The DLSU Medical Center at the Crossroads:

Moving Forward Towards—

a “World Class” University Hospital with a
La Salle Character
“Sama-sama, tulong-tulong tungo sa kaunlaran”

(A template for instituting reforms)

I. Prologue

With the appointment of a lay physician to the Office of the Vice

Chancelor for Hospital Operations, the De La Salle University Medical
Center ushers in and welcomes a new regime and now critically
stands at a precipice of a decision to institute reforms which must be
viewed from the highest level of perspective.

Moving forward towards attaining a goal requires knowing and

making an assessment of the present status and a clear vision of the
intended goal/s. Moving forward needs a template that will serve as a
pattern or guide for effecting the needed reforms. This document is
being offered to be such pattern.
A cursory reading of this document will probably give an impression of
stringency and inflexibility. However, this should not be. Some elbow
room or latitude for flexibility in making the changes based on the
hard data and/or circumstances met before and during the actual
implementation of the proposed reforms must necessarily be allowed.

Template modifications/ adjustments will be based on the results of

institution-wide consultations (strategic planning and SWOT analysis,
etc). Data derived from such activities shall be utilized in formulating
strategies and specific/ detailed plan of actions to achieve the
changes/reforms in and across all concerned departments, units,
offices and personalities towards the desired goal—a “world class”
university hospital with a La Salle character.

Moving forward at a crossroad necessarily implies change which

always have a personal, social and cultural impact on the
stakeholders in the Institution. Hence, stakeholders in the process of
change voluntarily or involuntarily venture from known (present) into
the unknown (future) resulting in fear of what is ahead.

Agnostophobia (from agnostos Greek word for unknown) is the fear of

the unknown. Many do not like change because of uncertainty of not
being able to cope with a new role or the new way of doing things.
Sometimes there is fear of the unknown because of the selfish feeling
of what the undetermined changes could take away. Being
confronted by fear of the unknown is like standing on the precifice of
change. Belief and trust on the sincerity of the intentions of the authors
of change are crucial and such fear of the indefinite vicissitudes
conquered by focusing on the good that could be and not on the
bad that might be. This is the precarious role of the “architect” of the
reform process— developing mutual trust and respect.

In the reform process, all components must be coordinated and

synchronized; that is-- the mind has a clear idea and concept of the
intended changes, the lips tell exactly what is in the mind, the hands
(left and right) know what they are doing and both feet knows the
direction where they must be going.

Most of all, this document was written grounded on the premise that:

“We all have a moral obligation to leave this Institution

a better place than what it was when we first came.”

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II. The Goals of the reform process:

A. Short term. Towards laying the preliminary groundworks

for achieving “world class” university hospital status:
fulfillment of majority of the targeted/ proposed reforms

DLSUMC shall provide quality health care services in an efficient, safe

and cost effective manner by accomplishing at least seventy-five
percent (75%) of the listed changes below in effect starting a total
house cleansing and ground preparation to make the landscape
favorable to laying down the foundation for more meaningful and
genuine reforms. (Duration: 12 months)

B. Medium term. Moving further towards attaining “world

class” university hospital status: continuing to pursue the
realization of the remaining unfulfilled reforms and
coming out with the hard copy of a uniquely Lasallian
“eclectic” quality and safety assurance health care
protocol

The term “world-class” had become cliché-- an overused descriptive

phrase. World-class service, world-class clinical care, world-class
buildings and facilities, world-class accommodations, world-class
experience, world-class research, world-class teaching and so on.

Being world class must be defined and its attributes fully elucidated.
World-class health care is when the extra-ordinary and rare medical-
surgical practices and procedures become commonly done in the
hospital and exceptional performance of its medical and support staff
becomes predictable and routine.

At first glance, being world-class connotes high cost and anathema to

being affordable to everyone regardless of ability to pay. But being
“world class” in the Lasallian context, should be ultra low cost without
compromising quality of care, that is-- patients receive one and the
same standard of care throughout the hospital whether confined in
the suites or the charity wards. This poses the greatest challenge to
everyone especially on the top echelon in the structural organization
of the Institution. Utilizing “economies of scale” and other innovative
strategies must be formulated to accomplish this paradigm shift. Focus
must be made on cost effectiveness rather than cost cutting in all
processes and operations.

