Client feedback on Southern Philippines Medical Center health care services in 2023

@#Client feedback is an integral part of the health care system’s quality and effectiveness. In health care operations, it is paramount as it serves as a vital tool for continuous improvement, ensuring patient-centric care delivery, and fostering trust and accountability within the health care system. Client feedback helps shape up new and existing policies and is, therefore, highly valued, considered, and acted upon. In health care institutions such as the Southern Philippines Medical Center (SPMC), incorporating client feedback into policy-making enhances health care operations and aligns services with patient needs and institutional goals. In SPMC, the Hospital Client Experience Survey is the primary feedback mechanism by which clients, both internal and external, can voice their opinions, concerns, and suggestions regarding its personnel, processes, and structure. Through directives from the Anti-Red Tape Authority (ARTA)1 and the Department of Health (DOH),2 SPMC uses the Hospital Client Experience Survey Tool (HCES) to enhance service delivery. Public Assistance and Complaints Desk (PACD) Officers conduct monthly surveys across 200 hospital areas. Each area expects 5 to 30 responses, based on a calculation by the HCES Online Report Generator (ORG). PACD officers actively engage staff within their designated areas, encouraging their participation in survey distribution per transaction and motivating clients to provide feedback during specified survey days. Highlighting the significance of these surveys, PACD Officers emphasize the invaluable insights gained from diverse client responses, which ultimately shape and validate the impact of service delivery initiatives within the hospital. At the end of each quarter, PACD officers analyze data using the HCES-ORG, collate comments and commendations, verify the accuracy of HCES results, and then post them for viewing by the different departments within the institution. Exceptional staff commendations are documented in the quarterly HCES results publication, prominently displayed within the hospital. These commendations contribute to individual performance evaluations. If a staff member receives negative feedback on the HCES form, their unit manager receives a photocopy of the form and may implement disciplinary action or enroll the staff in customer service seminars hosted by the Professional Education and Training Department (PETD). Consistent negative feedback over three consecutive months may trigger appropriate improvement plans or corrective actions among individual staff or even entire departments. The infographic displays the reports from the HCES for the first to the fourth quarters of 2023. Clients’ feedback comprises three domains: personnel, processes, and structures. Personnel covers attitude and character, processes involve system and organization, and structures include facilities and equipment. The feedback includes both positive and negative comments, with recommendations also identified. The HCES consists of statements rated on a scale from 1 (strongly disagree) to 5 (strongly agree). For this infographic, we computed the mean satisfaction scores for each domain and the proportion of clients who reported satisfaction with the service and timeliness of service they received. To summarize the recommendations from the HCES, we utilized the artificial intelligence (AI) chatbot-powered search engine Perplexity AI. We uploaded the recommendations in spreadsheet format and prompted Perplexity AI to "Summarize, in bullets, the recommendations into three categories: personnel, process, and structure," and then to "Count the times each of those summarized comments were mentioned in the file." We used the response of Perplexity AI to illustrate the results as a word cloud, with the sizes of the words in the cloud proportional to the frequency of mentions. In the HCES, the most frequently mentioned suggestion was to provide additional staff. Other suggestions included maintaining clean and functional restrooms, and improving overall cleanliness and sanitation. Infrastructure-related suggestions focused on better ventilation, air conditioning or fans, expanding wards and watchers’ areas, adding more hospital beds and chairs, ensuring a consistent water supply, and providing necessary diagnostic and therapeutic equipment and medicines. Process-related recommendations focused on reducing service delivery turnaround time, prioritizing senior citizens, PWD, and pregnant patients, improving billing and laboratory services, optimizing operation scheduling, and enhancing staff communication and coordination between and among offices. Personnel-related suggestions included improving staff interaction with patients, providing staff training, ensuring staff safety, and performing diligent patient checks. Client feedback helps SPMC retain positive responses, optimize health care delivery, and serve clients better through ongoing renovations, reorganizations, and transformations, affirming its vision of quality service.

