Moldova Invest in dialogue with Alexandru CALANCEA, Manager of Suceava County Hospital

The County Emergency Clinical Hospital “St. John the New” is the most important healthcare facility in Suceava, serving annually over 45,000 patients through the medical services provided: continuous hospitalization, specialty outpatient clinics, day hospitalization, or paraclinical services.

In the current edition, we will discuss with the Manager of the County Emergency Clinical Hospital “St. John the New” in Suceava, Dr. Alexandru CALANCEA, about the real possibility of implementing a county-wide medical project whose main aim is to achieve a MEDICAL MAP of SUCEAVA COUNTY that through MEDICAL COORDINATION, FRONTLINE CARE, and COMMON PROTOCOLS will lead to a significant increase in the efficiency and quality of medical services for the benefi ciaries of this large medical unit in the Moldova Region.

Mr. Calancea, first and foremost, we kindly ask you to provide us with an overview of the accessibility of the medical unit you oversee. Suceava is making consistent efforts to properly position itself on both the national and international tourist maps. Please also refer to the flow of “external patients” who are in Suceava County for tourism or business purposes.

The County Emergency Clinical Hospital “Saint John the New” in Suceava is the most important healthcare facility in the county, unique in the city of Suceava, with a hotel capacity of 1200 beds, distributed across 29 departments and 5 compartments. The medical services currently off ered are at the highest level of medical quality, modern, benefiting from exceptional material resources and highly qualified human resources, with specialties, services, and procedures unique to the county and the northeastern region of Moldova.

“The conception, writing, and implementation of a medical map of the county are more than a necessity at this moment.”

The accessibility comes from all over Suceava County, as well as from other counties, such as Bistrița, Neamț, Bacău, Botoșani, Iași, Vaslui, etc. With no hospital in the city of Suceava, we face a very high demand from city residents who do not have emergency county hospital pathology but have nowhere to go for resolving their respective medical problems.

Another major issue in Suceava County is the inability or major limitations of the other six hospitals (two municipal and four city hospitals) to keep pace with the county hospital, in terms of material resources and human resources, leading to the unpleasant situation for patients of having to travel tens of kilometers in search of quality medical services, leading again to the unjustifi ed overcrowding of the county hospital.

The very crowded periods of the Emergency Department of Suceava are also linked to the arrival of tourists in Suceava, such as Easter holidays, winter holidays, both the classic ones and those according to the old calendar, as well as the summer vacation period. Even though most tourists target the mountain resorts in Vatra Dornei, Câmpulung Moldovenesc, Gura Humorului, many times they do not fi nd solutions to their medical problems in the hospitals in the area and are forced to go to the county hospital. Not infrequently, we have had presentations in the Emergency Department from workers temporarily employed in Suceava County, from all its areas.

Could it be considered useful and necessary at this moment to conceive, write, and implement a MEDICAL MAP of SUCEAVA COUNTY?

The conception, writing, and implementation of a medical map of the county are more than a necessity at this moment. Personally, I consider it an absolutely paramount, even vital point in the economic and touristic development plan of the northeastern region of Moldova and Suceava County. This medical map must be structured into two main chapters: one focusing on the medical needs of the population and the other on the investment needs in the county’s medical system. This idea will form the basis of an efficient, well-organized, and coordinated county medical system that meets the needs of all those who seek its services.

The investment chapter of the county medical map aims to bring together all the structures within Suceava County that fi nancially support the county’s medical system. Here, I am referring to all administrative units that oversee hospitals, medical centers, family medicine cabinets, including the County Council, the supervisory authority of the County Emergency Clinical Hospital “Saint John the New.”

By understanding the medical needs of the entire county, the medical issues of each medical entity, fi nancial resources can be collectively directed where the priority needs lie, so that the entire ensemble, the county medical system, can operate optimally, meeting the needs of all patients.

Let’s discuss the general outlines of the first direction on which this Medical Map could be based, namely “Medical Coordination” between the various medical units in Suceava County. This working principle could ensure coherent and consistent medical care for patients throughout the county, regardless of where they present themselves for treatment or diagnosis. How could this fi rst step be concretely implemented?

Currently, in terms of medical coordination in the county, referring to family medicine, emergency centers, home care, medical laboratories, ambulance service, town, municipal, and county hospitals, private healthcare system in Suceava, and the Public Health Department (DSP), I strongly and responsibly affirm that IT DOES NOT EXIST!

From my point of view, as a physician practicing in Suceava  County since 2015 and as the county hospital coordinator since 2020, acting as the county medical coordinator for COVID pathology during the pandemic, I consider this point essential and indispensable in providing medical services in the county.

County medical coordination is a simple act, which is put into practice by establishing a set of rules, principles, and medical guidelines agreed upon by all decision-makers in the system, so that any patient, from any area of the county, can fi nd a rapid, modern, and effi cient resolution to their medical problem, as close to them as possible. The benefits would be significant for the patient, as well as for the county medical system, with fi nancial resources being spent judiciously and directed to areas of maximum medical need.

Could a common frontline improve the management of available medical resources in Suceava County? Through a medical map, a common emergency and frontline system can be established for all medical units involved, thus ensuring access to emergency care at any time of day or night?

Human resources represent another major problem of the county medical system, referring primarily to the lack thereof in certain medical units, in specific specialties, or the uneven and disproportionate distribution across the county.