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A quantitatively measurable factor to gauge operationalization of this
paradigm shift is monitoring the number of patients who have to travel
long distances and/or wait for long hours to receive care-- as many
patients with their relatives are even willing to travel by air, land or sea
and be lodged in a nearby hotel just to receive a truly exceptional
quality of care at a reasonable cost. The concept of “medical
tourism” and “global health care” now come to the fore and waiting
to be explored. (Duration: 12 months)

C. Long term. Towards achieving eminence as “world class”

university hospital: the lead institution in convening an
association of university hospitals and setting up a national
accreditation process and subsequently being accredited
as a center of excellence

Spearhead the organization of the proposed “Philippine University

Hospitals Association Foundation, Inc. (PUHAF Inc.)” an association
aimed to raise to “world-class” standards the quality, safety and cost-
effectiveness of medical care rendered to patients in university
hospitals as well as promoting and protecting the economic and
political interests of member hospitals in the country.

The Association will in turn create an accreditation board-- the

Philippine University Hospitals Accreditation Board-- that shall be
tasked to accredit member university hospitals based on fulfillment of
formulated “world class” standards of medical care and safety. The
envisioned Lasallian eclectic protocol, (product of the medium term
goal), shall be offered to the general membership of the Association
and to the Accreditation Board for further discussion, comments,
revision and possible adoption as the national standard for
accreditation.

The Accreditation Board shall be administratively under the umbrella

of the Association but shall be autonomous and independent in so far
as adoption/ formulation of standards of care and safety and the
evaluation/ assesment of the degrees of fulfillment of such standards
by member hospitals.

The Accreditation Board shall be composed of representatives from

various sectors concerned with quality health care delivery such as:
the Philippine Hospital Association, the Philippine Medical Association,
the Association of Philippine Medical Colleges (APMC), the
Department of Health and representatives of the governing board as
well as from the general membership of the Association.

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Membership in the Association shall be voluntary and seed money will
be contributed in equal amounts by the founding member hospitals
which shall draft the proposed by-laws and Securities and Exchange
Commission (SEC) articles of incorporation.

After fully accomplishing the enumerated reforms below (and others

that may be subsequently formulated) by the year 2022 and being
accredited by the national accreditation board, it can be said that
the long term goal has been achieved by DLSUMC, that of—being a
“world class” university hospital.

Parenthetically, De La Salle historically possess the experience factor in

ventures concerning quality assurance, setting standards and
accreditation.

In the 70’s, the founder of the College of Medicine (formerly Emilio

Aguinaldo College of Medicine), the visionary, Dr. Paulo C. Campos,
led in convening and organizing the Association of Philippine Medical
Colleges (APMC) Foundation, Inc. becoming one of its original
incorporators. In the mid- 90’s, DLSU College of Medicine’s sitting dean
and then president of APMC went on a trailblazing campaign for the
improvement of medical education in the country by resurrecting the
interest of medical schools in the voluntary accreditation process now
being conducted by PAASCU.

In so far as quality assurance and setting standards for medical care

rendered by university hospitals, it behooves on De La Salle to once
more set the pace and be the primordial institution, this time, for
improving quality and safety of medical care in university hospitals by
convening and becoming the lead organizer of the proposed
“Philippine University Hospitals Association Foundation, Inc. (PUHAF
Inc.)” that will in turn organize the “Philippine University Hospitals
Accreditation Board” that will serve as the national accrediting body
for university hospitals. (Duration: 12 months)

D. The Year 2022 and beyond. Towards venturing in

international accreditation, global health care and
medical tourism

The next order of business, after being accredited by the national

accreditation board, is finding ways of further (infinitely) continuing to

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improve services and facilities by considering international
accreditation by the Joint Commission International (JCI), United
Kingdom Accreditation Forum (UKAF), Accreditation Canada
International (ACI) or Australian Council on Healthcare Standards
International (ACHSI). At this stage, DLSUMC must be ready to launch
a campaign for medical tourism and global health care.
 
Medical tourism or global health care is one of the recent innovations
in health care delivery which is anchored on costs, quality and
accessibility. It is a cheaper option for obtaining treatment without
sacrificing safety and quality.