Health care financial support for patients needing medical assistance in Southern Philippines Medical Center

@#Medical assistance programs are government-funded programs that provide financial assistance to low-income individuals and families. These programs aim to reduce financial burdens and improve health care access. Coverage may include outpatient visits, hospital care, mental health services, diagnostic work-ups, prescriptions, and other services. This increases the detection of health conditions and improves drug utilization.1 2 3 Even though government health schemes and compulsory contributory health care financing schemes (e.g., PhilHealth) accounted for the majority of health expenditures in the Philippines, household out-of-pocket (OOP) payment still remains high. In 2022, the country’s total health expenditure (THE) was Php 1.12 trillion, with government health schemes and compulsory contributory health care financing schemes accounting for 44.8% of the THE and household OOP payment accounting for 44.7%. Thus, every Filipino spent an average amount of Php 10,059.49 for health care goods and services in 2022

Newborn Screening Center Mindanao census from 2019 to 2022

@#Congenital disorders cause a global estimate of 240,000 deaths in newborns and 170,000 deaths in children ages 1 month up to 5 years every year. 1 In order to detect metabolic, hematologic, or endocrine disorders in newborns, newborn screening (NBS) is conducted in many countries around the world. In the Philippines, NBS was introduced by the Newborn Screening Study Group in 1996, with the aim of establishing the incidence of six metabolic conditions, namely, congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, homocystinuria, and glucose-6-phosphate dehydrogenase deficiency, and creating recommendations for the adoption of NBS nationwide.2 The Republic Act No. 9288, otherwise known as the Newborn Screening Act of 2004, requires that the Department of Health shall ensure the establishment and accreditation of newborn screening centers (NSCs) in strategically located areas across the Philippines.3 At present, there are seven operational NSCs in the country,4 with the Newborn Screening Center-Mindanao (NSC-Mindanao) in Southern Philippines Medical Center (SPMC) as the only center catering to all NBS facilities all over Mindanao.5 NSC-Mindanao initially performed screening tests for five disorders, but now tests for a panel of 29 metabolic and other congenital disorders.

Southern Philippines Medical Center Outpatient Department consultation census from June 2020 to March 2021

@#Before the COVID-19 pandemic, almost all outpatient consultation services in Southern Philippines Medical Center (SPMC)一from triaging up to the actual consultations with doctors一were done face-to-face (FTF). Seeking medical care during the pandemic became more difficult. Since the start of the community quarantine last March 2020,1 all stakeholders in health care一health care workers, and patients alike一have had to comply with infection control measures like FTF interactions and travel restrictions to reduce COVID-19 transmission. When Davao City was placed under enhanced community quarantine (ECQ) last April 4, 20202, SPMC became the primary government tertiary care institution tasked to handle patients with COVID-19.3 Since then, most of the outpatient services, conducted by clinical departments, were limited to teleconsultations. SPMC created a set of procedures for doing teleconsultations in the Outpatient Department (OPD) to screen patients who need either urgent or routine care, and to either connect these patients to their physicians in the OPD or direct them to an SPMC department/unit outside of the OPD. A patient seeking outpatient consultation should send a private message via the SPMC Virtual Consultation Facebook page. A nurse moderator inquires about the patient’s concern or chief complaint through an online messaging platform and obtains a written informed consent by requesting the patient to reply with “Yes, I give consent” if, after reading the information form, they agree to the terms of the teleconsultation. New patients need to fill up a pre-formatted information sheet and download an app into their communication device. Returning patients are required to send their hospital numbers for record retrieval. The nurse then triages the patient to their designated clinical department. Through phone or online calls via the downloaded app, the resident-on-duty (ROD) contacts the patient, takes the patient’s medical history, requests diagnostic examinations, prescribes medications, and discusses diagnostic examination results and therapeutic plans with the patient, as appropriate. If the need for a physical examination in order to further assess the patient’s condition arises, the ROD obtains another informed consent for an FTF consultation. Before scheduling the patient for an FTF consultation, the ROD determines the patient’s risk of exposure to COVID-19 and directs them to the COVID-19 hotline if their risk is considered to be high. Low-risk patients, on the other hand, are given an appointment schedule and a checklist of requirements needed prior to FTF consultation. On the scheduled date of FTF consultation, the patient is reassessed for the risk of exposure to COVID-19. High-risk patients are redirected to the SPMC COVID-19 isolation area. All patients who physically walk in for outpatient consultation receive instructions from the outpatient triage nurses to follow this teleconsultation process. This report includes data from June 2020 to March 2021. Although the system for teleconsultation was immediately established in SPMC after the city was placed under ECQ,1 the procedures were only refined and strictly implemented in June 2020. Data in this report does not include appointments or consultations directly done in other departments such as SPMC Cancer Institute, Mindanao Heart Center, and Institute of Psychiatry and Behavioral Medicine. With the exception of some patients seen by the Family Medicine (FM) department, all patients who had FTF consultations in this report initially underwent the teleconsultation process, but were subsequently advised to show up for physical examination for further assessment of their conditions. The FM department sees both patients from the general public and those who come to the Personnel Health Services (PHS) of SPMC一including SPMC employees and their dependents. PHS patients, especially those who are already physically within the hospital vicinity when they decide to look for medical attention, have been allowed to seek outpatient care directly by FTF consultations, without the need for prior appointments arranged by teleconsultations. In this report, the FM census is presented as two graphs一the graph for the general public, and that for PHS patients. In general, there was a gradual increase in the frequency of teleconsultations across all departments over the months following June 2020. During the start of 2021, the frequencies of FTF consultations significantly rose in the Internal Medicine and Obstetrics-Gynecology departments. The FTF consultation frequencies also increased, albeit to a lesser degree, in the Dermatology, Ophthalmology, General Surgery, Urology, and ENT-HNS departments. The Orthopedics and Pediatrics departments had very minimal FTF consultations. The Dental Medicine department had no FTF consultations at all from June 2020 to March 2021. We calculated the OPD consultation ratio by dividing the number of FTF consultations with the number of teleconsultations. A higher ratio, expressed in decimals, would imply a higher number of FTF consultations done after teleconsultation. Excluding PHS data, the overall OPD consultation ratio for all departments from June 2020 to March 2021 was 0.17 (i.e., there were 2,557 FTF consultations done after 15,264 initial teleconsultations). The three departments who had the highest OPD consultation ratios for the entire report duration were the Urology (0.38), Internal Medicine (0.34), and Obstetrics and Gynecology (0.25) departments. On the other hand, the three departments with the lowest OPD consultation ratios for the entire report duration were the Orthopedics (0.01), Pediatrics (0.01), and General Surgery (0.10) departments. Data on specific morbidities/diagnoses and dispositions of patients after the teleconsultations or the FTF consultations are not included in this report.

