Farla Medical, one of the UK's largest supliers of medical technologies, commodities and consumables shared best practices from the UK. Including in infection prevention and control, tooling HRH and improving heath service delivery efficiencies.

1. Health Service or Illness Service ?
Daring To Make A Difference
Working Together Can Achieve
Measurable and Sustainable Change
Mike Smith
August 2019
3rd Health Sector Development Partner Forum

2. Who am I – Why am I here?

3. W.I.F.M ? What Will You Do Differently ?

4. Going
M.A.D
Making a
Difference

5. Meeting Aim : Disruptive Thinking
• Challenge the Status Quo
• Being a team player is commendable and exercising
diplomacy— admirable, but simply going along to get along is an ineffective strategy
“What if bucking the system meant resolve, not just for me,
but for others whose voices may be muted?”
• Get Uncomfortable
• If you’re feeling content with the ways things are, chances are
you won’t be motivated to change them
• Forget What Other People Think
• Striving to secure praise and avoid blame is a recipe for disaster.
• Welcome Failure – Celebrate Successes
• Imagine going through life and never making any mistakes.
What would be the point, really?
• Enjoy the journey
• Be bold – With Wild Abandon
• What’s the worst thing that can happen when you stick out your neck?
• Manage Risk
• Personal, Business / Institutional

6. • Disposable Bed Pans and Bottles
• Disposable instruments v
Reusable Instruments
• Profiling Beds and Mattresses
• Procedure Packs
• Taking a pulse v Pulse Oximetry
• Moist Wound Healing
• ISC v Urethral Catheterisation
• Stoma Care - Pauls Tubing
• Hand Gels
• Negative Pressure Therapy
Personal Challenges

7. The World Health Organisation Defines Health….
"not merely the absence of disease or infirmity, but a state
of complete physical, mental, and social well-being“
• Wellness has been defined more as the action an individual
takes to meet the above definition of health
U.H.C
Universal Health Coverage

8. What Does Great Look Like ?
Endeavours to achieve the best clinical
outcomes within controlled cost. Ideally,
it is based on evidence-based practice,
involves a multidisciplinary care team and is
designed to meet local needs and constraints.
“HSDPF was created to foster partnerships that
augment the creation of a coordinated, cohesive and
coherent health system that supports a
one-health approach at community and
primary level and increases financing and
partnerships for delivery at these levels. These
partnerships have the capability for sustainably and
domestically financing: interventions towards the
dual communicable and non-communicable disease
burden, improving public health outcomes, health
systems strengthening and disaster risk reduction”

9. Some Facts To Share
According to recent
data, the health care
utilisation rate in Kenya
is approximately 77%
for those who are sick,
meaning that a large
percentage of the
population does
not seek care despite
being ill.
The three most significant
barriers to entry in the Kenyan
health system are :
The cost of care
The availability of suitable care
within a reasonable distance
Confidence in Facility Health
Service Delivery
** lack of confidence – consistency

10. How Can we improve Health Care?
Or……
What is Stopping us ?

11. If you always do what you’ve always done, you’ll
always get what you’ve always got!

12. How Much Do You See of an “Iceberg”?

13. Focus On What You “Can’t See”
**SG & A Selling of Goods and Administration

14. Consistency
Supply
Standards
Efficiency
Time Management
Use of Available Resources
Quality
Reliability
Ease of Use
The Real Cost

15. A Model for Improvement
Project
Identification
Getting a
baseline
Did project
make a
difference
Will project
sustain
Evaluating
worth of the
project

16. In Every Day Life….

17. Marginal Gains
An epidemiologist with the Ondo State Government, Dr Stephen Fagbemi,
has reiterated the need for Nigerians to cultivate the habit of washing their hands
regularly, saying it was capable of saving the country from a lot of diseases
Infection Prevention / Control
Do you really know how to clean your hands?
Without leaving the bits between your fingers?
If you do things like that properly,
you will get ill a little bit less.
They're tiny things but if you clump
them together it makes a big difference.
Fagbemi, in an interview with our correspondent, said diseases,
such as malaria, diarrhoea, hepatitis A, cholera, typhoid, and measles
could be avoided by regular handwashing

