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 service Workforce: 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
Department of Health

Role
Governing body, financing, accreditation; Licensing & regulation of hospitals; Policy & regulatory body for quality health care. Institutionalization of programs of quality assurance at all levels of the health service delivery system; Provides health insurance to its members. Regular/Supplemental budget, Political influence and support Financing, accreditation

Philippine Health Insurance Corp.

Local Government Unit HMO

External Stakeholder
NGOs, Private Sector Dental, medical clinic Community

Role
Other/additional budget Referral and outsource services

Tax, beneficiary, income, possible Residents of Tagudin and nearby source of manpower for TGH, clients of health services municipalities Possible patients in the hospital; pays taxes to the LGU

External Stakeholder
Ilocos Sur Electric Cooperative Tagudin Water District Bank Tagudin Multi-purpose Credit Coop, Inc.

Role
Power supply Potable Water supply Loaning, deposit of income Financial assistance to businessmen, farmers and others

Rural Bank of Santol

Rural Bank of Tagudin Several medical and dental clinics Pacencia Gonzales Memorial Hospital

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

Rural Health Unit of Tagudin

Internal Stakeholder
Medical consultant Surgeon Resident Physician Nurse Midwife Ancillary services

Role
Specialized care Invasive treatment/ surgery General care Supportive, bed side care; assists physician Provides care to childbearing women Facilitate the daily operation of the hospital; Hospital maintenance and administration

Administrative service & Maintenance

Engineering

Housekeeping

Internal Stakeholder
Dentist Pharmacist Medical technologist

Role
Oral care and prophylaxis Drug dispensing Laboratory diagnosis and screening Radioactive diagnostic test procedures and treatment Maintains patient file and statistics Services in medical issues

Radiologist
Medical records officer Medical social worker

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 operation 8-10: 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

Classification (Political, Regulatory, Economic, Social, Competitive, Technological) 1. Prone Political, Social to flooding during the rainy months (JuneNov.) by virtue of its location

List of Issues/ Trends

(O/T)

Evidence

Impact to Probability of Organization continuing in (1-10) next 3-5 years (1-10)

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

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

List of Issues/ Trends

2. Prone to earthquakes

Classification (O/T) (Political, Regulatory, Economic, Social, Competitive, Technological) Political, Threat: Damage to Economic hospital and town infrastructures; increased morbidity and mortality from injuries; spread of disease

Evidence

Impact to Organization (1-10)

Probability of continuing in next 3-5 years (1-10)

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

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 Probabilit Organizati y of on (1-10) continuin g in next 3-5 years (1-10)

3. Abunda nt/ rich water, aquatic, mineral and agricultu ral resource s

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: Overquarrying 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

Classification (O/T) (Political, Regulatory, Economic, Social, Competitive, Technological) 4. Unsafe and Political, Threat: May cause inadequate Social flooding, increased solid waste airborne, watermanagement borne and vector- borne diseases; air and water pollution 5. Increasing urbanization and business opportunities Economic, Technological Opportunity: can lead to economic growth; increased clients and business tie ups for the hospital

List of Issues/ Trends

Evidence

Impact to Organization (1-10)

Probability of continuing in next 3-5 years (1-10)

Open garbage dumps near the river Practice of open burning of garbage Land conversion from agricultural to commercial and/or residential

4 Collection system already in place; There is a proposed plan to build a landfill facility 7

Classification (Political, Regulatory, Economic, Social, Competitive, Technological) 6. Presence Social, of educational Technological institutions

List of Issues/ Trends

(O/T)

Evidence

Impact to Organization (1-10)

Probability of continuing in next 3-5 years (1-10)

7. Presence of several commercial and light industrial concerns

Economic

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

From preschool to tertiary level (mostly vocational)

10

10

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

List of Issues/ Trends

8. Available financial institutions 9. Many Economic available means of transportation

Classification (O/T) (Political, Regulatory, Economic, Social, Competitive, Technological) Economic Opportunity

Evidence

Impact to Probabilit Organization y of (1-10) continuin g in next 3-5 years (1-10) 9 9

2 banks, 1 multi-purpose credit cooperative

Opportunity

10. Convenient, Technological fast and affordable access to communication facilities

Opportunity

15 transportation companies ply Tagudin to Manila; 4 companies ply Tagudin to Baguio; locally jeepneys, mini-buses, tricycles Telecom companies: Bureau of Telecommunications, DIGITEL, PLDT, RCPI; reached by radio, TV, Cable-TV networks

10

10

List of Issues/ Trends

11. Good electrification status (provided by ISECO) 12. Relatively Social good source of potable water 13. Drainage facilities present but inadequate

