Journal of Hospital & Medical Management

Introduction

The establishment of a new private hospital in Sarajevo, Bosnia, is set to enhance healthcare services amidst the region's socio-economic evolution and historical challenges [1,2]. With Bosnia and Herzegovina's healthcare system fragmented postwar into three distinct entities, inefficiencies, corruption and resource constraints have led to widespread public dissatisfaction [3]. These circumstances present a critical opportunity for private hospitals to fill existing gaps in healthcare provision by leveraging modern technologies and practices [4].

This study explores the design and implementation of a hospital model centered on three major pillars: quality control, cost control and superior patient service. Central to this initiative is the strategic collaboration with the Medical University of Vienna International [5,6]. This partnership not only facilitates the transfer of expertise and fosters professional development for medical staff but also plays a pivotal role in overcoming challenges related to licensing and staffing [7]. Furthermore, the ASA Institute, focused on research and innovation, transforms the facility into a hub for medical excellence. This environment serves as an attractive proposition for expatriate Bosnian doctors to return and contribute to the advancement of their home country's healthcare system [8].

By emphasizing rigorous quality control processes grounded in clinical governance and state-of-the-art technology, the hospital ensures continuous monitoring and improvement of treatment protocols [9,10]. Innovative cost-control strategies are employed to optimize resource allocation without compromising the quality of care, while patient service is prioritized through personalized care experiences that address individual needs with empathy and transparency [11].

International partnerships play a vital role in introducing innovative healthcare models and enhancing operational efficiency and effectiveness [12]. Scholars have noted that such collaborations can elevate educational standards and management practices, significantly contributing to mitigating systemic inefficiencies within the Bosnian healthcare system [13]. This approach aims not only to enhance public satisfaction but also to establish a benchmark for sustainable and efficient healthcare delivery throughout the region [14].

Through this comprehensive framework, the new hospital in Sarajevo aims to address existing healthcare challenges while fostering a new paradigm of excellence and innovation in the Balkan region.

Major Challengesz

Firstly, quality control processes

Our approach to creating a comprehensive set of standards delves into numerous dimensions, encompassing legal, ethical, clinical and operational considerations [15]. The purpose is to cultivate an environment that supports the highest quality of patient care, prioritizing safety and satisfaction while promoting an efficient and cohesive atmosphere for all healthcare providers.

Our new private general hospital, drawing on an esteemed lineage and advanced research methodologies, is committed to delivering exemplary healthcare standards through rigorous quality control processes.

By integrating evidence-based practices, interdisciplinary collaboration and ongoing professional development, the hospital ensures the delivery of superior patient care rooted in a tradition of excellence and innovation. In the dynamic healthcare landscape, adaptive strategies are essential to maintaining highquality care; our hospital addresses this need by embodying the academic and research-centered principles, outlining quality control processes that underpin its commitment to healthcare excellence. Central to this approach is interdisciplinary teamwork, where a collaborative model integrates the expertise of physicians, nurses and allied health professionals, thereby improving patient outcomes and fostering a cooperative culture.

Additionally, the hospital prioritizes transparency in managing medical errors while safeguarding patient rights and confidentiality, facilitating trust and continuous improvement in care delivery. Our hospital's evidence-based practice draws from World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and Joint Commission International (JCI) standards to establish protocols supported by contemporary research for developing practices that enhance patient safety and treatment efficacy.

The hospital is actively involved in comprehensive training and knowledge transfer initiatives, collaborating closely with the university to align healthcare providers with the latest advancements. Leading doctors and medical specialists at our hospital have counterparts at the Medical University of Vienna, serving as corresponding medical partners who exchange knowledge and experience. This counterpart program and collaboration has led to advancements in areas such as ENT cochlear implant surgery and fetal MRI diagnostics, ensuring that our practitioners acquire cutting-edge skills directly from experts in Vienna.

To optimize care quality, the hospital integrates feedback mechanisms and performance metrics, along with technological advancements such as electronic health records and telemedicine, enhancing operational efficiency and patient service.

