STAY IN MY LANE

I have been reflecting on what will happen in 2025, and how my life will change.  I always make lists because I don't want to forget or miss anything.  I have a daily "to-do" list, although I hardly complete the tasks on my list...  This time, I think I will make a lists of how I will change my lifestyle for 2025.

1.  STAY ON MY LANE.  I am usually assigned tasks to trouble-shoot problems areas.  In the past, this has spread me thinly to the point that I am not as efficient as I could have been.  My boss had announced during the budget proposal hearing this past month that I would be relieved of being the division chief of the Professional Allied Health Services so that I could focus on research.  This I will do, and on this I will focus.

2.  HEALTH AND WELLNESS.  I have always tried to promote health and wellness because this is MY weakness.  I wake up with severe arthritis, especially on my left hand so much so that I feel like a child again doing "close open, close open" exercises.  I need to watch my diet and exercise regularly to lose excess body weight.  I also deal with menopausal symptoms like hot flushes, so I need to focus on preventing other long term complications from menopause.

3.  QUALITY FAMILY TIME.  Realizing that I am dispensable at work, I need to focus on the people that really matter to me.  Family is forever.  Despite the quarrels and disagreements, family stick together.  Relationships need to be nurtured, so family time needs to be regarded as sacred.

4.  MENTAL HEALTH.  I have always used work as crutch to battle loneliness and depression.  Although I do enjoy one-on-one discussions with friends, colleagues and co-workers, I need to develop new coping skills in order to develop other aspects of my life, like my private practice, my hobbies and recreational activities.

5.  RETIREMENT.  I will reach midlife in a few years.  I need to streamline my investments and make wiser decisions on resource management.  It is true that being single and alone allows us to achieve more in terms of work, but when we grow old, we will be alone and highly dependent on others to take care of us.

2024 Bi-Annual Gathering

2024 has been a productive year for the VSMMC Medical Social Services, stepping out of our comfort zone and daring to do things differently.  Here's a shortlist of activities under our belt:

• Feb 12 - 6th Year Anniversary sa VSMMC Malasakit Center:  Mga Kadaugan og Kalampusan nga Nakab-ot
• Feb 14 - "Love, PAHS" Flower Sale with Serenade, thank you for sharing your musical talents with Guitar and Violin and beautiful angelic nightingale voices.
• March 19 - BUEN VIVIR means living well, living in harmony.  Happy World Social Work Day!
• June 21 - Ms. Mergin Acido, Gawad Parangal ng Natatanging Pagkilala sa Huwarang Manggagawang Panlipunan by the Department of Social Welfare and Development and ASEAN Social Work Consortium-Philippines during the 6th Filipino Social Work Day
• JUNE 28 - Filipino Social Work Day
• JULY - CPAHS Best Practices Presentation HIM, MSS
• AUGUST 20 - Hospital Week 2024 for daring to be different with BEST FILM in the  Short Film-Showing, Pinoy Games and Barrio Fiesta with Bayle
• OCT 30 - National Day of Charity
• NOV 12 - Wellness Campaign for Youth

I prepare ten (10) bullet points on why I think this is still the best office of this institution.  The social workers and social welfare assistants of the Medical Social Services have the following characteristics:

1.  LEADERSHIP WITH TRUST.  When I first started working with the MSS, Mergin Acido did not like me.  But she didn't have to like me.  She just needed to respect me enough to follow.  I reviewed the organizational structure of the MSS and saw that there were only two leaders (Mergin and Ruth), so I gave her an ultimatum - to choose four (4) leaders to develop.  If she didn't choose by the deadline I set, I would choose the leaders for her.  That was our first face off, which was just as well because when the MSS team grew in size and number, it was easier to manage the manpower complement when certain management tasks could already be delegated to the unit heads.  

Delegate tasks to your leaders.  But first, train them to be like you.  This is successor generation, when we develop your mini-me while allowing them to discover their own uniqueness. Empowered deputy, unit and cluster heads.  Nobody is indispensable so everyone should be capable of taking over anytime, for the continuity of the section.

