St Josephs Catholic Hospital Monrovia Liberia Strategic Plan

St Joseph’s Catholic Hospital Monrovia, Liberia Strategic Plan 2016 -2021 PRESENTATION FOR PARTNERS AND COMMUNITIES

Summary of the Presentation 1. Background and Context 2. Hospital Overview (including SWOT Analysis and Partner Analysis) 3. Strategic Direction (including philosophy, mission, vision, core values and overview of the 13 SMART Goals) 4. Making the Plan a Reality (including governance arrangements, Goal leads and key messages)

1. Background and Context • • St Joseph's Catholic Hospital (SJCH) has been providing essential health care in Monrovia, Liberia for over 53 years, as part of the global St John of God network of mission hospitals The need for a Hospital Strategic Plan has been recognised for almost a year, however the focus has been on gradually recovering from the Ebola crisis. During 2015/16, by working as a team, the Hospital re-opened becoming fully operational again. • Now that the Hospital is functioning well and there is a strong management team in place, the focus has turned to the future. In March 2016, A comprehensive Five Year Strategic Plan was developed with detailed targets and milestones in 13 SMART Goal areas. • The Hospital aspires to be the leading centre of excellence in health care provision in Liberia with nationally known maternity, diagnostic and general secondary health care facilities and services. • The Plan sets out how the management and staff intend to achieve this vision over the next five years

1. Background and Context • The full public health context of Liberia has been considered when developing this plan: – Highlighting the need to provide affordable, accessible and quality maternal and child health care as well as general secondary health care services while ensuring that diagnosis is accurate and timely so that preventable conditions can be quickly treated. – Also hospitals as well as primary health care facilities must undertake a public health education role as part of its services, reaching out to encourage service uptake and educate on basic health promotion and disease prevention. • There is a comprehensive plan document for Hospital use with all the detailed milestones, against the 13 SMART Goals, plus a shorter external plan version available for partners and the public. There is also a one page summary and an Annual Plan for 2016/2017 • Support is needed - This Plan will take the hospital from a good to great medical institution. In order to achieve this vision, current and future partners, government departments, training and regulatory bodies, together with local communities and civil society organizations are requested to support this Strategic Plan and work collaboratively with the Hospital leadership team and staff now and in the future

2. Hospital Overview • St Joseph's Catholic Hospital currently has a 120 bed capacity and 170 staff, with a $1. 2 million USD turnover and treated approximately 20, 000 patients per year in 2015. (next slide details the structural capacity) • Services are provided by a range of specialist and generalist doctors and nurses, both Liberian and international • Services include emergency and trauma care, internal medicine, paediatrics, general surgery, obstetrics and gynaecology and a range of traditional primary health care (including PMTCT, HIV care, antenatal and vaccinations) • Senior Management Team: – – – – Hospital Director: Br. Peter L. Dawoh Superior/Bioethics/ Pastoral Team Coordinator: Br. Bernard I. Benda Medical Director: Dr. Senga Omeonga Nursing Director: Mrs. Christine K Tarr-Attia Financial Director: Mr. Ibrahim Fatawu Human Resource Manager: Mr. Joel Williams

2. Hospital Overview

2. Hospital Overview: SWOT Analysis Key Strengths/Opportunities: – – – a capable and skilled management team and staff good administration systems and processes a great reputation and strong services to build upon clear ethos and values good quality infrastructure with the ability to expand on the current site Key Constraints: – – – – need to increase income, diversify donors and financial strengthen systems difficulty in recruiting local skilled staff and pay competitively; improvements needed to HR policies and procedures ongoing struggle to maintain the estate and equipment regional instability and impact of currency fluctuations lack of available drugs and supplies in the local market lack of literacy and knowledge in the community about basic health conditions and how to treat them.

