BACKGROUNDER

Macro Environment Scan • Location: • Ilocos Sur

• (bounded on the west by the South China Sea)

• Industry:• Agricultural• Commercial

• Health Services• Ilocos Sur District Hospital• Pacencia Gonzales Memorial Hospital• Rural Health Clinic ( Tagudin)

General Location

The boundaries of Tagudin

Terrain of Tagudin

Welcome arch

Tagudin as gateway to Ilocos Sur from La Union; the church and public market

Some of the schools

The oldest sundials in the Philippines are in Tagudin.

Location of Tagudin General Hospital

Micro Environment Scan:• The Southern Ilocos Sur District Hospital is a level 2 primary

hospital with: 1000 square meters corner lot 50 bed capacity 1st floor - administrative offices, Laboratory, Radiology,

ER, OPD consultation, Pharmacy, • The Rehabilitation center, Billing and Cashier. 2nd floor houses the DR, LR, OR, LR, Nursery complex. 3rd floor are the patients rooms, where they

only have 1 private room. 4th floor is their dietary service and central supply room. •

Services: In-patient services Out-patient Services Surgical procedure Health programs Diagnostic procedures Emergency services Operative Services Dental services Intensive care serviceWorkforce: Doctors, nurses, midwives, administrative support, dentists, ancillary services staff

2-3 nurses are on duty per shift and 1-2 medical doctors are on duty.

• Accreditation: DOH and Philhealth

• Average daily census admitted patients:56

• Bed Occupancy Rate:112.2%

• Total Admissions: 8,557

• Total Discharges: 8,560

• Authorized Bed Capacity: 50

• Actual Beds: 86

Figure 2. TOP TEN LEADING CAUSES OF DEATH (2010)

External Stakeholder RoleDepartment of Health Governing body, financing,

accreditation; Licensing & regulation of hospitals; Policy & regulatory body for quality health care.

Philippine Health Insurance Corp. Institutionalization of programs of quality assurance at all levels of the health service delivery system; Provides health insurance to its members.

Local Government Unit Regular/Supplemental budget, Political influence and support

HMO Financing, accreditation

External Stakeholder RoleNGOs, Private Sector Other/additional budget

Dental, medical clinic Referral and outsource services

Community

Residents of Tagudin and nearby municipalities

Tax, beneficiary, income, possible source of manpower for TGH, clients of health services

Possible patients in the hospital; pays taxes to the LGU

External Stakeholder RoleIlocos Sur Electric Cooperative Power supply Tagudin Water District Potable Water supply Bank Loaning, deposit of income

Tagudin Multi-purpose Credit Coop, Inc.

Rural Bank of Santol

Rural Bank of Tagudin

Financial assistance to businessmen, farmers and others

Several medical and dental clinics

Pacencia Gonzales Memorial Hospital

Rural Health Unit of Tagudin

Attending to health needs of residents , Referral and outsource services.

Internal Stakeholder RoleMedical consultant Specialized careSurgeon Invasive treatment/ surgeryResident Physician General careNurse Supportive, bed side care;

assists physicianMidwife Provides care to childbearing

womenAncillary services

Administrative service & Maintenance

Engineering

Housekeeping

Facilitate the daily operation of the hospital;

Hospital maintenance and administration

Internal Stakeholder RoleDentist Oral care and prophylaxisPharmacist Drug dispensingMedical technologist Laboratory diagnosis and

screeningRadiologist Radioactive diagnostic test

procedures and treatmentMedical records officer Maintains patient file and

statisticsMedical social worker Services in medical issues

Scoring system for Impact of Issues in our Organization:1-4: Non-important- there is no significant impact in our organization.5-7: Important- Minimal impact but the hospital can still continue with its operation8-10: Vital- will completely/ immobilized our operation Scoring system for Probability of Continuing in next 3-5 yrs.:1-4: Can be easily corrected and will only last less than 3 yrs.5-7: Depends on the impact of the issue, it may last in 3- 5 yrs.8-10: 3-5 yrs. to recuperate from the impact of the issue is not enough and may need more time

List of Issues/ Trends

Classification (Political,

Regulatory, Economic, Social,

Competitive, Technological)

(O/T) Evidence Impact to Organization

(1-10)

Probability of continuing in next 3-5 years

(1-10)

1. Prone to flooding during the rainy months (June-Nov.) by virtue of its location

Political, Social

Threat: hinder access to and provision of healthcare services; Increased cases of water-borne and airborne diseases; Flooding may worsen during the wet months due to effects of climate change (PAGASA, 2011)

Exposed to typhoons from the west

Proximity to the great Amburayan River and the Chico River and their tributaries, which overflow during the wet season

Prone to storm surges from the South China Sea (PAGASA storm surge map)

