| 4. In which ways is the initiative creative and innovative?
It innovatively addresses UN SDGs 3 and 17 as a “People-first PPP.” Per UNECE, it “set out a clear statement that out of all the stakeholders, ‘people’ should be the priority and main beneficiary. Their focus should be on improving the quality of life of communities, particularly those that are fighting poverty and by creating local and sustainable jobs.”
It is trailblazing as it advocates the “software” side of sustainable hospital management and operations, focused on capacity building for a public hospital’s human resources. This “soft PPP” supports and complements the technical and financial requirements, ensuring a sustainable strategy for public hospital management and operations. It goes beyond the usual components of PPP programs involving infrastructure support and procurement / contractual arrangements.
Research and review of existing literature revealed PPPs being implemented in public hospitals, but mostly designed to provide and improve infrastructure and equipment. Up until the MMC Foundation’s flagship “PPP Program for the Organizational Strengthening of Public Hospitals” was institutionalized, there existed no blueprint for private and public hospitals to partner, thereby serving majority of marginalized Filipinos who otherwise cannot access the higher quality and more expensive basic health care and medical services provided by private hospitals.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The Makati Medical Center (MMC) Foundation initiated this partnership with Rizal Medical Center (RMC) as the implementing organization, and through which the program was administered.
RMC, formerly Rizal Provincial Hospital, is a Department of Health-retained hospital, borne out of a need for the government to solve health problems and alleviate suffering of medically indigent patients and clientele particularly from the province of Rizal and its catchment areas, and the country in general.
It started as a 25-bed-institution in 1941, and has grown to a 300-bed capacity teaching and training hospital. Through the years, RMC trained medical students and interns, nursing students at all levels, medical technologists, as well as post-graduate trainees in medical specialties, nursing and hospital administration. For 75 years of loyal and dedicated service since its inception, RMC continues to make its institutional presence felt by promoting sound and appropriate management guided by the following objectives:
a. To provide a high quality of clientele / patient care to as many people as possible, economically and efficiently.
b. To render emergency treatment and first aid in accidents and disasters.
c. To assist in the preventive aspects of public health, such as case finding, immunization, pre-natal examinations, etc.
d. To serve as a laboratory and workshop for doctors, nurses, medical technologists and all other health disciplines who are in training.
e. To provide expanded and extended health services to other areas where there is a need.
f. To facilitate staff development of all technical and non-technical hospital personnel at all levels through formal and informal programs of education, in-service training and continuing professional education.
g. To enhance opportunities for research and studies.
During the PPP program’s implementation, RMC catered to an annual total of 113,000 OPD (out-patient department) patients, 73,000 ER (emergency room) patients and 14,500 in-patients.
| 6. How was the strategy implemented and what resources were mobilized?
A tri-partite Memorandum of Agreement (MOA) for a “Public-Private Partnership for the Organizational Strengthening of the Rizal Medical Center,” was signed on 19 June 2012 between :
a. Makati Medical Center Foundation, a not-for-profit organization and Corporate Social Responsibility (CSR) arm of Makati Medical Center,
b. Rizal Medical Center (RMC), a national teaching and training hospital of Department of Health; and
c. Department of Health (DOH), an executive department of the Republic of the Philippines.
MMC Foundation’s strategic directive was to assist public hospitals in developing a sustainable organizational and operational management plan, designed to help the hospital help itself. It provides for the organizational strengthening of public hospitals, through workshops and training interventions for hospital leadership, management and staff. Key result areas include development of a sustainable, long-term, strategic, organizational and operational plan for the partner public hospital.
The framework was Kotter’s 8-Step Change Framework, identifying change champions within the organization and recognizing roles of internal and external stakeholders, involving them in various phases of program implementation. An RMC core team contributed to program assessment, planning, designing and implementation. The strategy was implemented in four (4) modules :
a. Organizational Assessment - analysis of organizational capacities, competencies and resources
b. Strategic Planning - enhanced statements of service vision, mission and service values and goals
c. Operational Planning - defined work plan with Key Success Indicators and resources for priority Service Improvement Areas
d. Case study Documentation and Project Impact Evaluation – recording of the partnership’s best practices, lessons learned and areas for improvement
(1) Key developments and steps
a. A temperature check on RMC’s health, before and after the PPP program, measuring specific organizational indicators as key parameters;
b. A customized program impact evaluation conducted by an independent third-party evaluator that revealed whether the partnership fulfilled the goals and objectives it set out to accomplish;
c. A documentation of the partnership, capturing best practices and lessons learned, along with identified areas for improvement towards developing a template for engaging future partner public hospital partners at the local, national, regional and global levels.
(2) Main activities
a. Assess RMC’s organizational capacity, resources, competencies, challenges and opportunities;
b. Revisit its vision, mission and service values and develop strategic operational plans for policy reforms, systems development and human resource development;
c. Generate support and resources for a change management program among the national government, local government units (LGUs), local health boards of the district hospitals, civil society organizations, community health teams and other stakeholders.
