Process 6: Patient maintenance

As part of the preventive care patients are discharged from the hospital if they are deemed stable, improved, do not require ongoing review, or can have a follow-up from the nearest health clinic or district hospital. In addition, the dietician, pharmacist and physiotherapist will review the patient’s plan with the patient and any caregiver, provide relevant information and plans about eating correctly at home, correct medication intake and step-by-step exercises that can be applied at home.

Physio W #2: If a patient stops doing exercises, it will slow their recovery. That is why physical exercises are important to help patients improve their condition. We understand that at home, the patient may not have the same hospital exercise equipment. Therefore, we teach the family members or the carers to modify suitable things at home into functional exercise equipment. This will encourage the patient to continue doing exercises when they are at home, thus helping to reduce muscle stiffness.

Also at this stage, all the patient’s data gathered from the clinical procedures are recorded and stored systematically in HIS for further evaluation and future reference by the healthcare team in ABC and in other hospitals.

135

Special preventive care services

In addition, to the above six processes, ABC Hospital also provides special preventive care services through three units – the diabetes clinic, quit-smoking clinic and health- education class. The diabetes and quit-smoking clinics, pictured in Figure 4.10, were established to assist with health promotion through education and counselling. The clinics are run by experienced senior nurses and are supervised by senior doctors and consultants. These services are provided on a referral basis, whereby doctors can refer patients from any inpatient department for further advice and continuous health improvement during their treatment and before discharge.

Figure 4.10: Diabetes and quit-smoking clinics at ABC Hospital

For instance, a patient who has been diagnosed as having early diabetes will be referred by a doctor to the diabetes clinic to gain further understanding and awareness about diabetes. At this clinic, a diabetes educator will provide information about diabetes, show the correct way to use devices and monitor the patient’s progress. In addition, the educator may attend the outpatient’s ward to provide patients with advanced stage diabetes and severe complications with education and counselling. These services are usually offered during the patient treatment and monitoring process, and during the evaluation process. The educators always encourage family members to be involved with the patient during any follow-up. The educators also welcome any enquiries from patients and family members about the disease.

136

Nurse In #12: Serious wounds may cause infection and result in leg amputation. Therefore, before the patient’s condition gets worse, we will educate and counsel the patient on how to control their sugar level so that their blood circulation is right and help fasten the healing process. We also show them how to clean and treat the wound properly to avoid infection and to ensure another foot is not affected. During the counselling, we emphasise the importance of foot care and explain the implications, such as bacterial infection can enter the blood vessel and can attack organs such as the heart and kidneys and cause organ failure like kidney dysfunction.

At the quit-smoking clinic, patients are provided with education and counselling to help them practice positive steps in quitting smoking. Patients are also scheduled for follow- up and are supplied with medication to reduce their smoking. Patients who visit this clinic include those who are addicted smokers, with some having chronic diseases such as cancer, cardiovascular disease and respiratory disease.

The health-education unit is responsible for conducting classes, as pictured in Figure 4.11, as well as organising events and activities to provide knowledge for inpatients, outpatients and the public. Classes are arranged according to the type of chronic disease, and may include for example, hypertension, diabetes and respiratory disease, and cover a range of important topics such as foot-care management, symptoms of the disease, medication advice, as well as offering an opportunity to patients and the public to discuss related health issues.

137

Patients are provided with relevant documents and an education kit during the class. The class is free, and includes a snack at the end of the session. The health-education class schedule is posted on the hospital website, can be obtained in the form of pamphlets from the health-education unit, is placed at the diabetes clinic and mounted as banners at the entrance in the main lobby. During the class, a team of multidisciplinary healthcare practitioners deliver a talk, educate patients and the public regarding the risk factors of the disease under discussion and provide knowledge about prevention. Furthermore, this unit creates advertisements and collaborates with clinical departments to organise campaigns for preventive care.

Conclusion

ABC Hospital’s unique characteristics make it an interesting and important case to research, and demonstrate how a health organisation can develop and utilise its IS competencies and capabilities through its IS resources, in an overall preventive care patient process, and thus influence preventive care performance. ABC’s unique characteristics are:

1. It has a strong IT infrastructure that enables it to provide effective preventive care.

2. The large size of this hospital enables it to receive a high number of chronic disease patients who require preventive care services.

3. This hospital has successfully initiated many preventive care processes, helping it to promote preventive care.

4. Unlike many other hospitals, this hospital has an extensive range of secondary and tertiary services, including specialty services for preventive care, established in every unit of its services. These specialty services mean that patients with chronic diseases receive specific treatment according to the type of disease.

5. This hospital’s preventive care patient processes enable its healthcare practitioners to deliver comprehensive care to patients.

In summary, these characteristics make ABC different from most other hospitals, providing a rich environment in which to research preventive care.

138

Some of the elements discussed in this chapter, such as the six preventive care patient processes in Section 4.5, were used as a foundation to construct part of the research framework, presented next in Chapter 5.

Chapter 5 is concerned with the findings of how IS competencies and capabilities were developed from IS competency bundling and capability bundling, and leveraged towards preventive care performance, thus answering the research question.

139