The economic and financial crisis increased further in 2011. For the time being, Belgium remains out of the international markets' sights, for as far as the government can manage a sustainable budget balance in the following three years. There is no doubt that the remedy will be a mix of savings in government expenditure, efficient structural reform and looking for new sources of income. It is highly unlikely that healthcare will escape this. The persistent crisis holds a triple threat to our hospital.
Firstly, savings in healthcare implies less income. For example, reduced refunds of medical treatment or hospital activities of which the actual expenses do increase annually. But also for example due to the reduced offer in clinical scientific trials financed by the industry.
Secondly, economic crises reduce the demand, and therefore also the care consumption, resulting in stagnation of medical activities and therefore hospital income. The man in the street maintains a tight hold on his purse and medical care is pushed to the side-lines.
A third, less tangible effect, is located between the ears. Crisis and unrest, fed further by an often ruthless press, causes people to become more moody, uneasy, impatient and even aggressive. Perception wins over reality and subtle dialogue. Social values, such as tolerance and social solidarity which we perceive as acquired, threaten to move towards the "Me First"-feeling.
Yet the UZ Brussel (hospital) manages to hold its pose in the midst of all these social challenges. What does this prove?
The UZ Brussel has reached comprehensive and certain stabilization after a period of clear growth. "Global stabilization" is however not synonymous with stagnation. In this report, you will find excerpts of the numerous initiatives that were taken and realised in 2011. The results – because that's what it is after all about – are worth mentioning. Comparative surveys with other hospitals confirm this, such as the reputation survey carried out by Test-Aankoop midway through 2011. The patient is largely happy (UZ Brussel in top-three), the referring doctors are largely happy (UZ Brussel in top-two), the employees are working in a 'good' environment (UZ Brussel is Top-Employer), and scientific production (along with the faculty of Medicine and Pharmacy) continue to increase. The UZ Brussel is financially and structurally healthy and the operating results remain positive. This allows us to face the future with confidence, trusting in our own ability.
The review of 2011 therefore leaves us happy, proud and grateful. Because we know very well it is the absolute treasure trove of employees that eventually made all of this possible. We invite you to page through this annual report and to remember that behind every project, every development, every pleased patient, there are people who made this possible. This is therefore also our most important guarantee for the future.
In the postscript, you will find some of our answers to the - undoubtedly numerous - challenges we will be facing.
We did not try and achieve a complete overview with this annual report, but we want to give you an idea of the most important accomplishments and changes in 2011.
We hope you enjoy reading.
for the patient
In general, the hospital's activity level in 2011 is comparable to that of 2010. Here and there, we will nevertheless mention some highlights.
The UZ Brussel had 721 beds in 2011. A little more than 97 % of the patients come from Belgium. The next largest groups are patients from Italy, the Netherlands and France.
In 2011, 51,601 patients were hospitalised in total (classic and day-hospitalisation), or 1.4 % more than the year before. The number of planned classic admissions increased by 6.2 % to above 15,000. The number of day hospital admissions remained stable at 22,669 patients.
The substantial increase of planned classic surveys were realised mainly by the services pneumology, abdominal and paediatric surgery, and the new diabetes clinic.
The number of emergency admissions dropped slightly by 1.1 %, but the emergency services – our country's second largest established emergency service – continued with 48 % of the patients to ensure a large through-flow to other hospital services.
The number of day hospital admissions (excluding mini-forfaits) remained stable at 22,669 compared to 22,673 in 2010.
This is 43.9 % of the total number of admissions in 2011 (51,601).
An increase in day hospital admissions was however noticeable in certain sections: Paediatrics, ear-, nose- and throat surgery, cardiology, abdominal and paediatric surgery, obstetrics and prenatal care.
The number of consultations (excluding ER) increased from 274,032 in 2010 to 277,041 in 2011, an increase of 1.1 %.
In absolute numbers, the following sections booked more consultations: paediatrics, obstetrics and prenatal care, once again the diabetes clinic, and ear, nose and throat care.
The average duration of stay remained more or less equal: 6.8 days in 2011 compared to 6.9 days in 2010.
The number of technical referrals (excluding operating room and excluding clinical biology) amounted to 874,625 in 2011. This is a slight increase of 1.2 % compared to 2010.
The hospital's motto today is that the patient must be at the centre of care. The UZ Brussel has booked enormous development, growth, and increase in image since its start in 1977. In 2007, the year that it existed 30 years, a long-term process of change started that must result in a totally upgraded hospital in 2021. The past 10 years, the company, its care, the patients and the care providers changed in the most divergent areas and the UZ Brussel keep this meticulously in mind. Even more, it anticipates this.
The UZ Brussel has made enormous progress
The UZ Brussel starts with several large building projects expanding and reorganizing the existing hospital into a modern, logic hospital environment that complies with the needs of the patients and care providers of today and tomorrow. The Spatial Plan offers the spatial context for the implementation of the Strategic Care Plan. In that Strategic Care Plan, approved by the Flemish government in 2009, the UZ Brussel describes its vision and development strategy on care, now and in the future. Several actual building projects resulted from the Spatial Plan that shall shape the future UZ Brussel, based on the draft 'Caring architecture'. 'Caring architecture' implies: caring for the patient, caring for the care provider and caring for the environment. The entire operation of building projects shall be divided in two large phases: VIPA 1 and VIPA 2. An application was submitted with the Flemish government in 2011 to subsidise the VIPA 1 building projects.
Via the Spatial plan, the UZ Brussel is working on an even more efficient care infrastructure. Upgrading and improvement is however also included in the organisation of the care itself. A perfect example is the new diabetes clinic that was opened officially in 2011.