(3) Monitoring and Evaluation
Following the initial Impact evaluation conducted by a third party, and as part of the ISO accreditation in Quality Management System and Teaching / Training Hospital received by RMC on September 2013, RMC has consistently and regularly (bi-annual) conducted Internal Quality Audits and hospital-wide Management Reviews in order to tackle issues and concerns regarding conformance/non-conformance to standards we have set, root-cause analysis of unachieved targets and celebration of achieved targets.
AJA external auditors also conduct bi-annual accreditation visits to monitor whether non-conformance and previous observations have been acted upon; and, whether new non-conformance and observations have arisen. These are reported to the hospital management for planning and policy review.
(4) Project timeframe: Six (6) months, from 19 June 2012 to 30 December 2012.
(5) Estimated Program Cost: PhP 1 Million, broken down as follows :
1. Organizational Assessment : PHP300,000.00
1. Includes research component, baseline data
gathering, designing tools, surveys, interviews,
FGDs, data analysis, documentation, reporting
2. Learning Sessions / Workshops / Mentoring / Coaching 400,000.00
3. Program-related costs and management
1. Communications, documentation, transportation, 150,000.00
manpower and logistical requirements
4. Program Impact Assessment 150,000.00
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
a. Program Proponent: Makati Medical Center (MMC) Foundation
b. Implementing Partners: Rizal Medical Center (RMC) and
First Pacific Leadership Academy (FPLA)
c. Program Partners: Department of Health (DOH) and Makati Medical Center (MMC) Hospital
d. Program Impact Evaluators : Mr. Luigi Mapa, Organizational Development Consultant
| 8. What were the most successful outputs and why was the initiative effective?
a. The “Public-Private Partnership (PPP) for the Organizational Strengthening of Rizal Medical Center” is an innovative way to address the UN SDGs 3 and 17 as a “People-first PPP.” The partnership has been proven to be a working example of synergy between public and private institutions at its best.
b. RMC’s ISO Certification 9001:2008 award was a clear and palpable achievement of the partnership. As a result of the training in process documentation, write-shop seminars and coaching / mentoring approach, RMC was adequately prepared and equipped to accomplish the basic requirements for process standardization and documentation.
c. Continuous improvement, growth and development of its various programs and processes manifested at various levels during the course of their engagement with RMC. The PEPPP talks featured the best practices of MMC and the hospital tours demonstrated the situations on the ground, it became an inspiration to institutionalize innovative cultures of change and improvement in the hearts of the RMC leadership, management and staff:
(i.) Improved turnaround time of disposition of ER patients due to the creation of Modified Point-of-Care Laboratory testing.
(ii.) Recognition by the Philippine Civil Service Commission to meet the requirements in its pursuit of a Level II maturity in PRIME-HRM (Program to Institutionalize Meritocracy and Excellence in Human Resource Management).
(iii.) Enhanced the hospital client encounter due to the regular Customer Service Champion Workshop.
(iv.) Active promotion of Continuous Quality Improvement.
(v.) Computerization of business transactions was continuously improved to increase income and to enhance efficiency
(vi.) Increase in hospital income due to the Hospital Sponsored Membership (HSM), which resulted in a significant increase in PhilHealth member beneficiaries among admitted patients (from 44% in 2013 to 92% in 2016).
(vii.) Emergency Medicine Clinical Rotation of MMC doctors in RMC helped in the augmentation of the training program.
d. With MMC Foundation pursuing to replicate the success of this partnership, it subsequently partnered with other government medical institutions, utilizing the strategic template / model and having the RMC key mobilizers as subject matter experts, who are able to enhance their efforts to engage other health institutions. The positive ripple effects of this successful partnership provided opportunities for RMC to share the best practices and lessons learned with other public medical institutions at the local, national, regional and global levels.
Indeed, this partnership serves as an inspiring example of the potential good inherent in well-prepared and executed People–First Public-Private Partnership.
| 9. What were the main obstacles encountered and how were they overcome?
There were 2 main obstacles encountered during the implementation:
a. Getting the entire staff of RMC convinced to engage themselves in this partnership was almost an insurmountable challenge. They perceived the hospital to be in good condition, and not needing any intervention. There were several speculations and doubts as to the intentions of MMC Foundation and its ultimate goal was mistakenly perceived as a possible privatization of RMC. However, as soon as the RMC leadership managed the situation and clearly communicated the proper messages down to the rank and file employees, widespread cooperation gradually took place. After the initial organizational assessment was cascaded, the staff of RMC began to appreciate, cooperate and comprehend the need for the partnership.
b. The employees’ union took an aggressive stance by picketing during one of the visits of MMC Foundation. The confusion resulted from the perception that MMC Foundation was planning the privatization of RMC, where the job security of the employees were supposedly threatened. Upon assurance that their jobs were secure and the program’s scope and duration were limited to organizational strengthening, they were won over. Hence, active participation was demonstrated and outputs were facilitated.