CHAPTER II

Review of Related Literature

2.1 Related Literature

2.1.1 Foreign Researches

Figure 1.0 Singapore General Hospital

Source: https://www.sgh.com.sg

Singapore General Hospital (SGH) is Singapore’s flagship tertiary hospital with a history

and tradition of medical excellence spanning two centuries. The Singapore General

Hospital (abbrev: SGH) is the largest and oldest hospital in Singapore, of which the

foundation of its first building was laid in 1821. The hospital is where the founding father

of Singapore, Lee Kuan Yew, was treated with pneumonia and it is also the hospital

where he died.

The hospital, which is operated by SingHealth, occupies sprawling grounds in the

eastern part of Bukit Merah, sharing space with four specialist medical centres, namely

12
the Singapore National Eye Centre (SNEC), the National Heart Centre (NHC),

the National Cancer Centre (NCC) and the National Dental Centre (NDC).

Singapore General Hospital (SGH) is the first and largest hospital in Singapore. It

provides affordable specialist care for patients, training for doctors and other healthcare

professionals, and conducts research to bring better care to its patients. 

A not-for-profit institution, SGH is wholly owned by the government of Singapore

and the flagship hospital of the public healthcare system. SGH is a member of the

SingHealth cluster of healthcare institutions.

Mission

We deliver quality care to every patient through comprehensive integrated clinical

practice, medical innovation and lifelong learning.

We are dedicated to meeting the needs of:

 Our patient - excellent and cost-effective healthcare

 Our staff - continuing development and welfare

 Our nation - partnership in promoting health

Vision

To be a renowned organisation at the leading edge of Medicine, providing quality

healthcare to meet our nation's aspirations.

Core Values

 Compassion - I treat everyone with kindness, respect and dignity - the way i want

to be treated

12
  Integrity - I adhere to the highest standard of professional conduct and ethical

behaviour

 Collaboration - I deal with diversity with an open-mind and value the contributions

of all who are working together to achieve our common goals

History

The Singapore General Hospital was established in 1821, when the first General

Hospital was located in the cantonment for British troops near the Singapore River. It

later shifted to Pearl's Bank and then to the Kandang Kerbau district, before finally

settling at Sepoy Lines along Outram Road in 1882.

The modern history of Singapore General Hospital began on March 29, 1926, with the

opening of 800 beds in the Bowyer, Stanley and Norris Blocks. Today, only the Bowyer

Block with its historically distinctive clock tower remains. The Bowyer Block is now home

to the Singapore General Hospital Museum (SGH Museum).

In 1981, the hospital was rebuilt, with its current 8-block complex housing in-patient

wards, ambulatory and support services, research laboratories and

a postgraduate medical institute.

On April 1, 1989, the hospital was restructured, in an effort to modernise the

organisation of the hospital, due to rapidly developing changes in healthcare services

and patient expectations for better service. As a restructured hospital, the Singapore

General Hospital is still 100 per cent government-owned and is a not-for-profit institution.

More than 60 per cent of the beds are allocated for subsidised patients, giving them

access to an internationally established standard of affordable healthcare.

12
On March 31, 2000, following a major reorganisation of the public sector healthcare

services initiated by the Ministry of Health, the Singapore General Hospital came under

the management of Singapore Health Services or SingHealth. The SingHealth Group

currently serves the eastern sector of Singapore through a cluster network of

1（another） hospitals, 5 national specialist centres and 9 polyclinics.

Clinical Specialties

Clinical departments offering a wide variety of treatment options to their patients.

 Anaesthesiology

 Cardiology - NHCS

 Cardiothoracic Surgery - NHCS

 Colorectal Surgery 

 Dermatology

 Diagnostic Radiology

 Emergency Medicine

 Endocrinology

 Family Medicine Continuing Care

 Gastroenterology & Hepatology

 General Surgery

 Geriatric Medicine

 Haematology

 Hand Surgery

 Hepato-pancreato-biliary and Transplant Surgery

 Infectious Diseases

 Internal Medicine

 Neonatal & Developmental Medicine

12
  Neurology

 Neurosurgery

 Nuclear Medicine & PET

 Medical Oncology

 Obstetrics and Gynaecology

 Opthalmology - SNEC

 Oral & Maxillofacial - NDCS

 Orthopaedic Surgery

 Otolaryngology (ENT)

 Palliative Medicine - NCCS

 Pathology

 Plastic, Reconstructive & Aesthetic Surgery

 Psychiatry

 Radiation Oncology - NCCS

 Rehabilitation Medicine

 Renal Medicine

 Respiratory & Critical Care Medicine

 Rheumatology & Immunology

 Upper Gastrointestinal & Bariatric Surgery 

 Urology

 Vascular Surgery

Specialist Centres/ Services

12
These centres are designed to deliver one-stop services organised around disease

conditions.

 Allergy Centre

 Ambulatory Surgery Centre

 Ambulatory Endoscopy Centre

 Autoimmunity & Rheumatology Centre (ARC)

 Blood Cancer Centre

 Breast Centre

 Burns Centre

 Centre for Assisted Reproduction (CARE)

 Centre for Digestive and Liver Diseases (CDLD)

 Diabetes & Metabolism Centre (DMC)

 Eating Disorder Programme

 ENT (Ear, Nose & Throat) Centre

 Gastrointestinal Function Unit

 Haematology Centre

 Haemodialysis Centre

 Head & Neck Centre

 Health Assessment Centre

 Hearing and Ear Implants

 Hyperbaric & Diving Medicine Centre

 Inflammatory Bowel Disease Centre

 LIFE Centre: Lifestyle Improvement and Fitness Enhancement

 Lung Centre

 Obstetrics and Gynaecology (O&G) Centre

12
  Orthopaedic Sports and Joint Centre

 Pain Management Centre

 Pelvic Floor Disorder

 Peritoneal Dialysis Centre

 Rehabilitation Centre

 Sleep Disorders

 Transplant Centre

 Travel Clinic

 Urology Centre

Allied Health Departments / Units

Allied health professionals are essential members of the care team in every specialty.