One in 12 Belgians has diabetes, or 610,000 Belgians aged between 20 and 79. Diabetes type 2 is assuming epidemic proportions globally and certainly in Brussels as the most cosmopolitan city in Belgium. That was why the UZ Brussel opened the first integrated diabetes clinic in Belgium in 2011. Classic diabetes care is complex and dispersed in a hospital. Diabetes patients however more than ever have a need for customized care with attention to cultural diversity, certainly in Brussels. Almost all disciplines dealing with diabetes are working within a single new infrastructure. By combining all disciplines within one organisation and infrastructure, multi-disciplinary 'face to face'-discussion becomes possible, expertise is refined and research is optimised.
New technology is constantly emerging, both on a software level and that of medical apparatus. The UZ Brussel also continues to consider that technology must offer tangible improvement for the patient, healthcare and the care provider. Two examples.
Technology in service of the patient
The UZ Brussel took the first ultra-low dose CT-scanner in the world in use in 2011. This was the first in medical imaging to combine an adequate image quality with an extremely low radiation dosage. Until a few years ago, CT-scan imaging was accompanied by the highest radiation dosage in radiology. This was necessary to be able to reach the correct diagnosis. And they always had to try and find a balance between image quality and radiation dosage. Only recently did computers become fast enough to process all patient information. The radiology section at the UZ Brussel has carried out research with the manufacturer of the ultra-low dose CT-scanner on low dose CT-scans. Initially, the low dose scanner was used for children, young adults and pregnant women.
The UZ Brussel developed an electronic aid to discover and react to changes in patients' vital functions faster. Thanks to this software, serious complications can be predicted and treatment can be started on time to avoid this. The use of this software can reduce the number of deaths and complications by at least 10 %. Changes in vital functions are often not noticed or noticed too late, the severity is underestimated or knowledge and experience is lacking to be able to respond sufficiently. When the values of the vital functions are entered by the doctor or nurse in the electronic patient file, the programme automatically calculates a score from 1 to 6. The higher the score, the quicker the care givers have to respond. Thus it is often possible to react even before the patient feels something is wrong. After the early warning score was extensively tested on two nursing wards in 2010, it was taken in use with adults in 2011 throughout the entire hospital.
Quality management and patient safety are recurring threads throughout the UZ Brussel' policy. Both the patient and the care provider must after all be able to spend their time in the hospital in the most secure circumstances with as little room for error as possible.
All hospital employees are either directly or indirectly involved in patient safety. Not only medical and nursing care must take place safely, mistakes could sneak in during the preparation of meals, the administration of medication, lab-analyses, maintenance and use of materials, finalizing the administration, etc., that could lead to (possible) damage. That is why it is important for everyone to report every type of incident. The VIKA (QICR - Questions-Incidents-Complaints-Recommendations) electronic reporting instrument is therefore accessible to everyone and is subdivided in various categories of incidents. In 2011, the existing classification was extended by another 3 types, medication safety, unsafe situations and other incident types (general report form). Every incident is checked by one of the indicated administrators and where necessary, actions are taken to prevent repetition. The extra workload sometimes makes it necessary to expand the number of administrators. In 2011, this was the case for processing aggression reports, in which mostly personnel are involved.
The members of the VIKA-committee are in charge of the system and carry out campaigns to stimulate its use. The more incidents that are reported, the more prevention becomes possible. During the '14-day patient-safety drive' in November 2011, an information program was organised for the fifth time. This activity was supplemented by the 'safety rounds' pilot project. During such a round, policy keepers are inspecting the nursing wards to see whether the existing safety procedures (e.g. wearing identity bands and hand washing) are observed. The application is implemented throughout the hospital and therefore not department-bound. The reactions at the nursing wards were predominantly positive. The safety rounds were given a fixed form in 2012. Nursing wards will be visited twice a year, the other services once a year.
The safe-surgery checklist was also introduced in 2011. Based on a checklist which is available electronically, the anaesthetist, the nurse and the surgeon must explicitly check a number of details before every surgical procedure, like the identity of the patient, the presence of the material and the correct operation.
Information campaigns were also organised in 2011
Blood tracing was also implemented based on the same need for care in 2010. The full process, from order to application is followed electronically within the Clinical Workstation, therefore the risk of mistakes became smaller and possible errors in this procedure are easier to be found. The number of reported incidents was reduced from 92 in 2010 to 20 reports in 2011. This benefit can amongst other be ascribed to the implementation of blood tracing.
Raising awareness on patient safety of both patients and care givers also falls under the denominator 'quality control and patient safety. During the 'Patient safety Week in November 2011, all employees were informed about the importance of patient safety via information stands at the staff canteen, showing a film collage with testimonies by 30 employees on patient safety, followed by a debate and 'After-work drink' under the slogan of patient safety. The earlier mentioned safety rounds also fit in that context. The monthly personnel magazine regularly spends attention on the subject. Patients were also informed about the importance of keeping an eye on their own safety, amongst others by listing clear tips in the revised admission brochure.
In general, the UZ Brussel also stepped up information efforts for patients. The hospital strives to give answers to the informed and critical oriented patients of today via the website, general folders and brochures, and ward and pathology related folders.
Information campaigns were also organised in 2011, like during the 'Dietician's Week' (March) in the policlinic in Dilbeek on 'healthy food and sensible drinking', free screening of students on the risk of cardio-vascular and kidney diseases on 'World kidney day' (10 March), on 'European Heart Failure Awareness Day' (7 May) info sessions, info stands, advice on movement, quitting smoking and stress and free blood pressure, weight and middle measurement evaluation, during the 'Heart Week' (September) information on symptoms, treatment options and how to live after a heart attack and during the 'Premature Birth Week' (November) information on problems with premature births.