Recruitment of qualified doctors and nurse graduates, e. g. general surgeon Providing new services &new equipment Great collaboration with INGOs partners, stakeholder and donors (some are new partners) Increased participation of staff in planning and decision making Re-branding the laboratory and installing new modern digital equipment Achievements A good range of in service training in place for clinical staff (in last 5 years) Ensuring high quality performance and good discipline through supervision of all categories of nursing staff Management of the hospital by Indigenous people and Brothers There is increased visibility of the hospital amongst the Liberian population Re-opening of the hospital after the Ebola outbreak, withstanding major events Stronger procurement, financial, logistics and information management systems, with good adherence and internal financial controls Renovation and extension of the maternity unit Good IPC in place with appropriate training updates Improving patient care, improving quality 53 years of experience and assistance Management initiative for the strategic plan is great and much needed Putting the oxygen plant back to work Staff are demonstrating more commitment than ever before

Lack of Poor marketing/ incentives for communications/ staff and basic publicity of the salaries need services offered to to increase as the community they are not competitive Challenges Now Donor Fatigue Underfunding of activities The ongoing impact of the Ebola Outbreak and the devastation and deaths experienced by the hospital and staff Lack of HR policies and procedures, including HR handbook and occupational health approach High running costs, especially fuel Lack of specialist staff locally and need to recruit international staff (March 2016) Enabling the hospital to undertake charity work and also remain financially viable Expansion and redesign of the hospital within infrastructure and space available Limited accountability and decision making structures – need to be developed Too many stakeholders with competing priorities, can skew hospital management There is a need for more clinical policies and protocols to be implemented at dept level, in order to improve and measure quality (quality assurance approach is very limited) Need to have a more sustainable financial position Need to improve financial controls Patients not paying their bills Training of specialised staff and maintaining their skill levels (eg neonatal care) Staff retention difficult in general (Nos. have decreased) and current staff shortages Its challenging to keep nursing and medical skills up to date

2. Hospital Overview: Partners Productive and mutual relationships and partnerships have been forged with the Hospital’s many partners, with a clear engagement strategy going forward. Partners have been grouped and stratified into the following five categories:

3. Strategic Direction: Philosophy, Mission, Vision, Values The Hospital's Philosophy: People are the creation of God, with intrinsic value and inherent dignity, so our work must be person centred and human rights based. We respect the freedom of conscience of every person and will therefore act without discrimination of any kind. The rights of the sick person must be upheld and defended and everyone has a right to be fully informed and involved in their own care. Finally we seek partnerships with others who uphold this philosophy in promoting the best quality of life for those we serve. Mission: To provide holistic, affordable, quality health services to all people in Liberia, regardless of ethnicity, religion, gender, age or nationality. Vision: To be the leading centre of excellence in health care provision, delivered by a skilled, motivated and committed workforce, which applies the best evidence based practices, in order to improve the health and well-being of the people in Liberia. Values: Excellence and Quality; Honesty and Integrity; Confidentiality ; Teamwork; Dignity and Respect; Hospitality and Customer Service; Justice; Compassion; Staff Commitment, Development and Responsibility.

3. Strategic Direction: Core Values Excellence and Quality – We strive to provide the best quality of health care through implementing evidence based practice and the use of quality improvement methods within available resources. Honesty and Integrity – We are honest in our dealing with each other, with patients and with hospital supporters and donors. Honesty and Integrity are strong moral principles emerging from Catholic values. Confidentiality – We ensure that all patients and staff records and relevant information are kept strictly confidential and only shared in the best interests of patients and staff. Teamwork – We encourage effective teamwork to ensure satisfactory, high quality patient care and to increase productivity, by embracing the skills and ideas of all staff members. Dignity and Respect – We demonstrate a high level of respect for our clients, regardless of status and strive to uphold their dignity, human rights and respect their beliefs. Hospitality and Customer Service – Patient’s wellbeing and satisfaction is our focus! Our staff are friendly and welcoming and they listen attentively to client needs and strive to offer solutions and to make people feel at home. Justice - We ensure equal treatment for all who need our service, regardless of status (religion, economic, gender, social, age nationality). Compassion - We identify ourselves with the suffering of others and are always willing, prepared and ready to address their needs and concerns. Staff Commitment, Development and Responsibility – We have a responsible staff that are accountable to the needs of the clients and the institution. We enable and support staff to acquire new skills by offering a range of appropriate training opportunities. We recognise hard work through staff performance and incentives.

