Project Application Form

Project title: Rehabilitation of Clinic CF 2 Hospital, Bucharest

Student name: Cristina Sima Name of the team: Dare2Care

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A.
A.1 GENERAL INFORMATION

PROJECT OUTLINE

Duration of the project::

Starting January 2011 until July 2012 1 and a half years (1,5 years) Rehabilitation of CF 2 Clinic Hospital, Bucharest Rehabilitation of CF2

Title: Acronym/short title (max. 25 characters): Overall objectives:

A significant increase of the capacity to deliver quality health services geared to the needs of the community and which the hospital serves: to reduce the number of hospital-related deaths and complaints; to fulfill the Ministry of Health performance criteria that will assure the increase in financial Ministry of Health allocations;

Project goal:

Improved hospital capacity to offer competitive medical services thus transforming the CF2 hospital in a regional university emergency hospital. The County Council (City Hall of District 1, Bucharest) Cristina Sima No 9-13, Bucharest- Ploiesti highway +4 021.319 10 13/ +4 021. 319 10 06 cristina.sima@ymail.com

Coordinating institution Name and position of contact person: Address: Telephone/Fax: E-mail:

Other participating institutions:

Shareholders (owners) & hospital management; "Carol Davila", University of medicine and pharmacy, Bucharest; Investors and sponsors; Contractors and suppliers; Health insurance companies; Medical Council of Clinic CF 2 Bucharest; Health inspectorates; National Authority for consumers protection;

Total budget: Grant requested from the funding authority: % of total budget: Target sector(s)

5,000,000 ( 121359,5 RON) 4,000,000 ( 970873,8 RON) 80% Health system

A.2

SUMMARY

1. Justification of the proposal The project aims to solve specific problems of the hospital like the insufficient number of patients room and waiting rooms, also it targets the poor condition of the existing rooms and old equipment, this being an important factor that determines patients satisfaction. In the same time the lack of training and qualification programs financed and supported by the hospital creates conflicts at the work place leading to the lack of motivation of the employees and thus they look for more attractive conditions offered by other hospitals. This being stated by the decreased number of doctors who choose to work for this hospital. In general, all these problems can be structured in a core problem that can be identified as decreased competitive medical services provided by the hospital, leading to the increased number of hospital-related deaths and complaints. Followed by the worsened fulfillment of Ministry of Health (MoH) performance criteria, causing the diminishing of the financial MoH allocations. That in short term leads to the deteriorated hospital. This project will create not only high standard services but also jobs for well prepared doctors, improving the medical care system in Bucharest. It will target mainly the infrastructure problems, the part regarding competences and motivation of employees will represent a complementary project which will be founded like a continuous process after the rehabilitation of the hospital. 2. Results

The hospital infrastructure is improved, means that there are sufficient patients rooms and waiting rooms and also the conditions of the existing rooms are improved and high tech equipment is available. Mainly, the benefits of the improved infrastructure are seen in the reduced number of hospital-related deaths and complaints followed by the improved fulfillment of MoH performance criteria. Achieving these criteria automatically leads to increased allocation from MoH. That effect will solve the Hospital and target group problems, which ultimately contributes to the increased capacity of the hospital to offer competitive medical services. Structured and global we can talk about specific results of the rehabilitation project such as: - Improved at European standards the Hospital infrastructure( electricity, sanitary, thermal ,and water and gas); - High standard medical equipment.

3. Dissemination methods The purpose of the dissemination is to raise the awareness and publicity of the Rehabilitation of CF2 project as well as its outcome in order to make it a successful and sustainable project. In this context the target groups for external dissemination activities are on the one hand the general public and on the other hand potential investors and collaborators as well as specific scientific experts. Further target audiences are public institutions like governmental and European audiences. In order to reach the particular awareness level intended, the stakeholders have to work continuously in the field of dissemination and public relation. For their support as well as for the graphical identity within the consortium the partners have to be provided with templates (for presentations and reporting) and various communication materials (web site, fact sheet, press release etc.). The dissemination plan of the project has been arranged into a logical sequence of various activities, which will be described in the following Dissemination strategy section, whereas the real planned activities will follow later in the second section Planned dissemination of knowledge. Additional activities have to be expected when the stakeholders have prepared more detailed plans for their work. Invitations to contribute to both publications and conferences are expected as the project receives more attention throughout Romania and the rest of Europe. These activities will be reported during the periodic reporting after the end of each project period.

