What s up Doc Delivering Service Excellence in

What’s up, Doc? : Delivering Service Excellence in Health Industry June 22, 2012; 6 – 9 pm Ateneo Professional Schools Auditorium Rockwell, Makati MBA students from all the programs of Ateneo Medical students from Ateneo School of Medicine and Public Health

MBA students from all the programs of Ateneo Medical students from Ateneo School of Medicine and Public Health What’s up, Doc? : Delivering Service Excellence in Health Industry What’s up, Dr. Rey Joson? What are your thoughts, perceptions, opinions and recommendations (TPORs) on delivering service excellence in the health industry in the Philippines with focus on hospitals?

ROJ’s TPORs on Delivering Service Excellence in Health Industry with Focus on Hospitals • • Outline of Presentation When does one say there is service excellence in the health industry? When does one say there is service excellence in the hospital industry / in hospitals? . ………. . .

ROJ’s TPORs on Delivering Service Excellence in Health Industry with Focus on Hospitals Outline of Presentation • . ………. . • ………. . . • What are some recommended strategies for delivering service excellence in hospitals? • What are the most difficult (outstanding) challenges in delivering service excellence in hospitals?

ROJ’s TPORs on Delivering Service Excellence in Health Industry with Focus on Hospitals Questions (ROJ) • Service excellence in the health industry? Questions (Organizers) – Reference: MDH Demonstration of service excellence • Service excellence in Operating environment and key relationships the hospital industry / with patients and stakeholders, suppliers and in hospitals? partners Well-being of society Legal and ethical requirements • Some recommended What strategies ? How implemented How measured How communicated Cost-effectivity • Most difficult Challenges (outstanding) challenges ?

Q 1. When does one say that the health industry in the Philippines is delivering service excellence? The health or medical industry - a sector within the economic system that provides services and goods to people with health concerns.

Q 1. When does one say that the health industry in the Philippines is delivering service excellence? Health or medical industry – a conglomeration of • • regulatory bodies and offices on health programs, goods, and services; health care facilities; health care products and their manufacturers and sellers; health care practitioners and providers; health care insurances; health and medical educational and research institutions; other activities associated with human health.

Q 1. When does one say that the health industry in the Philippines is delivering service excellence? Just like any other industry, health or medical industry is expected to deliver, in a collective effort, excellent services and products to the community. Question: what criteria and indicators do we use?

Q 1. When does one say that the health industry in the Philippines is delivering service excellence? Look at Health care outcomes of catchment community – Philippines, a province, a city, etc. Criteria Indicators Average life span Acceptable percentage of Filipinos reaching targeted life span (e. g. 70 years old) Infant mortality rate Acceptable rate (25 / 1000 vs 19 / 1000) Maternal mortality rate Acceptable rate (94 / 100, 000 vs 52 / 100, 000) Control of specific diseases Controlled incidence, prevalence, mortality and morbidity rates (e. g. control of dengue and noncommunicable diseases) Quality of life index Acceptable rate (e. g. 7 vs 8 score – QLI; suicide rate Access to health care Acceptable indices Others

Q 1. When does one say that the health industry in the Philippines is delivering service excellence? Look at Health care outcomes of catchment community – Philippines, a province, a city, etc. Criteria Indicators Average life span Acceptable percentage of Filipinos reaching targeted life span (e. g. 70 years old) Infant mortality rate Acceptable rate (25 / 1000 vs 19 / 1000) Maternal mortality rate Are the set and agreed Acceptable rate (94 / 100, 000 vs 52 / 100, 000) indicators being achieved or Control of specific diseases Controlled incidence, prevalence, mortality and not? morbidity rates (e. g. control of dengue and noncommunicable diseases) Quality of life index Acceptable rate (e. g. 7 vs 8 score – QLI; suicide rate If yes, EXCELLENT! Access to health care If no, NOT or “NOT Acceptable indices Others excellent! SO”

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Excellent hospitals contribute to the achievement of targeted health outcomes in catchment community. National / Local Government Health Departments Catchment Community Programs for targeted health care outcomes Hospital Targeted Health Care Outcomes Life span Infant mortality rate Maternal mortality rate Control of specific diseases Quality of life Access to health care Others

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Excellent hospitals provide value-based health services (inclusive of cost-effective-efficient, quality and safe services). Value-based medicine (Porter & Teisberg) Evidence-based medicine Quality and safe medicine Cost-effective-efficient medicine

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Value-based Medicine or Health Services • Value created for and appreciated by patients served and for services rendered. • Value = health outcomes achieved per peso spent, not just access, convenience, volume, and cost containments.