They provide diagnostic, technical, therapeutic and direct patient care services.

 Allied Health Corporate Wellness Services

 Dietetics

 Medical Social Service

 Music & Creative Therapy Unit

 Occupational Therapy

 Pharmacy

 Physiotherapy

 Podiatry

 Speech Therapy

Nursing

The Nurses perform a wide range of clinical and non-clinical functions necessary to the

delivery of health care, and they are also involved in medical and nursing research.

12
  Specialist Nursing Services

 Nursing Specialties

Figure 2.0 Hospital in Downpatrick, Northern Ireland

Source:http://www.capitaproperty.co.uk/news__events/news/northern_ireland

On behalf of client South Eastern Health and Social Care Trust / Health Estates,

the new facility provides a ten bed observation unit; accident and emergency;

outpatients; three 20 bed inpatient wards; coronary care unit; 25 bed dementia ward; 25

bed acute psychiatric unit; day procedures unit; rehabilitation - physio and occupational

therapy; obstetrics and home from home birthing unit; radiology department; and

children’s centre.

The sublime local landscape also provided the ideal backdrop in which to

develop ‘Healing by Design’, a concept that takes hospital design away from being a

purely clinically functional layout and incorporates an understanding of the positive

effects nature and environment can have on improving patient care.

The design concept has been inspired by the extensive research which has

proven that the psychological aspects of a patient’s environment can reduce stress,

speed up recovery, reduce the dosage of pain killers and reduce anxiety.

12
 Consequently, the Hospital has been zoned on a physiological level where the

Capita Architecture team has created Patient Environments, Secondary Healing

Environments and a Medical Core.

The patient environment encompasses all the patients care areas throughout the

hospital which includes wards, outpatients departments and treatment areas. The

buildings form has been configured to allow each of these spaces to have open views

out to gardens and long distance views of the surrounding landscape. This setting is

designed to improve staff motivation, aid in the recuperation and healing process of

patients and convey to visitors that the hospital is a caring institution. The concept of

bringing together nature and the environment was developed further through the interior

design elements with the patient environment. The colours and textures reflect the

natural tones of the surrounding environment, bringing colour and light deep into the

building.

The patient areas and medical core are joined together by the introduction of the

secondary healing spaces. The spaces are created as free flowing volumes through the

patient environments and medical core. These spaces act as circulation, entrances,

waiting areas, coffee shops, providing entertainment, contemplation, gardens and a

sanctuary. The specific design of the secondary healing spaces allows patients, staff

and visitors to interact with the building and each other. The flowing walls through the

secondary healing space creates a variation in space which can be used to highlight

entrances, niches and framed views to the surrounding landscape.

12
 Figure 3.0 St. Mary Hospital

Source: http://www.theglobeandmail.com/report-on-business/industry-

news/property-report/sunshine-coast-hospital

The design team set out to reflect indigenous themes and take advantage of the

site’s natural beauty,’ says Tye Farrow, senior partner at Farrow Partnership Architects.

‘Their team took inspiration from the cedar bent [wood] box, unique to the coastal First

Nations. In this concept, the bent[wood] box holds our most precious possession – their

health.’

Diagnostic imaging reception area. St. Mary’s, a community hospital, serves the

communities of Sechelt, Langdale, Gibsons, Roberts Creek, Halfmoon Bay and Pender

Harbour. It provides medical, surgical, obstetrics, extended care, diagnostic and

emergency services. An ICU nursing station. St. Mary’s Hospital project was designed

with the goal of becoming a carbon-neutral hospital. The project includes 125 boreholes

sunk into the ground, each 76 metres deep, which provide a source of zero-carbon geo-

thermal energy for heating and cooling the building. A high-performance building

envelope minimizes energy loss. An ICU nursing station. St. Mary’s Hospital project was

designed with the goal of becoming a carbon-neutral hospital. The project includes 125

boreholes sunk into the ground, each 76 metres deep, which provide a source of zero-

carbon geo-thermal energy for heating and cooling the building. A high-performance

12
building envelope minimizes energy loss. Ward clerk station, level 2. The architecture

team came up with ways to make work easier by providing alcoves close to patient

rooms where doctors can update charts and by building in pull-out shelves between

patient rooms and hallways, where supplies can be loaded by staff on one side and

picked up later by nurses in the rooms. Public corridor, level 2. Wood is not a material

seen in traditional hospitals, but the architecture team wanted a material that reflected

the culture and environment of British Columbia. The health-care facility was opened to

the public in March with renovations to the existing site, including a new lobby, to be

finished by the spring of 2014. Chief Gary Feshuck, who’s Sechelt Indian Band originally

donated the land for the hospital in 1962, thanked the architects for showcasing native

culture in the building’s design.

2.2 Local Researches

Figure 4.0 Makati Medical Center

Source: www.makatimed.net.ph

Health for all regardless of race, creed, or economic status.” This was the

principle that drove the medical career of Dr. Constantino P. Manahan as he rose to

become a world-renowned obstetrics-gynecology specialist. This was the same

12
philosophy that gave birth to Makati Medical Center, the hospital that he and other

prominent Filipino doctors established in 1969.

The story of Makati Medical Center or MakatiMed began in the early 1960s when

Dr. Manahan, together with Dr. Jose Y. Fores, a distinguished surgeon, and Dr. Mariano

M. Alimurung, a famous cardiologist, decided to set up a world-class medical facility in

Makati.

Makati was just beginning to rise as a bustling residential and commercial center.

The Ayala conglomerate was still implementing the initial phases of its plan to transform

the Manila suburb into the country’s premier business district. The plan required a

modern hospital to service the community.

The founders established Makati Medical Center with the common vision of practicing

medicine of the highest order, and of founding the country's leading healthcare

institution.Today, they carry on their convictions, and continue the mission they founded.