Accreditation confirms skills and reliability
The Care paths or clinical paths are just another product the UZ Brussel also implemented to position the patient in the centre of care and to improve the care even further. A care path is a description of the full path a patient with a specific disorder has to follow in the hospital, in other words from the diagnosis through to the treatment, both inside and outside the hospital. A clinical path can ensure that the hospital rely even more efficiently on the family physician and after admission, the family physician can immediately pick up on the hospital message. The IT services at the UZ Brussel have developed software that makes it possible to integrate care paths in the Clinical Workstation. The care paths for heart failure and rectum carcinoma (rectum cancer) were developed in 2011.
Different quality control aspects of the UZ Brussel were awarded external accreditation in 2011. The Centre for Reproductive Care was accredited by the Federal Drugs and Health Products Agency (FAGG) as human tissue bank. The hematopoietic stem cell bank was accredited by the Joint Accreditation Committee-ISCT Europe (JACIE) controlling the standards for stem cell transplants. The Molecular Pathology section and DNA-laboratory of the Centre for Medical Genetics acquired a BELAC-accreditation (BELgian ACcreditation system).
The UZ Brussel has for many years co-operated with many other hospitals and healthcare institutions.
From within the PGD-network (Pre-implantation Genetic Diagnostics), forces were joined with the UZ Leuven and Heilige Hart Hospital in Leuven, the Louvain-La-Neuve University and the AZ Jan Palfijn in Ghent.
As planned in the Radiotherapy association agreement with the ASZ Aalst, the radiotherapy section UZ Brussel - campus Aalst was opened in the ASZ Aalst at the beginning of 2011.
The UZ Brussel also remained active internationally. The satellite clinic of the UZ Brussel Centre for Reproductive Care in the Royal Hayat Hospital in Kuwait was also operating at full swing in 2011.
Co-operation also concerns dealings with educational institutions. For the UZ Brussel as a university hospital - which, apart from Care and Research, also counts Education as one of its three core tasks - this is extremely important. The ties with the Free University Brussels, of which UZ Brussel forms part, and the alliance partner Erasmus College Brussels, were strengthened further in 2011 with the implementation of a working group within nursing. Nursing on campus is a steering group merging the nursing group of the UZ Brussel, the Erasmus College Brussels and the Brussels Free University in a consultation platform. The idea is that a lot more can be achieved together than each on its own. The steering group ensures that the UZ Brussel, the Erasmus College Brussels and the Free University Brussels achieve a better public image together. Prospective students can for instance be informed of education at the University College and the University, and prospective nursing staff can be recruited for a career in the hospital. From this intensive co-operation also followed the development of a new working group on scientific nursing trials and the organisation of monthly seminars. The purpose is to jointly inspire students and staff to carry out research in a nursing environment.
The UZ Brussel is fully tuned to ensure optimal care for the patient. It is therefore important to regularly listen to what they have to say about the healthcare being offered. The UZ Brussel has done this for some years already, amongst others by participating as one of the 10 Flemish hospitals in a 6-monthly questionnaire on patient satisfaction. Numerous indicators were questioned, from an opinion on the hospital in general to sub-sections like accessibility, the room, meals, quietness on the ward and the aftercare.
The UZ Brussel shall in future participate in the Quality Indicator project, an initiative in which almost all Flemish hospitals participate and of which the quality indicators were established in co-operation with the Flemish patient platform.
The Patient Rights Act of October 2012 states that each hospital has to have an independent ombudsman service that a patient can approach in case of a complaint. Although this does not have anything to do with patient satisfaction surveys, it is obvious that complaints can also be an indication of possible points of improvement in the hospital's healthcare. The UZ Brussel ombudsman service is registered with the Flemish Association Ombudsman function of All Care Providers (VVOVAZ). Each year, VVOVAZ prepares a benchmark on voluntary basic.
For 2011 complaints, 28 hospitals participated in the registration. In 2011, it became clear that the UZ Brussel patients found their way to the ombudsman services even easier. The hospital also took steps by publishing information on the ombudsman services on the hospital website, the distribution of folders on patient rights at the info counter and clear signage to the ombudsman services. In total, the ombudsman services treated 1010 files in 2011, of which 561 complaints.
The UZ Brussel shall in future participate in the Quality Indicator project
The other files were mainly questions pertaining to information and advice. 38 % of the complaints were related to the quality of healthcare and medical treatments in particular. In comparison with participating hospitals, the UZ Brussel made progress. The registration system indicated that the average number of complaints related to quality of care during hospitalization, amounted to 57 %. In 2011, patients still too often experienced that they received too little information on the cost of an admission and that their privacy wasn't always respected in the hospital. This will be sorted out.
"2011 was year of major adjustments for me. My new position as head of Orthopaedics and Traumatology is a huge challenge. The departmental organisation, lectures and the personnel aspects in particular, were a new adventure. I now really understand how busy my predecessor, prof. Casteleyn, could be (laughs). At times, it is much worse than I anticipated, but I have a great young team. It is wonderful when employees are able to excel and feel at home in the department. I have always appreciated the challenge of a job in medicine. As a final year student, I spent five months in Zimbabwe. That was a very enriching experience.