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Value-based Medicine or Health Services • Good health care outcomes (good results) on community and individual patient indices • Quality and safe services • Reasonable costs and expenses

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? ROJoson’s Survey on Excellent Hospital (2010) [141 Hospital Administrators; Physicians; Non-physician Health Care Providers; Patient-clients] Parameters of Excellence Overall Frequencies With affordable / reasonable hospital / medical costs With financial sustainability program 52% With state-of-the-art equipment 40% With quality and patient-friendly infrastructure and facilities With quality services 40% 46% 30%

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Excellent hospitals are those that are managed to be sustainable while providing excellent services. A hospital is sustainable if it has the ability to continue to achieve its operating objectives and fulfill its mission over the long term and is resilient over time!

ROJ TPORs on Sustainability of a Hospital Financial Sustainability Management Practice Sustainability Indicators: • Constantly positive net income • Constantly adequate liquid asset • Constantly manageable debt burden Indicators (COMPLIANT): • Baldrige Health Care Criteria for Performance Excellence • Quality and safe patient care standards • Investors in People

ROJ TPORs on Sustainability of a Hospital Programs Ultimate Goal Business development for the Maximal utilization of services whole hospital and its units Financial management Business continuity and disaster resiliency NO unwarranted losses Enough revenues and incomes to continue and expand Business continuity after a disaster Corporate social responsibility Sustenance of catchment community

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Excellent hospitals contribute to the achievement of targeted health outcomes in catchment community. Excellent hospitals provide value-based health services (inclusive of cost-effective-efficient, quality and safe services). Excellent hospitals are those that are managed to be sustainable while providing excellent services.

Q 3. What are some recommended strategies in delivering service excellence in hospitals? Strategic Framework: • Set 3 key indicators of an excellent hospital as goals. • Design and develop hospital performance excellence program. • Get committed support of top management and staff. • ………

Q 3. What are some recommended strategies in delivering service excellence in hospitals? Strategic Framework: • • • ………. Implement program perseverently. Evaluate results of implementation. Continually improve program until 3 key indicators of performance excellence are achieved to the highest degree.

Q 3. What are some recommended strategies in delivering service excellence in hospitals? Strategic Framework Design and develop hospital performance excellence program Implement program Evaluate results of implementation Facilitating Strategies • Baldrige Health Care Criteria for Performance Excellence • Joint Commission International or Accreditation Canada International accreditation for hospitals • Phil. Health Benchbook Investors in People standards Balanced scorecard

Baldrige Health Care Criteria for Performance Excellence US-based standard designed to help hospitals use an integrated approach to organizational performance management that can result to: • Delivery of ever-improving value to patients and other customers, contributing to improved health care quality • Improvement of overall organizational effectiveness and capabilities as a health care provider Questions and guides on how to achieve performance excellence for hospitals

Comparison of Patient-care Standards Accreditation Canada Individual Client/Patient Care Groups (14) that correspond to particular episodes of care and treatment Information Management Human Resources Development and Management Environmental Management Leadership and Partnerships (one team for management and one team for governance standards) Joint Commission International Patient-centered Standards • • Access to Care and Continuity of Care Patient and Family Rights Assessment of Patients Care of Patients Anesthesia and Surgical Care Medication Management and Use Patient and Family Education Phil. Health Benchbook • Patient Rights and Organizational Ethics • Patient Care • Leadership and Management • Human Resource Management Health Care Organization Management • Standards • • Quality Improvement and Patient Safety Prevention and Control of Infections Governance, Leadership, and Direction • Facility Management and Safety Staff Qualifications and Education Management of Communication and Information Management Safe Practice and Environment Performance Improvement

Investors in People Standards Business improvement tool designed to advance an organization's performance through its people!

Balanced Scorecard Blueprint formulated by organization to be used as a guide and reference for • implementation of strategies and tactical objectives • monitoring • evaluation of actions taken Management strategic tool as well as performance measurement system

Balanced Scorecard Popularized by Kaplan and Norton in 1990 Scorecard with four perspectives: • Financial • Customer • Process • Learning growth

MDH BSC What is the template being used in MDH BSC? MDH BSC Perspectives (2004 -2007) Financial Customer Process Learning and Growth MDH BSC Perspectives (2008 - 2012) Financial Customer Process Learning and Growth (People) Corporate Social Responsibility

Balanced Scorecard (Sample) Vision: Leading center of excellence and wellness in the Philippines providing holistic quality patient care Perspective Financial Goal Tactical Objective Financial Achieve viability profitable growth through normal operations Financial Prevent sustainability account receivables Hospital Image and Reputation Participate in programs of external award giving bodies promoting quality and excellence Performance Measures Target Gross XX% revenue increase Initiatives (Programs) Project Maximal Utilization of Services No. of admitted patients with account receivables – Management Award less than XX% Project Control of Account Receivables Submit at least 3 entries Project External Awards for Excellence

Balanced Scorecard (Sample) Vision: Leading center of excellence and wellness in the Philippines providing holistic quality patient care Perspective Customer Process Goal Tactical Objective Quality Provide service and quality care services – prompt, effective, and courteous Excellent Develop operational effective / mgt system efficient quality managem ent system Performance Measures Target Customer ≥ 90% satisfaction rating Conduct of Continual Improvement Program in 70% of units per division Initiatives (Programs) Project Customer Feedback and Relations Project Continual Improvement

