Friday, December 23, 2011

Healthcare Consulting Abroad

Today was our first day at the Sihanouk Hospital Center of Hope (SHCH).  Christian and I were picked up by the hospital at 8:30 AM in the morning from our guest house in Phnom Penh and driven over.  Even in the morning, driving through the streets of Phnom Penh is an experience unto itself.  I'm in awe that nobody was hit during the morning rush hour...

First order of business when we got to the hospital was a tour of the facilities by Sideth Chhin, the International Volunteer Coordinator.  SHCH also serves as a training hospital for the area - one of the issues that Cambodia faces is that there is no formal residency program. As such, many of the doctors don't have clinical experience when they get out of medical school.  SHCH has several international doctor volunteers that serve in the area helping to train the local doctors, making it possible for them to get supervised medical experience.  In the past, SHCH ran on a lottery system for non-critical cases, so it would be the luck of the draw as to whether someone would get treated.  Nowadays, they've moved to a triage system that prioritizes based on urgency. Additionally, they've made a conscious decision to focus on the poor, turning away those who can pay to one of the SHCH run medical clinics in the city that are fee-for-service.  It's been a strategy that's been working, as in the past they've had patients dropped off by their families in Lexus's.  Despite not charging for its services, SHCH is known for its quality, hence the large number of patients that swing by the hospital for services.  SHCH has been around for 15 years, treating over one million patients during its time of operations.


Plaque at SHCH


We also learned that due to budgetary issues (less donations coming in than expected due to natural disasters elsewhere) the hospital had to shut down its surgical ward and limit its emergency department operations.  It's a tragedy that they've had to do this because many of the people that come to the hospital have no other means of accessing healthcare.  Hopefully the work that we're doing with their lab will help lower one of the hospital's most expensive functions, making it possible to reopen some services to the public.


Unused Surgical Ward


We met with Don Fetherman, the CFO of the hospital in the morning to discuss the scope of what we're working on and how we could best help the hospital during our stay in Phnom Penh.  There was no significant changes to the project described in my previous post "On the Other Side of the World," which is good.  After meeting with Don, we went to the lab and met with the lab director Teav Syna to confirm our project and meet his team.  I think there's a huge opportunity here for us to do some small changes that will result in big gains for their operations.


The Lab Team


Some of the things that I've realized just in the first day is how difficult a consulting project on the other side of the world can be.  Language and technology are two big barriers that we already encountered and are in the process of surmounting.  Although Don speaks English (he's American), Syna learned English by himself on the fly and much of the hospital staff members don't speak English at all.  Even though we were able to narrow down the scope of our project to focus on microbiology lab tests and developing a marginal test cost template for Don and Syna to project costs, we were still faced with issues in data collection.  Christian went to work with the Director of IT while I went off to find Tea Eang, the Director of Procurement to source data.  Luckily for me, Eang grew up in San Diego, so we were able to communicate without a problem.  I can't imagine what it would have been like if I had to describe procurement reports in pictographs...


Working with the Lab Team


Christian and I got down to working with the lab team as soon as we gathered all the information.  We found there were a couple of areas where we could quickly contribute, most of them centered around Microsoft Excel and reporting functions.  It was great to be able to demonstrate value early on in the process and build a working relationship with the Lab team.


Working with the Lab Team Some More


Some of my key takeaways from the first day:

  1. As in any consulting project, it's critical to have an executive sponsor to act as the project champion and then a project manager to help implement the consulting project.  In this case we were lucky to have the support of Don the CFO and Syna the lab director.
  2. Again similar to consulting projects, scoping is key.  There's so much to do here and the more we talked with Don and Syna the more things that needed fixing were brought up.  It would be amazing if there was a hospital administration volunteer that could just help streamline operations for SHCH.
  3. Data gathering, deciding what you need and getting it, is tough. Deciding what types of data we needed wasn't bad in this case given that we've done similar projects in the past, but concerns over the iffy IT structure and data integrity led to us not being sure whether we could complete what we promised to complete.
  4. Sometimes, analysis means it needs to be done over Christmas.  Despite the fact that it's Christmas Eve (ALREADY?), Christian and I are still working late into the night on getting a costing model done so we have a template by Monday to populate and test.  Then again, whoever said this was going to be a walk in the park?
  5. Clear and constant communication with stakeholders is critical.  Although we're only here for a short while, we're looking at meeting with Don every day to provide updates on our progress as well as e-mailing Syna our updates daily (he's travelling out of town for training).  We'll also be immersed in the lab so that we can better understand their professional culture and integrate with the team.
  6. The Lab Team wants to learn!  I have been super-impressed by how dedicated everyone here is to the work that they're doing.  Many of the hospital team, especially in administration, are self-taught and internally promoted.  Not many people want to come to work with a nonprofit free hospital that serves the poor, so SHCH has had to promote from within for a long time now.  This has resulted in team members lacking the necessary knowledge to carry out their positions.  It's not for a lack of desire to learn, but rather a lack of opportunity.



The first day has been exciting and filled with revelations for me.  Christian and I are hard at work over the next week developing a marginal test cost template so that Don and Syna can have a better sense of how much the lab is costing the hospital to run, and how it might reach break-even point or possibly even turn a profit.  Make no mistake, this is definitely an aggressive consulting project given our timetable.  I can only hope that we can make a difference and provide sustainable long-term impact with the lab team.




The Beginnings of Our Project Plan

Yes, we are working in a hallway.  Necessity is the mother of invention, and there is much necessity here.  You can stay updated with my photos by checking out the public album link.

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