WHILE hospitals are equipped to deal with emergency situations that involve multiple casualties, they were not prepared to deal with an invisible enemy known as the Covid-19 virus.
Imagine the concerns and the fears going through the heads of hospital administrators. Will frontliners get infected? What rooms can accommodate Covid-19 patients? Do we have enough medicines to treat them? Do we have enough PPEs for frontliners? How can we get non-Covid patients to come back to the hospital so that their illness will not worsen?
The BusinessMirror had the opportunity to interview the executives of nine private hospitals to get their views on how the pandemic has changed the way they run and manage the hospitals. One theme was common with all the nine hospitals—the challenges they face with PhilHealth and how they managed to keep afloat financially in spite of this.
Makati Medical Center
LAWYER Pilar Nenuca P. Almira, President and CEO of Makati Medical Center (MMC), thinks she could not have managed the Covid-19 pandemic without the highly competent hospital personnel.
The Infection Control Committee and the Facilities Management Team were able to transform patient rooms into negative pressure rooms. The Quality Management Group ensured that safety protocols were in place. The doctors were quick to come up with algorithms and protocols to deal with these kinds of situations and determine the ways to treat patients along the way.
“Our recovery rates are very good, in fact our 2020 rate is better than the national index. That’s because our doctors are quick to come up with algorithms and protocols and they have really effected multidisciplinary teams to help treat our Covid patients,” she said.
On managing physical resources
In addition to negative pressure rooms, Almira said they also implemented zoning to separate the Covid from the non-Covid patients. This was to ensure that MMC is safe for non-Covid patients who required medical attention.
“We did not want the hospital to be the cause of infection. And with that assurance, the patients continued to come,” she said.
To accommodate the growing number of Covid patients, MMC put up tents in the Convergys area to serve as their drive-thru facility. This drive-thru facility not only offered RT-PCR testing, but also a venue for initial assessment or triaging for Covid.
“We have doctors available there and they would assess whether the patient is mild, moderate or severe. If the patient requires hospitalization, that is the only time that he is referred to the ER,” she said.
To handle clients who do not want to go to MMC for their blood works and other diagnostics, Almira made sure that MMC’s Wellness Center, an offsite facility, remained free from Covid. The hospital also opened the MakatiMed Outpatient Center at Discovery Primea, a complete clinic and diagnostic facility.
On financing and cashflow management
Almira related that since there were challenges in dealing with PhilHealth, the hospital had to be very judicious in the way it made use of its financial resources. It prioritized the needs of the patients like the purchase of ventilators and converting hospital rooms into negative pressure rooms.
The finance team also continued collecting from the patients but was cautious in implementing any price increases because of the financial situation caused by the pandemic.
“Because of the efficiency by which our finance team has managed our cash, we were able to provide all the needs. We never thought of offering retrenchment or cutting our people just because we don’t have money,” Almira said. “In fact, we have been able to get out of the deep in 2020 and the basis now for our performance is 2019.”
Management also put a lot of focus on connectivity, using virtual means because the medical team is very emphatic when it comes to social distancing and avoiding face-to-face meetings to avoid infection.
“So how are we managing? We are managing through the use of virtual means. We continue with our meetings and planning sessions and regular reviews to make sure that we respond to the needs of our patients,” she said.
On handling and protecting human resources
Almira placed much emphasis on how they looked after their staff during the pandemic because they “are the most important anchors of the hospital because it is the people who run the hospital, most especially our frontliners who are attending to our patients.”
To ensure the healthcare workers’ safety, Almira said they provided them with PPEs, vehicles, lodging because of the limitations in transportation. The hospital also continued its medical training programs for medical trainees who provided invaluable support to consultants.
“Every now and then, we would give them tokens of appreciation, free merienda. We would take care of them if they get infected. We provided and continue to provide for their medical needs just to make sure that they are kept well,” she said.
“Even during this pandemic, we continued to focus still on the development of our people. We did not stop training and development programs because we believe that we have to continue their progress in their career as they stay in MMC,” she added.
On services and upcoming plans
Even during this time of Covid, Almira said they purchased a piece of high-end equipment for the Catheterization Laboratory to treat heart ailments. MMC also added 13 to 15 rooms to its renal facility to accommodate Covid patients who required dialysis. A tent facility was put up in Mile Long to accommodate drive-thru RT-PCR testing and vaccination.
“We initiated what we call a mobile diagnostic hub wherein we partner with villages and communities. We would then set up a diagnostic hub there in either their gyms or in their clubhouses so that they don’t have to come to the hospital,” Almira explained.