Take the case of Per-oral Endoscopic Myotomy (POEM) for achalasia

which is now in advanced development in DLSUMC being the venue
for the first procedure done in the country and since then have been
receiving referrals from nearly eveywhere in the archipelago. The cost
of getting the procedure done in our Institution is just a miniscule
fraction of the amount to be spent when done elsewhere especially in
Japan where the innovative procedure was developed. The costs of
this operation in developed countries have increased exceedingly
beyond affordability of ordinary citizens especially those without
adequate health insurance.

There are a lot of other cutting-edge innovative technologies waiting

for interested consultants in the medical staff who want to be trained
abroad and eventually bring back such learned procedure and
techniques to DLSUMC.

These days, international travel to Manila has gone cheaper and

hopely going to Dasmariñas City from the airport becomes trouble
free in the near future. Internet facilities (Google, Facetime, e-mail,
etc.) have tremendously made easy contacting the DLSHSI website.

When DLSUMC has developed its image as a “world class” university

hospital and has been accredited by an international body such as
JCI, foreign patients will not hesitate coming for quality of care and
safety reasons.

The big bonus to the foreign patients and their relatives, aside from the
foregoing benefits, is the opportunity to travel to and see the
Phillippines which will in turn increase our dollar revenues. (Period: year
2022 and beyond)
 

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III. The Need for Reforms

a) There is burgeoning population, as of 2015, Cavite is the most

populous province with 3.68 million inhabitants as attested by
the sprouting of 7-eleven, Ministop, Alfamart and Puregold in
almost every street corner;

b) There are 63 other hospitals in Cavite and many more are rising.
The new facilities mostly belong to consultant staff of DLSUMC
who are either founding directors or majority shareholders;

c) The construction of new road infrastructures within the province

provides for easy access from outlying areas to DLSUMC;

d) Traffic congestion in Metro Manila discourages patients to travel

to the metropolis for their health needs;

e) The cost of services at DLSUMC is now generally less and to be

more affordable and the quality comparable, if not, better than
elsewhere;

f) The Institution’s human resources coupled with its other assets

are gold mines waiting to be tapped.

IV. The Metamorphosis of the Reform Process

The steps towards change is analogous to building a family home. Any

omisson or neglect may be costly, cause delay or even scrapping the
project all together such that attention to details is imperative.

The process in building a house can be typically categorized into

three (3) steps. They are:

Step-1. Preparatory— drawing the achitectural plans, selecting the

best and most suitable architect and engineer for the project,
dropping the time capsule, ground preparations, laying the
foundations, and erecting the pillars

Step- 2. Sustaining the construction process—building the walls, laying

the floor slabs, mounting the trusses and roofing, applying the paint
coats

  -7-
 Step- 3. Achieving the goals and keeping them Up— inaguration and
house blessing and making the house a home.

Similarly, just as in building a house, in instituting the reform process in

DLSUMC, the preparatory phase is the most crucial. It is when all the
stake holders (admin sector, consultant staff, rank and file, etc.) must:
(a) be convinced of the need for and agree on instituting reforms, (b)
annoint the primovers for the change (top hospital administrators) and
(c) draw/ adopt an initial blue print of the reforms (this template?) and
agree on the final end product/ outcome (“world class” university
hospital by 2022).

Dropping the time capsule corresponds to the imprimatur by the

highest governing body of the final blueprint and the corresponding
budgetary allocation. Ground preparations, laying the foundations,
erecting the pillars which continue with sustaining the process include
the execution of the list of needed reforms, namely: re-structuring the
table of organization, psycho-social and cultural transformation and
guiding principles and operational policy changes.

V. The Needed Reforms

A. Re-structuring the Table of Organization— the foremost

strategy to successfully attain the goal.

The over riding concern in re-structuring the table of organization is

that the boxes are created/ adjusted/ arranged and the solid and
dotted lines drawn with the end view of obtaining the desired goal/s.

Under the current 5 pointed star model, the CEO (President) generally
the director of an organization’s broad policies, mission, and goals is
concurrently the COO (Chancellor) traditionally the overseer at-large
of functions and general operations. Incidentally, during the present
dispensation, the CEO and contemporaneous COO is not a medical
person. The recent appointment of an MD- Vice Chancellor in charge
of the hospital is a welcomed relief.

