American International Health Alliance

TbilisiAtlanta

Tbilisi, Georgia / Atlanta, Georgia

2002-2007

Focus: Nursing, Health Management, Pediatric Emergency Medicine, Medical Informatics, Quality Indicators

The Partners
Partnership Objectives
Key Events and Achievements
Participating Institutions
Related Links

The Partners

US Partners: Partners for International Development, an Atlanta-based NGO that evolved from AIHA’s first Tbilisi/Atlanta partnership (1992-1999), drew on the expertise of dedicated professionals from Emory University, Georgia State University, Georgia Institute of Technology, Grady Health System, and Morehouse College.

Georgia Partners: The Georgian partners include the Ministry of Health, Labor, and Social Affairs, the Gudushauri National Medical Center, Iashvili Children’s Central Hospital, and Partners for Health, a Tbilisi-based NGO.

Partnership Objectives

The overall goals of this partnership were to improve the quality of health and healthcare services provided by Georgian partner organizations and to create a professional nursing model at partner institutions.

To achieve these objectives, partners:

Conducted a series of “training of trainer” workshops for hospital management to improve operations and administrative services, with a particular focus on improving financial systems, management and administration, medical care and quality assurance procedures and policies, and leadership development;
Developed administrative and leadership skills by training master trainers in healthcare management education and initiating a certificate program in Health Services Management for partner hospitals;
Assisted partner hospitals in the development of new policies and protocols, including emergency preparedness plans; and
Utilized existing Learning Resource Centers at partner hospitals to develop clinical practice guidelines, medical informatics databases, and distance education materials.

Key Events and Achievements

Clinical Organization and Capacity Building

Partners achieved significant improvements in the delivery of nursing care, introducing new nursing services at both Gudushauri and Iashvili, as well as developing new documentation forms, clinical curricula, and the capacity of local trainers. They opened Nursing Resource Centers at both hospitals and expanded continuing education opportunities for nurses. Collectively, these efforts led to greater roles, responsibilities, and professional empowerment for the nurses.
Partners effectively strengthened organization and management structures at Gudushauri and Iashvili. The middle management training and technical assistance provided by US partners resulted in significant improvements in the cost recovery and registration systems at both facilities, which in turn has raised patient awareness of payment rules and improved accounting for all cash due to the hospital, as well as greatly reduced “gray market” payments.
The new, detailed registration system implemented by partners provides valuable information to management for decision making.
Both partner hospitals have made significant changes in the physician compensation system. Physicians were moved from a salary to a “per procedure” performance-based compensation formula. Gudushauri and Iashvili are also working with a number of private insurance companies, thus increasing hospital revenues from private insurance companies.
Partners have made noteworthy changes to the organizational structures of both hospitals. For example, each department now has its own goals and objectives, and functions as an independent unit. The number of committees operating in the hospitals has expanded to include groups focusing on quality control, rational use of drugs, and infection control. Both Gudushauri and Iashvili have experienced an increase in hospital occupancy and a decrease in hospital mortality.
The partnership has been instrumental in opening the region’s first emergency room at Iashvili Children’s Central Hospital. The position of ER physician has been institutionalized, as has the concept of triage. The introduction of emergency medicine practices and training has resulted in significant measurable improvements in patient health in the areas of diarrhea, abdominal pain, nervous system infections, head trauma, febrile seizures, coughing, and pain management. Related training has led to noticeable decreases in the average length of stay — down from 13 days to 7 days. Also, a greater proportion of patients are now being discharged directly from the ER resulting in greater efficiency.
Partners developed and implemented clinical practice guidelines, along with retrospective studies to determine changes in the number of complications, secondary admissions, length of stay, and treatment cost.
Partners trained four nurse master trainers and developed a clinical nursing curriculum that has been implemented at a number of hospitals selected in collaboration with the Ministry of Health. More than 300 hospital nurses throughout Georgia participated in the trainings.
Partners trained five master trainers in health management and developed a 90-hour course in health management and administration with an emphasis on hospital management. The curriculum includes modules on leadership and strategic planning, operations management, management information systems, financial management, human resource management, and team building. About 265 people were trained in the Health Administration courses.