Corporate Management of Health Facilities
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Manila Doctors Hospital
Manuel E. Villegas, Jr., MD
Head, Corporate and Strategic Planning Office
Manila Doctors Hospital
June 28, 2013 (9-10am); Iloilo City
DOH 7th NATIONAL STAFF MEETING
THEME: Governance Reforms for Health
Thank you (Organizers from the DOH Health Policy Development and Planning Bureau) for the invitation and the honor and privilege to be a participant in the DOH’s 7th National Staff Meeting.
We were given this title, “Corporate Management of Health Facilities” by the Organizers to develop into a paper for a one-hour allotted talk.
In the preparation for this talk, we first asked for clarifications from Planning Officer Engr. Laurie Mendoza, one, on the operational meaning of the title, particularly on the term “health facilities,” and two, on the focus as desired by the Organizers or Secretariat of this National Staff Meeting. Here is the reply of Laurie:
“We would like your presentation to focus on the management of physical facilities and how the DOH can learn from this in terms of its Health Facilities Enhancement Program (HFEP), one of the thrusts of the Kalusugang Pangkalahatan or Universal Health Care of this administration. It would be worth knowing also its relevance and application to the government health facilities as a whole.”
Using the information given to us by the Organizers as a guide, to facilitate our giving and sharing of information and practices of Manila Doctors Hospital (MDH) in terms of management of physical facilities that may be useful and applicable in government hospitals, we decided to conceptualize the “MDH Health Facilities Enhancement Program.” Honestly, there is no program that formally carries the name of Health Facilities Enhancement Program in MDH at the time that we received the invitation on June 14, 2013. MDH has a Revenue Enhancement Program, but it doesn’t have a so-called or so-named Health Facilities Enhancement Program. For sure, there are myriads of programs, projects, and activities present in MDH that if gathered together, synthesized and integrated, will rightfully constitute a Health Facilities Enhancement Program for the hospital. This is exactly what we did to prepare for our talk today, mentally gather all the existing programs, projects, and activities of MDH that are relevant to facilities enhancement; look at their rationale, strategic and operational objectives, policies and procedures, and practices; then synthesize and integrate all of them into what we think constitute the “MDH Health Facilities Enhancement Program.” Thereafter, we develop a paper entitled “Practices in the Health Facilities Enhancement Program of MDH” to facilitate our giving and sharing of information and practices of MDH in terms of management of physical facilities. We hope that with such a paper that contains the same program name as that of DOH (Health Facilities Management Program), you will be more at ease in listening to our presentation of a program that has essentially similar goals as yours but in a private hospital setting. From our presentation, we hope you will easily be able to discern similarities and differences and pick up what you think are practices in MDH that may be applicable and useful to your government setting.
“Practices in the Health Facilities Enhancement Program of MDH”
“Health Facilities” in “Health Facilities Enhancement Program of MDH” is operationally defined as the infrastructure and equipment worth P250,000.00 or greater.
“Enhancement” is operationally defined as addition and renovation which include deletion or refinement.
Below is a framework of the work systems of MDH Health Facilities Enhancement Program.
Identification of Indications for Physical Facilities Enhancement
Bottomline indication for facilities enhancement is continual improvement towards viability and sustainability of the hospital.
The traditional areas that MDH Senior Management Team reviews at planned interval to look for indications for facilities enhancement consist of the following:
- Vision, mission and strategic objectives
- Statutory and regulatory requirements
- Clean, Comfortable, Safe and Green Hospital Programs
- Voice of customers
Vision, mission and strategic objectives
MDH has been holding strategic planning conferences at intervals of 3 years since 1999. We are using the following hospital strategic planning framework:
In every strategic planning conference, in the process of doing an external and internal assessment with a SWOT analysis, then formulating strategic objectives and then reviewing our vision and mission statements, we invariably identify areas of improvement and make resolutions and plans, inclusive of facilities enhancement, for the next 3 years with annual milestones. [Example / Illustration]
Our current vision, social vision, mission, and strategic objectives are:
Leading center of excellence and wellness in the Philippines providing holistic quality and safe patient care.