However, being solely in-charge of hospital operations, as the current

VCHO nomenclature designation implies, is totally misplaced because
the question that maybe asked is: who in the hierarchy is in-charge of
and expected to interpret and spell out the broad policies set by the
Board of Trusttees in achieving the Institute’s misson and goals?

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Consequently, the expediency to rename the post-- Vice Chancellor
for Health Services and specify in the Admin Manual that he/she
should be an MD. The star model organizational structure appears to
have been designed based on personalities who were favored to
occupy a certain position— that of the VCHO—leading to chaos and
confusion in role.

The foregoing brings to fore the classic idiom— “square peg in a round
hole”.

Figure  1.  The  De  La  Salle  Health  Sciences  Institute  “Star  Model”  organizational  structure  
and  flow  chart.  The  final  output  of  an  ad  hoc  committee  created  during  the  early  to  mid  
2000’s  tasked  to  study  and  make  recommendations  on  reforming  the  then  De  La  Salle  
Health  Sciences  Campus  (DLSU-­‐  HSC).    

Hence, the need for a simplified organizational structure capable of

fulfilling/ satisfying the broad concepts of a university hospital that—
(a) can effectively and smoothly deliver quality health services; (b)
can efficiently carry out teaching as well as research functions; (c) is
responsive to the foreseen (long and short term) challenges ahead
and those encountered (current) during daily hospital operation;
and (d) will show the relatioship between power and accountability
thus easily tracing accountability/ resposibility in the event of
untoward events/ failure and of course --success. To achieve these
attributes, there is an urgent need to carry out the following specific
activities (and some others):

  -9-
 1) Rename the Office of the Vice-Chancellor for Hospital
Operations to Vice-Chancellor for Health Services and
modify its functions and duties accordingly. That is--
absorbing the functions and duties of the medical director
into the new office of the Vice- Chancellor for Health
Services and in effect phasing out the office of the medical
director (professional services).

2) Re-organize/ integrate the existing offices directly under the

Vice-Chancellor and those of the to be defunct office of the
medical director with the view of clearly delineating
responsibilities relative to the service, training and research
functions of the Institution, (eg.: chief of clinics, chief nurse,
director for planning and research, director for hospital
operations and director for ancillary and support services)

3) Merge and integrate the functions of the current Patient

Assistance Office (PAO) and Patient Safety Committee into a
regular office/unit under the Chief of Clinics that will be
concerned not only for overseeing patient but human
resources and environmental safety as well. The office will
also be tasked to monitor professionalism and ethical
conduct of the medical staff and other health care
providers/ workers and to receive/ entertain/ investigate
complaints and/or may on its own, when the need arises,
initiates an inquiry and submits findings and
recommendations thereon.

4) Revitalize/consolidate the PR and Marketing offices into one

entity that will be responsible for projecting the good image
of the hospital to the general public as well as looking for
possible market expansions and making internal and external
surveys to quantify the experiences of clients with respect to
services rendered, value for money spent and efficiency in
transacting business with the hospital;

5) Create a funtioning unit (under the Chief of Clinics) headed

by a senior medical staff that will monitor the operations of
the hospital on a 24-hour basis taking note of and offering
immediate solutions to critical events/occurences and
informing/referring such to higher hospital authorities
(sending a spot report) when needed.

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 6) Establish a Clinical Programs Office under the Chief of Clinics
that will implement (in collaboration with the Academic
Services) the program of instructions for various levels of
clinical training in the hospital and create appropriate tools
for evaluating acquired compentencies at the end of the
program (eg.: OSCE/ clinical revalida at the end of clinical
clerkship, internship as well as residency).

7) Rename classification of Medical Staff (active, associate

active, etc.) to a scheme using clinical faculty ranks, eg.:
Clinical Assistant Professor of Medicine (or Surgery), etc.

8) Integrate the status of dental practitioners in the hospital into

the medical staff.

9) Restructure the Emergency Room staffing and overhaul its

operating procedures focusing on staff competence and
speedy/ smooth flow of patient processing with the end view
of reducing operational costs and from which savings may
be used for augmenting budget earmarked for salary of
residents

10)Integrate offices/units with similar or related functions and

dissolve redundant ones to have a “lean and mean”
organizational structure.

11)Constitute a standing oversight committee under the Vice

Chancellor to review and submit its own comments/
recommendations regarding specific critical plans and
decisions prior to their final approval and implementation.