2.  ONE VISION.  The staff of MSS are indoctrinated to focus on the same goal, guided by the same North star:  our patients.  The work of the MSS is patient-centered, as it should be.  Planning, implementation, monitoring and evaluation.  Row the same boat in the same direction.  Teamwork makes the dream work.  If you want to go fast, go alone.  If you want to go far, go together.  The MSS is aligned with the VSMCC emblem to grow deeper and go higher to achieve impacts of better health outcomes, responsive healthcare systems and access to all levels of care.  The MSS is also aligned with the DOH 8-point action agenda of "bawat Pilipino, bawat komunidad at bawat healthcare worker dahil sa Bagong Pilipinas, bawat buhay mahalaga."

3.  PROMOTION and COMMUNICATION.  Pakighimamat, Mag-Istorya 'Ta! is a breakthrough, providing medical social workers with a platform to express their emotions, feelings and to renew their purpose.  Atty Panugaling taught us that "Performance + Communication = Reputation".  Not to brag, but to take accountability and to maintain transparency for the work that we do, the medical social workers communicate with its global audience what it means to be a social worker.  When we feel exhausted and burned out, it helps to revisit one's WHYs and refresh on this vocation.   Feel good vibes for being in the profession of service as social workers!

4.  OBEDIENCE is the best virtue.  Work ethics with passion, compassion and competence.  Just like the OSM LAW: No reason.  No justification.  No excuses.  No explanation.  Just Deliver.  There is trust that the leaders can see the bigger picture, but acknowledging that every single person has a role to play to make the whole team function well.

5.  MAXIMIZE CONNECTIONS.  We find ways!  Making connections is an occupational requirement for social workers.  The MSS is recognized for it efficient funds utilization and burn rate = CAF, MAIFIP, referral to other funders.  Medical social workers find ways to connect its patients and clients with people and organizations who have the resources to assist them.  We should strive more to strengthen the network of social workers within the healthcare provider network.

6.  PAUSE and BREATHE.  Stress debriefing and caring for the carers.  I have seen that the MSS set this as a priority.  Protect mental health despite stress and DEMANDING excellence and work efficiency.  YOU will continue to suffer if you have an emotional reaction to everything that is said to you.  True power is RESTRAINT.  Breathe and allow things to pass.

7.  EMPLOYEE ENGAGEMENT.  Organizational development, capacity building - in-house trainings and providing training for govt social workers, even engaging in research.  Medical social workers are sent for training in preparation of the specialty centers and for cross training as well.

8.  WALKING THE EXTRA MILE.  I've seen how field work for social workers is literally walking for miles, umbrella in hand to protect them from the weather and the elements.  Metaphorically, medical social workers also walk the extra mile to look into holistic approach to personal development, reintegrating patients with the family and the community, post-discharge follow up and monitoring, referral and case management.

9.  DISRUPTIVE INNOVATION.  Corporate service responsibility - going out of our comfort zone and reaching out to where our patients are. The social determinants of health are usually not medical in nature, but more social.  This year, the medical social workers dared to go to the community and to schools for wellness campaigns for the youth, and to organize livelihood activities for chronic patients and their significant others.  Most of all, medical social workers are not afraid to try new things.  Medical social workers are not afraid of change, as it is the only constant in life.  Albert Einstein said that doing the same things expecting different outcomes is insanity.  We need to keep trying new things until we find the optimal solution to the problems we face.

10.  SERVICE.  The MSS in all its activities are aligned with VSMMC to impact better health outcomes, responsive health systems and access to all levels of care.  The MSS is also aligned with the 8-point action agenda para sa bawat Pilipino, para sa bawat komunidad at para sa bawat healthcare worker. The MSS embodies the mantra "kalidad nga serbisyo among garbo!"

#APMR2024

 

CPAHS (HIM, MSS) AND RESEARCH INSTITUTE

Annual Performance Management Review 2024

 

Peter Sondergard said that information is the oil of the 21^st century, and analytics is the combustion engine.  The goal is to turn data into information, and to turn information into insight.  
 