They believe that as their patients, their total health needs are their primary concern.

They place their physical, emotional, and spiritual needs—their total wellness—at the

very core of their operations. They regard their patients, as important lives connected to

other lives; as lives rich with the potential to do great things; as lives that deserve the

utmost care, dignity, and courtesy.

They provide exceptional health care services through integrated specialty

centers that harness the combined expertise of various medical disciplines in treating

particular conditions; specialty centers operated by highly qualified physicians, nursing,

technical, and management staff. They maintain only the best staff by attracting them

with well-developed training and research programs, arming them with appropriate

professional equipment and specialized tools, and providing them with an environment

conducive to excellence. They consistently strive to practice a Total Quality Approach to

healthcare, and they place much effort on continuously improving their methods and

12
services. They have set up Centers of Excellence to ensure that they provide a

multidisciplinary approach to healing and wellness. They have made medical history

because of the unswerving commitment to give them only the best.Today, they are well

on their way to becoming an internationally recognized, world-class hospital because at

MakatiMed, they do not just treat patients, they help make lives better.

Vision

To be the Philippines' undisputed leading medical center by 2015 and

competitive with the best in the world by 2020,Staffed with highly experienced/highly

qualified medical and healthcare practitioners,Enabled by state-of-the-art diagnostic and

medical/surgical equipment and a cadre of well-trained professional support staff. Our

patients and their families should experience the highest level of satisfaction with the

health care service we provide.

Mission Statement

To provide our patients with the safe and effective health care, delivered by the

most competent, most caring and the most compassionate team of medical

professionals and support staff. 

Core Values

Compassion Care

You carry out your duties knowing that each minute of the day calls for extending

your unwavering compassion to those who matter most: your patients.

Service Excellence

They don't just treat their patients. They extend to them the best service they can

give, because they believe that they deserve no less than utmost care.

Safety

12
 They refuse to cut corners because they know that every detail counts when it

comes to ensuring the safety of each and every individual within the walls of this

institution.

Quality Of Life

Extending only the best care is something they are passionate about, because

they know that they have the power to enhance the quality of life of the people whose

lives were touched.

Respect

They know that the only way to earn respect is to give first, and that true nobility

lies in recognizing others' dignity, regardless of rank or status.

Teamwork

Know that working together as a team means combining each other’s skills and efforts to

deliver premium quality health care no one person can do by himself.

Accountability

Acknowledge that you alone are answerable for your actions. You not only take

responsibility for everything you do, you embrace it without reservation.

Professional

There is no room for politics or special favors in your system. You believe only in doing

your job with the purpose and dedication of a true professional.

Integrity

In all your professional undertakings, you adhere to the principles of honesty and

truthfulness, fully aware of the significance of the ethical standards that this institution

stands for.

12
Transparency

You lay down what needs to be laid down. You refuse to withhold information

that those around you have a right to know, because you believe that transparency is

founded on trust.

At Makati Medical Center, the continuous pursuit of excellence is part of our legacy,

which we are proud and honored to carry on.

 Their legacy includes the brilliant and competent practice of medicine, and a

history dotted with achievements and milestones.

 Their legacy involves countless contributions to medicine, made by our past and

present roster of outstanding doctors, nurses, and medical health professionals.

 Their legacy embraces exceptional and compassionate patient care that has

earned them the reputation of being a “hospital with a heart.

Throughout the hospital, they find ways to continuously improve their service.

They look at patients as a total person, deserving of care, dignity, and courtesy.

This is one reason why they won the 2005 National Product Quality Excellence

Award, a “seal of excellence” awarded by the customers, in market surveys, for

being able to:

 Satisfy a customer’s needs or requirements

 Be free from service defects

 Deliver the services promised

 Maintain high standards

12
  Be trustworthy

 Have high value.

Going Global

Today, Makati Med is ready to serve the world.  Makati Med is the first and only

Philippine health institution to be certified with the 4th edition Joint Commission

International (JCI) accreditation standards. 

Figure 5.0 St. Luke’s Medical Center

Source: www.stlukesmed.com.ph

St. Luke's Medical Center (SLMC) has provided high-quality healthcare for over

a century. It was founded in 1903 with a mission to provide outstanding out-patient care.

Today it is the foremost and most admired hospital in the Philippines and an

acknowledged leader in Asia.

St. Luke's delivers on its mission of healing by gathering under one roof the

finest medical expertise, the most sophisticated medical technology and facilities, and a

deep-rooted culture of compassion. It supports this mission with research and continuing

12
education for those who serve. The total dedication to quality and caring of the St. Luke's

family is what distinguishes the hospital as a center of healthcare excellence in Asia.

The 650-bed hospital is home to ten (10) Institutes, eight (8) Departments, and

twenty-three (23) Centers. These centers of excellence bring to the Philippines the latest

medical advances and treatment modalities. Over 1,700 hospital-affiliated medical

consultants see out-patients in more than 450 private clinics.

SLMC is the undisputed leader in virtually all medical specialties, including

cardiovascular medicine, neurology and neurosurgery, cancer, ophthalmology, and

digestive and liver diseases. It is the first choice of medical and health-related

practitioners and patients for executive check-ups.

SLMC receives patients from around Asia, Micronesia, the Middle East, Europe

and the United States.

With its rich legacy of excellence and a second new and modern facility at the

Fort Bonifacio Global City, SLMC is in a position to realize a bolder vision of the

institution as one of the top five hospitals in Asia by 2010.

St. Luke's Medical Center's state-of-the-art healthcare fuses the expertise of locally

and internationally-trained doctors and medical professionals with industry leading

technologies to deliver excellent medical care.

A Tradition of Successful Clinical Outcomes

Their clinical outcomes are comparable to, if not better than, the performance of the

best hospitals in the USA, Asia and Europe based on latest available data.