- We are a health institution providing holistic care that exceeds industry standards and that anticipates and responds to the needs of the patients, their families and relevant communities.
- Driven by our determination to make healthcare accessible to the marginalized and the underserved, we consider it our ardent commitment to provide service that is guided by ethical standards and improve the healthcare delivery system with pronounced social impact. These establish ManilaDoctorsHospital as a vital partner of the Department of Health, local government units and other likeminded institutions in empowering the communities and the public we serve to sustain health and wellness.
- We are engaged in heightening the consciousness and the participation of the public in targeted health and environmental issues in the global community.
- To operate a world class hospital.
- To undertake training and research programs to continually improve quality and safe services.
- To pursue corporate social responsibility programs.
2012-2014 Strategic Objectives and Goals:
Goals (Excellent: Structured, Comprehensive, Integrated, Sustainable)*
|Governance and Finance (Shareholders)||Systems perspective in governance||Excellent* governance system|
|Integrated value-based health care service||Excellent* value-based service system|
|Physician engagement (patronage and loyalty)||Excellent* physician engagement promoting patronage and loyalty|
|Maximal utilization of services with controlled expenses and losses||Excellent*business development system and resource management system|
|Customer||Customer delight||Excellent* customer engagement program|
|Process||Full compliance with the quality and performance standards (local and international)||Excellent* process system promoting quality, efficient and safe services|
|Excellent* Continual Improvement Program|
|Integrated IT-enabled operations system||Excellent* IT-enabled operations system promoting accuracy and efficiency|
|People (Workforce)||Staff engagement||Excellent* employee / staff engagement program|
|Learning organization||Excellent* educational program|
|Corporate Social Responsibility (Community)||CSR program with tangible social impact||Excellent* CSR program|
Statutory and Regulatory Requirements Related to Facilities Enhancement
MDH constantly monitors and complies with all existing and future statutory and regulatory requirements associated with hospital operations in general and with facilities enhancement, in particular. In cases where there is a need to enhance the facilities in terms of additions and renovations because of statutory and regulatory requirements, the usual sequential processes of formulating a design and development plan followed by screening, approval and authorization and other subsequent steps are followed. (see framework.) [Example]
Clean, Comfortable, Safe and Green Hospital Programs
MDH has four key programs that are closely associated with physical facilities enhancement management. These are the Clean Hospital Program; Comfortable Hospital Program; Safe Hospital Program; and Green Hospital Program. Although each program is managed separately with clear goal and objectives and with a distinct coordinating and supervising body, there are overlaps and interfacings among the four programs in which mechanisms for alignment and integration are in place.
The following table shows the coordinating and supervising bodies and goals of the different programs and examples of facilities usually needed to be put into place and continually enhanced.
Coordinating and Supervising Bodies
Examples of Physical Facilities
|Clean Hospital||Linen and Housekeeping Services||Aesthetically cleanHygienically cleanenvironment, infrastructure, equipment, amenities, etc.||ToiletsCleaning devicesPest control devices|
|Comfortable Hospital||Customer Care Committee||Easy accessibilityFriendly atmosphereSafe atmosphere
|Signages – directional, instructional, etc.Customer assistance desk|
|SafeHospital||Safety Promotion and Disaster Preparedness Committee||Safe infrastructureSafe environmentSafe patient care
|Sturdy buildingsStorage of hazardous wastesSafe patient beds
Incident Command Post
|GreenHospital||Environment and Waste Management Committee||Reduced carbon footprints||Green infrastructureGreen equipment|
In cases where there is a need to enhance the facilities in terms of additions and renovations as required by the Programs after continual reviews, the usual sequential processes of formulating a design and development plan followed by screening, approval and authorization and other subsequent steps are followed. (see framework.) [Example]
Voice of customers
MDH operationally defines its customers or clients to consist of patients, health-maintenance-organizations and companies, and its accredited physicians. It listens to its current and potential customers through a customer need inquiry system and customer feedback system.