4. Participating institutions

The nature of the project involves a significant number of institution and organization of which leads to the success of the project implementation. The Shareholders (owners) & hospital management in collaboration with the City Hall must determine and raise the interest of hospital employees and staff to support and help facilitate the process, also they will work closely with the management team to attract funds from Investors and sponsors, paying attention to the contract clauses and condition imposed to the Contractors and suppliers involved in the process. Also the Shareholders (owners) & hospital management and the City Hall, will elaborate marketing plans to attract Health insurance companies for future collaboration and staff medical services for companies. In the same time to elaborate research groups collaboration with "Carol Davila", University of medicine and pharmacy, Bucharest, that will contribute to the design of the hospital, through experienced doctors that worked in other developed countries of Europe. 5. Project Management and operational timetable Due to the specific and problematic nature of the project it will be assembled a project team with economic and medical background. The project management is organized in order to achieve all qualitative and quantitative objectives set. Mainly the project management is composed of City hall officers, hospital employees with medical and economic studies, and specialized project manager. Thus the operational timetable is structured as follows: Having all necessary documentation and approbation for the project Detailed analyze of the infrastructure Establish architecture, and execution of the project Supplying high standard medical equipment Evaluating the impact and the implication of the project Measuring the result and the returns of the project. (For a detailed description see Section D)

B.

PROJECT GOAL
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B.1.

JUSTIFICATION OF THE PROPOSAL

1. Background With European integration, each institution, through its employees, must find the best way of compatibility with similar structures in the Community. As the flagship institution of the health system, the hospital had to face major challenges regarding its role and its place within a system tried hard in the years after 1989. Romania's accession to the European Union has made health and health services in the EU member states to become the reference framework for the citizens of Romania ( The Programming Document for the Regional Operational Program and the Framework Document for the Implementation of the Regional Operational Program). Modernizing and increasing the health sector in our country, initiated by the Law no. 95/2006 on healthcare reform, had to align the health system performance in other countries. Reforming the conceptual, financial and health management system has proven to be a long and difficult journey. Restructuring health requires a new approach in terms of units providing health services, professionalization of health management in order to enhance the efficiency of the health and quality of medical care, as a premise for improving general health of the population. External and internal pressure forces the hospital to structural changes, efficiency, changes in volume and quality services, the safety of medical care, technology used and the degree of satisfaction of consumer expectations. All these changes will be designed by the management team; transforming the hospital in a regional emergency hospital involves setting up specific departments related to this: UPU, cardiology, gastroenterology, hematology, neurosurgery, vascular surgery, in the context of modernizing their own service. Improving the quality of hotel conditions with judicious and efficient use of space and circuits according to European standards (This investment will complete building works and modernization). Improving all this weak pints of the hospital with a efficient resources management and correct prioritization of needs will construct at the end of the project in promoting Hospital CF 2 as a center of excellence in research university education and professional development.

2. The problems addressed by the project and the means of identifying them The main problems addressed by the project are related to the infrastructure of the hospital: the poor condition of the existing rooms and old equipment; insufficient number of patients room, waiting rooms; poor ( inadequate) infrastructure of the hospital. All this leads to the main problem, more exactly the decreasing competitive medical services provided by the hospital. These problems were identified by the analysis of the hospital structure, the standards of the hospital services, the quality and the accuracy of the technology used. CF 2 Hospital is a hospital with 639 beds, of which 55 day hospitalization, 13 clinical sections. Functional Circuit of patients, food and waste does not meet current standards of a modern hospital and is one of the strategic objectives of the project. Also, the building structure is in a poor condition and deteriorated, this being identified by a constructing specialist analysis. The hospital facilities offered must meet the EU standards and indicators imposed by the Health Committee. The building was designed according to the rules in force at that date; the rules did not reach the requirements of the regulations currently in force relating to the safe operation of hospital construction. Although reaction to earthquakes has been good, the building has structural damage and necessary rehabilitation works of the resistance structure of the building. Since the opening of the hospital there have not been executed works to strengthen the body of the hospital itself. From the functional point of view, conditions are not met: energy efficiency, fire safety, hygiene, health and environmental protection, safety in operation. The situation is precarious technological facilities. 3. The specific activities of the project Diagnosis of the hospital building structure; Establishing civil engineering specifications for further improving infrastructure; Efficient space management of the hospital buildings; Executing the rehabilitation of the and establishing architectural specifications for optimizing the hospital space; Setting up the high standard equipment; Promoting the hospital; Attracting collaborators and customers