Current legislation does not allow for the redistribution of personnel between medical units, but the conception and implementation of common frontlines between nearby hospitals are feasible. I will illustrate this using the example of the mountainous area of the county, Dorna-Câmpulung-Humor, during the winter season, when ski slopes are operational and the area is full of tourists.

“The county medical map will provide an overview of all medical needs in the county, even in the region”

Currently, a minor incident involving an orthopedic medical issue, which could be addressed by municipal and town hospitals in this area, as there is no orthopedic frontline, ends up traveling tens of kilometers to the county hospital, overcrowding the Emergency Department. The ideal solution to this example would be to establish a frontline at each territorial hospital in the area. However, as mentioned, human resources are deficient. Therefore, establishing a common orthopedic frontline between the three hospitals would be the ideal solution for this moment.

This entails that on certain days of the month, emergencies in the area would be directed to a specific hospital, and on other days to another hospital, covering all days of the month in a common frontline for the area. This way, we can quickly and efficiently address all medical issues at the nearest hospital, avoiding overcrowding at a single hospital in the county.

Implementing common protocols means that all medical professionals in Suceava County will work according to the same standards and procedures, which would contribute to a more uniform and effi cient medical care. Do you consider this essential for ensuring patient safety and optimizing treatment outcomes?

In general, medical activity is carried out according to nationally, European, and globally recognized and approved procedures, protocols, and guidelines. If we are to discuss county medical coordination and collaboration aimed at creating an efficient county medical system, YES, the jointly agreed implementation of collaboration protocols to streamline patient fl ws between all medical institutions, in order to shorten and optimize response times, is an indispensable measure for this system.

In the context of briefly presenting some positive outcomes in the healthcare system resulting from the implementation of a County Medical Map project, please provide brief comments on each of them.

1. Improvement of medical care coordination: A county medical map can facilitate the exchange of information between various medical units in the county, such as hospitals, clinics, and health centers. This can contribute to more efficient coordination of medical care, ensuring that patients receive coherent and well-managed care. A county medical map will allow all patients to quickly, modernly, and effi ciently fi nd solutions to their medical problems, at the closest possible distance, using the fi nancial and human resources of the medical system effi ciently.

2. Addressing gaps in access to medical services: By identifying areas with defi ciencies in access to medical services, a medical map can help authorities take measures to address these issues. Proper allocation of resources and establishment of new health centers or clinics results in a more equitable distribution of medical services.
The county medical map will provide an overview of all medical needs in the county, even in the region, allowing financial resources to be judiciously directed, with knowledge and agreement from all decision-makers and those investing fi nancial resources in the county’s health. Thus, joint efforts can be made to create facilities for medically underserved areas.

3. Increasing healthcare system efficiency: By implementing common protocols and a common frontline, the healthcare system can become more effi cient in managing resources and medical staff time. This can lead to cost reductions and improved access to medical services for patients. Medical coordination and investment in the county will create a modern, efficient, and high-performing county medical system, so by implementing these principles across all counties, we will collectively create a modern and high-performing Romanian healthcare system.

4. Optimization of treatments and medical outcomes: By establishing common protocols and care standards, a medical map can contribute to improving the quality of treatments and medical outcomes. Medical professionals will have a clearer and more uniform framework for diagnosis and treatment, which can lead to improved patient health.

Coordination means saving fi nancial resources, which can be directed according to the current needs, but most importantly, saving time for patients. Many pathologies represent extreme emergencies and short periods of time, hours in which intervention must be prompt from specialists. Without this prompt medical intervention, many cases result in lifelong medical sequelae, classification into various degrees of disability, which means pressure on social systems and enormous care expenses.

5. Monitoring and performance evaluation: Implementing a medical map can facilitate monitoring and evaluating the performance of the healthcare system in the county. This can help authorities identify areas that need improvement and take corrective measures accordingly. Creating this uniform, coordinated, and organized medical system will enable careful and accurate monitoring, with the possibility of urgently taking all necessary measures to remedy and streamline county medical activities.

Adopting and subsequently implementing a strategy could serve as a first step in creating the future Medical Map of Suceava County. What is the timeframe in which Suceava could benefit from such a medical system?

A first step in establishing such a medical system is the IDEA. The second step is bringing together all decision-makers from medical institutions, as well as institutions investing fi nancial resources in this field. I believe that this idea of a coordinated county medical system, both medically and investment-wise, can be implemented and streamlined, with quantifi able results, within a maximum of 6-12 months.

Extremely important is the positive signal that Suceava County can send to the Ministry of Health, indicating that from several effi cient county medical systems, an effi cient and high-performing national medical system can be created, necessarily with the legislation of this coordination, to be implemented even where there is unjustifi ed reluctance.

• During the dialogue with the hospital manager, Dr. Alexandru Calancea, the necessity of implementing a medical map of Suceava County was highlighted.
• To optimize and streamline medical care in Suceava County, the implementation of such a County Medical Map is imperative. It would facilitate coordination and collaboration among all medical units in the area, ensuring coherent and consistent care for all patients, regardless of where they seek treatment or diagnosis.
• By identifying and addressing gaps in access to medical services, optimizing treatments, and evaluating the performance of the healthcare system, a County Medical Map could significantly contribute to improving the quality and efficiency of medical services, benefiting both patients and the entire community.
• As for the implementation of this project, it could be realized within a relatively short period, provided that all decision-makers and medical institutions in the county are involved, emphasizing the importance of legislating this coordination to ensure the sustainability of the county’s healthcare system.