3. Strategic Direction: 13 SMART GOALS

SMART GOAL No. 1 • • • By 2021, SJCH will be providing a range of high quality secondary health care services in the following areas: Expanded paediatrics (paediatrician and paediatric nurses) Expanded emergency medicine (supported by a new orthopaedic surgeon) Extended internal/general medicine (with possible extra Internist, with a specialty in medical cardiology) Increased capacity for general surgery, orthopaedics and ENT (new orthopaedic surgeon as above and an ENT surgeon) and Primary Health Care New physiotherapist to support patients, post orthopaedic surgery and for general rehabilitation Dietician to support inpatient nutrition Psychosocial care Trained Resuscitation team in place by 2021 (and resuscitation equipment available) Reviewed and amended referral policies

SMART GOAL No. 2 • By 2021, the maternity department of SJCH will have increased in size to manage the increased demand for maternity care by a skilled birth attendant. • There will be additional staff (Obs & gynae Doctors, Midwives, neonatal nurses) a doubling of the beds (from 14 to 30/40), 1020 cribs and 5 -10 incubators. This will require an increase in drugs, medical supplies, diagnostic and monitoring equipment. • A new ambulance service will reach out to patients in need. • There will be improved protocols and clinical guidelines, including IPC in place to assure quality and patient safety (SJCH will be adhering to the WHO Maternal and Child Health guidelines ). • As a result the maternal and neonatal mortality rates in the Hospital will be minimised.

SMART GOAL No. 3 • By 2021, SJCH will have a state of the art diagnostic centre capable of providing timely and reliable results for all clients, in the areas of laboratory, radiology, EKG, ultrasound, endoscopy and others. • Achieving this vision require highly qualified and skilled personnel (including a Radiologist), market analysis and prioritisation of needs, establishment of protocols and periodic evaluation of hospital activities

SMART GOAL No. 4 • By 2021, the leadership team will be fully equipped to manage and continue to develop the leading secondary care facility in Liberia. • There will be strong governance and decision making processes in place that allow effective delegation to service delivery. • Staff are empowered to speak their minds and the leadership team is seen as listening and responding to the needs of patients and staff.

SMART GOAL No. 5 • By 2021, SJCH will be adequately staffed with skilled, professional and well motivated personnel, which will ensure reduction in staff turnover and increased productivity. We will achieve all of this through: • The development of the HR handbook and standard policies • Annual appraisal program for staff • Standard operating procedures for all departments • An agreed year on year percentage increment in staff salaries • Performance related bonuses and scholarship/housing/car loan programs • Periodic in-service training programs, medical and improved terminal benefits • Staff occupational health policy will be in place

SMART GOAL No. 6 • By 2021, SJCH will be a financially viable institution with income diversification, increased income from direct fees, reduced reliance on donor support and doubling the annual revenue plus increased unrestricted income • Underpinned by excellent, effective, transparent financial and procurement systems.

SMART GOAL No. 7 • By 2021, a newly established fully functioning IT department will manage an integrated and centralized electronic data system thereby reducing patient waiting time, improving service delivery and promoting client satisfaction. • The Hospital will generate accurate, timely and reliable data to support clinical management decision making, the HMIS system and reporting and hospital policies. • Staff will be trained on data collection, analysis, interpretation. • Staff will use data and understand the value of accurate clinical data as well as resource utilisation (drugs, supplies etc) and service uptake statistics. • The new system will overcome the current challenges of paper based systems and enhance patient safety, improve resource use and patient billing, enable value for money to be measured, provide essential reporting and monitoring information and tools (including morbidity and public health data) and hence improving the management and productivity of hospital services.

SMART GOAL No. 8 • By 2021, the current estate will have been expanded to accommodate new services (both inpatient and outpatient) and a new admin block and triage facilities. • In addition, the existing clinical areas will be re-modelled based on best clinical practice and patient safety requirements. • The Hospital will be working on solar power with reduced reliance on expensive generators.

SMART GOAL No. 9 • By 2021, SJCH will deliver the safest, highest quality care to all clients by skilled committed staff. • This will be achieved by creating a Quality and Patient Safety department, with a clinical lead, together with the development and implementation of new standards and operating procedures (SOPs). • The department will oversee of the implementation, compliance and review of the agreed SOPs. • This will ensure both staff and patient safety, minimise critical incidents and uphold the good reputation of the Hospital.