MMC will continue to grow, Almira said, as its board of directors has approved its plan to open a complete offsite diagnostic facility in Cubao, Quezon City.
“It’s going to be a 1,000-square-meter outpatient facility with renal services in Manhattan Plaza in Araneta City. We are supposed to start construction on October 1 and hopefully in six months, we should be able to operate it,” she said.
On lessons learned
During this pandemic, Almira said that while she and all the other MMC employees experienced fear during this time, she said there was a need to continue inspiring the employees about the hospital’s mission and vision “so that all together we will be strong as a team to continue providing care for all Covid patients.”
“We continue to interact with them, to provide them with the support that they need, for example, for their mental health. We have fellowship activities just to make sure that we are able to balance the fatigue, hardship and fear and reinforce the spirit of care and service because we are a hospital,” she said.
Additionally, Almira said they had to operate very judiciously and observe the culture of frugality.
“Meaning to say, during these times where there are a lot of difficulties, we have to be very judicious in the way we use our resources. We have to be frugal without sacrificing the quality of care that every patient deserves,” she said.
Another key learning for Almira is the importance of strengthening the organization and making sure that the relationship among employees is positive and teamwork is the key to all this.
For the work they did to fight Covid-19, MMC received several awards from the Gawad Bayaning Kalusugan. The MakatiMed Covid-19 Task Force was declared winner in the Team category for the national award. MMC Medical Director Dr. Saturnino P. Javier was the overall winner for the individual category, while MMC’s Head of Infection Prevention and Control Janice C. Caoili was recognized in the Individual Category. MMC also won the gold award at the Asian Hospital Management Awards for its efforts to help healthcare workers. It also received a Gold Award from the International Public Relations Association Golden Awards for Excellence crisis communications online category for its Covid-19 Information Program.
“We are happy to get affirmation that we are doing well. And we are out of the deep of 2020. We have bounced back,” she said.
Almira added that MMC is also an advocate of vaccination and to date, it has already vaccinated 30,000 people, including employees of sister companies in the Metro Pacific Corp.
“We are balancing the fact that we have to make sure that we are stable as a hospital and at the same time grow because with this pandemic, we have to make sure and assure the organization that we are stable and viable. We are sustainable yet not forgetting that we are going to grow,” she said.
St. Luke’s Medical Center
Not too many people know that at the start of the pandemic, Dr. Arturo S. de la Peña, President and CEO of St. Luke’s Medical Center, was diagnosed to be positive for the virus. The diagnosis came three weeks after he had to undergo an emergency coronary heart bypass.
“You see the treatment then was not standardized and everything that could be tried were given to me and we now know that many of those treatments did not work,” Dr. De la Peña said. “More or less, we were able to standardize. We know what worked, we know what does not work and to this day, that has contributed to the good outcomes in terms of managing patients with Covid infection.”
No one was really prepared to handle this pandemic, Dr. De la Peña conceded, because not much was known about handling the virus. The last time the world had to handle a pandemic was in 1918 and the virus behaved differently.
“So those are knowledge gaps regarding the behavior of the virus. So what we know was that this was highly transmissible and many of our hospitals were not designed to separate the physical structure for those resources that would handle Covid patients,” he said.
On managing physical resources
Since St. Luke’s Medical Center Global City is a new hospital, Dr. De la Peña said they were able to segregate the Covid from the non-Covid patients.
“For Covid patients, we have a separate emergency room, a separate ward, separate diagnostic equipment and even separate elevators,” he said. “We were also able to segregate the people assigned to the Covid wards because later on, there were also a lot of patients who are getting sick of non-Covid conditions. So that is what we have learned throughout the year.”
The hospital also launched different services to reduce the exposure of patients going into the hospital.
“We were the first one to launch the drive-thru: in the comfort of your vehicle, you pass through a certain part of the hospital where your blood examinations could be done,” he said. “We were also the first one to develop a system wherein there is a home-service capability of extracting the blood and some minor tests that could be done to patients.”
For its foreign patients, especially those coming from the Asian Pacific islands like Guam and Palau, St. Luke’s established the “Medical Bubble.” Dr. De la Peña described it as the point-to-point care of patients coming from overseas wherein the patients are quarantined at the hospital, they do the tests and treatments here.
“As soon as they are finished, we swab them also, we bring them to the airport and they go back to the countries of their origin,” he added.
St. Luke’s also has mobile vans that go to different areas like condominiums, corporate accounts, subdivisions and are capable of doing blood extractions and X-rays.
