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Annual Report 2014

Tygerberg Hospital

HealthTygerberg_complete report_FINAL.indd 12015/11/04 9:35 AM

Annual Report 2014

Tygerberg Hospital

Tygerberg_complete report_FINAL.indd 22015/11/04 9:35 AM

Vision

access to person-centred quality care

Mission

We undertake to provide equitable access to quality health services in p artnership with the relevant stakeholders within a balanced and well-managed health syst em to the people of the Western Cape and beyond.

Values

The core values of the Department are:

innovation

Caring

Competence

accountability integrity responsiveness respect

VISION,

M

ISSION &

V ALUES Tygerberg_complete report_FINAL.indd 32015/11/04 9:35 AM

CONTENTS

Message from: Dr Beth engelbrecht

Message from: Dr Keith Cloete

Message from: Dr Dimitri erasmus

Finance

..............................6 administration .............35 nursing ...........................86 CLINI C

AL DEPAR

TM EN T S

Biomedical sciences

.98

Clinical psychology

..125

Community Health

.....131

Medical imaging and Clinical oncology

...................................136

Medicine

.......................153 obstetrics and Gynaecology paediatrics and Child Health psychiatry ....................316 surgical sciences ....334 unit for infection prevention and Control (uipC) ...............348 A

UXILIARY

S ER V I C ES

Human nutrition

.......352 occupational Therapy physiotherapy ...........375

Voluntary aid service

statistics ......................380 Tygerberg_complete report_FINAL.indd 42015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20141

F ore W or D

Head of Western Cape Health

Dr Beth

e ngelbrecht We recently concluded the Annual report for 2014/15, analysing our performance against set targets and re The Annual report also provides an overarching picture landscape impacting on it.

In 2014/15, the Department remained committed to

delivering quality health care that is provided by a professional workforce, and health services that are safe, comprehensive, integrated, continuous and respectful of the people we serve. The Province is faced with a quadruple burden of disease, which continues to place enormous strain on the health system. The burden of communicable and non-communicable disease is of particular concern, as i ncreasingly people present with multiple, interacting and compounding health problems. This situation is unlikely to change in the short to medium term, given the trends in the social de terminants of health and wellbeing. These trends directly impacts on the services and pressures within Tygerberg

Hospital.

In the Western Cape, life expectancy at birth is 66 years, 68 years for women and 64 years compared to 27 nationally. The maternity mortality ratio is 78 as compar ed to 269 for South

Africa. The provincial health system, in 2014/15:

Had 14 250 244 Primary Health Care (PHC) contacts

Had 180 769 patients on ART

Had a 80,6% TB cure rate

Delivered 96 750 babies

Had a mother to child HIV transmission rate of 1,4%

Immunised 95 393 children under 1

Transported 515 237 patients, of which 41% were priority 1

Admitted 540 430 patients to acute hospitals

Performed 7 929 cataract surgery operations

In the interest of enhancing public participation and the person-centred ness of the health system, the Department undertook to revise the Western Cape Health Facility Boar ds Act 7 of 2001, and a new bill, the Western Cape Health Facility Boards and Committee Bill,

2015, is being prepared

Independent Health Complaints Committee Act 2 of 2014, was promulgated o n 21 November

2014/15, we received 13 580 compliments and 5 528 complaints of which 88,1% was resolved

within the target of 25 days.

Dr Beth

e ngelbrecht Tygerberg_complete report_FINAL.indd 12015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20142

p eople at the centre Staff members are the backbone of the healthcare system in the Western C ape. It is crucial that environment. While the Health Department in the Western Cape is among the best perfor mers in the country, our policies and strategies must change to meet the growing demands of the people we serve. In order to do that, we need to fully grasp the context in which we operate . The public health system to rise. We have ascertained that majority of those who use our services are affected by, what we call, the quadruple burden of disease, i.e. infectious diseases such as HIV/TB, -non-communicable diseases such as high blood pressure, diabetes and cancers, maternal and child health conditions e nabling Factors chain processes, human resources, infrastructure, information management and information and communication technology (ICT). The Department delivered health services in the Western Cape within 0,2% of its equitable share audit for the past 11 years. Robust systems, processes and controls have been put in place, together with an ongoing vigilance, to ensure this outcome is sustainable. The prototype for 'The Single Patient Viewer' has been completed; it is a web-based viewing application that allows clinicians to access an integrated perspective o n patient data available across various, vertical patient information systems in one platform. It provides a consolidated view of patient information along patient encounters, laboratory data, links to electronic radiological develop a comprehensive understanding of the client's interactions wi th the health system across the province and aid towards improved continuity of care.

