As the Asian Productivity Organization (APO) Center of Excellence on Public Sector Productivity, the Development Academy of the Philippines (DAP) held a Webinar Series on Productivity and Quality Frameworks in the Public Sector last 13-15 October 2021.
The webisode was attended by over three thousand participants from various public and private sector agencies. Speakers included Engr. Charlie A. Marquez, DAP resource speaker; Dr. Ralph Sherwin A. Corpuz, director of Quality Assurance at the Technological University of the Philippines; and Dr. Juliet J. Balderas, head of Management Services Department at the Philippine Heart Center (PHC).
Engr. Marquez, who is a certified QMS Lead Auditor and a Lean Six Sigma practitioner, gave a general overview of Lean Management. It is a philosophy based on the Toyota Production System (TPS) that is focused on improving process performance. He explained, “when we say Lean, the objective is simply eliminating everything that does not add value to the customer’s eyes… Meaning, who defines quality is the customer, not us as service providers.”
He briefly touched on the history of the TPS and Toyota’s 4P’s, namely Problem Solving, People and Patterns, Process, and Philosophy. Engr. Marquez also expounded on the Lean Management Framework.
Stability and standardization serve as the foundation of the Lean Framework. He added, “If there is no standardization, bawat office kanya-kanya [each office will vary in their ways of doing things]… We do not want that. We want standardization.”
Engr. Marquez underlined some principles of Lean and mainly discussed the eight (8) wastes in Lean Management, namely defects, overproduction, waiting, transport, inventory, motion, extra processing, and skills. He also highlighted a few benefits of Lean, which include an increase in sales and profits, improvement of quality and lowering of costs, optimal utilization of resources, and most importantly, improvement of customer satisfaction. As he pointed out, “in everything that we are doing—Total Quality Management, ISO 9000, Lean—at the top is ultimately customer satisfaction. That’s what we are here for.”
In his conclusion, Engr. Marquez recommended that participants perform an 8-Waste Analysis, using the Check Sheet that he shared in the talk. He also gave other practical suggestions such as the creation of Value Stream Maps (VSM), Root-Cause-Analysis (RCA), and formulation of solutions and prioritization of projects or activities.
TQM and Business Excellence
On the second day of the webinar series, Dr. Corpuz presented an overview of Total Quality Management (TQM) and Business Excellence. His topic zeroed in on the application of the approaches in the public sector.
To start his talk, Dr. Corpuz outlined some of the needs and challenges faced by the public sector such as inconvenient and tedious government transaction processes and unsystematic queuing. He added that in order to meet the needs of the public, the Government must exert greater efforts to provide more citizen-focused services, invest in innovation and emerging technologies to improve services, push for a smart government through the integration of ICT with management systems to address red tape, provide seamless connection among processes and governments toward one-stop-shop services, and partnership with the private sector in the country and abroad.
Quality service is what public servants have sworn to deliver and hence should be the prime focus in all government endeavors, Dr. Corpuz pointed out. To realize this, the biggest hindrances to public sector productivity must be dealt with through a solid management solution such as TQM. These barriers include security of tenure which may result in the complacency of government employees, a culture of resistance to reforms in the organization, and a complex political environment.
The speaker discussed principles and tools of TQM such as cause-and-effect diagram, check sheet, control chart, histogram, Pareto chart, scatter diagram, and flow chart. He also explained business excellence approaches that evolved from TQM and its models, including the Malcolm Baldrige National for Performance Excellence and the European Foundation for Quality Management Excellence Model. Additionally, Dr. Corpuz described business excellence as more than a mere award but, more so, a journey of building a competitive nation.
Dr. Corpuz also shared his insights into other TQM tools, including Deming’s Seven Deadly Diseases that infect an organization’s culture, Ishikawa’s Diagram and Total Quality Control, and the Philippine Quality Award Framework.
Philippine Heart Center Best Practices
On the last day of the webinar series, Dr. Balderas presented the best practices of PHC to help flatten the curve amid the past COVID-19 surges. She also shared about the center’s quality journey in the new normal, which dates back to 2010 when the center was awarded the PhilHealth Center of Excellence. To improve its hospital processes, the PHC has also been undergoing multiple internal accreditations since 2011. In 2015, it received national recognition for good governance at the Asia Pacific Economic Cooperation (APEC) Summit. Dr. Balderas noted, “our history of quality is stronger than COVID. If we look back at the history in 10 years, we have improved ourselves so much that probably, what we evolved over the years could be something that we can use productively against COVID.”
Dr. Balderas discussed one of PHC best practices when the pandemic started—the creation of an Incident Command System, which is a standardized emergency response management structure comprising an incident commander, liaison officer, public information officer, safety/security officer, and operations, planning, logistics, and finance divisions. According to Dr. Balderas, the chain of command members meet every month to discuss all the operations in the hospital. They also hold multidisciplinary daily COVID-19 meetings to ensure that COVID-related problems are addressed as they happen. Additionally, new COVID-19 policies by ISO standards on patient admission and on the cohorting of COVID and non-COVID patients among other policies were implemented. These policies were also made accessible to the staff and the patients through its Intranet. The speaker also put forward other best practices of PHC such as stricter compliance to safety protocols, observance of ICP policies for healthcare workers in terms of daily symptoms monitoring and electronic health declaration every fourteen days, and expansion of GeneXpert PCR Testing.
Dr. Balderas also presented PHC’s Beyond Better Strategy Map for the year 2017 to 2022. The map outlines the center’s support and core processes, strategic position, and impact areas that are geared towards its change agenda, which are to become a leader in cardiovascular care that is at par with global benchmarks and to be a leading advocate in the prevention of cardiovascular disease in the country.
Maintaining a high standard of quality is doubly difficult due to the ongoing health crisis, but PHC’s performance governance system, which includes unit scoreboards that help monitor the staff’s individual performance and breakthrough results, has made it possible. Dr. Balderas explained, “when there was little budget for the Heart Center, [our question was] how do we go towards development? We only know that we have to remain the best heart hospital and we are the heart hospital referral center. Our strategy was to improve the performance, so performance monitoring despite COVID was a PHC Culture.”
Despite changes in leadership every five to six years, the center has achieved outstanding breakthrough accomplishments yearly until 2016. And even amid the ongoing COVID surge in 2021, the scoreboards guided the center in decreasing patient safety incidents and the number of healthcare workers diagnosed with COVID 19 by 50 percent.
The use of scoreboards has been recognized as a best practice in all of PHC’s external audits. In 2019, the center was awarded by the Philippine Quality Award as the leader in upholding standards of cardiovascular care. PHC’s quality and performance excellence have also led the center to be recognized as a “Leader in Upholding Highest Standards of Cardiovascular Care” in 2018 at the 21st Cycle Philippine Quality Awards. Dr. Balderas noted that despite the hurdles brought about by the COVID-19 pandemic, good governance and pursuit of excellence in quality improvements must continue.