 100% procedural success rate in Trans catheter Aortic Valve Replacement

* (SLMC-Global City)

*standard surgical procedural – defined as the ability to successfully implant a

valve; patient is alive 30 days after the procedure

 98% success rate in coronary artery bypass graft surgery

12
  99% success rate in open heart surgery

 98.9% survival rate for coronary angioplasty and stenting

 16% five-year survival rate for liver metastasis from colorectal carcinoma treated

with radiofrequency ablation, for tumors even bigger in size (over 5cm) compared

with statistics worldwide of 18% of smaller tumors of less than 5 cm

 67.1%, 34.7% and 19.2% for 1-, 3-, and 5-year survival rates respectively on

primary liver cancer (hepatocellular carcinoma) with median survival time of 23

months for large tumors measuring 7 to 11cm as compared to Asian statistics of

78.6%, 35.1%, and 35.1%, for 1-,3-, and 4-year survival rates respectively for

tumors measuring 5-7cm. No published data on 5 year survival rates of

tumors>7cm in Asia and worldwide.

 42% clinical pregnancy rate (CPR) for its In-Vitro Fertilization (IVF) center

compared to 31% world CPR and 36-42% CPR in leading Asian and US IVF

centers

 36% live birth and ongoing pregnancy rate for its IVF center compared to 25%

world live birth (LBR) and 31-36% LBR in leading Asian and US IVF centers

o We use state-of-the-art technologies to diagnose and restore patients to

health while treating them utmost compassion and care.

The Most Modern Medical Equipment and Technologies

They continuously invest in the latest medical equipment and technologies to make

superior diagnoses and treatments possible.

 Third generation da Vinci Si Surgical System, a revolutionary minimally-invasive

robotic surgical technology

 PET CT Scan, currently the most accurate and powerful medical imaging

machine available in the Philippines

12
 256-slice CT Scan, touted as the most advanced computed tomography imaging

machine

 Leading cancer treatment technologies such as the Linear Accelerator, High

Dose Rate Brachytherapy, Stereotactic Radiosurgery, Stereotactic Radiotherapy,

3D Conformal Radiation Therapy, Intensity Modulated Radiation Therapy (IMRT),

and Radiotherapy Simulator.

A Culture That Put a Premium on the Needs of Patients

Their patient-centered culture assures people that they will receive the best

possible care and attention from your admission until their discharge, sometimes even

beyond the time you have left the hospital.

The St. Luke's Emergency Department is composed of a group of adult

emergency physicians trained in Emergency Medicine and pediatric specialists with a

background in Pediatric Emergency. It can handle medical, surgical and toxicologic

emergencies in adults and children 24 hours a day. The latest in diagnostic modalities

and therapeutics can be made available to patients on a timely basis.

Better diagnosis. Better treatment. Better cure. With the hospital's state-of-the-art

equipment, comprehensive facilities, top-notch doctors and healthcare experts, St.

Luke's has the full capacity to implement a multi-disciplinary approach to treatment and

patient care. Through its Institutes, St. Luke's continues to lead the way towards the

management of diseases that is not only focused on diagnosis and treatment, but should

also be expanded to include strong advocacy for prevention as well as patient and family

education.

St. Luke's departments assemble traditional medical services into specialties,

imparting dedicated medical expertise and support facilities to the areas it covers.The

individual departments are the leading choices for primary health services among

Philippine hospitals. St. Luke's operates the Departments in Medicine, Nuclear Medicine,

12
Obstetrics and Gynecology, Surgery, Ear, Nose,Throat-Head and Neck Surgery,

Anesthesiology, Rehab Medicine and Department of Radiation Oncology.

Each of these departments boast of the most advanced equipment, unmatched

by any local hospital, new or old. Further, its comprehensive array of services is

supported with continuous training and research to improve the quality of its care.

The Quality and Patient Safety (QPS) Group is at the forefront of ensuring

hospital-wide quality and patient safety which is aligned with St. Luke’s Medical Center’s

vision, mission and values. The QPS Group integrates all quality and patient safety

initiatives and activities across all levels of the St. Luke’s organization, which ensures

the delivery of a patient-centered, safe, timely, effective, efficient, equitable and quality

service. The QPS Group has two departments: Quality Management & Patient Safety

and Risk Management. These departments provide consultancy service, collaboration,

education, and expertise in quality improvement and patient safety.

The Group’s key initiatives are:

 Sustain a Culture of Safety

 Establish the components of a Quality and Patient Safety Program

 Provide institutionalized systems-based solutions to errors, near misses, sentinel,

adverse and hazardous events

 Implement an effective and safe education and learning process in the whole

organization

 Continuously maintain, sustain, improve and innovate quality and safety

initiatives with appropriate measurable indices and outcomes

 Maintain and further improve compliance to the Joint Commission International

standards, measurable elements and the International Patient Safety Goals as

12
 well as compliance to other required local quality, regulatory agency standards,

and other accrediting bodies

As a strategy to deliver its Mandate, the QPS Group spearheads the following

teams:

 Hospital-wide Performance Improvement Council

This team oversees all direct and support patient care activities and programs

focused toward improving quality patient care and safety; also a reporting venue

for all improvement activities conducted by different groups from the medical and

administrative performance improvement teams.

 Risk Reduction and Management Committee

It is the body responsible for identifying, evaluating and reducing risks of injury,

errors, adverse and sentinel events to ensure safety and quality of health care

provided. It implements strategies that ensure patient safety and quality health

care through immediate and countermeasure response to sentinel events and

root cause analysis.

 Quality Management Teams

The team monitors, assesses, evaluates and improves on compliance primarily

of clinical practice guidelines, clinical pathways, policies, procedures, and other

quality improvement programs.

 Environment of Care (EOC) Point Persons and Inspectors Teams

This team supports St. Luke’s advocacy of providing a safe, functional, team

effective and supportive environment for patients and other individuals in the

hospital. It assures consistent practice and compliance of all associates and

medical staff to the EOC disciplines such as cleanliness, safety, infection control,

maintenance, resource conservation and self-discipline.