Table 1 illustrates an example of the clinical quality metrics and operations dashboard used for the continuous monitoring of inpatients in general surgery and internal medicine. The purpose of this dashboard is to enable real-time monitoring and improvement of clinical quality metrics and operational performance.

Table 1: Example of the Clinical Quality Metrics & Operations Dashboard [16].

Committed to quality improvement and patient engagement, our hospital consistently evolves strategies to adapt to new challenges and innovations. Compliance with local, national and European regulatory standards, including Bosnian and Kanton Sarajevo licensing requirements, ensures the legal and professional integrity of its services.

Our new private general hospital in Sarajevo exemplifies how the integration of the Medical University of Vienna's researchoriented culture with global standards fosters an outstanding healthcare model, successfully navigating modern healthcare complexities and advancing towards excellence in service provision.

Secondly, exceptional patient service

Our hospital is dedicated to delivering exceptional patient service through a comprehensive framework emphasizing holistic patient-centered practices, patient safety and ethics, professional conduct and continuous education. Central to this approach is the incorporation of shared decision-making practices, where patients are actively involved in their treatment plans, ensuring a more tailored and satisfactory healthcare experience. The patient and family education committee, empowers patients by enhancing their understanding of health conditions and treatments, affirming their role in healthcare decisions. Anchored in evidence-based protocols, care is customized to individual patient needs, leading to improved health outcomes within a patient-focused healthcare environment.

Exceptional patient service in our healthcare facility is anchored by our innovative "patient navigator" program, which functions similarly to a 'medical butler service.' This program not only streamlines patient interactions through an online call service that coordinates appointments with the appropriate doctor, minimizing waiting times and enhancing overall efficiency, but also ensures individualized care by having patient navigators welcome each patient upon entering the hospital. These navigators guide patients throughout their visit, attending to their questions and needs with personalized attention. Such an approach guarantees that only emergency and walk-in patients are processed through the emergency room, while others smoothly transitioned into their scheduled appointments. This seamless integration of care continues as healthcare professionals personally introduce themselves and their roles in patient rooms, conveying a genuine willingness to listen and respond to their concerns. By taking the time to sit beside the patient, clinicians convey a readiness to listen and respond to their concerns, underscoring a commitment to attentive, personalized care. When concluding visits, staff exit courteously, offering clear explanations of future steps or timing for followups - keeping patients well-informed and reassured during their journey.

Patient safety and ethics are prioritized through a robust credentialing and privileging process for our healthcare professionals and a thorough informed consent policy that underscores patient autonomy. Ensuring confidentiality and privacy, ASA Hospital Sarajevo follows stringent data protection measures, aligning with guidelines to uphold ethical standards and safeguard patient rights.

Professional conduct is underscored by a code of ethics that sets clear expectations for staff behavior and training in cultural competence to address the diverse needs of Bosnia's population, fostering trust and improving patient outcomes. Continuous medical education is highlighted through ongoing training and initiatives like the "Vienna Lectures" which provide continuous professional development, to maintain high standards of care and address evolving healthcare needs.

In summary, the ASA Hospital Sarajevo's commitment to rigorous medical standards ensures high-quality care delivery. By embracing continuous evaluation and adaptation of these standards, the hospital remains responsive to the dynamic nature of healthcare, ultimately securing community trust and fostering the growth and development of its medical staff.

Thirdly, innovative cost-control strategies without compromising care quality

Our new hospital achieves a remarkable reduction in overall energy costs approximately 30% by employing renewable energy sources, including solar and other green technologies. In our endeavor to implement cost-control strategies without compromising care quality, we have identified centralizing highcare resources, such as intensive care or ‘monitored beds,’ as an essential approach. Many hospitals currently face challenges with prematurely transferring patients from the ICU to standard wards, which results in disorganization and discomfort while straining resources. This approach leads to inflated costs, driven by the need for expensive trained staff and advanced medical infrastructure in non-specialized areas and increases the risk of severe complications, staff dissatisfaction and damage to the hospital's reputation.