HEALTH INFORMATION MANAGEMENT SECTION (HIM).  The Health Information Management Section, is involved in:

1. the creation and maintenance of quality standardized health records for every patient treated; and 
2. the improvement of accessibility of the health record through digitization and digital transformation; in order for 
3. data collected to be maximally utilized not only for health facility statistical reports, but also for research, continuous quality improvement and policy development. 

 
The organizational structure involves one supervising administrative officer overseeing five units, namely:

1. the outpatient health records management unit, 
2. the ER and admitting health records management unit, 
3. the inpatient health records management unit, 
4. the health data analytics and 
5. the health records processing and releasing unit. 

The HIM has 98 employees: 59 regular employees, 26 job order employees and 13 institutional workers, 70% female, 77% (76/98) are individuals aged 40 years and below with 40% (40/98) with 6 to 32 years of service under their belt.
 
MEDICAL SOCIAL SERVICES SECTION.  On the other hand, the Medical Social Services aims to be a proactive partner of patients and their families in building self-reliance, free from social and physical illnesses.  Their mandate is based on Republic Act 11223, the Universal Health Care Act stating evaluation as a function of the medical social workers in the health facility.  Administrative Order 44 series of 2021 provides guidelines in determining eligibility for social care, medical and financial assistance and point of service.  Republic Act 11463, the Malasakit Center Act provides financial risk protection.
 
The organizational structure involves one social welfare officer IV with four units, namely:

1. the Special Programs Unit; 
2. the Eligibility and Assessment Unit; 
3. the Case Management Unit, divided into general services and specialty services; and 
4. the performance monitoring, research and technology development unit.

 
The MSS has 99 employees: 84 social welfare officers, 14 social welfare assistants and 1 administrative aide; 87% female; 92% (92/99) are individuals aged 40 years old and below; with 17% (17/99) having served in VSMMC for more than 6 years.
 
VSMMC RESEARCH INSTITUTE.  Although the VSMMC Research Institute was originally created in 2021 by Hospital Order No.  2021-182, the VRI has become an independent institute directly reporting to the Office of the Medical Center chief effective last May 1, 2024 through HO No. 2024-62, dated April 22, 2024. This is aligned with the DOH mandate for research and the medium-term goal of VSMMC for Grow Deeper Go Higher 2024 and beyond. 
 
Currently the VRI has 7 core staff under one medical specialist IV with three major units (patterned after the UP Manila Research Grants Administration Office) namely, 

1. the Grant Application and Protocol Development Unit (GAPDU) tasked with the overall approval of researches submitted; 
2. the Fund Administration Management Unit (FAMU) designed for all regulatory, fund, and fiduciary matters; while 
3. the Research Implementation Support  Unit (RISU) is tasked in assisting researchers in all matters concerning the implementation of the research.  

The age of the staff ranges from 25 to 58 years old; three males to 4 females; two of them are married, the rest are still single.
 
Aside from the core group, the VRI was able to reorganize the VSMMC Technical Review Board with 25 trained members.  They help technically review research proposals submitted by our researchers: our residents and fellows in training, our non-physician employees, as well as partners and stakeholders willing to collaborate on research projects and clinical trials. The VRI also organized thirty five (35) department research officers  appointed by their respective departments to be in charge of monitoring research activities of their departments and offices.
 

SCORECARD TARGETS AND RESULTS

For the HIM.  Of the five main targets of the HIM, information capital on electronic health records have been implemented in special clinics like the Women and Child Protection Center, Child Survival, Renal and Lithotripsy as well as pilot runs in the ER thanks to our Family Medicine ER team.  For training, 100% of the HIM staff have attended the basic health information management (HIM) seminar and the medical certification of the causes of death. Almost half of the staff have attended the ICD-10 coding seminar.
 
For the MSS.  To establish specialty centers with advanced comprehensive services and expanding training for healthcare professionals, the MSS has sent 12 medical social workers for trauma-informed care (TIC); 9 medical social workers for 4Rs (Recognizing, Reporting, Recording and Referring) for Women and Children Protection; 9 functional specialty social workers for advanced care and 1 functional specialty social worker for basic care. 
 
