What’s up, Doc?: Delivering Service Excellence in Health Industry Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg June 22, 2012; 6 - 9 pm Ateneo Professional Schools Auditorium Rockwell, Makati

1. 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

2. 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?

3. 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?
.………..
………...

4. 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?

5. ROJ’s TPORs on Delivering Service Excellence in Health
Industry with Focus on Hospitals
Questions (ROJ)
Questions (Organizers) – Reference: MDH
•Service excellence in
the health industry?
• 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
strategies ?
•
•
•
•
•
•Most difficult
(outstanding)
challenges ?
• Challenges
What strategies
How implemented
How measured
How communicated
Cost-effectivity

6. Q1. 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.

7. Q1. 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.

8. Q1. 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?

9. Q1. 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

10. Q1. 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 / 100,000 agreed
Acceptable rate (94 set andvs 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 If yes, EXCELLENT! suicide rate
rate (e.g. 7 vs 8 score – QLI;
Access to health care
If indices
Acceptableno, NOT
Others
or “NOT SO”
excellent!

11. Q2. 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

12. Q2. 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

13. Q2. 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.

14. Q2. 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

15. Q2. 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%

16. Q2. 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!

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

18. 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
NO unwarranted losses
Enough revenues and
incomes to continue and
expand
Business continuity and
disaster resiliency
Business continuity after a
disaster
Corporate social
responsibility
Sustenance of catchment
community

19. Q2. 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.

20. Q3. 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.
• ………
• ………
• ………

21. Q3. 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.

22. Q3. What are some recommended strategies in
delivering service excellence in hospitals?
Strategic Framework
Facilitating Strategies
Design and develop hospital
performance excellence
program
• Baldrige Health Care
Criteria for Performance
Excellence
• Joint Commission
International or
Accreditation Canada
International accreditation
for hospitals
• PhilHealth Benchbook
Implement program
Investors in People standards
Evaluate results of
implementation
Balanced scorecard

23. 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

25. 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
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
PhilHealth Benchbook
• Patient Rights and
Organizational
Ethics
•
Patient Care
•
Leadership and
Management
•
Human Resource
Management
•
Information
Management
•
Safe Practice and
Environment
•
Performance
Improvement

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

27. 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

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

29. 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

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

31. Balanced Scorecard (Sample)
Vision: Leading center of excellence and wellness in the Philippines
providing holistic quality patient care
Perspective
Goal
Customer
Quality
service and
care
Process
Excellent
operational
mgt system
Tactical
Objective
Provide
quality
services –
prompt,
effective,
and
courteous
Develop
effective /
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

32. 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
Performance
Measures
Target
total number of At least
units
85%
participated in
one competency
based training
Develop
No. of indigent
CSR
patients served
Programs (inpatients)
Greater
than
20XX
total
number
Initiatives
(Programs)
People Growth and
Development
Program
Project CSR

33. History of MDH BSC (2004-2011)
Outcome
Has been useful in serving as
- communication
- alignment
- collaboration
- monitoring
- evaluation tool
in the implementation of strategic direction in
Manila Doctors Hospital.

34. Q4. What are the most difficult (outstanding) challenges in
delivering service excellence in hospitals?
Challenges
Strategies
Man
Method
Money
√
√
√
√
√
√
√
√
Implement
√
√
√
√
√
√
Evaluate
√
√
√
√
Improve
√
√
√
√
Design and
Develop
Get
Committed
Support
Machine Monument Trends in
Health
√
√
√

35. 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

36. Q4. 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
paradigm shift
of a
(community health outcomes targets, valuebased delivery system, and corporate social
responsibility)

37. Q4. What are the most difficult (outstanding) challenges in
delivering service excellence in hospitals?
ROJ’s Recommendations to meet the challenges:
•
Facilitating strategies – Standards, IiP, 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

38. ROJ’s TPORs on Delivering Service Excellence in Health
Industry with Focus on Hospitals
Questions (ROJ)
Questions (Organizers) – Reference: MDH
•Service excellence in
the health industry?
• 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
strategies ?
•
•
•
•
•
•Most difficult
(outstanding)
challenges ?
• Challenges
What strategies
How implemented
How measured
How communicated
Cost-effectivity

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

40. Summary and Closing

41. ROJ’s TPORs on Delivering Service Excellence in Health
Industry with Focus on Hospitals
Questions (ROJ)
Questions (Organizers) – Reference: MDH
•Service excellence in
the health industry?
• 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
strategies ?
•
•
•
•
•
•Most difficult
(outstanding)
challenges ?
• Challenges
What strategies
How implemented
How measured
How communicated
Cost-effectivity

42. 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.

43. 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!

44. 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!

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

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