“Customer need inquiry system” refers to the communication system to obtain information on the service needs (inclusive of the facilities and amenities needs) of the customers before they go to the hospital. This is usually applicable to potential customers of MDH and these include those who have used the services of other hospitals. The communication tools used may be face-to-face and/or non-face-to-face (print or digital media) interaction.
“Customer feedback system” refers to the communication system to get information, particularly reactions, comments, and suggestions, from the customers on the quality of services rendered and also of the facilities and amenities, both during or intra-service and after or post-service. This is done to current customers of MDH. Information on needs of customers may also be obtained from the feedbacks received. The communication tools used may be face-to-face and/or non-face-to-face (print or digital media) interaction.
In cases where there is a need to enhance the facilities in terms of additions and renovations as derived from the results of the customer need inquiry and customer feedback systems, the usual sequential processes of formulating a design and development plan followed by screening, approval and authorization and other subsequent steps are followed. (see framework.) [Example]
Design and Development Plan
As mentioned, during the review of vision, mission and strategic objectives; statutory and regulatory requirements; clean, comfortable, safe and green hospital programs; and voice of customers, we invariably identify areas of improvement for which we make resolutions and plans, inclusive of facilities enhancement. Aside from these four traditional areas as sources for indications of physical facilities enhancement, proposals can also come from the department heads, committee chairs, and any internal staff for that matter but channeled to their respective department and committee heads.
The resolutions and plans are formalized in the so-called “design and development plans” (DDP) which carry a standardized template. The DDP consists of feasibility study; expected impact; ownership options and schemes (full ownership, joint venture, or leasehold); business plans; physical facilities requirements; budget; return of investment; deployment and implementation plans; and monitoring and evaluation plans. [Example]
Approval of Plan
The Committee on Purchasing, Investment, and Contracts (COPIC), the Management Committee (Mancom), the Executive Committee (EXCOM), and the Board of Directors (BOD) are the usual screening, approving and authorizing bodies for all design and development plans, especially those plans that carry a budget of Php 250,000 or greater.
The membership of the COPIC consists of the Hospital Director, Medical Director, Administrative Director, Finance Director, Head of Material Management Department, and a member of the BOD (as Chair).
The membership of the Mancom, which is created by the BOD, consists of the President, SVP for Corporate Affairs, SVP for Medical Affairs, another member of the BOD, Hospital Director, Medical Director, Administrative Director, and Finance Director with the President as the Chair.
The membership of the EXCOM, which is created by the BOD, consists of the Chairman of the BOD, vice-Chair of BOD, Treasurer, President, SVP for Corporate Affairs, SVP for Medical Affairs, Hospital Director, Medical Director, and Administrative Director with the Chairman of the BOD as Chair.
The flow of screening and approval of proposals for physical facilities enhancement (infrastructure and equipment worth P250,000.00 or greater) is shown on the graph below:
At the COPIC level, before recommending the supplier for purchase of equipments and the contractor for construction / renovation of physical facilities, there is an invitation-to-bid with at least 3 sealed bids handled by the Materials Management Department. [Example]
At the COPIC level too, the proponents and end-users are invited for discussion on issues such as need; urgency; risk not only on financial aspect but also on the impact on clean, comfortable, safe and green hospital goals; preferred equipment and design; and return of investment. [Example]
Risk assessment, transparency, ethical practices and fiscal accountability are observed early on at the level of COPIC. Oversight is done by the Mancom then EXCOM prior to getting the imprimatur of the BOD.
Implementation of Approved Plan
After the proposals and design and development plans for facilities enhancement are approved, they are executed with resultant purchase of equipment and construction / renovation of infrastructure.
Upon arrival of the purchased equipments or products, these are inspected for compliance with specifications and functionality by the concerned departments of the hospital such as Biomedical Unit and end-users for equipments. For the finished infrastructure products, the Facilities Management Department does the inspection.
Depending on agreement with the suppliers and contractors with the hospital, the payment scheme can be on down-payment or full-payment basis. Depending on the circumstances too, particularly for high-cost facilities, MDH can opt to practice a retention payment scheme to ensure quality purchased equipment and after-sale services. It usually requires from contractors guarantee or performance bonds equivalent to 10% of the total costs for infrastructure projects.