Mandates pertaining to the ethical review of researches involving humans, and the establishment and accreditation of research ethics committees

@#In 2003, the secretaries of the Department of Health (DOH) and the Department of Science and Technology (DOST) signed a memorandum of understanding to institutionalize the Philippine National Health Research System (PNHRS) for the management of research in the country.1 One of the groups constituted under the PNHRS was the Technical Working Group (TWG) on Ethics, which created strategies that highlight the role of ethics in a responsible health research system. Among the recommendations of the Ethics TWG was the establishment of the Philippine Health Research Ethics Board (PHREB).2 In 2006, the PHREB was formally created through DOST Special Order 2006-91 “to ensure that all phases of health research shall adhere to universal ethical principles that value the protection and promotion of the dignity of health research participants.” Since then, PHREB has become the country’s policy making body on health research ethics.2 3 In 2013, the Republic Act 10532一or the PNHRS Law一was enacted.4 The Act strengthened the mandate of PHREB to ensure protection of the welfare, rights, and safety of human research participants, and the implementing rules and regulations (IRR) of the Act specified the policies that facilitate the achievement of the PHREB mandate.5 In 2017, through DOST Special Order 2017-248, DOST established research ethics monitoring boards (REMBs) in Region I, Region VI, and Region XI to assist in the comprehensive and consistent implementation of PHREB policies at the regional level.6 The creation of PHREB in 2006 initiated several other mandates from PHREB and other agencies that implement the PNHRS. These mandates一shown in the infographic一support human research participant protection through ethical reviews of research protocols, establishment of research ethics committees, and maintenance of quality standards of these committees through accreditation. Many of these mandates are national in scope, but a few are specific to Davao Region (Region XI).

