Our vision is… To become a GREAT children’s hospital… Providing excellent health care for children, irrespective of their financial situation and in particular for children with disabilities or impairments and little financial resources. To become a specialist in complex pediatric medicine.

As a GREAT children’s hospital we will have

• Outstanding quality and safety of care;
• State of the art facilities and equipment
• Well trained, talented, respected and valued Peruvian staff
• Excellent patient and family-centered care
• Excellent secondary services

And a culture of:

• Evidence-based practice
• High performance
• Continuous learning and quality improvement
• Accountability
• Effective management and strong organizational systems

We will be… A strong, united and focused organization

TMR Medical Care for children from different income groups

The objective of PAZ Holandesa by means of the TMR hospital is to provide great care for all children, irrespective their family income. PAZ’s strategy to achieve this goal is to finance care for children from poor families with the earnings from care provided to children from the middle and upper class families (with or without private health insurances). This means that PAZ will offer subsidized care to children from the lower class that will be cost-covering and within the means of the lower incomes. In view of the fact that there are more people representing the lower class economic categories than the middle and upper class categories, PAZ has to safeguard long-term financial sustainability.Therefore, during the first three years of its existence the TMR hospital will offer free care in organized campaigns with fixed budgets for the children representing the D and E categories.In order to be albe to attend more children from these categories -beyond the mentioned campaigns and without charging them for medical care- PAZ will try to come to an agreement with the Ministry of Health and partialy finance this service by recovering basic costs via the SIS insurance. At the moment of writing of this plan, this agreement is in negotiation

In the first years of its existence, PAZ will depend on financial input from donors. As the activity of the TMR hospital will expand and TMR will also get renowned for its services among people from the higher and middle class incomes, we expect that more paying patients will come to the hospital (and more patients with private insurances) and that the dependency on foreign funding will gradually become less. It is expected that after 10 years, PAZ will be able to completely finance the social programs of the hospitals with its own funds.

Because the category C is better represented in the society (29%) than the categories A and B (14,3%) it can be expected that around 67% of paying people will pay the subsidized prices and only 33% the commercial prices. .

Concepts of “great care”

The TMR hospital strives to offer excellent medical services for all children regardless their background or the financial status of their family and aims to improve health care for children in general. The TMR hospital will distinguish itself from other hospital services in the area by means of the following:
Impartiality: All children receive the best medical care possible, irrespective of family income or background. The TMR hospital does not distinguish between private and subsidized medical care and does not allow health care staff to refer patients to their private clinics if treatment can be offered within the TMR services (control is made possible through hospital software). Health care professionals work on contract basis (instead of the for private clinics regular system in which the professional and the clinic both get 50% of the paid amount) and economic background is not visible to them in the software system. Payments can only be done at the counter.

Care Coordination: All hospital admissions and consultations that require multidisciplinary care are discussed in multidisciplinary meetings involving all staff to whom the case concerns. Together they propose he best medical treatment taking into account all different professional viewpoints. This treatment plan is discussed with the patient’s family. After agreement has been achieved, the treatment is started and monitored by the multidisciplinary team. The child’s home environment will be taken into account when the treatment and follow up care is decided upon.
Respect for Children and Children’s Rights: PAZ considers it important to take the child’s opinion seriously and involve the child in his or her treatment. Parents have to decide on treatment plans for children under the age of 12. PAZ applies the following policy concerning children from 12 to 16 years of age: both parents and the child need to agree on the treatment plan. The treatment cannot be started if one of the persons involved refuses his or her consent. It is the role of the medical practitioner to pursue agreement. If the child wants the treatment and the parents don’t, the practitioner will evaluate if the procedure can be delayed without any harm to the child until the child becomes 16 years old and can decide for his/herself. If the parents want a treatment and the child doesn’t, the treatment cannot be started either. The medical practitioner will –if possible- propose an alternative treatment with which the child and parents may agree. Otherwise the medical practitioner has to evaluate the consequences of suspension and take a decision whether treatment is imperative. If no serious harm is caused by delaying the treatment, it will be put on hold. The child’s interest is always priority.

Family support services. These include accommodation facilities for members of the child’s family from remote areas; a social worker, psychological support for parents; parent’s information sheets on specific health conditions; support for interest groups (for example interest group for spina bifida patients).

Involve family and patients in rehabilitation. Recovery is not only the responsibility of the health workers, it also involves the caretakers of the child and in some cases the child itself. PAZ will motivate parents to work with their children on rehabilitation in order to achieve a quick recovery and the best results possible. The TMR hospital recognizes the limitations of hospital-based clinical services and will take care that rehabilitation fits in daily life and the child’s home environment.