4. The target population and eligibility criteria for participants

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As target population, the project addresses three categories: 1. The hospital patients and their family( including here the hole community in which the hospital operates) by offering high quality medical services; 2. The medical and auxiliary employees of the hospital by creating a comfortable and pleasant work environment. 3. The medical universities and medical research centers within the Romanian territory and also in Europe. Eligibility criteria for the targeted population of the project are based on their specific characteristics, thus: 1. For the hospital patients and their family due to the nature of the situation the only criteria are the type of illness from which the patient suffers and the capacity and resources of the hospital to treat it. 2. For the hospital employees: - the education background - the professional experience - the recommendations and abilities 3. For the medical entities: - the quality and amount of research done in the field - their image in the community - the interest in improving the healthcare system

5. Incentives for the target group to participate in the project The project bring as incentives for the target group the following: Increased satisfaction of the medical services provided Increased quality of diagnosis and treatment Increased quality of accommodation during the hospitalization Pleasant atmosphere at the work place Creating positive competition at the work place Developing new research centers and providing higher quality of result Help improve and develop talents in the medical area

B.2.

BREAKDOWN OF RESULTS

1. General description of results Mainly the benefits of the improved infrastructure are seen in the reduced number of hospital-related deaths and complaints followed by the improved fulfillment of MoH performance criteria. Achieving these criteria leads automatically to increased allocation from MoH. The general vision of the project consists by improving the quality of care provided, correlated with increasing the comfort of hospitalized patients, which is achieved by the modernization and space management of the hospital, also by adapting the utilities at the European standard. Another element part of the result is increasing awareness of hygiene and microbial control through the employees, patience and visitors also increase in fire protection, due to the latest accident that led to a numerous deaths in a hospital from Bucharest. An key element is the creation of accessibility to persons with disabilities in at least 3 key entrance points of the buildings, and creating a special equipped room for this purpose. Of course, optimizing utilities costs due to the environmental issue of our decade entails a high interest of the project in friendly-environmental specifications and it is important that the project takes the environment into consideration, fact that imposes compliance with safety regulations in force, energy conservation. 2. Breakdown of results 90% of hospital infrastructure is improved by 2012; The number of rooms increased by 30% by 2010, compared to 2010; Conditions of patients rooms and waiting rooms are improved by 60% by 2012, compared to 2010

3. Detailed description of results 90% of hospital infrastructure is improved by 2012; Involves the restructuration of hospital activity so that it can be started the cleaning of plasters of the entire building, remaining only the base structure, dumping the residual waste in a recycling unit. Then painting back the hospital and restoring all utilities circuits. - 100% of walls (internal and external) will be restored - 23200sq m - roof restored - electrical, plumbing, heating and ventilation systems and medical gas supply restored: - building Hospital - rehabilitated area: 16400 sq m - building Ambulatory - rehabilitated area: 2300 sq m - building Hospital pharmacy and block food - renovated area: 4500 sq m - Functional area 1359.65 sq rehabilitated The number of rooms increased by 30% by 2012, compared to 2010; It is accomplished by the architectural company contracted, that will structure and reorganize the space more efficiently, creating more rooms and better use of all the available space. - Increase the number of beds by 200, in 2012 - Space management for all the building so that the number of room increase from 80 in 2010 to 105 in 2012. Conditions of patients rooms and waiting rooms are improved by 60% by 2012, compared to 2010; - There will no longer be 10- 12 beds in a room, all the rooms will be structured and equipped with standard meeting utilities and furniture.