Classification (Political, Regulatory, Economic, Social, Competitive, Technological) Technological

(O/T)

Evidence

Impact Probability to of Organiz continuing ation in next 3-5 (1-10) years (1-10) 10 10

Opportunity

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

Opportunity

Political

Threat

The Tagudin Water District serves the Poblacion; other areas have electric, jet-matic or pitcher pumps for water Overflows and clogs during the rainy months

10

List of Issues/ Trends

14. Relatively good implementatio n of Health and Nutrition Program by RHU

Classification (Political, Regulatory, Economic, Social, Competitive, Technological) Competitive

(O/T)

Evidence

Impact to Organization (1-10)

Probabilit y of continuin g in next 3-5 years (1-10) 8

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

List of Issues/ Trends

15. Low acceptors for the RHUs Family Planning Program 16. Presence of other health care and dental facilities

Classification (O/T) Evidence (Political, Regulatory, Economic, Social, Competitive, Technological) Competitive Opportunity: As Only 21% of total families both government are Family Planning entities, the TGHCC acceptors and RHU could collaborate Competitive Opportunity for collaboration and referral Threat as competitor Pacencia Gonzales Memorial Hospital (private); RHU; several medical and dental clinics

Impact to Probability Organization of (1-10) continuing in next 3-5 years (1-10)

INTERNAL SCAN

Internal Factors
CLINICAL

Strengths
Ancillary Services ( Radiology, Laboratory, Dental, Pharmacy) Conducts surgical procedures 0 deaths of obstetric patients

Weakness
Lack of Manpower Specialized Medical Services Health Programs Promotion

GENERAL MANAGEMENT

Support of both Recording system government and private Inappropriate/Ineffective sectors staffing & organization The only Capillariasis Center Infection Prevention and control No internal audit/survey in quality Underutilized of hospital committees

Internal Factors
PHYSICAL FACILITIES

Strengths
Have adequate lighting

Weakness
Inadequate room for communicable disease patients Inadequate ventilation Underutilized areas No elevator Inadequate facilities & equipment Hygiene ad Sanitation
No accreditation from any HMO There are more nonPhilhealth members patients Increase in HAMA Government subsidy is not enough to sustain hospital expenses for expansion

FINANCIAL

Stable budget from Governments subsidy Top 2 boxes showed that there is a remarkable increase in income Philhealth accredited

Internal Factors
MARKETING

Strengths

Weakness

Increasing average Promotion of daily census specialized medical services Residency Program
Ineffective staffing plan

ADMINISTRATIVE Licensing of DOH and Philhealth SUPPORT Hospital statistics updated

Future Quadrant
1. Expansion of Hospital & facilities 2. Good referral system to other Health facilities & packages in specialized medical services

Internal Fix-It Quadrant

1. Collaboration from other hospitals for best practices in hospital administration. 2. Improve staffing & organization structure

External Fix-It Quadrant

Survival Quadrant

1. Implementation of a sound solid 1. Implement an Emergency hazardous & liquid waste management Preparedness Program 2. Implement an Information, Education & Communication Program on good sanitation & hygiene

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

Professionalism

Respect

Integrity

Service Excellence

Social Responsibility

Consumer Mix

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

Product Mix

Self Paying Service patients Covered by HMO Covered by Philhealth 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

Outside Relations

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. Public-Private Partnerships HMOs Pharmacies Ambulatory services Philhealth DOH Referral System From rural and other local health units To provincial hospitals

STRATEGY FORMULATION
Strategic Goals/KRA: Facility Enhancement Adaptive Stabilization Plan Strengthening of current specialty medical services and surgical procedures

Market Entry

Joint Venture

*Partnering with HMO and entrepreneurs to increase financial capital

Creating *Health care packages that are affordable Specialized medical services facility in the region Purchase of new radiologic equipments (e.g. ultrasound, ct scan)

Positioning

Differentiation Focus to

Implementation

Facility and Equipment

Marketing Control Monitoring and Review

Brochures, media events, newspapers with focus on gatekeepers (e.g., medical societies) Internal audit and external audit

STRATEGY FORMULATION
Strategic Goals/KRA: Capability Building Adaptive Stabilization Plan Creating and hiring new plantilla positions for additional hospital staff (e.g. Hospital director, specialist, nurses) *Partnership through affiliations with nearby medical schools Focus to the population of Tagudin needing high quality but affordable healthcare services Inviting additional consultants/specialist practitioners Training and development for the hospital staff

Market Entry Positioning Implementation

Alliance Focus to one Organizational Structure Human Resources

Control

Monitoring and Review

Internal audit and external audit

Scenario Building

TGH in 3-5 years

THANK YOU!