12)Merge/ upgrade/ rename the bio-medical engineering and

IT units into a Techology and Resource department. The
emergence of electronic medical records (EMR’s), patient-
monitoring devices of all sorts, complicated alarms and
sensors, the hospital’s computer system and other
sophisticated gadgets, virtually make a modern hospital
powered by technology and such calls for the hospital bio-
medical engineering and IT groups to keep them seamlesly
functioning.

13) Creation of an “adhoc reforms committee” that will serve as

the core of volunteers who will oversee the implementation

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 of the reform processs by acting as liason between leaders of
change and the grassroots ensuring genuine information
dessimination and collecting facts and figures from various
sources.

B. Psycho-social and Cultural Transformation-- an important

consideration in implementing reform is the culture and
values of the organization.

Being La Salle— upholding the spirit of faith, zeal for service,

communion in mission, and respect/ reverence for life, etc. are mere
re-statements of some of the seven themes of the Catholic Church’s
social doctrines. How these various themes are observed and carried
out in the Institution, guided by teachings and way of life of St. La
Salle, will be more appropriately and uniquely termed Lasallian.

Being Catholic— guided by the Social Doctrines of the Catholic

Church (e.g.: option for the poor, dignity of the human person and
common good); as enunciated in 25 Papal and Vatican documents,
the earliest being Rerum Novarum (On the Condition of Labor) by
Pope Leo XIII in 1891; the latest being Laudato Si (On the Care of Our
Common Home) by Pope Francis in 2015. and--

Being Filipino— nurture unique Filipino customs and tradition such as

respect for everyone regardless of race, sex, culture, socio-economic
status and belief and the “bayanihan” team spirit of cooperation and
sharing.

Cast aside—

a) “talangka (crab)” mentality

b) self-attributtion of Institutional accomplishments
c) passing the blame on the weakest link in the chain
d) feudalism (in-fighting)
e) “silo mentality” or “turfism” (walang “paki-alaman”; this is my
territory, don’t mess it up)
f) “amoeboid” movement towards attainment of goals

Foster—

a) “I am Lasallian. I am my brother’s as well as my Institution’s

keeper”
b) self-commitment to work for attainment of Institutional goals

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 c) “pakikisama” and “utang ng loob” for attainment of
Institutional goals
d) recognizing outstanding achievement by giving appropriate
compliment when praise is due.

C. Change in Guiding Principles and Operational Policies—

these are broad policy modifications in rendering decisions
and in the way certain day to day activities are carried out

1) Review/revise charging scheme of professional fees in the

laboratory and other ancillary diagnostic services;

2) Set aside sufficient funds to raise to competetive levels the salary of

residents; thereby attracting the best and most qualified
applicants into the program;

3) Make all hospital conferences, meetings and other activities

relevant to Institutional needs and congruent with institutionally
established goals and objectives and making attendance to
certain conferences (eg: grand rounds, mortality-morbidity,
hospital audit, etc.) be credited with points for purposes of meeting
the CME requirements of the Professional Regulation Commission
(PRC) for renewal of professional licenses of various professions;

4) Foster the honor system. Report to immediate superior any

untoward event coming to one’s personal knowledge committed
by a peer or even him/herself that directly involve or related to
patient care or adverse to the interest of the Institution;
5) Institute safeguards against administrators acting as concurrent
“commissioners”;

6) Encourage external clients (patients/ relatives and visitors) to rate/

evaluate hospital services and facilities by filling-up appropriate
evaluation forms, giving incentives (discounts/ points/ prices) for
the purpose;

7) Provide incentives to encourage medical staff to increase practice

time in DLSUMC and limit devoted time elsewhere;

8) For PR purposes, refrain from situating along or comparing viz a viz

DLSUMC with other hospitals in Cavite or Southern Luzon because it
is already to be accepted as a given that DLSUMC is the best in the
region (unless they themselves doubt) it being the sole university
hospital (at least in name) that can be found in this area. Besides,
the practice dilutes our thrust for projecting to be world-class. If a

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 humble stance (barangay-class) is to be taken in projecting the
image of the Institution, then the same defeats the very essence of
PR;

9) Formulate and adopt a written set of rules of procedure governing

conduct of official meetings at least covering the department level
and up;