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4. Delivery system
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The project delivery system consists in how the participants are organized to interact, transforming the owners project goals and objectives into a finished facility The selection of the delivery system is established upon the number of factors including the general project requirements, the experience level of the project team, budget, time constraints and many others. The delivery system will take into account the delicate situation of Romanian health care and it will have n significant component of quality and multilevel marketing. It will involves: Results presentation within conference and study seminars from medical field Publicity materials, which guarantees a trustful collaboration of the hospital with the community. Creating a system of recommendation within the patients and their community Creating a trustful center of research and diagnosis
B.3. IMPACT

1. Impact on the primary target population The project will improved hospital image, that will attract more professional and better trained personnel, thus becoming a hospital of choice for the local community (increased no. of patients); By rehabilitating the hospital, the employees will have EU working standards and also higher terms of evaluation, leading to an efficient, high standard and professional health system. Setting thus a model for the whole system. The patients will recommend the hospital and the will beneficiate of a quality medical service, improving this way the health of the community. Also, concluding more partnership and collaboration agreements with universities and research centers will determine that the hospital will become a European reference and a diagnostic center, thus attaining a higher level of job satisfaction.

2. Project's potential transferability to other sectors and users a. Community outreach The impact over the primary target will be transferred to the residence students and researchers within the hospital. This way being the personnel of the hospital being encouraged to get involved in the community, creating a healthy, stabile and trustful relation between the Hospital and community. Concluding more and bigger contracts with suppliers and contractors will increase also the economy in the nearest community, by creating demand.

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b.

Systemic impact The project aims at rehabilitating and improving the health care delivery system in District 1, Bucharest, and thus in Romania. The project is consistent with the Governments Health Care Development Plan which had put an emphasis on the necessity for increased decentralization of health care services at the district level and the increased availability of financial resources to provide efficient health care services. The new high standard services will determine other competitive hospitals to improve their condition, thus leading to a continuous and dynamic solution for the evolution of the health system in Romania Permanence The entire Health system in Romania will benefit from the project through the dissemination of the results that will be achieved. The project will impact over the competition; over the standards of medical services provided in Romania. The permanence of the project is ensured by its nature, all rehabilitation projects representing a continuous development of the health standards, creating competition and establishing higher standards.

c.

B.4.

DISSEMINATION

1. Strategies and initiatives to ensure that the project has the desired impact

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A dissemination campaign will be developed to create a better image of the importance of development of the health system. Promotional materials will hand over to the general public and target populations, institutions and will provide complete information on the new conditions and standards of the hospital. As dissemination methods we include: information seminars, special events, and media advertising. The dissemination strategy is made up of three consecutive phases: The goal of the first, awareness-oriented phase is to raise awareness the community about the project and its objectives. Raising awareness involve the setting up of the basic marketing materials and awareness-raising presentations at different related events. Therefore, the main activities of this phase are the following: Setting up a common project design, such as logo, templates for documents and presentations. Creating the project website, this will describe the challenges and the goals of the project and will introduce the project members. Designing the project information materials (such as a leaflet and an introductory off-the-shelf presentation), which can be distributed later on without investing greater efforts. Giving introductory presentations at conferences and workshops about the challenges and goals of the project in order to raise awareness among the scientific and industry stakeholders. 2. Dissemination during the project The second, result-oriented phase aims to promote the results of the project, in order to allow potential interested parties to get to know the achievements and the related benefits of the project. For promoting the results Update of the project website with public deliverables and news in order to encourage active communication, to keep interested parties informed and to demonstrate project liveliness and progression. Presentations of the research-oriented theoretical results of the project at international level Publishing and dissemination of press releases following the finalization of important project milestones. 3. Dissemination at the end of the project

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At the end of the project the dissemination will be based on the efficiency and impact of the project documentation, followed by the impact analysis over the community and the health system, thus the management team can promote the hospital as a Hospital of choice, attracting further investors and collaborators.