 Document Control Center Officers

12
 They ensure a smooth documentation system process, particularly of policies

and quality procedures.

Figure 6.0 Asian Hospital and Medical Center

Source: http://www.asianhospital.com

Asian Hospital and Medical Center is a tertiary hospital accredited by the Joint

Commission International (JCI), the world’s most prestigious accrediting body for health

care organizations.

Asian Hospital is a part of the Metro Pacific Hospital Group, a group of hospitals

managed by the Metro Pacific Investments Corporation (MPIC), the local unit of the First

Pacific Group headed by Manuel V. Pangilinan.

The hospital stands on a 17,258-square meter campus, carefully planned and

specially designed to provide a healing environment, care and comfort, and ensure the

safety of their patients, guests and staff. We have 1,000 expert doctors from different

specialties who have been trained in top institutions worldwide. Asian Hospital also has

over 1,000 highly skilled employees and staff to provide high quality and compassionate

patient care.

12
 Asian Hospital and Medical Center is strategically located in the Filinvest City in

Alabang, Muntinlupa City—only 10 kilometers from the country’s central business district

Makati City, a mere 20-minute drive from the International and Domestic airports, and

less than a kilometer from the South Luzon Expressway (SLEX).

Vision

We will be the Center of Global Expertise in caring for the unique needs of our patients

and the communities we serve.

Mission

We deliver accessible world-class compassionate and integrative healthcare service to

every individual.

Values

 Fairness (‘Pantay-pantay na pagtingin, Patas at Walang Kinikilingan’)

 Integrity (‘Paninindigan, Katapatang Loob, Pagpapakatotoo at Pagkamatuwid’)

 Teamwork (‘Pagmamalasakit, Bayanihan at Pagkakaisa’)

 Excellence (‘Kahusayan’)

 Respect (‘Paggalang’)

History

Asian Hospital and Medical Center is a tertiary care hospital in the Southern

Luzon corridor of Metropolitan Manila. Officially inaugurated and opened to the public on

May 11, 2002. It is the first hospital in the Philippines that was designed with a hotel-like

ambience that promotes healing and provides comfort for patients and their families and

friends.

12
 Asian Hospital and Medical Center is strategically located in the Filinvest City in

Alabang, Muntinlupa City—only 10 kilometers from the country’s central business district

Makati City, a mere 20-minute drive from the International and Domestic airports, and

less than a kilometer from the South Luzon Expressway (SLEX).

With 289-bed capacity, the hospital has a total floor area of 44,147 square

meters and stands on a 17,250-square meter campus which houses the Main Hospital

and the Medical Office Building (MOB). It has 1,041 employees and 1,000 medical staff;

all trained to provide high quality and compassionate patient care. Over 500 doctors

hold their clinics at the MOB, which has 145 clinics and offices.

In December 2011, Asian Hospital and Medical Center became the largest single

hospital investment of Metro Pacific Investments Corporation (MPIC); the local unit of

the First Pacific Group headed by Manuel V. Pangilinan, currently operating eight

hospitals across the archipelago, the MPIC Hospital Group.

Asian Hospital and Medical Center’s world-class tertiary facilities include:

 8 OPERATING THEATERS

 24-HOUR EMERGENCY SERVICE CENTER

 INTENSIVE CARE BEDS (Cardiovascular Surgery, Intensive Care, Coronary

Care, Medical, Surgical, Neonatal Units, and Neuro Intensive Care Unit)

 BIRTHING ROOMS, DELIVERY SUITES AND OPERATING ROOMS

 BONE MARROW TRANSPLANT PROGRAM

 BREAST CENTER

12
 o The Breast Center of Asian Hospital and Medical Center is a fully

equipped, “one-stop shop”, specialty unit of excellence for the care of

breast patients – from disease prevention to screening and diagnostics.

Quality of care is based on international standards and follows

multidisciplinary management.

The Breast Center of Asian Hospital and Medical Center is the biggest of

its kind in the country and is headed by a Breast Surgery Specialist who

has trained in foreign countries including Italy, the Breast Center capital of

the world.

o Diagnostic Procedures

o Breast Ultrasound

o Digital Mammography

o Biopsy Procedures

o Stereotactic Breast Biopsy

o Ultrasound-Guided Core Needle Biopsy

o Ultrasound-Guided Vacuum-Assisted Breast Biopsy

o Reconstructive Surgery

o Breast Reconstruction

 CARDIAC CATHETERIZATION LABORATORY

o Diagnostic and Interventional

o Pacemaker Implantation Service

12
 CARDIAC REHABILITATION UNIT

 CHEMOTHERAPY INFUSION UNIT

 DIABETES EDUCATION SERVICES

 ELECTRO SHOCK WAVE LITHOTRIPSY (ESWL)

 EMERGENCY DEPARTMENT

 ENDOSCOPY UNIT

o Diagnostic and Therapeutic

 EYE CENTER

o Special Diagnostic Procedures

o A and B Scan Ophthalmic Ultrasound Studies

o Automated Perimetry (both Octopus and Humphrey Visual Field

Analyzers)

o Automated Refraction

o Fluorescein Angiography

o Fundus or Disc Photography

o Optical Coherence Tomography (OCT)

o Special Ancillary Procedures

o Anterior Segment OCT

o Biometry (IOL Master) RXP Water Immersion (Eye measurement

prior to cataract surgery)

12
 o Specular Microscopy

o Focal laser

o Laser Indirect Ophthalmoscopy

o Laser Iridotomy (for narrow angle or angle-closure glaucoma)

o Laser YAG Capsulotomy Nidek YC 1800 (for secondary cataracts)

o Ophthalmic laser procedures using Iris Occulight SLX 532mm and Iris

Occulight GLX 810mm Ophthalmic laser equipment with variable delivery

systems

o Pan Retinal Photocoagulation (for Diabetic Retinopathy) Selective Laser

Trabeculoplasty (for open angle glaucoma)