SMART GOAL No. 10 • By 2021, SJCH will use internal clinical audit and research tools to routinely to inform and improve patient care. • The Hospital will also regularly review research from across the region in order to apply any relevant research findings to health care provision in the Hospital

SMART GOAL No. 11 • • • By 2021 SJCH will routinely engage with community groups and leaders and use patient feedback to improve health care delivery. This would include: Patient and client feedback mechanisms in place, through support groups (like the HIV support group) and though exit interviews and suggestions boxes Regular meetings will take place with community stakeholders in order to – Raise awareness of the Hospital services, changes, quality standards and so on, as part of the communications and marketing approach – Listen to community views about the Hospital, take this feedback and make changes within the Hospital where necessary and appropriate – Inform communities how their feedback is being acted upon by the Hospital and share achievements and challenges with the community as they often have great ideas on how to solve problems – Gain wider views on possible improvements, development and changes as the Hospital grows – Use these engagement opportunities for public health messaging and awareness raising on signs and symptoms of key illnesses • Hence, communities are encouraged to get involved and support the Hospital, enhancing community ownership and improving community health

SMART GOAL No. 12 • By 2021, SJCH will establish a strong and mutual relationship with various partners, stakeholders, training institutions and so on, in the management and development of services. • To achieve this goal, transparency, communication and participation of identified partners will be encouraged.

SMART GOAL No. 13 • By 2021, SJCH will have a national profile, with a key identity as the leading secondary care hospital in Liberia • The Hospital will be known for quality services, high patient satisfaction and good client and customer care , accessible and affordable care, highly skilled staff and working to core Christian values. • All staff will know the key messages and be able to explain them to partners, communities and patients

4. Making the Plan a Reality: Governance The Strategic Plan has internal ownership and oversight with quarterly reporting: • Each of the 13 SMART goals has a named owner (see below) • The Senior management team will oversee performance and progress of the Plan, led by the Hospital Director and this will be integrated into the monthly leadership team meetings. • The 2016/17 Annual Plan has been produced as a separate document and has quarterly targets for year one of the Five Year Strategic Plan. • The SMART Goal Owners will produce written performance reports on a quarterly basis using a specified template for the management team.

4. Making the Plan a Reality: Key Communication Messages Quality Services: We provide diverse and high quality services such as Maternal and Child health care, laboratory services, surgery and internal medicine. Affordable Services: Our responsive and transparent cost recovery practices allows us to focus on our patient care. Our services are not expensive and also free to the poor and needy. Highly Skilled staff: We have some of the most renowned and skilled midwives and doctors who provide the best health care in the country. Customer Service: We have friendly, caring, informed staff who are prompt and efficient. Laboratory/Diagnostic: We have a nationally recognised service, providing accurate and timely results with state of the art equipment. Dedicated Maternal and Child Health Services: With the top Doctor in the country leading our excellent team, we provide high quality and safe services to all mothers and babies with a one-stop-shop approach Patient Satisfaction: We are always open to receiving patient feedback and suggestions on how to continue to improve our quality of care. Centralised Services: Our Hospital serves as a onestop-shop for all necessary care and all care is accessible within the building. Charity Care fund: We increase access to health services to the most vulnerable populations through the provision of charitable services. Accessibility: We are open to all, regardless of income or status and in an easily accessible location. Reduced waiting times: You won't have to wait as long as other hospitals to see a doctor or nurse at our hospital. Core values: Our services are based on our values of honesty, hospitality, teamwork, quality and customer care.

We are always ready to serve, despite challenging conditions We are great because. . Patients believe in us We have a great location in the heart of Monrovia, accessible to all We work as a family with everyone participating We have an experienced management team We do not discriminate against patients or staff regardless of their status (religion, social background etc) Of our strong values: hospitality, respect of human dignity and dedication to serving people holistically We have a well equipped laboratory and x-ray depts providing a quality diagnostic services We are honest with partners, staff and patients Of our skilled qualified staff and the way in which we provide caring services We provide quality health care We work as a team We are united, willing and because we care! Our prices are competitive We have both general and specialist staff We are respected and have a long standing reputation for service delivery

Any Questions or Comments? For more information and copies of the documents, please contact Br Peter Lansana Dawoh: brpeterlansanadawoh@gmail. com