ICT achievement over the last year includes:

Clinicom and AR billing rolled out in 47 of 54 hospitals saw 195 install PMI, Appt in 130, eRMR in 50, eHeadcount in 68, MOU in 1

3 and eReception in

2 facilities

Picture Archiving System (PACS) and the Radiology Information System (

RIS) implementation

has been concluded in 4 sites and PACS only in 12 sites The Tech Refresh Initiative has now concluded its second year of a 3-yea r process, 2 500 out year Single waiting list system developed for arthroplasties across the provi nce, resulting in public Tygerberg_complete report_FINAL.indd 22015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20143

The Department has furthermore managed to:

Build new ambulance stations at Robertson and Heidelberg Upgrades and extensions at New Horizon Clinic in Plettenberg Bay and Del ft CHC in the Metro Build new Emergency Centre at Heideveld CDC to enable work at GF Jooste Hospital Project Build new acute psychiatric units at Mitchells Plain Hospital and George

Hospital

Build a new CHC in Table View, Du Noon, a CDC in Hermanus and a clinic i n Rawsonville Upgrade the OPD and Emergency Centre at Knysna Hospital Commission the New Emergency Centre at Karl Bremer Hospital I wish to take this opportunity to express my sincere appreciation to th e staff of Tygerberg Hospital for the dedication to organisational health, organisational rep utation and towards like you. _________________________________

Yours sincerely

Dr Beth Engelbrecht

_________________________________ Tygerberg_complete report_FINAL.indd 32015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20144

F ore W or D

Deputy Director General:

Chief of

o perations

Dr Keith Cloete

There has been a smooth transition in political and senior management level within Western Cape Government:

Health (WCG: Health) during the 2014/15 year. The

implementation of the 2030 Road to Wellness strategic vision for the Western Cape. The senior management team of the Department has committed itself to value- based leadership and building a coherent whole systems approach centred around the patients' needs. There is a clear intent to take all WCG: Health staff members along on this exciting journey. A central hospital such as Tygerberg Hospital is a very important part of the care continuum offered across the health service delivery platform. Tygerberg Hospital is an integral part of the Metro East, West Coast, Cape Winelands and Ov erberg "healthcare ecosystems". The population growth and the commensurate increase in p atient care needs, in Tygerberg Hospital drainage area over the past number of years. management and organisational challenges. The ageing and out-of-date inf rastructure adds to this complexity. The re-development project is therefore a very importan t undertaking, and it provides exciting opportunities to remodel the way services are rendered , in addition to providing a platform for training and research. The numerous instances of excellent and ground-breaking care that are of fered at Tygerberg Hospital make the Department and the Western Cape proud. The commitment and service excellence exhibited by the individual staff members serve as a reminder of the quality of the human resources we command in the Western Cape healthcare system. envelope in real terms, in the face of increasing healthcare needs. This will challenge individual staff members, teams of staff members and the entire healthcare system i n the Western Cape services. The emphasis will be on strengthening the capacity of the whole system t o deal with patients' need more effectively. This will require a total commitment of all role players to managing vital role that Tygerberg Hospital staff members can play to strengthen the capacity of staff members at the other levels of care, need to be harnessed to its full po tential. I wish to express my sincere and humble appreciation to the hospital management, the clinical leadership and each and every staff member of Tygerberg Hospital for the daily contributions they make towards making the Western Cape healthcare system the best in South Africa. I continue to be humbled and amazed by the resourcefulness, ingenuity, high levels of technical skills and the total commitment to the public healthcare system by our staff members. I am proud to be associated with this team.

Dr Keith Cloete

Tygerberg_complete report_FINAL.indd 42015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20145

Dr Dimitri

e rasmus

Tygerberg Hospital is the largest hospital in the

Western Cape.

The Hospital plays an important role in the delivery of specialised and highly specialised services to the people role in system strengthening and outreach and is a referral base for the drainage areas of Metro East, West

Coast, Cape Winelands and Overberg.

It is an integral part of the teaching and training platform for the training of health professionals for the four universities, namely, Stellenbosch University, University of Cape Town, University of the Western Cape and Cape Peninsula University of Technology. The Hospital remains a n institution of academic excellence through its key strategic partnership with the Facul ty of Medicine and

Health Sciences of Stellenbosch University.

particular relevance to Metro East.

The service outputs were as follows:

Inpatient separations = 70 121

Outpatient headcount = 337 551

Bed occupancy rate = 86.5%

Number of operations = 31 145

Number of new-borns delivered = 7 538

The total expenditure for the 2014/15 year amounted to R2 271,6m. The commissioning of a new magnetic resonance imaging (MRI) scanner an d a new linear improvement in patient care. I wish to thank all the staff for their dedication and commitment which has culminated in the F ore W or D

Dr Dimitri

e rasmus Tygerberg_complete report_FINAL.indd 52015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20146

F inan C e

Director:

Mr Toufeak

s alie The funding streams for Tygerberg Hospital, the single biggest health facility in the Western Cape, are secured from:

R131 177m HPDTG (professional training), and

R976 495m Provincial Equitable Share

a n overview of the Hospital's a nnual Financial r esults: 2014/2015 yr budgetye actualVariance%

Expenditure(R29,2m)(1,3%)

e xpenditure The results achieved to provide ever demanding patient care (specialist and generalist care), was over the budget by r 29,2m
, which is just over a percentage point. Throughout the year, the the other programmes within the department. Tygerberg Hospital was allow ed to overspend. The reason is the hospital faced major challenges during the year due to continuous patient load pressures, burden of disease and the burden of unfavorable economic fact ors (international and local), relating to currency exchange rates, interest rates, energy/oil price increases and the high

Mr Toufeak

s alie Tygerberg_complete report_FINAL.indd 62015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20147

The graphic displayed indicates the quarterly spent.

Revenue

TargetAchievedSurplus%

RevenueR111,0mR153,1mR42,1m37,9%

R42,1m (37,9%) against the 2014/2015

target of R111,01m. Tygerberg Hospital realises the most revenue and is the highest achiever in the

Department of Health.

The closing revenue outstanding balance of R194,5m as at 31/03/2015, an increase of only 6,6% due Tygerberg_complete report_FINAL.indd 72015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20148

Tygerberg_complete report_FINAL.indd 82015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 20149

An explanation of the expenditure results:

Personnel expenditureYR budgetYE actualVariance%

Persal StaffR10,5m0,69%

Joint StaffR58,0mR63,8m(R5,8m)(10,00%)

Agency StaffR24,2mR21,0mR3,2m13,13%

TOTALR7,9m0,49%

Hospital staff stabilised at

4 393 as at year end March 2015. Nursing posts made up

43,2% and

doctors 13,3% 95,9%. The general salary adjustments had a welcome effect on all staff. The need to utilise substantial nursing agency staff during the year rem ains a necessity due to the national shortage of nurses. Nursing utilised a monthly average of

90 FTE's

. The strategic position is rather to have full-time nursing equivalents appointed. Tygerberg_complete report_FINAL.indd 92015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 201410

Goods and

s ervices (excludes agency cost): yr budgetye actualVariance%

Goods and ServicesR616,8mR654,5m(R37,7m)(6,12%)

Major expenditure comparative spending trends:

Category

clinical consumablesactual 2013/2014actual 2014/2015% > l aboratory s erviceR79,8mR87,1m9,09%

PharmaceuticalsR59,4mR74,5m25,47%

Blood & Blood ProductsR53,4mR68,6m28,47%

Medical/Surgical ConsumablesR200,4mR208,9m4,22%

o ther Goods & s ervices

Support ServicesR51,3mR55,7m8,66%

Steam, Gas, Energy and UtilitiesR57,9mR66,3m14,47% Engineering & Service MaintenanceR40,9mR45,7m11,85%

RemainderR25,1mR26,7m6,27%

p atient activity2012/20132013/20142014/2015% >

PDE's541 315561 385560 784(0,1%)

Admission67 59669 89470 1220,3%

Patient Days408 330428 703436 1181,7%

OPD Headcount344 031346 777337 551(2,7%)

Tygerberg_complete report_FINAL.indd 102015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 201411

Cost per PDE concluded at R4 435 against the target of R3 939. Tygerberg_complete report_FINAL.indd 112015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 201412

Capital Equipment:

Tygerberg Hospital Capital Equipment Funding Sources

The main items prioritised for capital equipment:

Medical and Allied Equipment - R5,17m

Computer Hardware - R3,27m new and refresh of old IT hardware

Domestic Equipment and Furniture - R1,2m

Motor Vehicles - R0,27m - Pallet truck for Pharmacy Tygerberg_complete report_FINAL.indd 122015/11/04 9:35 AM

Tygerberg Hospital - ANNUAL REPORT 201413

linac - r5m (accrual)

Biplanar angiography - r10m (part payment)

Hermes - r1m (accrual)

Backup image Vault - r1,3m

Holmium laser - r0,7m

Theatre light - r0,7m

Kitchen ovens - r1,3m

anaesthetic Monitors - r2,2m emergency Trolley complete - r0,6m

Colour Doppler ultrasound - r0,5m

Ventilators - r0,4m

Multiple sample well counter - r0,5m

Various ultrasound machines - r1,2m

Flexible pleuroscopy stack - r0,4m

Cabinet endoscopy dying - r0,4m

S maller E quipment I tems R4,1m and outdated equipment with the acquisition of new modern high-tech medi cal equipment.

Donation Funding

R2,1m

Ge ultrasound - r1,8m

ultrasound Machine - r0,3m F Y : 2014/2015

R'000 R'000%

Compensation of employees5,9

Goods and services641 036717 62411,9

Transfer leave6 0056 3535,8

Machinery and equipment11 32615 03532,7

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