 HEARING AND DIZZINESS UNIT

o Audiometric Test

o Acoustic Reflex

o Child Pure-tone Audiometry

o Eustachian Tube Function Test

o Pediatric Audiometry

o Pure-tone Audiometry Speech Audiometry

o Tympanometry

o Balance Test

o Electrocochleography

12
 o Videonystagmography

o Neuro-Diagnostic Test

o Auditory Brainstem Response

o Auditory Steady State Response

o Newborn Hearing Services

o Otoacoustic Emission Test

 HEART STATION

o Ambulatory Blood Pressure

o Echocardiography

o Electrocardiogram

o Holter Monitoring

o Peripheral Vascular Test

o Stress Testing

o Dobutamine Stress Echocardiogram

o Transesophageal Echocardiography (TEE)

o Treadmill Exercise Test

o Treadmill Stress Echocardiogram

 HEMODIALYSIS UNIT

 NEUROSCIENCES – EEG UNIT

12
 o Electroencephalogram

 PAIN MANAGEMENT

o Compounding Services

o Inpatient and Outpatient Services

 PATHOLOGY AND LABORATORY DEPARTMENT

o Anatomic Pathology

o Blood Banking and Transfusion Services

o Clinical Pathology

o Drug Test Screening

o HIV Test

o Stat Laboratory

 PHARMACY SERVICES

o Clinical Pharmacy

o Compounding and Oncology Pharmacy

o Inpatient and Outpatient Pharmacy

 PHYSICAL MEDICINE AND REHABILITATION

o Diagnostic Services

o Electromyography (EMG) and Nerve Conduction Velocity (NCV)

Studies

12
 o Videofluoroscopic Swallowing Studies (VFSS)

o Therapeutic Services

o Medical Acupuncture

o Neurodevelopmental and Behavioral Rehabilitation (OT, PT, SP)

o Occupational Therapy

o Physical Therapy

o Speech Therapy

 RADIOLOGY DEPARTMENT

o Diagnostic Radiology

o 64-Slice (Scanner) CT Scan

o Bone Mineral Densitometry

o C-Arm Mobile X-ray

o Digital Mammography

o General Radiology

o Magnetic Resonance Imaging (MRI)

o Nuclear Medicine

o Ultrasonography

o Interventional and Vascular Radiology

o Non-vascular Interventional

12
 o Ultrasound Guided Biopsy

o CT-Guided Biopsy

o Paracentesis

o Thoracentesis

 SPORTS MEDICINE AND HUMAN PERFORMANCE CENTER

o Sports Rehabilitation

o Goal-oriented Wellness Program (Weight Management, Strengthening,

etc.)

 SUPPORTIVE AND HOME CARE UNIT

Medical Services

Their holistic orientation is at the vein of everything they do. Among those that

take this to heart are their nurses whose dedication is apparent in their patient-centered

and personalized approach to nursing care.

Except in extraordinary circumstances, every nurse at Asian Hospital and

Medical Center supervises only six patients, an international standard. This enables

them to give them the quantity and quality of time, energy and attention that they

deserve whether they are a patient or a family member. Trained in all aspects of nursing

care, their staff members are ready, willing and able to listen to their concerns, help

speed up admission, familiarize them with the hospital grounds and procedures, attend

to bedside needs, address discrepancies, and assist in the discharge process. As with

all their staff, nurses are well-versed with and respect the patient’s rights.

2.3 Related Studies

12
 2.3.1 How to establish and develop a tertiary hospital or medical center
 
Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg
2003

Definition of terms: 

Establish – means building the structure and furnishing it with facilities 

Develop – means formulating, implementing and constantly improving the system 

Hospital or medical center – one that has both inpatient (confinement) and outpatient

(ambulatory) facilities 

Tertiary hospital or medical center – means hospital or medical center based on DOH

standards – see DOH standards (generally, one that has sophisticated medical services

not only in terms of diagnostic facilities but also treatment capabilities) 

Establishment of a tertiary hospital/medical center

Do a feasibility study – in terms of need and financial viability (sustainability included)

 Need – for a tertiary hospital/medical center in the community where it is being planned

2.3.2 How many tertiary hospital/medical centers presently in existence in the

community?

If there is none, there is a need for one in an urban community.  However, the

next thing to consider is viability/sustainability.  Will the citizenry of the community avail

and afford to avail the services of the tertiary hospital/medical center to be built?

If there are already existing tertiary hospitals/medical centers, the initial questions

to answer are:

-         Is there room for another one? Are the existing hospitals/medical centers

(supply) inadequate in terms of demand for hospital confinement?

-         If the present suppliers can meet the demand, can you offer a better

alternative (in terms of a better tertiary hospital/medical center) for the

12
 citizenry of the community that will be attractive and competitive enough to be

financially viable and sustainable?

Better in the sense of better structural set-up, facilities, and quality

management system.

Financial viability and sustainability 

Consider the following:

1.      Cost of fulfilling the standards required by DOH and PhilHealth

2.      Culture of the community in terms of perception and practices with

regards to tertiary hospitals/medical centers

(Do they prefer tertiary hospitals/medical centers over lower level

centers/clinics/indigenous health practitioners? Do they prefer

going to other cities for their sophisticated health care needs?

etc.)

3.      Economic conditions in the community and economic capability of

the citizenry for services of a tertiary hospitals/medical centers

4.      Presence of a physician-force to patronize your tertiary

hospital/medical center  (adequate and willing at least, if not

committed, generalist physicians and specialist physicians

to refer patients to the center as well as help manage, build

reputation, and market the hospital and its services)

5.      Presence of existing and potential financiers

   Location of the tertiary hospital/medical center – accessible to target

clients, convenient to go to, with a “captured-client location” by virtue of

proximity to clients in constant need of  medical services. 

Once a decision is made to establish a tertiary hospital/medical center in a certain

location, the next decisions to make are:

12
 1. Architectural and functional design

2. Phases of operation

 The architectural and functional design will be influenced by the following:

The functional requirements of the hospital based on the concept and vision-

mission-goal-objectives of the center.