Prevention programs. PAZ will provide (future) parents information on the prevention of congenital birth defects and in particular cases PAZ will supply micronutrients (for example acid folic). Vaccination programs are the responsibility of the Ministry of Health.

Evidence based practice. PAZ has build a collection of concise and easy-to-use clinical guidelines for care combined with the best available evidence. The guidelines follow the latest developments in clinical medicine and bring evidence into practice. Both diagnosis and treatment are included. The guidelines reflect real clinical experience.

Working towards a full spectrum of pediatric disciplines, becoming a specialist in complex pediatric care. Based on results, PAZ will gradually expand its medical services, both on inpatient and ambulatory basis. PAZ will be restrained by the pediatric specialists available, yet will encourage young professionals to take interest in pediatric subjects and encourage experienced professionals to update themselves in their fields of interest. In addition, in the first three years of the TMR hospital, within some pediatric disciplines the offered treatments will also be limited, depending on the experience of the physicians and available medical equipment. Taking its own experience as a basis, PAZ will gradually implement the following specializations in the coming three years:

- General children’s surgery, including laparoscopy;
- Orthopedic surgery (Clubfoot correction, Osteotomies, Tendon lengthening, Arthrodesis)
- Reconstructive Plastic Surgery (cleft lip and/or plate, burn marks)
- ENT specialist;
- Urology
- Neurology
- General children’s medicine
- Ophthalmologist.

Pre and post operative therapy. Whenever required, the TMR hospital will supply pre and post operative therapy as agreed upon in the multidisciplinary sessions. TMR offers the following services:
Psychology
Speech therapy
Dental care
Physiotherapy
Social Worker

Training in post operative therapy. Distance often impedes children from remote areas to assist at their regular post operative therapy. Therefore, the TMR hospital will offer traineeships for young professionals from other departments in psychology, speech therapy, dental care and physiotherapy. Once training is accomplished satisfactorily, PAZ will hire the services of these young professionals to attend children from other departments for post surgery therapy in the “free of charge campaigns”.

Preventive treatments and (corrective) surgery. In “free of charge” programs, PAZ will offer surgery for children who otherwise won’t have access to the treatments they need. In particular PAZ will offer corrective plastic surgery for disabled or impaired children or children who may become disabled due to the effects of for example burn marks. Once a neurosurgeon can be contracted, PAZ will also help children hydrocephalus by placing drains.

Modern equipment. The TMR hospital acquired modern equipment in order to provide patient-safe and clean surgery. Contemporary operation rooms are devoid of a theater setting. The operating rooms are spacious, easy to clean, well-lit and have typically overhead surgical lights, viewing screens and monitors. The rooms have a controlled temperature and humidity environment. Special handlers filter the air and keep rooms slightly pressurized in relation to the outside.

Software Program to control all hospital processes. An all-inclusive software program is indispensable for efficient hospital management. It will enhance patient care and make the implementation of fluid processes possible. With such a system, digital clinical records can be managed confidentially. It also will allow hospital administrators to significantly improve the operational control and thus streamline operations. It can make referral practices to private practices visible and hence prevention of this undesirable practice possible. It will increase the profitability of the organization because costs on personnel can be cut since for example stocks are automatically updated (and visible for the medical practitioners). At the moment of this writing, PAZ is looking for possibilities to finance such a system.

Planning. Unlike state-run hospitals, patients can plan their medical treatment by making appointments (via telephone).This is especially important for children from remote rural areas. The TMR hospital strives to prevent the appearance of waiting lists and will make every effort to attend patients on the scheduled time.

Efficiency. Whenever possible, patients are cured in day treatment. Only more complex cases and cases that require observation will have a multi-day stay. The clinical guidelines are adapted to these concepts. PAZ has acquired modern medical equipment, such as for example laparoscopic surgery equipment, to make this objective achievable.

Secondary services. The TMR hospital will offer secondary services, such as laboratory, imaging (X-ray, echoscopes), pharmacy and catering with the highest quality possible.

Well trained professionals. PAZ’s staff will attend congresses and symposia in their field of interest. Via Telemedicine TMR physicians can get medical advice from the Sophia’s Children Hospital of the Erasmus Hospital in Rotterdam, the Netherlands. On specific subjects of interest, lectures will be organized via Telemedicine between both hospitals. Students may participate in these sessions.

Carefulness and Respect. All medical data will be treated confidentially. All people will be treated with respect, including respect for culture and beliefs.

Traineeships for interns. PAZ will offer traineeships for young professionals and hence contribute to the formation of well trained professionals, especially in pediatric fields.