Balanced Scorecard (Sample) Vision: Leading center of excellence and wellness in the Philippines providing holistic quality patient care Perspective Goal People Competency Development Corporate Social Responsibility Excellent corporate social responsibility program Tactical Objective Provide training programs based on identified training needs Develop CSR Programs Performance Initiatives Measures Target (Programs) total number of At least People Growth and units 85% Development participated in Program one competency based training No. of indigent patients served (inpatients) Greater than 20 XX total number Project CSR

History of MDH BSC (2004 -2011) Outcome Has been useful in serving as - communication All departments have BSCs - alignment cascaded from hospital - collaboration BSC! - monitoring - evaluation tool in the implementation of strategic direction in Manila Doctors Hospital.

Q 4. What are the most difficult (outstanding) challenges in delivering service excellence in hospitals? Strategies Challenges Man Method Money √ √ √ √ Implement √ √ √ Evaluate √ √ Improve √ √ Design and Develop Get Committed Support Machine Monument Trends in Health √ √ √

Alignment, Integration, Coordination and Collaboration (Teamwork) Alignment of Players, Processes and Systems Integration of Processes and Systems Goals and Objectives of Health Industry Hospital Coordination and Collaboration of Players

Q 4. What are the most difficult (outstanding) challenges in delivering service excellence in hospitals? Most difficult challenge – how to manage the people with different mindset and behavior, particularly in the face of a paradigm shift (community health outcomes targets, valuebased delivery system, and corporate social responsibility)

Q 4. What are the most difficult (outstanding) challenges in delivering service excellence in hospitals? ROJ’s Recommendations to meet the challenges: • • Facilitating strategies – Standards, Ii. P, and BSC Leadership – direction, motivation, commitment, innovation, etc. • Managership – technical competence in planning, implementing and evaluating • Communication – clear and closed-loop communication • Education – mentoring and coaching of all concerned

ROJ’s TPORs on Delivering Service Excellence in Health Industry with Focus on Hospitals Questions (ROJ) • Service excellence in the health industry? Questions (Organizers) – Reference: MDH Demonstration of service excellence • Service excellence in Operating environment and key relationships the hospital industry / with patients and stakeholders, suppliers and in hospitals? partners Well-being of society Legal and ethical requirements • Some recommended What strategies ? How implemented How measured How communicated Cost-effectivity • Most difficult Challenges (outstanding) challenges ?

ROJ’s TPOR on Hospital’s Medical Tourism Program • A hospital can have a medical tourism program as long as it does not forget its primary responsibility to its nearby society or its catchment community.

ROJ’s TPOR on Hospital’s Medical Tourism Program • A hospital – excellent based on the 3 key criteria – compliant with • Baldrige Health Care Criteria for Performance Excellence • international patient-care standards (JCI or ACI) • Phil. Health Benchbook • Attract international patient-clients to its premises – part of the medical tourism program – foreigners who got sick while visiting the Philippines as tourists

Integrated Value-based Health Services (2012 -2014) Baldrige Heath Care Criteria for Performance Excellence Balanced Scorecard 2004 Accreditation Canada International ISO 9001: 2000 /8 V-M CSR Mission 1999 Social Vision Investors in People 2005 2007 2009 Phil. Health Benchbook Center of Excellence 2010 2011 MDH Journey towards Excellence 2012

Summary and Closing

ROJ’s TPORs on Delivering Service Excellence in Health Industry with Focus on Hospitals Questions (ROJ) • Service excellence in the health industry? Questions (Organizers) – Reference: MDH Demonstration of service excellence • Service excellence in Operating environment and key relationships the hospital industry / with patients and stakeholders, suppliers and in hospitals? partners Well-being of society Legal and ethical requirements • Some recommended What strategies ? How implemented How measured How communicated Cost-effectivity • Most difficult Challenges (outstanding) challenges ?

Q 2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent? Excellent hospitals contribute to the achievement of targeted health outcomes in catchment community. Excellent hospitals provide value-based health services (inclusive of cost-effective-efficient, quality and safe services). Excellent hospitals are those that are managed to be sustainable while providing excellent services.

Why deliver excellent service in health industry? Obligation Health industry and its components owe it to the clients they have decided to serve! Clients = communities with families and individual citizens therein. They should do what is right for their clients.

Why deliver excellent service in health industry? Sustainability With excellent service, value-based services, • • • more clients, maximal utilization of services, enough revenues and incomes to continue to operate and to expand the business of the hospital when and as needed!

Why deliver excellent service in health industry? Sustainability With a social vision, corporate social responsibility, there will be sustainability of the catchment community and, in the end, sustainability of the hospital!

Hospital Performance Excellence - a Long Journey Advice: Start early as the journey is long and tedious! Need to be very perseverant as there a lot of challenges and things to learn!

Thank You! Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg 0918 -804 -03 -04 For queries and for my Websites!