Transforming healthcare beginning with heart care

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DR. JULIET BALDERAS

THE decision to improve governance in the Philippine Heart Center (PHC) is part of the legacy of its former executive director, Dr. Manuel T. Chuachiaco, Jr., and shows his desire to sustain the PHC despite the changes in administration. In 2011, the hospital was confronted with the challenge of maintaining its status as the “best heart hospital” in the Philippines, while facing problems such as competition from private hospitals and standalone laboratories, a saturation of patients from all over the country, and a decrease in patient support budget by 30 percent.

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Governance in Philippine hospitals is further complicated by the fact that: 1) diseases have naturally reached levels that require advanced expert care and upgraded diagnostic labs and treatments; 2) the number of sick Filipinos has increased and so have hospital costs; 3) hospital personnel must also be increased; and 4) fund requirements for patient services and hospital costs are now higher.

To address these, the healthcare sector has made use of management schemes attached to various accreditation institutions. In 2010, PHC pursued Kaplan and Norton’s Balanced Scorecard, Canada International accreditation, and ISO certification. However, once accreditation was accomplished, whether or not the plans were made a reality was not monitored using set targets. In 2013, PHC began to work with the Institute for Solidarity in Asia (ISA), which had developed the Performance Governance System (PGS). Ultimately, this was the framework that showed that transformation in healthcare could be done, and it led to PHC’s being recognized as an Island of Good Governance (IGG) during an APEC-led event in 2015.

In just a little over three years, the hospital has seen tangible results: 1) cardiac surgery mortality rate is now at par with international standards at 3.1 percent of an average 3,100 heart surgeries per year; 2) hospital infection rates are lower at less than 2 percent; 3) 93 percent of patients discharged stay at the hospital for less than seven days; 4) laboratory procedures have increased from 1.7 percent in 2010 to 22.8 percent in 2016; and 5) patients served have increased from 7,000 to 36,000.

PHC has managed to improve processes through standardized treatments known as “clinical pathways,” which are applicable for the Philhealth Z-benefit program. Since 2013, this has benefitted 1,747 patients that needed coronary artery bypass surgeries, congenital heart disease correction through Ventricular Septal Defect patch closure, and total correction of Tetralogy of Fallot. In this sense, PHC has been able to provide equitable healthcare, administered as well in regional heart hospitals now equipped to bring the national heart center’s services to patients outside of Metro Manila.

Our Department of Health (DOH) has recognized these efforts, and has aligned the regional heart hospitals to the Philippine Health Agenda.

PHC also continues to campaign for better health sector governance by encouraging other government hospitals through a sharing of best practices. The hospital held its first Governance in Healthcare Summit in July 2016 to discuss the national healthcare situation and corresponding improvements and indicators in government hospitals. The response was overwhelming, with 434 participants (including hospital directors and administrators, quality managers, doctors, and nurses) signing up from 96 hospitals nationwide.

The summit stimulated interest in PHC’s governance model, which seeks—and even requires—individual contribution to successful hospital outcomes in patient-focused care, and patient safety and satisfaction.

The hospital’s next major contribution to transforming healthcare in the country is to actually teach other hospitals how to do PGS. Ten participating hospitals will be guided in drafting their hospital roadmaps and scorecards, aligned of course to the Philippine Health Agenda 2016-2022. PHC wants to help these hospitals “reinvent” themselves by asking what group of patients they can serve most, and what they can do to best develop their institution’s social impact, patient counts, and organization and fund management. The strategies will likewise address improvements that must be made in primary, secondary, and tertiary prevention. These hospitals will all be encouraged to undergo ISA’s full governance pathway, which involves defending these roadmaps and scorecards in public revalidas.

At the end of the day, PHC aspires to make governance a shared responsibility in healthcare, beginning with this one-hospital-at-a-time outreach plan. It hopes to influence organizations and government itself to improve health policies for all. At the entrance to the hospital is an inscription of a quote that reads, “Be there one Filipino sick and uncared for, our mission is not done.” Well into the future, PHC will continue to imbibe this spirit and continue to be passionate about achieving healthcare excellence in its patient care, continuing education, and research.

Dr. Juliet J. Balderas heads the Philippine Heart Center’s Department of Pediatric Cardiology, and the Office for Strategy Management (OSM), responsible for instituting the hospital’s major reforms. She is also an associate of the Institute for Solidarity in Asia (ISA). To learn more about her work and about the hospital’s governance reform story, visit www.phc.gov.ph and isacenter.org.

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