18. • Habit
• Make washing hands an action automatically taken upon entering or leaving a patient
care area, as well as before and after patient care.
• Active feedback
• Leadership plays an important role in continually communicating with staff member,
patients and relatives about their hand hygiene compliance. Leaders can provide
feedback by reminding staff to wash hands, engaging staff with real-time performance
data, providing proper training and acknowledging and celebrating improved hand
hygiene.
• “No one excused”
• Every staff member needs to be held accountable and responsible for proper hand
hygiene. Identifying hand hygiene as an organizational priority communicates that
everyone is expected to follow suit.
• Data driven
• Monitoring adherence to hand hygiene policy and analysing that data can help identify
areas for improvement and spur the creation of ideas on targeted solution
implementation.
• Systems
• Hand hygiene compliance is a system-wide effort, and protocols should be ingrained
throughout the organisation. The infrastructure of systems should be designed in such a
way that it is easier to adhere to proper hand hygiene, with infrastructural features such
as easy access to hand hygiene equipment, technologies to help
staff remember to wash hands and patient care areas set up in a way that is
conducive to hand washing
Strategies to Improve Outcomes

19. What Does Great Look Like?
The Granny Test

20. Change

21. Moving From Illness to Health and
Fitness

22. What Does Great Look Like ?

23. Potential Cost Savings : Single Use vs Reusable
Thoughts
Availability of Water / Cost
Rivers contaminated ?
Track and Trace
Large amounts of water,
Detergent,
Steam,
Electricity
Ecological Effects
Thoughts
Waste Disposal?
Costed Patient Journeys
Variance v Planned
Patient Outcomes

25. Advantages of Procedure Packs

26. Linked to Wound Healing Continuum
TurningtheModelonItsHead
DaringToBeDifferent

28. Farla-Led Success Criteria
Health Change
Outcome Led
Employ a single project team
Benefits
Realisation
Change is about delivering benefits
The project team is responsible for delivering clearly specified benefits
not for creating systems, structures nor introducing technologies.
There should be no other success criteria!
Business change projects should always be driven by benefits that support strategy
A Sense of
Urgency
Organisational change with patient pathways / service redesign delivered with urgency
Describe the clinical need - why the change project is necessary
Specify the time-scale within which the project must deliver the benefits
Successful organisations set a challenging schedule and stick to it –
even when expert opinion suggests this is unachievable
Time-Boxing Time-boxing is used to push the project team to make decisions about what is really needed
Detailed analysis has the effect of putting the brakes on change.
Quick Wins -
Motivation
Large scale organisational change = momentum + a sense of achievement + bags of optimism
Time-boxing encourages quick wins, ensuring results are achieved at speed

30. Questions:
Contact Details:
mike@farlainternational.com

31. Who Are Farla Medical ?

33. Thank you
Health Service or Illness Service
Daring To Make A Difference
Working Together Can Achieve
Measurable and Sustainable Change
Clinically Led Outcome Driven Care

34. Common Clinical Issues In All Aspects of Care :
• Demand will outstrip supply
• High turnover of all levels of staff
• Not enough qualified staff
• Different levels of ability
• Some with no registered nurses
• Reduced funding
• Difficulty in access to education and training
• Too many products
• Too much inappropriate use of products
• Too much waste
Global Challenges
Global Solutions
“Daring to be Different”

35. The World Not Ready For An Aging Population
Comorbidities by Age Range
Global Healthcare Spending Growth

36. The Future Is Here Now

37. Why “Dare To Be Different”?
• Wound care global market value over $23B by 2022
• UK Market value £500M
• Over 170 wound care companies (60 UK)
• Too many products to choose from : commoditisation
• Lack of specialist support
• Care delivered by non specialists
• Need for better outcomes
• Improved cost
• Over complicated decision making
Develop “New Care
Models”

38. How Will Farla(Care) Dare To Be Different?
• Clinically Led - Consultative Approach : New and Innovative
• Define the real needs of the customers
• Understand the real needs of the customer, patients and family
• Engage with stakeholders and key decision makers
• Link to NHS Plans / National Wound Care Strategy / CET / HEE / AHSNs
• Simplify Messaging / Terminology : WYSIWYG
• Freeing “Time To Care”
• Involve the patient – Self Care Models
• Audits and Training Needs Analysis
• Implement new ways of working “Evidence Based”
• Locally – Regionally – Nationally – Globally
• Journal Submissions / Awards
• Best Practice Statements
• GS1 Care Pathways
• Scanning4Safety
• NICE approvals
GIRFT(E)
Getting It Right First Time
EVERYTIME