The Kariba-district where I worked is half the size of Belgium and therefore it wasn't all that simple to reach the people. Every trip between the clinics turned out to be a safari. There were only three doctors and they had their hands more than full. The challenges were enormous... What I eventually found very difficult was that as a doctor you often do not have the necessary medicines to help the people. That feeling of powerlessness was frustrating. That's why decided against my idea to specialise in tropical diseases. I eventually discovered orthopaedics as a specialisation in the Sint-Pieters hospital.
What I like most is that you can effectively help patients almost instantly. You do an operation and your patient is helped from one moment to the next. This approach creates a special bond. It satisfies. Why do I like working here?... Well, the biggest advantage of the hospital is the openness with which people interact with each other, and that is typical of the VUB. You also see this in the close co-operation on scientific level between the orthopaedics, radiology and anatomy sections. Due to the good working relationship, projects can be started that are often difficult to launch elsewhere. And this can only benefit the patients..."
for the student
As a university hospital, apart from healthcare and education, research is one of the three core tasks. Research is stimulated via the University Medical Centre Research Council (UMCOR), a merger of the scientific research groups of the Brussels Free University and the UZ Brussel.
The number of published scientific articles continues to grow. Between 2005 and 2010, the number of published scientific articles increased from 208 to 423. Upon finalising this annual report, the figures for 2011 were not yet available.
Samuel Bral wrote a doctoral thesis on 'Radiotherapy in non-small cell lung cancer: is the only way up?' and Evy Vandemeulebroucke on 'Preservation of Functional Beta Cell Mass, Assessed by Hyperglycaemic Clamp, in Human Type 1 Diabetes'.
The UZ Brussel successfully conducted a pilot study to treat intestinal cancer in patients who are no longer eligible for an operation or chemotherapy with high precision radiotherapy. As much as half of the patients showed a total or partial reduction of the disease and more than 85 % were still alive a year after treatment. Apart from lung cancer, intestinal cancer is the most important cause of death due to cancer.
The UZ Brussel was the first hospital in Belgium in 2011 to start using xenon-gas as aesthetic in operations. General aesthetic is taxing for everyone. For patients with a markedly impaired left and right ventricular function, this is even worse. A surgical procedure can now be carried out a lot safer for them, thanks to xenon-gas. The gas after all has a specific supportive effect on the blood pressure, and does not have any negative influence on the contraction of the cardiac muscle.
The book 'The Life and Times of Guillaume Dupuytren, 1777-1835', on the talented French hand surgeon, was released in 2010. Prof. Wylock received the 'Prize for the history of medicine, period 2005-2010' from the Royal Academy for Medicine of Belgium for his book in 2011.
Dr. Wendy Werckx of the Paediatric Neurology services received the prize for best presentation of the Belgian Society of Paediatric Neurology this year. She was awarded this prize for her explanation on the follow-up and outcome of children born prematurely.
The purpose of the learning clinic is to maximise the chances of children with learning impairments to succeed and develop. The team was awarded the BNP Paribas Fortis Foundation Award Brussels Region for the mission in 2011. Their project was one of the 3 selected from a list of 100 candidates.
In 2011, the British Medical Association awarded the prestigious Medical Book Award for the publication 'Medical thorascopy/pleuroscopy: manual and atlases'. One of the co-authors of this reference work is delegated director prof. Marc Noppen, also a renowned pneumologist.
The KWS of the UZ Brussel was awarded the 'Stage 6'-label by the Healthcare Information & Management Systems Society (HIMSS). 7 levels (from 'stage 0' through 'stage 7') correspond with the degree of automation within hospitals. 'Stage 6'-hospitals have an almost complete support of the electronic and medical nursing file, both on static and on dynamic level, and functions more or less paperless. The UZ Brussel achieved 'Stage 6' and is thus the only hospital in Belgium.
The UZ Brussel achieved in 2011 for the 3rd year in a row the label 'Top Employer', allocated by the Corporate Research Foundation. This achievement is based on a prior objective survey by a panel of assessors under leadership of the Hay Group.
Receives BNP Paribas Fortis Foundation Award
Education, Care and Research form the three cornerstones of functioning at the UZ Brussel. To be able to perform these core tasks, the hospital works closely with the Faculty of Medicine and Pharmacy of the Brussels Free University (VUB) at the green campus Jette. This co-operation is strengthened further within the University Medical Centre / University Medical Campus (UMC). The healthcare department of the Erasmus University College Brussels (EhB), also forming part of the campus Jette, maintains strong contacts with the UZ Brussel, also in the context of the existing higher education accord between the VUB and EhB within the University Association Brussels (UAB).
The UZ Brussel offers all (para)medic, pharmaceutical and biomedical secondary education at this campus, both general clinical and specialist (doctor-specialist) education, apart from permanent education for specialists, GP's and other paramedic personnel. Offering normal specialist healthcare in all disciplines, a mix between scientific and clinical activities and the development of targeted activities in the narrow co-operation within the University Association Brussels offer the necessary guarantees for the quality of this education. The competency and expertise profile of the instructors and the institution is furthermore guaranteed by their academic embedding.
All (para)medic studies at the campus is aimed more and more at the presentation of context related knowledge units, skills and attitudes, embedded in professional performance. Context bound learning in other words is the key concept.
Working 'the way it is' is taught systematically using both preparatory practical training, taken care of by the UZ Brussel, as practical training in the Skills lab. The Skills lab is a unique collection of technological gadgets and clinical knowledge, supported by the UZ Brussel. The 'Clinical Skills and Simulation Centre' is coordinated and controlled by the department Critical Care, more specifically by the titulars and the instructors of the Medical Skills training components. The official opening in 2011 received a lot of media attention.