Monitoring of Implementation of Plan
Monitoring of the approved plan is not limited to the functionality of the purchased equipments and constructed / renovated infrastructure but include all the key measures and indicators of performance, outcome, and impact contained in the approved design and development plan. Examples of usual key measures are return of investment; contribution to vision and mission and goals of strategic objectives; contribution to clean, comfortable, safe and green hospital programs; customer engagement; efficiency and productivity; workforce engagement; fulfillment of societal responsibility and support of community; and, last but not the least, the bottom-line target, impact on viability and sustainability of the hospital.
Focusing on the equipment, monitoring primarily includes functionality, life span, and return on investment. Proper usage and preventive maintenance are key measures to promote continuing functionality to reach and even surpass the expected life span of the equipment. Effective business development programs are strategies to promote maximal utilization of the equipment so as to achieve the target on return on investment. [Example] The workforce in charge of monitoring and measuring the performance of the equipment are the requesting department, Biomedical Unit, Business Development Division, and Finance Department.
On infrastructure, monitoring primarily includes functionality, safety, and return on investment. The Facilities Management Department (FMD) and the Finance Department are in charge of collection and measurements of data and information, the former on the functionality and safety and the latter, on the return of investment. Evaluation of functionality and safety is done by the FMD regularly, one, through the annual inspections done by regulatory agencies when MDH gets all the required business permits each year, and two, also annually, through use of the DOH Safe Hospital Initiative checklists, particularly on the structural and non-structural indicators. Evaluation is also done every time the hospital experiences strong earthquakes, weather disturbances, and other natural and also man-made events that may affect the functionality and safety of the hospital. [Example]
Evaluation of Implementation of Plan
The same policy used in the monitoring of implementation of plan applies in evaluation. Evaluation is not limited to the functionality of the purchased equipments and constructed / renovated infrastructure but include all the key measures and indicators of performance, outcome, and impact contained in the approved design and development plan.
Various scorecards and checklists are being used. There are scorecards and checklists that are specific for equipment and for infrastructure. There are also scorecards and checklists that are more encompassing, which go beyond the functionality of the equipment and infrastructure, meaning they look at the entire design and development plans in which physical facilities are enhanced just to afford convenience for service or health programs to be implemented.
- For the overall business plans of the hospital, the balanced scorecard (BSC) and the list of approved initiatives for the year or 3 years (long-term plans) are used. The MDH BSC contains five perspectives: Governance and Finance; Customer; Process; People; and CSR. There are a number of initiatives in each of the perspectives which require enhancement of physical facilities. If the targets in the BSC are achieved, it can be assumed that any accompanying enhancement of the physical facilities contributed to the achievement. [Example]
- There are checklists for the clean, comfortable, safe, and green hospital programs. Again, if the measures are achieved, it can be assumed that any accompany enhancement of the physical facilities contributed to the achievement. [Example]
- There are specific checklists for equipment and infrastructure as referred to under “Monitoring of Implementation of Plan.” The key measures of usually functionality, life span and return of investments of equipment. For the infrastructure, functionality, safety, and return of investments. [Example]
The evaluation of the implementation of plans is done by both internal auditors (self-assessors, internal quality auditors, and an internal auditor reporting to the BOD) and external auditor, namely, SGV & Co.
Summary points or messages:
- All health facilities enhancement program must have a structured and comprehensive work systems. It should start with identification of indications for enhancement. Then, design and development plan of identified need for enhancement. Then, approval of proposals. Then implementation of approved plan; monitoring and evaluation of implementation.
- There should be clear-cut policies and procedures.
- Risk assessment, transparency, ethical practices and fiscal accountability should be considered and observed throughout the entire work systems.
- There should always be measurement, analysis, and evaluation of outcomes of the program.
- The bottom-line goal of facilities enhancement program is continual improvement towards viability and sustainability of the hospital with achievement of it’s vision and mission.