By consolidating high-care treatments within dedicated units and allocating around 30% of all beds as high-care monitored beds, our new hospital can significantly curtail these inefficiencies and enhance patient outcomes through increased specialization. Centralization facilitates the pooling of resources and personnel, allowing a highly trained team to manage patient care more effectively and efficiently, reducing dependency on costly consumables and infrastructure elsewhere. Consequently, standard wards can function with a reduced resource profile, akin to high-level hotel services, requiring less expensive staffing and equipment. This approach not only strengthens the hospital’s financial sustainability but also elevates the quality of intensive care through specialized expertise, routine care and environmentally responsible operations.

In the pursuit of innovative cost-control strategies within our hospital without compromising care quality we were able to galvanize efforts across the board to minimize wastage of resources. For instance, a motivated nurse ensuring the judicious use of expensive surgical sutures can save hundreds of dollars during a single operation. This heightened awareness and accountability lead to substantial cost savings, as staff recognize that unnecessary consumption affects their own earnings potential.

In addition, re-evaluating clinical practices can further slash costs while enhancing patient care. A prime example is the use of skin staplers in surgeries, which are not only costlier than absorbable intra-cutaneous sutures but also result in more pain and less aesthetically pleasing outcomes for patients. Each stapler costs approximately USD 20 compared to USD 2 per suture. By opting for the latter, our new hospital improved surgical outcomes, offer better patient experiences and produce significant long-term savings, illustrating that quality and economy can go hand-in-hand. Figure 1 shows the aesthetic results after six weeks, comparing the use of absorbable intradermal sutures (left) with skin staplers (right).

Figure 1: Another step towards reducing expenses and cutting costs - primarily, it emphasizes achieving aesthetically pleasing skin scars and minimizing postoperative pain for patients by eliminating the use of skin staplers. Figure 1 (left) shows the aesthetic results after six weeks, comparing the use of absorbable intradermal sutures with skin staplers (right).

The industry's costly disposable products are attractive but wasteful, risking hospital budget overruns without strict regulation. Employees motivated by incentives can creatively save money and resources by opting for reusable consumables when possible.

These strategies, although modest when considered individually, represent only a fraction of the possibilities available to modern hospitals striving to maintain excellence without exceeding their budgets.

Moreover, implementing a profit-share model effectively curtails the hospital's reliance on pricey, disposable products that, while convenient, tend to inflate the budget when not rigorously managed. When employees are financially incentivized to conserve materials, they become creative and proactive in identifying efficiencies and reducing unnecessary expenses (Figure 2).

Figure 2: The development of monthly patient numbers treated by the new hospital from its opening in April through the end of December. The holiday period during the summer months of August and September is clearly evident.

Conclusion

Our hospital model serves as a blueprint for sustainable, highquality healthcare by exploring an innovative framework designed to elevate healthcare standards.

The integration of the ASA Institute, which focuses on research and innovation, transforms the facility into an attractive hub for medical excellence. Close collaboration with European universities and the Medical University of Vienna enables participation in cross-border research projects and the acquisition of subsequent research grants. This infrastructure, which is quite unique for a private hospital, promotes innovation and high medical standards, attracting ambitious doctors and medical personnel to join this promising institution.

Our model emphasizes the integration of research and innovation, rigorous quality control measures, the implementation of cost-efficient practices and a steadfast commitment to exceptional patient service. By adopting these strategies, it aims to enhance patient outcomes, reduce operational costs and improve overall patient satisfaction, showcasing its potential to transform healthcare delivery. Additionally, we aspire to inspire similar models globally, advancing the healthcare sector toward a more efficient and patient-centered future.

Acknowledgements

To improve the English language and grammar of the manuscript, AI assisted technology (ChatGPT) was employed, as none of the authors are native English speakers.

Conflicts of Interests

All authors contributed equally to the conception, the acquisition, analysis, or interpretation of data for this work.

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