The pinnacle of this realistic education can obviously be found in the masters in Medicine internships. These are the most extensive masters in Medicine internships of all medical education in Flanders. It is during these internships that the translation of theory into practice must occur and the skills and approach that a doctor will use his entire life will be acquired. The UZ Brussel offers an essential support in this by presenting internships in all its departments. Reversed, the internships also support the hospital. The recruitment challenge has after all become much less acute in 2011, because many students continue on with a job in the UZ Brussel.
Is a unique collection of technological gadgets and clinical knowledge, supported by the UZ Brussel
All these internships and practical exercises can obviously not take place without intensive supervision from the departments presenting them. This supervision is organised as effectively as possible, with a large emphasis on student directivity.
The learning process is, in co-operation with heads of departments and all involved supervisors, formalized by the development of summaries of knowledge and skills that a basic doctor should have at the end of his/her study and practical training. The supervision is also constantly updated.
On the level of training of the teachers, the FUB gives its members who are involved in teaching activities, the opportunity to follow various trainings and educational programmes at the Campus of Jette, organised by the Quality Control and Education Innovation cell. Newly appointed lecturers and assistants are expected to participate in a course in professional education.
In this course emerging instructors are confronted with a critical analysis of their own educational skills. Both forms of quality control were greatly appreciated by the visitation doctors training in Flanders. This led to an extremely good evaluation of the internship.
The most extensive masters in Medicine internships of all medical education in Flanders
Besides the courses of the Masters in Medicine in the UZ Brussel, we also provide the education for the medical specialists in training. The Master after Master (ManaMa) programme in specialist medicine was established in the academic year 2009-2010, within the Flemish University and in close co-operation with the professional field. During this education the doctor-specialist acquires generic and specific competence levels, characteristic for the actual scope in which he/she will engage in his/her career.
The CanMeds role models (role models based on the professional skills of the doctor-specialist) are used as a reference guide for this education. Within the Flemish Inter-University Council the university internship masters of the UZ Brussel contribute to determining the final competences in the various specialisations and the operationalisation of the educational programme.
The UZ Brussel offers a range of specialisations sure to cover all disciplines and sub-disciplines of Specialist Medicine. The university internship supervisors are ZAP members (academics) of the Free University of Brussels (full-time or part-time) and are nationally and internationally accredited specialists in their fields. They were, apart from their educational qualities, selected based on their research file and their professional specialism in the area of patient care.
The UZ Brussel and the medical studies of the Faculty of Medicine and Pharmacy of the FUB complement one another nicely.
"The most important fact from 2011? Personally I believe it was the success of the autologous dendritic cell therapy. Developed for patients with a progressive melanoma. Of the 15 patients that we treated in the first study, five people have been better for more than a year now. Without any further treatment. This research trial follows 10 years of development of dendritic cell therapy and the future offers us an attractive perspective. Once the RIZIV has undersigned the agreement with the UZ Brussel we will receive financial intervention for our patients. Allowing us to operate on a greater scale.
If the results of this body cell therapy are confirmed we can make the difference between life and death for many people. Along with prof. dr. Kris Thielemans we manage the dendritic cell bank here in the UZ Brussel. This forms the basis for the development of the therapy. This also means that the trial itself cannot be moved from the FUB, where I also followed my education.
I specifically ended up in oncology due to a prospective mandate of the Fund for Scientific Research in Flanders. During my secondary school studies I was interested in genetic and molecular classes. The step towards higher education in medicine was therefore not such a big one. There I also found the human aspect of my studies important. You really study to be able to help people.
The last two years of the training to become physician I did not really know which way I wanted to go. Until I saw the proposal to combine the studies for internist with four years of scientific research into the molecular background of cancer thanks to a scholarship from "Kom op tegen kanker" via the FWO Flanders. This was extended for the last ten years in the clinical research into cell-therapy for melanoma. The result is this very promising cancer treatment."
for the employee
Employees are the key to the ambitions and actualisations of the UZ Brussel.
In 2011 the hospital had a total of 3,345 employees, mostly woman. 44,16 % of the personnel of the UZ Brussel works on a part-time basis. The nurses make up the largest group, at almost 41 %. Not surprising for a hospital after all.
The Human Resources department is available to all hospital employees, this goes without saying. The HR department should therefore also have the right people in the right place for the various service aspects. Motivation, support and a personal approach are important aspects of this. But how can a team of 24 personally assist 3,345 persons? Apart from the HR service centre which concentrates on the individual employee, the concept of HR business partners was further developed in 2011 for this goal. They advise, mediate and form a unique consultation point. Their task is specifically directed at assisting the Heads of Department with their people-task: recruiting new employees, coaching their teams, solving organisational issues. In the Centre for Reproductive Medicine for example, the business partners guided the acquisition of employees in Abu Dabi in 2011, in the pharmacy they gave advice on the new internal organisational structure. Reversed, the department heads can also turn to their business partners with questions and problems.
The HR business partners approach symbolises where the department would like to go in future. By thoroughly analysing every department, every issue, the problem of bottleneck jobs can for instance be addressed more effectively. It is a shortage which every hospital has been faced with in the recent past. In order to give you an idea: The Flemish Department for Recruitment and Vocational Training recorded 8,921 open vacancies for nurses at the end of 2011. Because of this it is important to approach and select people personally. The UZ Brussel has been very successful here, the through-flow from internship to employment has been very successful.
But in order to convince people to apply for a job at the UZ Brussel, one has to reach them first. Communication is an important way of introducing the hospital and employees to the outside world. Who are we? What are our trumps? What is unique about our culture? The past six years the relationship with the media has grown strongly. Efforts are made to uphold an open policy to the world beyond the hospital. The intensive media politics is one example of this. The magazines published by the communication department (the three monthly magazine Muze for general practitioners and the monthly magazine for employees) are another example of the transparency that the UZ Brussel is striving for.