D.
d.1.

ORGANISATION AND MANAGEMENT OF THE PROJECT

Work PACKAGES

WP1: Establishment of the main working institutions

Description: This work package establishes the organizational parties that will participate during the whole project; also in this stage are set up the assigns and plans of the project activities. Start and finish dates: January 2011-February 2011 Activities Establishment of the Steering Committee; Appointment of for the Management team and the coordinating institution; Appointment of participating institutions; Establishment of the project scope and implications.. WP leader City hall of District 1, Bucharest

WP2: Project Management

Description: This work package represents facilitating the project implementation, by establishing the code of conduct, constrains, obligations and rights. Start and finish dates: February 2011- July 2012 Activities Establishing the responsibilities and the structure of the project team; Planning, monitoring and evaluating activities; Narrative and financial reports;

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WP leader Steering Committee

WP3: Documentary and analyze phase

Description: Within this work package is will be established the current situation, the level of need and the project plan. Also it will involve all the documentation for the decision WP leader making obtained and also the public information campaign will be discussed. Steering Committee

WP 4: Implementing and supervising the project

Description: This work package is specific to the implementation of the project, the execution of activity and the continuous supervision of risks and cost correlated to the time frame and the initial objectives. Start and finish dates: May 2011- February 2012 Activities Conduct a survey among hospital management, employees and staff on how to improve space management of the hospital buildings; Establishing architectural specifications for optimizing the hospital space; The contractor executes and delivers the final results according to the contract. WP leader Steering Committee in collaboration with the City Hall and the Hospital management.

WP 5: Setting up the high standard equipment

Description: After the completion of the structural rehabilitation and the conduct of management space of the buildings, the hospital is equipped with high standard utilities, furniture and medical equipment, finalizing the modernization of CF2.

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Start and finish dates: February 2012- April 2012 Activities Conduct a market analysis on high standard medical equipment market; Select the proper required medical equipment; Prepare tender documents, organize the tender and select the equipment suppliers; Distribute the equipment to the newly designed rooms. WP leader Steering Committee in collaboration with "Carol Davila", University of medicine and pharmacy, Bucharest.

WP 6: Final documentation
Description: This work package involves the surveys and impact analysis of the project over the community, over the employees and the health care system. It means precise indicator of value, of efficiency, the correct result and the comparison with the terms establish initially, so that the project can be promoted to attract further collaboration and investments. Start and finish dates: May 2012- June 2012 Activities Efficiency and impact of the project documentation; Promoting the hospital Attracting investors and collaborators Dynamic evaluation of project results Dissemination of the outcomes Preparation of the project results and their distribution to the EU WP leader Steering committee

WP 7 : Project close down

Description: This work package consists in the final documentation and the evaluation of the strategic impact of the project combined with the communication of its returns to the stakeholders and the public.

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Start and finish dates June 2012- August 2012 Activities Preparing project closure documentation Monitoring Establishing the returns of the project WP leader Steering committee

D.2.

PROJECT MANAGEMENT

1. Steering Committee

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The Steering Committee is responsible for approving major changes to the project's scope, objectives, timelines, costs and other key attributes. It may also be called upon when significant project business decisions are required, especially of a cross-functional nature. Their role and responsibilities are: Reviews and approves the Project Charter for quality, accuracy and strength of business case Reviews progress against the project plan Reviews and approves changes to the business case Reviews and approves changes to project resourcing, timelines, scope, objectives, costs, etc. Makes decisions on major priority of deliverables Approves interim deliverables Approves project development strategy Actions escalated project issues Resolve conflicts between stakeholder groups 2. Organization and management structure The team would have a mix of people so that all the necessary skills, knowledge and understanding are collectively within that team, subject to any further specialized support that is needed. The technical elements of the overall solution have been recognized as requiring a team of specialists, so, in fact, we have part of the team structure fully process-structured and another part in a resource pool form. It is specifically tailored to meet the demands of the project by isolating unique work and maintaining a strong focus on completing the project. Once the project is completed, this structure disbands. This structure is effective in maintaining dedicated resources throughout the life of the project.

