 1, 2013

Responsible The director of UNIclinic, the ExB responsible for the legal aspects, for the economic aspects and for human resources Indicators “Ustav” (charter), “polozhenie” (regulation) of the clinic, staffing positions, “polozhenie” of salaries, “polozhenie” of paid services, job descriptions, clinical area description and inter-functionality between the different areas activities within the UNIclinic.

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Action Z2: Redefinition of internal structure and responsibilities in ECC Description A review of the staff and their positions with the introduction of new strategic program will be needed. The revision will affect staff salaries, responsibilities with the determination of urgent and emergency priorities for ECC. Expected results A regulatory documentation specific for the ECC functional structure Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible Director of ECC, the ExB responsible for the legal aspects, for the economic aspects and for human resources Indicators “Ustav” (charter), “polozhenie” (regulation) of the clinic, staffing positions, “polozhenie” of salaries, “polozhenie” of paid services, job descriptions

Action Z3: Redefinition of internal structure and responsibilities in the KazNMU Dental Institute Description A review of the staff and their positions with the introduction of new strategic program will be needed. The revision will affect staff salaries, responsibilities with the determination of urgent and emergency priorities for the KazNMU Dental Institute.

Expected results A regulatory documentation specific for the KazNMU Dental Institute functional structure Starting Date

September 1, 2013

Ending Date

October 1, 2013

Responsible Director of KazNMU Dental Institute, the ExB responsible for the legal aspects, for the economic aspects and for human resources Indicators “Ustav” (charter), “polozhenie” (regulation) of the clinic, staffing positions, “polozhenie” of salaries, “polozhenie” of paid services, job descriptions Roadmap to IUHN

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Action Z4: Identification, definition, planning and monitoring of the use of available resources.

Description Identification, definition, planning and monitoring of the use of available resources such as human, economical, technological resources and etc. This will be realized through monthly reports of responsible members of ExB that will be reviewed by the EPRB. Expected results Creation of an accountable IUHN Starting Date September 1, 2013 Ending Date

June 1, 2023

Responsible Specific coordinators of the ExB Indicators Number and type of reports/month

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Annexes 

Guideline Program for the development of Kazakh National Medical University UNIclinic for 2013-2023 (Программа-гид по развитию UNIclinic Казахского национального медицинского университета на 2013-2023 годы).



Gantt Project of Reconfiguration of the IUHN

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For further information on UNIclinic and KazNMU visit www.kaznmu.kz or use the QR-code

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The creation of this document was supported by HTAcamp