39. How Will We Achieve This?
Identify best practise
Reduce variance
Develop new models / pathways of care
Reduce waste
Share best practice and
implement nationally
(and internationally)
Integrate and improve care and
communication across all settings
Reduce hospital re-admission & HAI
NHS Plan : FOM / STPs (Future Operating
Model / Sustainability and Transformation
• These break down the barriers in
providing care
• between family doctors and hospitals
• between health and social care service
• With the intention to result in better
care for patients
• particularly those with long-term or
complex needs
• The strategy also aims to improve the
efficiency and productivity of hospital
services
• through closer collaboration
between hospitals
Develop “New Care Models”

40. Packaging and Modelling : Innovative Collaboration
Bags not boxes
Easy to store, view product
Hydrogel
Gelling Fibre
Foam
Antimicrobial (e.g. Silver)
Super Absorbent
Dressing type
Hydrocolloid
Film Dressing

42. Delivering Better Outcomes
Daring To Be Different
Clinically Led Outcome Driven Care
Preserve LifePreserve
Prevent the Condition becoming worsePrevent
Promote recoveryPromote

43. Extra Slides

45. Cost of
Wound Care

46. Cost of Care
Economic Estimation of Country Specific Hospital Costs
Taghreed Adam, David B Evans and Christopher JL Murray
HOSPITAL COSTS
Cost per bed day by hospital level*
Int $ 2005 LCU 2005
Primary 19.64 373.60
Secondary 25.62 487.40
Tertiary 34.99 665.73
Cost per outpatient visit by hospital level*
Int $ 2005 LCU 2005
Primary 5.55 105.65
Secondary 7.88 149.86
Tertiary 11.65 221.68
HEALTH CENTRE COSTS
Cost per visit at health centre by population coverage for a 20 minute visit **
Int $ 2005 LCU 2005
50% 7.29 138.72
80% 8.59 163.45
95% 13.04 248.02

47. Single Use V
Reusable Time Saving
- Readily available – set up
time – turnaround time –
standardisation – reliability
- Staff Training -
Life Saving
- Dangers posed by ‘prion
diseases’ such as Variant
Creutzfeldt-Jakob disease
(vCJD)
other spongiform
encephalopathies. SSI’s
Cost Saving
- Cleaning – Sterilization –
Staff Time – Maintenance –
Storage - Loss – New
Technology – New
procedures – Facilities

48. Savings:
“poorly organised clinical equipment can waste significant amounts of time
otherwise available for direct patient care.” At a time when the NHS and
other healthcare providers are under increased scrutiny and are operating
on ever tighter budgets, it is evident that new efficiencies and processes are
needed.
BMJ Quality Improvement Reports 2015; 18th May 2015
This problem is not a new one nor is it insubstantial. According to a 2009
survey by Nursing Times, “more than one-third of nurses spend at least an
hour finding items of equipment during an average hospital shift.” This could
mean that nurses spend up to 40 hours per month looking for equipment
with which to treat patients.
Nursing Times Feb 10th 2009

49. Some Solutions To The Challenges We Face

50. Infection Control In Africa. Nosocomial Infection.
• The effectiveness of prevention and control efforts is dependent on health care services and the
prevalence of disease.
• Funding for health care, the perceived economic impact of infection control, and trained
administrators determine the availability of health services and the spread of disease.
• The challenge is to provide cleanliness, aseptic techniques in patient care, and protection for the
health worker. If the hospital infection rate is as high as 15% of admissions and each case requires
an additional 7 days of hospitalization, the estimated costs nationally could exceed US $110 million.
• Africa has a massive infectious disease burden, in addition to HIV and tuberculosis.
• The spread of Ebola fever shows how out-of-control infections can become.
• Most African countries are unequipped with infrastructure to handle surveillance of the new resistant
bacterial strains resulting from indiscriminate use of antibiotics.
• In Zimbabwe, infection and prevention control was proved possible and cost effective.
• Education was provided at the village level in basic hygiene, home nursing, construction of fly-proof
pit toilets, and a safe water supply.
• Training of trainers expanded the process of education.
• The "Infection Control Manual" provides the manager with the principles and background knowledge
for prevention and control of infections. The Infection Control Association of Southern Africa is a
useful source of information, standards, and support base.