Naturally this involves recruiting new employees. A lot of attention is paid to the active employee population. In a hospital it is essential that the best people do their jobs with a passion. This is even more important with supervising employees. This is also why an evaluation procedure was introduced for the medical Heads of Department. Heads of Department have a mandate of five years. After these five years, a round-up is made with, amongst others, the input of colleagues about their supervisory capabilities and actualisations and such. The purpose of this is to assist people in developing their task as supervisor further and to guide them where necessary.
The Human Resources department insures a personal approach for every employee
Let's zoom in on the personnel services itself. Has anything changed internally? Yes, quite a bit actually. A new system is being introduced that makes personnel management a little more detailed. The department is also getting a new look and an open working environment. There is a central reception, supplemented with multiple discrete work spaces for in depth and more discrete discussions. It fits in the service-ambition that the department introduced in 2010. Another example of the 'open door' with Human Resources, is the introduction of 'Top desk', an electronic question and reply bank for quick and correct service. With this system, individual questions by personnel can be answered better and faster, 24 hours a day.
Even more is being done to offer the employee a proper working environment.
Doctors in training received a legal framework which better describes their performances, working and on-call hours in 2011. A protocol was drafted on this in co-operation with the doctors and will be followed up further.
A reformation of the additional pension plan was drafted, commencing on the first of January 2012, in discussion with the social partners. This implies especially that new employees be included in a new additional plan.
Education is an important point in a dynamic healthcare environment. Employees receive many training opportunities, both to optimise their performance as well as for personal development. The VTO policy (Formation, Training and Education) received a boost in 2011 with amongst other an extended and diverse range of educational opportunities.
An active training policy is encouraged even more intensely throughout the entire hospital. An example: Quality at the counter, French, English and Team coaching trainings were organised at the patient administration department.
2011 introduced the further exchange of the on-call service with the heads of department of various departments. The following heads of department were appointed in 2011: prof. dr. Herman Tournaye (Centre for Reproductive Medicine), prof. dr. Anne Hoorens (Anatomic-Pathology), prof. dr. Dirk Michielsen (Urology), prof. dr. Thierry Scheerlinck (Orthopaedics), prof. dr. Maurice Mommaerts (Mouth, Jaw and Facial surgery), prof. dr. Marc Soens (Rehabilitation and Physical Medicine) and prof. dr. Moustapha Hamdi (Plastic Surgery).
"2011 was special for me as this was the year that I started living on my own. It has taken some adapting to get used to being independent. In my job I do many different things. I bring patients from their rooms to the various examinations. I am sometimes also responsible for the dispatch of transport and regularly spend time in the mortuary. The latter is less scary than it sounds (laughs). I have been working for the hospital for 4 years, I came here on my mother's advice.
She is a logistics employee. I did not consider this job at first, to be honest, but I have to say I enjoy it. Like many other young men, I would have like to become a professional soccer player, but unfortunately I had too many problems with my knee. Or a job in the construction sector, I would have liked that as well. When I say that I work in a mortuary most people form a picture in their minds. It is mostly paper work actually (laughs). Sometimes I have to prepare a body so that people can say their final goodbyes. But it is really not as creepy as it appears."
for the future
Under the denominator 'Building bridges' we have seen how the hospital is contributing to the future via the Spatial Plan that should lead to a completely renovated hospital in 2021.
The future is also being prepared by many, not always large scale, but nevertheless essential amendments and improvements: From spatial expansions in Nephrology and Gastro - Enterology to the completion of the new andrology lab and the clean room for semen treatments in the Centre for Reproductive Healthcare.
The revised policlinic was officially opened in 2011. Not only was the facade renovated and refreshed, the entrance to the policlinic was made more patient-friendly and the environment more pleasant. Various kiosks were placed for patients where one can log in using the e-id, so that one no longer has to pass the counter.
The pre-admission activity was separated into an administrative pre-admission, integrated into the KIO function (Counter Registration Admission) and a pre-hospitalization function with a greater patient focus, conducted by nursing staff. The methodology used (kiosks, reception on the work floor, etc.) is a model for the method of works which will be further developed and standardised in the future. We started using colonoscopy rooms (internal bowel examination). A reception for non-urgent patient transport was also developed, which leads to a great de-stressing for the emergency services department and a considerable improvement of the service to patients.
In 2011 we also started with the construction of the new nursing and emergency services wing. Apart from additional space to house beds and an extension and renovation of the emergency services department, the building will also contain the accounting department and the sleep clinic.
A renovated and updated policlinic
A hospital should also strive to become more and more environmentally friendly and energy efficient. Because of this UZ Brussel started drafting an energy management plan in 2011. Several routes will be examined in order to use energy as responsibly as possible and a series of possible investments projects with positive effect on energy consumption will be investigated.
In April the Hospital received a new permit from the Brussels Institute for Environmental Management. Hereby the hospital is bound to uphold the environmental standards, such as the standards regarding sound and pollution. The responsibility area of the environmental department was extended during the year with 'green management', 'waste water' and 'mobility''.
The staff services Infrastructure Equipment consists of 3 activities: Staff room management, Environment - Waste - Mobility (MAM) Department and hospital signage. The environment section is headed by the environment co-ordinator, assisted by 3 environment operators who are responsible for amongst other removal of specific waste flows at the departments. Thanks to revised arrangements and modified procedures the share of 'recycled waste' could be increased to 18.4 %.