10)Provide venue (decury room) for clinical small group discussion for
use of student nurses, clinical clerks, interns, residents and fellows in
each hospital floor/ nurse station;

11)Give special awards as a recognition for outstanding performance

in clinical teaching or research that brings honor and prestige to
DLSUMC;

12)Purge the drug formulary of non-essential medicines;

13)Implement full digitalization/computerization and electronic

recording/storage of patient records to include results of laboratory
and other ancillary procedures, inventory of stocks and equipment,
business records and communications, among others

14)Adopt a proactive stance in appropriating capital outlay for

purchase of state of the art equipment and opening new or
upgrading present facilities by factoring in profit not only in terms of
cash or revenues but also fulfillment of unquantifiable gains
befitting a university hospital in the equation.

15)Revise the Manual on Hospital Practice as well as Staff Manual to

reflect the new organizational structure and functions. Re-visit
vague provisions and make necessary amendments/
improvement.

16)Promulgate the long overdue MAC Usage Rulebook after due

consultation with leases as per Contract with various consultants.

The pursuit of the reformation process in the organizational, psycho-

social/ cultural, policy making and In all daily operational activities in
the hospital must always proceed in a “vectorial” (with full force and
towards a definite direction) character that is-- purpose driven and
goal oriented (not in amoeboid movement).

VI. Rationale for the Reforms —

Being a University Hospital— Historically, the “founding father” Dr.
Paulo C. Campos, first established a nursing/midwifery (Marian) then a
medical school (Emilo Aguilnaldo College of Medicine). Thereafter, he

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founded a hospital to be known as University Medical Center (UMC),
the forerunner of the present DLSUMC, to serve as training venue for
the students in these schools. At present, in addition to delivering
medical care to patients, the UMC provides clinical education and
training to future (2nd, 3rd, and 4th year medical students) and already
doctors (interns, residents and some fellows), nurses and other health
professionals. As such, DLSUMC must fully live up to its essense of being
a truly university hospital (as intended at its very inception) by:

Figure  2.  The  amoeba  organism  goes  toward  a  stimulus  (food)  by  its  cellular  components  
(cytoplasm)  forming  pseudopodia  (false  feet)  that  moves  forward,  side-­‐wards,  back-­‐wards  
or  in  any  direction  sometimes  even  contradictory.  

a) functioning as a referral center that is— provide highly

technical, sophisticated but cost-effective care to patients
with complex clinical conditions who are referred by
surrounding practitioners/ hospitals;

b) promoting, sponsoring or subsidizing training of medical staff

abroad in “centers of excellence” to acquire higher level of
professional skill (“world class”) in diagnosing and treating
challenging diseases;
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 c) becoming a highly effective focal point for disease-specific
health promotion and education activities (public or out-
patient fora on diabetes care, G. I. cancer education,
disease prevention, etc.);

d) setting-up the necessary infrastructure so that e-mail or tele-

conferencing consultations may be made available to other
practitioners in the catchment area and elsewhere
concerning difficult cases;

e) acting as center for training and education of technician/

assistants for routine as well as innovative procedures and/or
use and maintenance of “state of the art” equipment, and

f) collaborating with known “centers of excellence” in the

development of new or innovative technologies; serving as
site of research, for their initial launching and introduction
and evaluation of their local applicability and efficacy.

VII. The Journey into the Reformation Process—

a) The keystone for effecting a successful institutional change or

transformation is ownership of the plan, that is— making
everyone think that the change is their idea.

b) All stakeholders must feel and understand the need for change.
Hard data must presented on the threats facing the Institution.
Downfall of institutions are mainly attributable to failure to
institute internal changes in order to be able to adapt to the
demands of and be competetive with and relevant to its
changing external environment (extinction of the dinassours).

c) It has to start from the top echelon down to the grassroots. Or

better, from both ways—from the top going down and vice
versa—when all sectors feel the need for change.

d) No forced adaptation. It must be based on a shared vision,

consultative and participatory process. Hence, the need for
strategic planning (SWOT analysis and developing/ updating
the mission/vision statement). All stakeholders must be
encouraged to contribute their own inputs. Encourage
divergent perspectives that must be seriously considered,
discussed and addressed in order to reach a consensus.