3. Approach and methodology

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This project take in consideration today's demanding business environment that requires solutions to deliver what they are supposed to deliver, when they were asked to deliver it and below budget. The project is split up into 7 individual phases regarding the improving of health care, each with its own tasks and deliverables. Each phase provides functionality and payback for the customer. Regardless of the size of the project, several steps are necessary to ensure the solution is developed in the most effective, efficient and economical way. Also the project is achieving the specific objectives of Regional Operational Program. The team will be formed by experts with both medical and economic background so that all the project elements and aspects are approached in same measure. Creating a specific methodology of the project which involves a double perspective on problem solving decisions. 4. Conflict resolution The Steering committee will be responsible for the conflict resolutions within the project, adopting a problem solving attitude that involves the use of logical thinking to understand the problem. In this conflict resolution technique, it is needed to understand the view point of all conflicting parties. The problem-solving technique is the best for conflict resolution. It also helps in developing trust in the team, since each party collaboratively tries to explore possible solutions. By using the problem-solving technique, it can be achieved a win-win situation for all conflicting parties. The steering committee will respect a base line of behavior requirements in conflicts: Encourage participants to discuss the situation in a respectful manner. Never take sides. Do not pressure participants to agree, rather to collaboratively reach an agreement. 5. Work package leaders Every work package has its own work package leader. The work package leader is responsible for monitoring progress in the work package and the Working Groups coordinating the activities and compiling the responses. For the duration of a work package, the work package leader will monthly discuss progress with the project leader. For every work package is designed a leader from the institutions participant at the project, responsible for the efficient completion and delivery of the final product. Within these Working Groups a working group leader is responsible for the designation of tasks between working group members and the timely cooperative action of the Working Group.

6. Schedule

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The schedule consists of the list of project's terminal elements with intended start and finish dates. Terminal elements are the lowest element in a schedule, which is not further subdivided. Those items are estimated in terms of resource requirements, budget and duration, linked by dependencies and scheduled. A variety of inputs and tools are used in the scheduling process, all of which are designed to help understand resources, constraints and risks. The end result is the Gantt graph that links events in the best way to complete the project efficiently. 7. Evaluation The project evaluation will study the outcome of the project (changes in income, housing quality, benefits distribution, cost-effectiveness, etc.). The evaluation consists of controlling and monitoring incorporated in all the steps of the project, it is present in each part, is constantly done and with a lot of attention for every detail! Project evaluation is a systematic and objective assessment during the ongoing and at the completion of the project. The aim is to determine the relevance and level of achievement of project objectives, development effectiveness, efficiency, impact and sustainability. The evaluation also feed lessons learned into the decision-making process of the project stakeholders. The project evaluation strategy consist in a continuous and monitoring and evaluating mechanism, realistic approach of the objectives set, consistency in the evaluating criteria and deadlines. 8. Criteria for evaluating the success of the project 1. 2. 3. 4. 5. 6. No. of patients coming to the hospital after the rehabilitation; MoH performance indicators for hospitals achieved after the end of the project; No. of deaths and complaints reduced; Hospital and target group problems are reduced by 50% from 2010 onwards. Hospital capacity to offer competitive medical services increased by 75% from 2012. Number of recommendation given by the patients increased with 80%.

9. Methods for monitoring and reporting progress 20

The project plan should be monitored and updated on a weekly basis. This is important since tasks are usually underestimated and many new tasks will be identified as the project moves forward. Every party involved in the project will report every month their work progress to the Steering Committee. The reporting includes information about the technical progress, results obtained and compliance with the work program. The Steering Committee will come with a feedback and recommendation for further improvements, preparing project reports and distribute them within the stakeholders of the project. Methods used in the monitoring and reporting progress can be summarized in: Evaluation plan Record keeping and data collection Adherence to time scale by partners. Arrangements for ongoing monitoring. External evaluation Review meetings. 10. Project assumptions and project risks 10.1 Project assumptions The publicity campaign conducted by the project team impacts positively on improving hospital image. The hospital management is effective in attracting more patients and professional medical employees and staff. Hospital conditions and services will reach a high standard and will remain stable for at least 5 years. 10.2 Project risks - Financial risks: Creating extra cost that leads to a deficit of funds. Increasing of the inflation rate and the prices for materials. The contractors bale out and we cannot afford to hire others - Climate risks Bad weather or catastrophically events that determine delays for the project. 10.3 Measures for risk management The steering committee will establish risk management by the identification, assessment, and prioritization of risks (defined in ISO 31000 as the effect of uncertainty on objectives, whether positive or negative) followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events or to maximize the realization of opportunities. Developing back up plans and ensure from the start risk budgets, also ensure that all activities of the project have included at least one day for unexpected events.

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