Requirements of DOH and other regulatory agencies including international

standards in considerations of the culture of the community, economic capability of the

clients, culture of the physician-force, and existing logistics.

The phases of operation will be influenced primarily by the availability of capital

(logistics) and marketing strategies, like a particular service should be initially completed

to attract clients to the center (example, physicians’ clinic or a specialty medical service

unique in the community such as a wellness program). 

While the construction of the new hospital is being made, recruitment, selection,

motivation and training of physician-managers should be made already.

http://hospmgt.tripod.com/howtoestablish.ht

2.3.3 Guidelines & Main Requirements in the Planning and Design of Hospitals

General requirements

The following general requirements are to be obtained

I. Environment: A hospital and other health facilities shall be so located that it is readily

accessible to the community and reasonably free from undue noise, smoke, dust, foul

odor, flood, and shall not be located adjacent to railroads, freight yards, children's

playgrounds, airports, industrial plants, disposal plants.

II. Occupancy: A building designed for hospital / healthcare facility shall be used only for

this purposes.

12
III. Safety: A hospital and other health facilities shall provide and maintain a safe

environment for patients, personnel and public. The building shall be of such

construction so that no hazards to the life and safety of patients, personnel and public

exist. It shall be capable of withstanding weight and elements to which they may be

subjected.

 Exits shall be restricted to the following types: door leading directly outside the

building, interior stair, ramp, and exterior stair.

 Minimum of two (2) exits, remote from each other, shall be provided for each

floor of the building.

 Exits shall terminate directly at an open space to the outside of the building.

IV. Security: A hospital and other health facilities shall ensure the security of

person and property within the facility.

V. Patient Movement: Spaces shall be wide enough for free movement of

patients, whether they are on beds, stretchers, or wheelchairs. Circulation routes

for transferring patients from one area to another shall be available and free at all

times.

 Corridors for access by patient and equipment shall have a minimum width of

2.44 meters.

 Corridors in areas not commonly used for bed, stretcher and equipment transport

may be reduced in width to 1.83 meters.

 A ramp or elevator shall be provided for ancillary, clinical and nursing areas

located on the upper floor.

 A ramp shall be provided as access to the entrance of the hospital not on the

same level of the site.

12
VI. Lighting: All areas in a hospital and other health facilities shall be provided with

sufficient illumination to promote comfort, healing and recovery of patients and to enable

personnel in the performance of work.

VII. Ventilation: Adequate ventilation shall be provided to ensure comfort of patients,

personnel and public.

VIII. Auditory and Visual Privacy: A hospital and other health facilities shall observe

acceptable sound level and adequate visual seclusion to achieve the acoustical and

privacy requirements in designated areas allowing the unhampered conduct of activities.

IX. Water Supply: A hospital and other health facilities shall use an approved public

water supply system whenever available. The water supply shall be potable, safe for

drinking and adequate, and shall be brought into the building free of cross connections.

X. Waste Disposal: Liquid waste shall be discharged into an approved public sewerage

system whenever available, radioactive waste and others hazards liquid waste to be

collected and treated in accordance to international rules and solid waste shall be

collected, treated and disposed of in accordance with applicable codes, laws or

ordinances.

XI. Sanitation: Utilities for the maintenance of sanitary system, including approved water

supply and sewerage system, shall be provided through the buildings and premises to

ensure a clean and healthy environment

XII. Housekeeping: A hospital and other health facilities shall provide and maintain a

healthy and aesthetic environment for patients, personnel and public.

XIII. Maintenance: There shall be an effective building maintenance program in place.

The buildings and equipment shall be kept in a state of good repair. Proper maintenance

shall be provided to prevent untimely breakdown of buildings and equipment.

XIV. Material Specification: Floors, walls and ceilings shall be of sturdy materials that

shall allow durability, ease of cleaning and fire resistance.

12
XV. Segregation: Wards shall observe segregation of sexes. Separate toilet shall be

maintained for patients and personnel, male and female.

XVI. Fire Protection: There shall be measures for detecting fire such as fire alarms in

walls, Peepholes in doors or smoke detectors in ceilings. There shall be devices for

quenching fire such as fire extinguishers or fire hoses that are easily visible and

accessible in strategic areas.

XVII. Signage: There shall be an effective graphic system composed of a number of

individual visual aids and devices arranged to provide information, orientation, direction,

identification, prohibition, warning and official notice considered essential to the optimum

operation of a hospital and other health facilities.

XVIII. Parking: A hospital and other health facilities shall provide a parking space

XIX. Zoning: The different areas of a hospital shall be grouped according to zones as

follows.

 Outer Zone – areas that are immediately accessible to the public: emergency

service, outpatient service, and administrative service. They shall be located

near the entrance of the hospital.

 Second Zone – areas that receive workload from the outer zone: laboratory,

pharmacy, and radiology. They shall be located near the outer zone.

 Inner Zone – areas that provide nursing care and management of patients:

nursing service. They shall be located in private areas but accessible to guests.

 Deep Zone – areas that require asepsis to perform the prescribed services:

surgical service, delivery service, nursery, and intensive care. They shall be

segregated from the public areas but accessible to the outer, second and inner

zones

12
  Service Zone – areas that provide support to hospital activities: dietary service,

housekeeping service, maintenance and motor pool service, and mortuary.

They shall be located in areas away from normal traffic.

XX. Function: The different areas of a hospital shall be functionally related with each

other;

 The emergency service shall be located in the ground floor to ensure immediate

access. A separate entrance to the emergency room shall be provided.

 The administrative service, particularly admitting office and business office, shall

be located near the main entrance of the hospital. Offices for hospital

management can be located in private areas.

 The surgical service shall be located and arranged to prevent non-related traffic.

The operating room shall be as remote as practicable from the entrance to

provide asepsis. The dressing room shall be located to avoid exposure to dirty

areas after changing to surgical garments.