Low elevation and relatively flat terrain

Inadequate drainage canals/infrastructures

7

10

Probability greatly affected by political will to address the impacts of flooding

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive, Technological

)

(O/T) Evidence Impact to Organization

(1-10)

Probability of continuing in

next 3-5 years (1-10)

2. Prone to earthquakes

Political, Economic

Threat: Damage to hospital and town infrastructures; increased morbidity and mortality from injuries; spread of disease

Presence of numerous fault Lines in the region where Tagudin is located

8

10

Risks from earthquakes greatly influenced by political will and availability of funds to build earthquake resistant infrastructures

List of Issues/ Trends

Classification (Political,

Regulatory, Economic, Social,

Competitive, Technological)

(O/T) Evidence Impact to Organization (1-10)

Probability of

continuing in next

3-5 years (1-10)

3. Abundant/ rich water, aquatic, mineral and agricultural resources

Social Opportunity: the resources serve as source of food and income for residents, improving their health and increasing their capacity to pay for health services

Threat: Over-quarrying of the rivers can increase risks from flooding

Source of irrigation for farms

rich source of fish and marine plants, which are used for food

once a mining site for iron magnetite

Amburayan River being quarried for aggregates

One of the top rice producers in Ilocos Sur

Nutritional status of children in Tagudin better than the national average

9 9

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive,

Technological)

(O/T) Evidence Impact to Organization

(1-10)

Probability of continuing in

next 3-5 years (1-10)

4. Unsafe and inadequate solid waste management

Political, Social

Threat: May cause flooding, increased airborne, water-borne and vector-borne diseases; air and water pollution

Open garbage dumps near the river

Practice of open burning of garbage

7 4

Collection system already in place; There is a proposed plan to build a landfill facility

5. Increasing urbanization and business opportunities

Economic, Technological

Opportunity: can lead to economic growth; increased clients and business tie ups for the hospital

Land conversion from agricultural to commercial and/or residential

7 7

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive,

Technological)

(O/T) Evidence Impact to Organization

(1-10)

Probability of continuing in

next 3-5 years (1-10)

6. Presence of educational institutions

Social, Technological

Opportunity: Education could lead to improved health; source of manpower for the hospital

From pre-school to tertiary level (mostly vocational)

10 10

7. Presence of several commercial and light industrial concerns

Economic Opportunity Public markets, sari-sari stores, rice and corn mills, blanket weaving, wine and vinegar making

8 8

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive,

Technological)

(O/T) Evidence Impact to Organization

(1-10)

Probability of

continuing in next

3-5 years (1-10)

8. Available financial institutions

Economic Opportunity 2 banks, 1 multi-purpose credit cooperative

9 9

9. Many available means of transportation

Economic Opportunity 15 transportation companies ply Tagudin to Manila; 4 companies ply Tagudin to Baguio; locally – jeepneys, mini-buses, tricycles

9 10

10. Convenient, fast and affordable access to communication facilities

Technological Opportunity Telecom companies: Bureau of Telecommunications, DIGITEL, PLDT, RCPI; reached by radio, TV, Cable-TV networks

9 10

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive,

Technological)

(O/T) Evidence Impact to

Organization (1-10)

Probability of

continuing in next 3-5 years

(1-10)

11. Good electrification status (provided by ISECO)

Technological Opportunity 98% of total residential, commercial and institutional establishments have electricity

10 10

12. Relatively good source of potable water

Social Opportunity The Tagudin Water District serves the Poblacion; other areas have electric, jet-matic or pitcher pumps for water

9 10

13. Drainage facilities present but inadequate

Political Threat Overflows and clogs during the rainy months

5 6

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive,

Technological)

(O/T) Evidence Impact to Organization

(1-10)

Probability of

continuing in next

3-5 years (1-10)

14. Relatively good implementation of Health and Nutrition Program by RHU

Competitive Opportunity for collaboration

Good accomplishment for “Operation Timbang” and Vit. A supplementation; improving nutritional status of children; But inadequate accomplishment for Iron and iodine supplementation programs

8 8

List of Issues/ Trends

Classification (Political,

Regulatory, Economic,

Social, Competitive,

Technological)

(O/T) Evidence Impact to Organization

(1-10)

Probability of

continuing in next 3-5 years

(1-10)

15. Low acceptors for the RHU’s Family Planning Program

Competitive Opportunity: As both government entities, the TGHCC and RHU could collaborate

Only 21% of total families are Family Planning acceptors

6 6

16. Presence of other health care and dental facilities

Competitive Opportunity for collaboration and referral

Threat as competitor

Pacencia Gonzales Memorial Hospital (private); RHU; several medical and dental clinics

7 9

INTERNALSCAN

Internal Factors Strengths WeaknessCLINICAL Ancillary Services

( Radiology, Laboratory, Dental, Pharmacy)