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 e) The goal or vision should be communicated and understood by
all stakeholders. It must be continually reinforced and everyone
encouraged to move toward the vision. Deficiency of or
breakdown in communication creates an information vacuum
that maybe filled up by speculations, gossips and inaccurate
information creating assumptions that have no factual basis.

f) Each individual stakeholder, department, unit and office must

always be aware of the specific tasks/ activities (role) that must
be accomplished to achieve the desired goal.

g) The changes must deal fairly and considerately with others who
might be adversely affected and those pushing for specific
reforms must not take unfair advantage of others with intent to
gain or favor self.

h) A “must have” is an effective leader who is all the way

committed to effecting the changes, aware of and understands
the mechanics of resistance and ways of handling them. By
training, physicians often are not good followers, for being one
indicates a sign of weakness. Physicians usually tell (patients)
what and how things are to be done. Hence, the need for a
figure head of stature who commands respect, has the ability to
understand the nuances of transformation, support and explain
it, communicate at strategic, operational, and individual levels
and move the whole Institution towards attaining the desired
changes.

Having an advanced post-graduate training such as an

MS/MA/PhD is a desireable qualification for the leader but
should not be mandatory as some, if not many, of those who
enjoy appending after their name the degrees earned
miserably fail to live up to it. They probably fail to realize that the
concepts taught them in the classrooms are just but “glorified
common sense”.

VIII. Maintaining/ sustaining the momentum of the reform process—

Everyone must have the mindset of irreversibility, that is: the reform
process has reached a point of “make or break;” there is no going
back. Once the “cruise control mode” has been activated, there is no
stopping except in a pitstop.

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 The core group (volunteer army) who serves as the leaders/ promoters
of change must be able to communicate at fixed intervals to all
stakeholders the sense of urgency of the reformation, identify barriers
and saboteurs (those giving lip service only and those undermining the
efforts for change). The leadership must be able to incessantly inspire
others to move in a vectorial manner towards the set goals and solve
problems chanced upon along the way.

Official periodic assessments (monthly/ quarterly) of the progress

towards the final goal at each period of the reform process (eg. short
term, medium term, long term, the year 2022 and beyond) must be
communicated to all stakeholders by the Vice Chancellor.

Sustainability is not a goal to be achieved but a problem (inertia) to

be solved.

“Walang suntok sa buwan, walang suntok sa hangin,

walang bibitaw. Kaya natin ito, basta sama-sama,
tulong-tulong tungo sa kaunlaran” (Nothing is
impossible if we work together in attaining the
goal; “nothing ventured, nothing gained”).

IX. Key Success Indicators—

The key indicators for success must be clearly, directly linked, aligned
and correlated with the identified reform objectives—that is: a “world
class” university hospital. A measurement tool for the degree of
attainment at periodic intervals of each and every specific activities
for each department, office, unit and even individuals must be
developed. These, among others that maybe suggested, pertain to
the number/ frequency of:

a) specialty referrals received from nearby practitioners/ medical

facilities,

b) house staff with world class qualifications in diagnosing and

treating challenging diseases

c) disease-specific health promotion and education activities

conducted

d) teleconferencing consultations made with other practitioners

e) trainees/ assistants trained by the Institution on the

use/maintenance of state of the art equipment and procedures

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 f) research projects done in collaboration with centers of
excellence abroad

g) research outputs published in international scientific journals

h) visits by international experts

i) foreign engagements by local experts to regional or

international fora for the purpose of delivering a scientific
lecture, assisting in or demonstrating an innovative procedure,
presenting a scholarly productivity or acting as resource person

j) instances a scholarly productivity authored by a DLSUMC staff is

cited by authors in other international publications

k) trainees (interns, residents and fellows) who trained in the

hospital and received awards for their outstanding
achievement/s and/or cited for outstanding accomplishments
in their respective specialty fields

l) other relevant indicators.

X. Epilogue—

Some years ago, an ad hoc committee was created and tasked to

study and make recommendations regarding the reformation of the
then De La Salle University Health Sciences Campus (DLSU- HSC). It was
a rare privilege and personal honor to be one of the members of the
Committee. With all excitement and enthusiasm, this author punctually
attended and participated actively in the initial few sessions of the
weekly (every Wednesday) meeting and even on his own initiative
proposed for a ten (10) point guiding priciples for the reform process.
However, due to unknown reasons, his inputs did not probably sound
well with some, he was deliberately no longer included among the
invitees to subsequent sessions.

