Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium
Best Practice Focus Area/s
Leadership, Human Resources, Operations
This is GBPR Entry
Pursuant to Proclamation No. 922 s. 2020, former President Rodrigo Roa Duterte declared a state of Public Health Emergency throughout the Philippines and designated Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium (DJNRMHS) as a COVID-19 Treatment Facility. Following this, DJNRMHS took drastic yet necessary steps to prepare its facilities and logistics through its Hospital Order No. 0226 s. 2020, initiating a Hospital Emergency Incident Command Structure (HEICS)—a management system that hospitals can adapt during emergencies. In adopting this system, the hospital could implement effective changes toward addressing the pandemic in only two months.
Background and Problem
On 21 January 2020, the Department of Health (DOH) released Department Memorandum No. 2020-0034, “Interim Guidelines on the Preparedness and Response to Novel Coronavirus (2019-nCOV).” It provided the implementing guidelines on Surveillance, Laboratory Testing, Clinical Management, Communication, and Infection Prevention and Control. Likewise, DJNRMHS did its due diligence and implemented the necessary precautions for additional facilities and logistics. However, during this time, typical hospital operation was already at its peak. In terms of the number of admitted patients, around 500 were admitted, and approximately 700 patients were visiting the Outpatient Department and Emergency Room (ER) daily.
And adding to their already constrained situation, In March 2020, the hospital set-up shifted as former President Rodrigo Roa Duterte proclaimed three COVID-19 referral hospitals in the National Capital Region—and their hospital was one of the selected. And yet, among the three identified institutions, their hospital was the first to accept the exceptional challenge of converting the hospital into a COVID-19 referral facility. Pursuant to Proclamation No. 992 s. 2020, the leadership of DJNRMHS committed that all staff would provide service to all Filipinos amidst the pandemic and despite f minimal resources and high risk to all health workers. With all this, on 17 March 2020, DJNRMHS started its difficult transition from a Level 3 teaching training health facility to a COVID-19 referral hospital.
However, as the pandemic started affecting more of the general population, medical staff and other personnel experienced a fast-paced paradigm shift in their professional practice and psychological well-being. Especially during the beginning of hospital preparation, all of their staff experienced anxiety, difficulties, and fear. Nonetheless, DJNRMHS staff participated in all the activities to be more knowledgeable and skillful to become confident and an expert in providing quality care.
Notably, the medical staff was experiencing discrimination in their communities. Some of them were being avoided during rides on public transportation, and others were even forced to evacuate their residences because their family members were being abused by their neighbors. All these affected the general welfare of the medical staff. Particularly for DJNRMHS, these incidents translated into low morale and high levels of distress for their staff. The community around the institution expressed their fear and anxiety through a mass rally, and a few even caused civil disturbances.
Solution and Impact
On 17 March 2020, under Hospital Order No. 0226 s.2020, the Hospital Emergency Incident Command Structure (HEICS) was initiated to employ more structure in its command, control, and coordination. It consisted of changes such as creating a more logical management structure, redirecting roles and responsibilities, creating more comprehensive reporting channels, and revising nomenclature. Through these changes, the institution could comply with all social and environmental standards as a COVID-19 referral hospital. In only two months, the entire hospital was able to adapt.
Notable structural changes included:
- Regular wards from Pediatric, Surgery, Diagnostic buildings, and Internal Medicine buildings, including offices, were redesigned into a COVID-19 ward with a 300-bed capacity which complied with isolation requirements;
- The COVID-19 ward was designed with a traffic flow system that separated “clean” from “dirty” areas;
- Nurse stations, donning and doffing areas, and storage areas for medical stocks were strategically placed throughout the hospital;
- The Emergency building was repurposed to house the Hospital Infirmary, the Hospital Epidemiology, and Surveillance Unit (HESU) office, Communication Center office, Medical Social Service Unit satellite, and the COVID training office;
- The receiving area for COVID-19 referrals was also strategically placed near the patient admission and discharge entry/exit point.
Also, notable procedural changes included:
- A Communication and Operation Center was immediately activated to ensure that all concerns on contingency plans and protocols are cautiously implemented and evaluated.
- Protocols were adapted from DOH’s interim guidelines on the handling of COVID-19 patients.
- Infectious Disease Specialists and Infectious Disease Nurses were assigned to manage COVID-19 cases and Person Under Investigation.
- And through the joint efforts of its Human Resource Section, COVID-19 training unit, Public Health Unit, Psychology Department, and HESU, all hospital staff and related communities were also trained to be prepared against current and future pandemics.
Overall, the health facility was able to redesign its physical structures while executing, monitoring, and evaluating new policies and procedures. Despite COVID-19 cases being at its peak, the hospital staff could adapt to the new normal while still managing to resume normal business functions.
As a result of robust leadership and good governance, along with active engagement and strong commitment of staff, many positive outcomes were achieved. These included low rates of affected hospital staff with no record of death, high number of recovered cases, stable status of budget allocation and funding, high staff retention, and high rates of augmentation (i.e., the integration of healthcare workers from other agencies and hiring of Contract of Service employees dedicated to the management of COVID cases). Besides short-term results, a long-term impact of the institutional transformation was the hospital becoming renowned for managing emerging infectious diseases while still sustaining its institutional mandate to provide general and leprosy care to the public.
Beyond the requirements of being a COVID-19 referral hospital, a swabbing area and molecular laboratory for RT-PCR testing was established and approved for operation. Furthermore, DJNRMHS was able to affirm partnership with government and non-government agencies to support this endeavor.For now, the challenge with this new endeavor is maintaining a pool of competent healthcare professionals to meet the increasing public healthcare demand.
Along with facility preparation, they also implemented workforce conditioning. Training programs were accredited with Continuing Professional Development units by the Philippine Regulatory Commission (PRC). Also, all hospital staff were tasked to undergo a series of training sessions and orientations to be more equipped and engaged in their roles and responsibilities.The COVID-19 ward team also underwent a pre-deployment activity consisting of cycles of training and orientation, physical/medical examination, psychological assessment, and briefing before and after clinical duties.
Existing policies and procedures were also modified in accordance with COVID-19 operations. New policies and procedures were also created, related to operations such as RT-PCR testing, staff welfare, procurement and distribution of resources.
And with the timely response of the institution towards the government mandate, DJNRMHS received commendations from DOH Secretary Francisco T. Duque III, DOH Undersecretary Leopoldo Vega, and the Inter-Agency Task Force for the Management of Emerging Infectious Diseases Chief Implementer Secretary Carlito Galvez, Jr.