Conducts surgical procedures

0 deaths of obstetric patients

Lack of Manpower Specialized Medical

Services Health Programs

Promotion

GENERAL MANAGEMENT

Support of both government and private sectors

The only Capillariasis Center

Recording system Inappropriate/Ineffective

staffing & organization Infection Prevention and

control No internal audit/survey in

quality Underutilized of hospital

committees

Internal Factors Strengths WeaknessPHYSICAL FACILITIES Have adequate lighting Inadequate room for

communicable disease patients

Inadequate ventilation Underutilized areas No

elevator Inadequate facilities &

equipment Hygiene ad Sanitation

FINANCIAL Stable budget from Government’s subsidy

Top 2 boxes showed that there is a remarkable increase in income

Philhealth accredited

No accreditation from any HMO

There are more non-Philhealth members patients

Increase in HAMA Government subsidy is not

enough to sustain hospital expenses for expansion

Internal Factors

Strengths Weakness

MARKETING Increasing average daily census

Promotion of specialized medical services

Residency Program

ADMINISTRATIVE SUPPORT

Licensing of DOH and Philhealth

Hospital statistics updated

Ineffective staffing plan

Future Quadrant1.Expansion of Hospital & facilities2.Good referral system to other Health facilities & packages in specialized medical services

Internal Fix-It Quadrant1.Collaboration from other hospitals for best practices in hospital administration.2.Improve staffing & organization structure

External Fix-It Quadrant1. Implementation of a sound solid hazardous & liquid waste management2. Implement an Information, Education & Communication Program on good sanitation & hygiene

Survival Quadrant1. Implement an Emergency Preparedness Program

Tightened the Mission:Reason For Being

Primarily to serve the people of

Tagudin with safe, affordable,

effective health care services

delivered by highly qualified

healthcare practitioners and

well-trained support staff.

Restated the Vision:Where We Want To Be

To be the leading secondary hospital by

2015 and to be the first tertiary hospital in

Tagudin by 2020 providing excellent,

accessible and equitable medical services

in the areas of patient care, medical

training and research.

Staffed by highly trained and qualified

healthcare providers.

Values: Defining our culture

Compassionate Care

Respect

IntegrityService

Excellence

Professionalism

Social Responsibility

Consumer Mix

Priority target patients include those with some or all of the following qualities:

▫ Self Paying▫ Service patients▫ Covered by HMO ▫ Covered by Philhealth

Product Mix

▫ General/Family Medicine▫ Internal Medical▫ Pediatrics▫ Obstetrical and Gynecologic ▫ Surgical & Anesthesia▫ ENT/Ophthalmologic▫ Radiological/Laboratory services

Service Areas

▫ Ambulatory Surgical Clinic▫ Critical Care Units (ICUs, PACU, RR)▫ Dialysis Center▫ Newborn Screening Center▫ Trauma care▫ TB DOTS▫ Animal Bite Center

Goals and Objectives

• Goals and objectives▫ To ensure and sustain investments to provide equitable

healthcare▫ To improve health system performance through

continuous training and technological advancement▫ To ensure essential, accessible, quality and affordable

medical and surgical services.

Competitive Advantage

• Competitive advantage▫ The first and only government-subsidized

hospital in Tagudin providing affordable, holistic approach, and quality health services with financial stability than our private competitors.

Outside Relations

▫ Public-Private Partnerships HMOs Pharmacies Ambulatory services Philhealth DOH

▫ Referral System From rural and other local health units To provincial hospitals

Strategic Goals/KRA: Facility Enhancement

Plan

Adaptive Stabilization Strengthening of current specialty medical services and surgical procedures

Market Entry Joint Venture *Partnering with HMO and entrepreneurs to increase financial capital

Positioning Differentiation Creating *Health care packages that are affordable

Focus to Specialized medical services facility in the region

Implementation Facility and Equipment

Purchase of new radiologic equipments (e.g. ultrasound, ct scan)

Marketing Brochures, media events, newspapers with focus on gatekeepers (e.g., medical societies)

Control Monitoring and Review

Internal audit and external audit

STRATEGY FORMULATION

Strategic Goals/KRA: Capability Building

Plan

Adaptive Stabilization Creating and hiring new plantilla positions for additional hospital staff (e.g. Hospital director, specialist, nurses)

Market Entry Alliance *Partnership through affiliations with nearby medical schools

Positioning Focus to one Focus to the population of Tagudin needing high quality but affordable healthcare services

Implementation Organizational Structure

Inviting additional consultants/specialist practitioners

Human Resources Training and development for the hospital staff

Control Monitoring and Review

Internal audit and external audit

STRATEGY FORMULATION

TGH in

3-5 years

Scenario Building

THANK YOU!