51. Preserve LifePreserve
Prevent the Condition
becoming worse
Prevent
Promote recoveryPromote

52. KISS
Principle

53. Communicate
…
Communicate
…
Communicate

54. The Future is here
NOW…..

55. What Does Great Look Like ?
Endeavours to achieve the best clinical
outcomes within controlled cost. Ideally,
it is based on evidence-based practice,
involves a multidisciplinary care team and is
designed to meet local needs and constraints.
‘HSDPF was created to foster partnerships
that augment the creation of a coordinated,
cohesive and coherent health system that
supports a one-health approach
at community and primary level and increases
financing and partnerships for delivery at these
levels. These partnerships have the capability
for sustainably and domestically financing:
interventions towards the dual communicable
and non-communicable disease burden,
improving public health outcomes, health
systems strengthening and disaster
risk reduction’.

56. The Communication Model : It’s Good To Talk
Early Stakeholder Engagement
Regular Reviews
Agreed Goals
Measurement
Celebrate Wins

58. The Chimp Paradox
Professor Steve Peters is a Consultant Psychiatrist who
specialises in the functioning of the human mind. His
work, past and present, in the field of psychiatry and
education includes: the National Health Service (NHS) for
over 20 years; Clinical Director of Mental Health Services;
Clinical Director at Bassetlaw Hospital; Forensic
Psychiatrist at Rampton; Senior Clinical Lecturer of
Medicine at Sheffield University for over 20 years;
Undergraduate Dean at Sheffield University for over 10
years; and visiting Professor at Derby University. He
holds degrees, higher degrees and postgraduate
qualifications in medicine, mathematics, education,
medical education, sports medicine and psychiatry.

59. The Cost of Health Care : How Does it Compare?

60. Kenya Health Check
A country of approximately 37 million people,
Kenya has struggled to build a health system
that can effectively deliver quality health
services to its population.
Access to health care varies widely
throughout the country and is determined on
numerous factors, though in particular:
Major divides between rural
and urban communities,
Between the moneyed elite and
the poorer masses
In Kenya, the poorer masses—those living below the national poverty line
constitute approximately 52% of the population.
According to the World Health Organization (WHO) 2007

61. Kenya Health Check
Life Expectancy Kenya
(both sexes) 54 years
Global Average 68 years
Child Mortality Rate
approximately 121 per
1000 live births
Double global average
Prevalence of
communicable diseases
major factor in
health outcomes
HIV prevalence
Urban Adults 10%
Rural Adults 5.6%
Co infection rates for
TB and HIV 45%
According to the World Health Organization (WHO) 2007
Malaria 13.6 of deaths in
children under 5

62. Why Single Use Instruments
Decontamination Single use instruments guarantee a completely clean and sterile
instrument for every patient, which is used once and disposed of,
removing the need for lengthy decontamination processes.
Furthermore, compliance with the new HTM 2030 guidelines for
National Decontamination will mean that small practices and surgeries
now have to comply with the same standards as set for Sterile Service
facilities in NHS Acute Trusts.
• .
Traceability Single use instruments are all individually traceable.
The lot number that appears on the packaging is all the information
that is required to trace the instrument back to its production batch
and date.
Logistics and
Supplies
Minor procedures are increasing in local clinics and GP surgeries.
Single use instruments purchased directly from a medical device
supplier allow a clinic to manage their supplies in line with their demand

63. Why Single Use Instruments
Risk
Management
Managing the risk of infection is high on the agenda of all healthcare professionals.
The dangers posed by vCJD, and other prion diseases, is a major
consideration when talking about a move to single use instruments. The prion
that infects a person with vCJD, found in neurological tissue, is thought to
survive for up to 10 decontamination cycles, meaning that infected
instruments could be being used in procedures. Recent findings suggesting that
many more people could be carrying vCJD than was previously thought compounds
concerns that the disease is being passed on through contaminated instruments.
Cost
Allocation
In an increasingly cost aware health service it is important that the cost of each
procedure can be accounted for accurately. When using single use instruments and
procedure packs the cost is simple and easy to calculate. However attributing cost
when using reusable instruments is not always accurate as the real cost of
sterilisation is difficult to record as the costs can be hidden in utility bills and
staffing costs.
Waste With all single use instruments the environmental impact of disposal is often
questioned, as currently to comply with EU Directives on the disposal of medical
waste they go for incineration and landfill. However this has to be weighed up
against the real effect of reusing items. A reusable instrument has to undergo the
thorough decontamination regime which includes large amounts of water, detergent,
steam, electricity etc. to prepare it for re-use. The impact on the environment of the
use of these utilities and detergents during sterilisation has to be factored in equally
when comparing the ecological effects of single use to reusable instruments.
.