 The delivery service shall be located and arranged to prevent non-related traffic.

The delivery room shall be as remote as practicable from the entrance to provide

asepsis. The dressing room shall be located to avoid exposure to dirty areas

after changing to surgical garments. The nursery shall be separate but

immediately accessible from the delivery room.

 The nursing service shall be segregated from public areas. The nurse station

shall be located to permit visual observation of patients. Nurse stations shall be

provided in all inpatient units of the hospital.

 In wards the Rooms shall be of sufficient size to allow for work flow and patient

movement.

 In wards the Toilets shall be immediately accessible from rooms.

 The dietary service shall be away from morgue.

12
XXI. Space: Adequate area shall be provided for the people, activity, furniture,

equipment and utility.

https://www.linkedin.com/pulse/20140613201200-65586394-guidelines-main-requirements-in-

the-planning-and-design-of-hospitals-part-ii

2.3.4 The Effect of the Built and Natural Environment in Health Units on

Patients,

Staff and Visitors

According to Dr. Ulrich, a Professor of Architecture at the Center for Healthcare Building

Research at Chalmers University of Technology in Sweden and adjunct professor of

architecture at Aalborg University in Denmark, consideration to the design of the physical

environment of a hospital can provide major support for patients and their treatment

programs, as well as for their families and for the staff. A well-designed facility has good

health outcomes for the users especially related to stress reduction and greater job

satisfaction. By reducing stress within the environment there is improved job satisfaction

for employees enabling fewer staff absentee rates and a lower staff turnover. The

patients are also affected by having a decrease in hospital stay and even a decrease in

the amount of medication taken. Overall it appears that patients feel that physical

changes in ward environments help them to feel better, whilst staffs are able to generate

a more positive work attitude.

On his proposed Theory of Supportive Design, he stated that the basic principle

underlining his theory is that the potential for environments to promote improved

outcomes is linked to their effectiveness in facilitating stress coping and restoration

(quoting his own research Ulrich 1991, 1997, 1999). He stated that the great majority of

patients experience stress and many suffer from acute stress, which is a significant

health outcome in itself and which can directly and negatively affect many other

12
outcomes such as numerous psychological, emotional, physiological, biochemical and

behavioral changes. He also stated that good design can reduce stress, anxiety, lower

blood pressure and lessen pain. He offered the following list to answer the question,

“What advantages can health care administrators, designers, and medical professionals

(and the public) reasonably expect to achieve by including psychosocially supportive

design criteria in the objectives for a new facility?”

The effect of noise, lighting, sun, temperature and color are additional features that

contribute to the overall ambiance of the mental health unit. Each feature has to

minimize the stress it places on the individual using the environment. Noise is often

considered as a widespread source of stress that can affect patient comfort and work

performance by staff. By simply minimizing noise levels from identified sources can

reduce stress, in both patients and staff. Lighting has different impacts on different user

groups. Patients, visitors, support staff andpractitioners each require different lighting.

Patients may benefit from increased levels of lighting during the awake period and

decreased levels of lighting during the sleep period, which may enhance sleep quality

and thus speed recovery. Exposure to sun in ward rooms in a psychiatric ward has

significantly reduced the average number of days spent in the ward. Room temperature

was shown to have physiological impacts and different impacts on males and females.

The impacts included hot rooms producing more aggression in both genders, but more

so for males, to raised blood pressure in hot rooms and conversely, lowered blood

pressure in colder rooms. Color does influence behavior and that it can be harnessed to

influence productive function and improve the quality of life. Such issues as way finding,

highlighting and camouflaging particular areas and mood enhancement can all be

influenced by the use of color.

Healing Environment in Psychiatric Hospital Design facilities are public buildings that

may have a significant impact on the environment and economy of the surrounding

12
community. As facilities built for "caring", it is appropriate that this caring approach

extend to the larger world as well, and that they be built and operated "sustainably". It is

critically important to ensure the safety of the patients, visitors and staff.

The American Psychiatric Association report on patient safety primary concerns are

suicide, aggression, falls, elopement, medical co morbidity, and drug/medication errors–

all but one can be directly or indirectly influenced through environmental design. While it

is not possible to design a space that prevents every potential event, the safety options

for the built environment should be addressed from the beginning of any psychiatric

hospital project. The primary safety focus of the designer should focus on prevention of

events from the use of the built environment. By incorporating strategies suggested by

the research literature, physicians can help to ensure they are providing a facility that is

both functional and secure.

2.4 Synthesis

Based on local and foreign related literature, health status in the Philippines has

improved but as much as in other countries. Rapid urbanization, high population density,

and climate change have begun to influence the emergence and re- emergence of the

hazards of everyday life. Based on the literature that the researcher gathered and

analysed, the foreign countries are enhancing and improving their medical and health

capabilities and services. The Philippines on the other hand is still trying to keep up.

The proponent bring to a close that the demand of a further approach to realize

the potential of the Filipinos to exceed the abilities of their health and medical care is

greatly needed. The related literature present the possibilities of innovation of design

and concept that will provide the required element that is needed to create an

12
architectural outcome that benefits not only the physical characteristics of medical care

but also the mental characteristics of the facilities.

After analysing related study the proponent found out that there are many

innovative ideas that incorporated in designing a disaster resilient building. The study

helps the proponent understand the topic better because it clarifies vague points and

helped the author come up with some knowledge regarding hospital.

St. Luke’s Medical Center- Global City was recognized 11th on “The 25 Most

Beautiful Designs in the World”. The proponent come up with a design that will boasts

and integrate a fine architecture that are conducive to healing a wellness.

In past researches, the study aims to create an environmentally-friendly yet

innovative hospital. It provides some idea for the researcher.

Now a day parted combination of creative design of an architect and

technologies from engineer’s field can establish a form that provides sustainable building

for present time and for the future. The gathered ideas and knowledge in this chapter

should be a guideline in giving most appropriate solution to the problem.

12