Several months later, the “De La Salle Health Sciences Institute Star
Model” came into being which was graphically outstanding,
appealing and looked very good on paper. However, (many will
surely disagree) on the ground, the “star model” organizational
structure is structurally flawed and misapplied. Sadly, such will not and
did not work well in so far as DLSUMC is concerned.

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 Operations usually denote daily routine activies being conducted--
likened to the hands and feet. For these appendages to function
properly, it needs the mind. Any sensible two legged creature may
orchestrate routine activities. However, it takes an informed mind to
know what and how things will be done.

The improvements on the physical plant in the hospital are not directly
attributtable to the new organizational structure. Whether it was the
“old Campus model” or the current “Institute star model”, the defining
issue is: who is sitting where in the administrative hierarchy.

By and large, the 5-sided star model resulted only in the “amoeboid”
type of movement towards the intended goals. Much much more
must have been achieved without this “amoeboid” movement. No
doubt there are changes in the Campus (now called “Institute”); but
“All change is not growth, as all movement is not forward” --- Ellen
Glasgow.

Hoping and praying that lessons will be learned from past experiences
as “The only real mistake is the one from which we learn nothing.” --
John A. Powel

XI. Executive Summary—

The need for reforms in DLSUMC is evident even probably from the
viewpoint of a passing observer as shown by the mushrooming of new
medical clinics and hospitals in the neighborhood. Many of which
were founded by members of its own consultant staff or in which they
are active shareholders.

The way to effecting institutional changes is a tempestuous one, full of

hurdles and struggles. Fear of the unknown is the strongest barrier to
instituting reforms and at its worst maybe traced to selfish motives.

The developmental milestones to be achieved in the proposed reform

process include:

Phase I. Era of immediate, fast and deliberate implementation of

the priority reforms listed under organizational,
psychosocial and guiding principles and operational
policies thereby laying down the necessary ground works
for achieving “world class” university hospital status.
(Period/ duration: 12 months)

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Phase II. Era for further vectorially carrying out the pending
unaccomplished listed reforms and formulation of a
uniquely Lasallian “eclectic” quality assurance health
care and safety protocol. (Period/ duration: 12 months)

Phase III. Era for convening the proposed Philippine University

Hospitals Association Foundation, Inc. (PUHAF Inc.) and
creation of a national accreditation body— the Philippine
University Hospitals Accreditation Board. And, receiving
accreditation and earning distinction as one of the
national centers of excellence. (Period/ duration: 12
months)

Phase IV. Era for venturing in international accreditation (JCI, ACI,

UKAP, etc.) and global health care/ medical tourism.
(Period/ duration: year 2022 and beyond)

Laying the ground works for change is an ardous task and ownership
of the change is a critical factor to its success. Its architect must have
the needed stature, respect, trust and confidence of the stakeholders.

Many will argue that DLSUMC has grown by leaps and bounds. But
such growth must have been fantastically much, much more if the
organizational structure only supported and dovetailed for such
growth and there were no “round pegs on square holes” in the
adminstrative hierarchy.

The human resources coupled with the other attributes of the

Institution are gold mines waiting to be tapped to make the DLSU
Medical Center a “world class“ university hospital— a temple of
disease and a safe haven for the sick.

This manuscript might be irritating to some. To them the author

deeply apologizes. However, to others (hoping they are more in
number) it is wished that they will find this as a “lustrous gem” born
of an irritating process and ultimately not just a “pearl cast before
the swine”.

The author uses the pseudonym “Anonimo Dela Salyano, MD”, to

represent the multitude of unknown members of the DLSHSI
commmunity who wish a change for the better of the Insititution
for the benefit of the next generations to come. Despite having
spent more than half of his lifetime with the Institution, he
undergoes a cycle of apathy and deep concern for its welfare
due to helplessness and exasperation in seeing how things are
being done when there are better ways of doing them.

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 Hence, the author offers this manuscript as a tangible legacy to
DLSHSI, hoping that it may, to some extend, contribute to the
transformation of the DLSU Medical Center into a truly “world
class” university hospital that everyone who was once upon a
time associated with it will be very proud of.

30 October 2017

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