On financing and cash flow management
Dr. De la Peña said St. Luke’s encountered challenges in terms of financing and cashflow management because the demand for the medical supplies in handling Covid patients is high and the supply is really low.
“So you really have to manage those contingencies and that is why we were able to go and determine exactly how much do we need in our inventory,” he said.
Like all the other hospitals, St. Luke’s is also having difficulty with PhilHealth. According to Dr. De la Peña, PhilHealth has not been paying them on time. Even if PhilHealth has remitted any payment to St. Luke’s, it is only a partial payment.
“If they try to give us only 60 percent and certainly the receivables have been going on for more than a year so that is not fair for the hospital not to be paid immediately. So those really are the challenges,” he said.
A certain amount of St. Luke’s resources were also allotted for hazard pay, transportation, meal allowances and accommodation of many of their healthcare workers due to limited access to transportation when surges occur. Resources also have to be set aside for the RT-PCR testing of healthcare workers to ensure that they do not spread the virus to patients.
“From our experience, most of the Covid transmissions to our healthcare workers are acquired in the community. There are very few transmissions in the hospital because everybody follows the very strict standard health protocols,” he added.
In handling and protecting human resources
As for its human resources, Dr. De la Peña noted that the hospital did not let go of any of its employees and added that it did not implement a no-work, no-pay policy.
“We paid them. We spent a lot of money during the pandemic but we did not regret that decision because we gained the loyalty of our people and these are the people who saved us through these years also,” he added.
It was not only the patients who had second thoughts of going to the hospital. Even doctors were hesitant to go to the hospital because they would be unnecessarily exposed to the virus. To help treat patients during the pandemic, the doctors decided to adopt the group practice concept.
This meant that most of the doctors band together in their specialties so that they do not have to go on duty at the hospital every day and they just go to the hospital on a scheduled basis.
“This limits the exposure of our healthcare workers to Covid patients and this is one of the positive things that came out of this,” he said. “We were able to standardize the treatment for Covid and doctors when into group practice so that not all of our resources are exposed to the elements.”
On services and upcoming plans
Dr. De la Peña noted that during the pandemic, patients with chronic diseases developed severe complications of their diseases because they missed follow-ups and the continuous care of their doctors.
As such, the hospital received almost every day four to five heart-attack emergency cases or the same number of stroke emergencies. The condition of cancer patients worsened as they did not want to be treated inside the hospital for fear of getting the virus.
“So we embarked on campaigns that stressed that the hospital is safe and for those who would want to continue to maintain their health, they should try to have their checkup with their doctors in the hospital,” he said.
To achieve this, Dr. De la Peña said they launched the telemedicine service to enable doctors to attend to their patients in the comfort of their homes. Additionally, the hospital also introduced wearables that allow doctors to monitor their conditions.
He also revealed that the hospital is in the final stages of developing its hub-and-spokes model of healthcare delivery.
“The hub meaning to say the centers and the spoke are the areas where we bring our presence to where our patients do live. And should they need the services of the hub, they are referred back to us,” he said.
The model, Dr. De la Peña explained, does not necessarily mean that they will open clinics. For now, St. Luke’s is making do with the vans as well as the laboratories. As demand increases, they will be able to determine the kind of services that will be needed. He did say though that the areas that they are targeting are the growth areas of Regions 3 and 4.
In terms of non-Covid services, Dr. De la Peña said they are looking into subspecialization and are in the process of developing the concept of Centers of Excellence—excellence in fields like cardiology, neurology, cancer and on minimally invasive surgery. They are also looking into cancer specifically for children.
“The concept of treating patients now is you cannot be an expert of all and a master of none. We are going to spread out the centers of excellence in the different hubs that we are going to put up,” he said.
Healthcare will not be determined by price, Dr. De la Peña said, but will be defined ultimately by the highest quality of care that you can give to patients at a minimal cost.
“In every aspect of healthcare, there is value to our patient as well as their relatives who will look into the nonmedical aspect,” he said. “It is the experience to make their life or stay in the hospital as comfortable as possible and this will be one of the main determinants of the success of healthcare delivery.”
On lessons learned
As for the lessons learned during this pandemic, Dr. De la Peña said the experience has taught them to reserve their resources not only on supplies but on manpower as well. Technology will also be required to increase process efficiency and improve the patient care process.
Digital transformation is also important because the data that will be gathered in the process will be analyzed and transformed into artificial intelligence. This artificial intelligence will help predict the success of a treatment, the course of the treatment and which treatment will be tailored for a particular patient.
“And of course, we have to take care of our people, which is most important in healthcare,” he said.