The hospital has been pleading for a long time for more support with mobility. It supports the future installation of the tram 9 line, obviously for as far as the line is effective for the hospital. In anticipation of more government support the hospital has drafted its own company transport plan.
It is important that employees are stimulated to carpool, cycle or use public transport via various forms of compensation. This stimulation to use environmentally friendly transport also falls in with the company transport plan that the hospital introduced in 2011.
The hospital is working on an energy management plan
The UZ Brussel has since become a loyal participant in the Brussels Week of Transport. On the 22nd of September 2011, in this context, the hospital offered free breakfast to all staff members who did not come to work by car.
In the last year the staff service room management has tried to make management more efficient. A stocktaking of conference facilities was made which can be viewed via the intranet. This makes the search for and reservation of conference facilities much simpler. A project was also started to analyse the degree of occupancy of the consultation booths. This way these can also be used more efficiently. Another project was the start-up of a Local ID system whereby everyone received a unique local number to amplify internal communication. Later this will also play a deciding role within the new ERP system. These projects will be continued in 2012.
Agreements were also made between the logistics department (responsible for internal signage), prevention department (responsible for safety signage) and the facilitating department (responsible for external signage) in 2011 to start a new comprehensive project to improve hospital signage.
In 2011 UZ Brussel continued working on professionalizing project working and the efficiency of daily functioning (project Nexus). Last year the focus was on the introduction of the Lean-principles on the work floor. The Lean method comes from the industry and represents 'working smarter'. The objective is to increase the value of the performances for the patient, the employee and the organization via continuous (minor) improvements. The following is essential: It no longer concerns the activity, but rather working differently and thereby getting more done.
Working differently and thereby getting more done
On the one hand personnel learnt more on these principles via the Nexus trainings. On the other hand the 5 principles were implemented in two pilot departments - the dispensary and nursing unit EH52 (Orthopaedics and Traumatology) - to test and analyse the efficiency.
Clean desk was introduced at the dispensary department for reception and administration. This is exactly as it sounds. A desk without paper files (replaced by computer memory) and therefore a relaxed, arranged work space. Further, a more logical system is being used for storing and readying of medication so that employees can quickly retrieve their medicines at the distribution zone. This should improve the service towards the patient and internal client.
Nursing unit EH52 - orthopaedics - suffers from an extremely high work pressure. Because of this the team went in search of wastage in the current organization of the department. This concerns wastage of work space, materials, time and persons. Several simple measures were imported, such as labelling carts and material storage units so that one did not have to open every drawer to find the correct material. The admission and discharge checklist was also markedly cut back and simplified. Measures were also taken in the medication zone to simplify selecting the correct medicine and to limit errors as much as possible. An improvement board was placed on which all department employees could suggest points of improvement and possible solutions. This way everyone contributes to the more efficient functioning of the department.
ICT is becoming an ever more important instrument in the health sector for every medical user. The information systems department therefore continuously strives towards having a positive impact on the efficiency, quality and information supply for every employee, by introducing intelligent systems (such as decision supporting systems, electronic order sets, healthcare routes, etc.) and by adapting to the needs of the patient and care provider.
What if a smart computer programme can make doctors aware of several daily healthcare tasks to be performed? IT successfully developed this in 2011 with the further introduction and extension of the Medical Organizer. And what if nurses could manage patient's time schedules on the screens in the departments? IT also took care of this with the so-called dynamic screens, which offer the possibility to adjust requests of medical examinations live at the department.
In 2011 Our Clinical Workstation (KWS) of the Healthcare & Management Systems Society was allocated a 'stage 6'-label. HIMSS developed a model for IT evaluation within hospitals.
This consists of 7 levels: From 'stage 0' through 'stage 7'. They correspond with the degree of automation within the hospitals. There is a direct link with the quality of healthcare. 'Stage 6'-hospitals have an almost complete support of the electronic and medical nursing file, both on static and dynamic level, and functions almost completely paperless. UZ Brussel is the only hospital in Belgium with the 'Stage 6' label. On European level there are a number of hospitals with stage 6 accreditation: Les Hôpitaux Universitaires de Genève, Universitätsklinikum Hamburg-Eppendorf, Badalona Serveis Assistencials (Barcelona).
The KWS manages the information flows of the core procedures of a hospital, namely those where the patient is central and is examined, treated and taken care of by a beehive of doctors (both within and outside of the hospital), nurses, paramedics and technicians. Only with proper orchestration can some rest be introduced into something that could very quickly turn ugly. Kws sets the score; managers at all levels provide us with the pace; people on the work floor play their allocated notes. Eventually this translates into patients who heal quicker and feel safer when they have to return the following time.
The ICT domain expert of the KWS, in close cooperation with a selection from the masses on the work floor, keep the information streams flowing smoothly despite:
Kws and the organization around KWS have provided a solution to each of these challenges. Successfully, both in the area of the use and penetration in the organization, the effect on the quality of care, the re-earning effect based on measurable parameters and the enthusiasm with which the applications and partial applications are appropriated.
Electronic Nursing file optimises information exchange
Another important IT-project is the Electronic Nursing File (EVD). The EVD was introduced further to all hospital departments, maternity and the emergency services department in 2011. The patient file must guarantee the continuity of the best healthcare and hereby the quality. This file contains the tasks that nursing staff should fulfil for a patient. This way specific material and medication can be entered in the file. This list can be update online, meaning that it is easy to follow what has been done. Also, doctors can view the EVD from the EMD (Electronic Medical File) and reversed. This way the status of a patient can be shared within a healthcare department. The EVD transcends departments. Crucial patient information with internal transfer remains visualized and no important details are lost. This is rather unique in the world of electronic patient files.