COVID-19 vaccine roll-out in Davao City

@#The Republic Act No. 11494, also known as the "Bayanihan to Recover as One Act," mandates the allocation of funds and provides guidance for the procurement of COVID-19 vaccines.1 However, with the limited availability of COVID-19 vaccines, the Department of Health (DOH) established different policies and guidelines for the selection, access, and deployment of these vaccines throughout the country.2 3 4 5 To date, the Philippine Food and Drugs Authority (FDA) has granted emergency use authorizations for eight COVID-19 vaccines, namely: Pfizer-BioNTech COVID-19 Vaccine, COVID-19 Vaccine AstraZeneca, CoronaVac, Sputnik V, Janssen COVID-19 Vaccine, Covaxin, COVID-19 Vaccine Moderna, and COVID-19 Vaccine BIBP/Sinopharm.6 One of the guidelines established by the DOH is the implementation of a prioritization scheme, wherein citizens are categorized into different prioritization groups based on risk of exposure to the virus and risk of mortality from COVID-19.4 In Davao City, the COVID-19 vaccination roll out started last 5 March 2021 among health care workers at Southern Philippines Medical Center. 7 Aiming to vaccinate 1,200,000 individuals in Davao City,8 the City Government of Davao, DOH Davao Region, and other participating sectors established 59 vaccination sites throughout the city.9 We gathered online data posted in the official facebook pages of DOH Davao Region and the City Government of Davao. According to the DOH Davao Region reports, as of 27 July 2021, a total of 742,710 doses of COVID-19 vaccines were allotted for Davao City. From the total allotted doses, the City Government of Davao City has successfully administered a total of 330,954 first doses, and 149,122 second doses of COVID-19 vaccines.10 According to the City Government of Davao, as of 25 July 2021, Davao City has administered a total of 85,260 doses (1st dose - 47,332 doses, 2nd dose - 37,928 doses) of COVID-19 vaccine among individuals in the A1 prioritization group, 103,837 doses (1st dose - 76,472 doses, 2nd dose - 27,365 doses) among those in the A2 prioritization group, 179,479 (1st dose - 101,833 doses, 2nd dose - 77,646 doses) among those in the A3 prioritization group, 98,502 doses (1st dose - 97,446 doses, 2nd dose - 1,056 doses) among those in the A4 prioritization group, and 12,998 doses (1st dose - 7,871 doses, 2nd dose - 5,127 doses) among those in the A5 prioritization group.11 All in all, as of 27 July 2021, 149,122 individuals out of Davao City's target of 1,200,000 individuals (12.43%) have received complete COVID-19 vaccination. In addition, 181,832 individuals have already received the first dose of a two-dose COVID-19 vaccine.8

Dengue reports in Davao Region 2008-2019

@#The Regional Epidemiology Surveillance Unit of Region XI (RESU XI) regularly gathers and summarizes all reports on diseases of epidemic potential in Davao Region. The summary surveillance report, which is released on a weekly basis, reflects the number of patients reported to have particular reportable conditions based on presenting signs and/or symptoms, clinical suspicion, clinical diagnoses, or laboratory-confirmed diagnoses. This infographic shows the number of patients suspected to have dengue who were reported to the RESU XI from January 2008 to October 2019. A patient suspected to have dengue is a previously well person who develops an acute febrile illness for 2-7 days duration, and has at least two of the following signs and symptoms: headache, body malaise, myalgia, arthralgia, retro-orbital pain, anorexia, nausea, vomiting, diarrhea, flushed skin, and/or rash (petechial, Herman’s sign).1 These dengue reports are prepared by the 10 identified sentinel hospitals throughout Davao Region (6 in Davao City; 1 each in Davao del Norte, Davao Del Sur, Davao Oriental, and Compostela Valley). The first six graphs show data from Davao City and the individual provinces in Davao Region. Reports were counted based on the city or province where the patients came from. The large graph at the bottom represents overall counts for the entire Davao Region. Each bar in a graph represents the monthly number of patients reported.

Non-communicable diseases survey in Davao Region—alcoholic beverage drinking, smoking, diet, and exercise profiles

@#The Non-Communicable Diseases (NCD) survey in Davao Region conducted by the Department of Health-Davao Center for Health Development (DOH-DCHD), with technical support from the DOH-Epidemiology Bureau and World Health Organization–Philippines, was a descriptive study done to determine the prevalence of NCD risk factors among adults from October 2018 to February 2019. A total of 5,312 participants from 6 cities and 43 municipalities in Region XI (at least 100 participants per city or municipality) were interviewed for this study. The mean age of the participants was 45.4 ± 12.6 years, and the sex distribution was 62.6% (3,323/5,312) women and 37.4% (1,989/5,312) men.1 This infographic shows the alcoholic beverage drinking, smoking, diet, and exercise profiles of the participants of the survey. The results show that 935/5,312 of adult participants in Davao Region currently smoke tobacco products. A total of 37 (0.7%) participants use electronic cigarettes. Davao City has the highest proportion of participants who use electronic cigarettes (3.8%). Two out of 5 adults consumed alcoholic beverage within 12 months prior to interview, and out of those two, one engaged in heavy episodic drinking (had 6 or more standard drinks on at least one occasion) within 30 days prior to interview. With regard to diet, the average days the participants consume fruits per week is 3 days, with 812/5,312 of the participants eating fruits everyday. The average days participants consume vegetables per week is 6 days, with 3,621/5,312 participants eating vegetables everyday. On average, the participants consume 2 bowls (or around 300 g) of fruits, and 2 bowls (or around 300 g) of vegetables per day. The proportion of participants with insufficient physical activity based on the levels of physical activity for adults recommended by the World Health Organization2 is 62.5% (3,320/5,312). Among the participants aged 18-65 years old, 2,819 has work that does not involve moderate- to vigorous-intensity physical activity. There are 2,629/5,312 participants who are classified as overweight/obese (BMI of ≥ 25).