PPPHealth4All Persona — Çiğdem Pekgüleç, Consultant at the Board of Directors in Turkey and International PPP Health Projects and Health Facilities

We welcome Çiğdem Pekgüleç, who has shared with us her extensive experience in general and medical facility management of healthcare PPP projects.

Çiğdem started her career in various public health institutions of the Turkish Armed Forces including Military Hospital and dispensary for 16 years. She stepped into the private sector in 2014 and managed branch and multi-branch hospitals. After that, she focused on PPP Projects in the emerging markets. She took several crucial roles in the largest in Europe and 3rd largest hospital in all over the world – the Ankara City PPP Hospital, and was appointed as a Member of the Board of Directors in Kocaeli, İzmir and Etlik Integrated Health Campuses, and managed the entire project.

She is currently the consultant at the Board of Directors in Turkey and International PPP Health Projects and Health Facilities.

In a healthcare PPP project, at what stage your job starts?

As I always say, the operation starts with the first brick in healthcare projects. In order for the operation processes to be carried out correctly and effectively during the operation period, it is necessary to examine the process setups and scenarios of the operation team during the construction period.

For example, in such a project like Integrated Health Campus with a large area, time (for reasons such as penalty error scores, time constraints, etc.) is much more important than in other health projects. The route of the patient from the inpatient service or the intensive care unit to the operating room should be determined by design so that the patient can go to the operating room in the shortest and most accurate way.

In addition, the demographic structure of the geographical area where each project is located and the evaluation of the endemic disease structure are also important for an efficient hospital project during the operation period.
Hospitals are complex structures and organisms that never sleep. In PPP Health Projects, this organism is a little more complicated. You have to provide 19 services and you have to evaluate each service separately and not make mistakes.
As a result, the projects actually start operations during the construction phase. In these structures, which are long-term and are expected to last 20-25 years according to the project, if you can’t set up the right operation, the investment will be meaningless. It is the right operation processes that add value to the investment.

What are the challenges you usually face and how are they solved?

In a PPP project, private and public parties sign a contract. This contract aims to work and serve together for a long time. It is like a marriage: in good and bad times – always together. 
The only problem I have encountered in PPP projects is that the contract is not well known by the parties. Both parties must know the terms of the contract very well. Making requests from you that are not your responsibility and that you cannot do even in good faith will tire the parties. In hospitals, it really turns into chaos. Speaking the same language brings communication, and communication brings solutions to problems.

“When the parties do not know the contract, their demands are not correct and communication accidents come to the fore.”

PPP Health projects are exemplary marriages and are indeed great gains for the health system. Even just speaking the same language provides the best health service and causes both sides to win.

Could you name the reasons why the Turkish experience is so valuable?

The most important reason for Turkey’s success in PPP health projects is the correct demarcation of respect and boundaries between the parties. PPP Health projects are managed by a consortium in Turkey. This consortium is formed by the senior management of the public and private parties who are in charge of the relevant project. This consortium holds a meeting once a week by determining the agenda items and the agenda items are closed with decisions for more effective and improvement of the operation.

Another important reason is motivation. The biggest source of this motivation is the belief in the project. If the subcontractors, subsidiary companies(SPV), operation and management companies(O&M) and the public side believe in the project, they act by thinking that they are on the same boat and that they are one family. The common goal is to provide accurate, quality and innovative health services keeping in mind that those who receive the services are also their families, relatives and friends. In other words, empathy is also a reason for being successful.

What is unique in the idea of a healthcare campus?

Although, of course, there are satellite areas in the centre of the campus, since the service areas established for examination and treatment are located in a single area, they provide faster, more accessible and higher quality service to larger masses. They are cost-effective projects. Savings in labour and consumables can reach great figures for both parties.

In addition to financial evaluation, it is an indisputable fact that the biggest gain is that the patient can reach each and every one of them on campus in cases such as consultation, referral, transfer for further examination and treatment of a complicated patient in health campuses where every branch is located. Because time is precious.

Do you have a “recipe” for the operation of a successful project?

I have a few thoughts with the applications I have mentioned above. For example, there should not be any organic connection between the company or companies in the SPV structure and O&M and EPC so that the SPV can remain neutral and risk-free. I don’t think anyone can be impartial in their own company’s audit.

As I pointed out earlier, the parties should speak the same language. In terms of SPV, there is another detail that needs to be evaluated separately. Namely, in PPP health projects, the managers of the private party need to know the health service delivery so that they can foresee the disruptions that may occur in the operation processes and take precautions. One day, a doctor told me: “Mrs. Çiğdem, I expected a manager who knew the sterilization and disinfection in the project. Because when I was dealing with the health of the patient, I did not have time to explain what sterilization and disinfection is, what are the differences between them.” I got him so much.

Also, the private side should appoint managers who are responsible for the areas. Thus, the area administrators on the public side become a person they can find their interlocutors. This enables them to solve the problems that may occur by talking and taking precautions.

“A successful PPP healthcare project consists of three key elements: time management, crisis management and relationship management.”

Knowledge, cognitive intelligence(IQ) and emotional intelligence(EQ) are required for these three basic elements. You can’t manage information without IQ, at the same time IQ means nothing without EQ. In fact, these three elements are essential in every industry today.

How do you manage innovation in a hospital PPP project?

It is inevitable to use technology. The fact that each material is tagged with active RFID tags and followed by access points located in appropriate places ensures effective use of the workforce. Thus, you can see where every material is from, from textiles to medical equipment, from furniture to computers. In addition, when the field managers make a general count in their own fields with general RFID readers once a month, they provide auto control.

In addition to all these, I need to mention the health management information system(HMIS) and the Facility Management Information System. Both systems need to talk to each other. When you see where the problem is and which problem is more intense with the data in the digital environment, solutions and measures are faster. This means that by using the Facility Management Information System with separate modules for 19 Services, the management is also effectively provided in the digital environment.

Are the powers and responsibilities of the public and private parties in the contracts clear enough for the operation?

Although the parties signed long and comprehensive contracts as a result of long discussions and evaluations in order to clearly define all mutual powers and responsibilities with great sincerity and goodwill, it was seen that many grey areas emerged with the start of the operation process. The best management of the elimination of this problem should be a solution-oriented approach with the same goodwill and sincerity, additional protocols and a joint responsibility matrix should be prepared and signed.

It should be able to be revised according to the changes and newborn needs of hospitals, which is an organism that constantly lives in this matrix. The clearer it is, the smoother the operation is possible.

Can the profitability of the operation be increased?

It can of course be increased. As in every business, methods that will provide profitability can be created in health businesses by evaluating them individually or correlatively. How this profitability will be created can be analyzed separately for each project and for each service, and profitability can be achieved.

In addition to these, the ideal is to start and maintain the project construction and operation together. Despite this, if a project isn’t completed by executing in this way and cannot be carried out effectively, situation analysis, process management revision, organisational structure, etc. It is possible to reach a cost-effective and high-quality operation process for both parties with revisions.

Although PPP projects are perceived as financial projects in the world, it has been seen that these projects are human-centric, cost-efficient management and priority projects for human health, as understood by the recent pandemic experience.

Interview by Dinara Khubieva.