Because there are no more actual paper files due to the digitizing of the nursing file, the briefing rooms of all nursing departments are equipped with a beamer projection screen and wireless keyboard. With more transparency everyone can be followed more easily and there is maximum efficiency
Every nursing unit furthermore has multiple mobile computers on which the nursing staff can constantly share information. This guarantees a correct exchange of information and also allows reports to be consulted interactively.
|Operating results / Operating income||-0,2%||+1,3%||+0,8%||+1,6%||+1,0%|
|Results of the financial year||6,2||-14,0||6,5||2,9||2,8|
Based on this the financial situation of the UZ Brussel remained stable in 2011; just as the year before. This remains striking in a society that is threatened with one financial crisis after another. The hospital ended 2011 with a profit of 2.7 million euro. This is 200,000 euro more than in 2010.
In 2011 the operating results amounted to 3.5 million euro or 1 % of the operating income. This is a decline compared to the previous year when the result was 5.5 million euro.
The total proceeds increased by 4.7 % and reached an amount of 352.9 million euro, with regard to the 337.1 million euro of 2010. In 2011 a cash flow of 30.2 million euro was confirmed, compared to an investment of 25.2 million euro.
Because the financial policy remains cautious the hospital has been able to extend its reserves with almost 3 million euro, which comes to a total of 174.4 million euro.
Contrary to the previous year, the investments in 2011 again increased by 18.9 %, or from 21.2 to 25.2 million euro. The largest part of this will again go towards 'medical investments' (40.5 %), followed by 'major Service' (26.9 %) and - not surprising with the planned Innovations - 'buildings' (15.7 %).
Considering the huge pressure on the available finances, an important step was taken in 2011 towards a more professional course of action of the fund-raising by entering into an agreement with the specialized fund raisers of Emolife.
the world lights
Nobody can predict the future. Nobody knows what direction society, the government, the economic crisis, the world will take either. What we do know is who and what we are. What we stand for and where we can make a difference, how we could best approach the insecurities of the future.
2012 will be the year where we will set out new landmarks. Starting from our individuality and our qualities, and those of our Faculty, we plan for sustainable anchoring and evolution of the University Hospital.
The UZ Brussel represents a clear mission, vision, and values. Presenting high quality and at the same time accessible healthcare of solid medical and paramedic education, and innovative scientific research. We find unity in our unique mix of regional specialist healthcare and services. And also in our tertiary referral services with international appearance. And even in our unique position as Dutch (speaking) hospital in Flanders, Brussels, Belgian and International Brussels. But especially in our culture, the heritage of the liberal ideas of our Alma Mater, the Brussels Free University: active humanism, pluralism, respect and tolerance.
Starting from here, in 2012 you will see the opening of a new strategic plan, the realisation of the University Medical Centre (the increased strategic and operational cooperation between the hospital and Faculty of Medicine and Pharmacy) and Campus; continued rollout of the (re) construction, adjusting our internal operations and organization, the powerful and formal rollout of a quality culture, the development of regional, national and international networking in healthcare and academic activities, stimulating valorisation and other alternative financing resources, are only some of the 'great' strategic lines.
This will undoubtedly lead to large and many smaller concrete realizations, which will appear in the annual report of 2012. They will determine the 'global' result of the hospital and will again be realized by our people!
Just the latter makes us optimistic, more so than the 'moral duty' of Karl Popper.
Together we look forward to the future.
In the University Hospital in Brussels the patient always comes first. With respect for the patient as a person, irrespective of origin, language, social status or philosophic conviction and with respect for their right to independence.
The University Hospital of Brussels at regional, national and international level aims at a total package of accredited healthcare services of the highest quality which entails both basic medicine and technology which is accessible to everyone.
As university Hospital the University Hospital of Brussels is a teaching hospital and it also organises scientific research. It endorses the core values of the Free University of Brussels, which it forms part of: The principle of 'free research' and the principle of 'democratic decision making'. The hospital collaborates closely with the Faculty of Medicine and Pharmacy and other faculties.
The Dutch (speaking) University Hospital of Brussels would like a driven and innovative working community that works based on open humanistic ethics and active pluralism. It respects the welfare of its employees within an independent and financially healthy organization.
President - B. Van Camp
Rector of the Brussels Free University - P. De Knop
President of the Brussels Free University - E. Van Gelder
Representatives appointed by the Board of Directors – Brussels Free University
Doctors appointed by the Medical Council
Non-doctors appointed by the employee's delegation of the works council
M. De Rudder
M. Van Humbeek
Invited counsellors in support of the policy
Secretary of the Council
Chief Executive Officer
Rudi Van de Velde
Director of Human Resources and Communication
Director Department of Nursing and Midwifery
The UZ Brussel always welcomes new personnel, such as nursing officers, laboratory personnel, maintenance personnel and IT specialists.
Contact the HR department of the hospitalt today or go to www.werkeninhetuzbrussel.be
We try to surround you with the best care and the latest techniques every day, because you are worth it!
You can help us with this: www.vriendvoorhetleven.be
This annual report is a development of the Communication Department of the UZ Brussel:
Editorial coordination and editorial staff:
Edgard Eeckman en Eva De Vriese
The following persons made an editorial contribution to this annual report:
Melissa Buelens, Paul Ceulemans, Marc De Beukeleer, Petra Jacobs, Marc Noppen, Ben Van Camp
The photos are amongst others of Jerry De Brie, Edgard Eeckman en Lander Loeckx
The design and development is by www.megaluna.be