The MSS was also able to send 3 medical social workers for cross training for comprehensive exposure and training relative to case management of specialty areas. 
 
As its contribution to building resilient facilities, starting March 13, 2024 the MSS totally banned the single-use plastics in all offices through an office policy.
 
For provision of quality healthcare through improved service delivery, 99.99% of all admitted patients under basic or ward accommodation were assessed for eligibility within 24 hours from admission.  The MSS also implemented the use of psychosocial assessment tool for pediatric and geriatric patients, piloted to 44 elderly and 6 pediatric cases last May 2024 and fully implemented by October 16, 2024 under seven departments and to ONCOLOGY and transition clinic cases.  17 medical social workers who were hired in 2022 participated in a case presentation conference as part of their training.
 
For case management, the MSS is working on operational guidelines in the conduct of ward visits, multi-disciplinary case and family conference, grief work, kangaroo mother care case management, among others.  With the breakthrough of discharging patients at the Center for Behavioral Sciences starting January 10, 2024, 80% of the 191 patients were successfully monitored post-discharge.  Beginning July 2024, this was replicated by other specialty social workers. Starting April 2024, at the emergency room, readmitted patients within 15 days from discharge with social complications are managed by the EAU social workers.

Utilizing technology to improve service delivery, the MSS utilized an online assessment tool for inpatients under basic or ward accommodation.  This tool is processed for privacy impact assessment.  Starting March 1, 2024, an inpatient general registry for ED, OB and elective clusters provides real time contribution  to the digitization program.
 
To achieve core impact of financial risk protection, 8,245 (102% of target) eligible patients were enrolled to POS; 100% or all 20,852-hospital bill in excess of PHIC were charged to MAIFIP, CAF or Quantified Free Service.  To add corporate service responsibility, the MSS conducted two dishwashing soap making activities last June 18 and October 1, participated by 28 ONCO and 100 ORTHO patients and their significant others.
 
This year, 499 ward classes were conducted, participated by 10, 159 patients and their significant others.  The MSS aims to continue strengthening social service programs and services and are grateful for the recognition of its efforts through the following awards: 
●    Best Office Award during PRAISE 2024,
●    CSC Presidential Lingkod Bayan Award during PRAISE 2024,
●    Best Practice Award from HFDB in celebration of World Social Work Day 2024
●    Gawad Parangal Award for the Health of Office Ms Mergin D Acido during the celebration of the Filipino Social Work Day 2024
●    Cancer Assistance Fund Excellence in Fiscal Management Award during the CSPMAP and CAD Access Site Forum
 
For the VRI.  Despite its being a relatively young office with overwhelming research submissions and recent transformations, the VRI implemented reforms to commit to a 14-working day turnaround time for technical review of research proposals and case reports.  The VRI cooperates with 25 research technical reviewers of the VSMMC Technical Review Board headed by Dr Reden Patalinjug to ensure timely release of reviews.  On the average, technical reviews are released in an average of 10 working days for 437 research proposals and 215 case reports; totaling 652 protocols from January 2024 to November 2024.
 
The VRI has recorded eighty (80) research presentations to local and international conferences as of November 30, 2024; 47 research papers (36 local and 11 international presentations); 33 case reports (16 local and 17 international presentations). 17 out of 47 research papers garnered recognition and awards; while 6 out of 33 case report presentations garnered the same; totaling 23 recognition and awards out of 80 presented research papers and case reports.
 

Anent to providing an enabling environment for research, the VRI performed research consultations for 85 protocol versions and statistical services for 35 protocol revisions.
 
With all these interventions,  the VRI was able to recommend six (6) researches (5 of which were completed in 2024; while the other 1 was last 2023) to the concerned departments for policy adoption last October 2024. We are still looking forward to the feedback from these departments regarding our recommendations, and to conduct a policy brief writing workshop to assist in policy development.
 
For the second target “at least twenty (20) researches presented into a local/international research forum or conference”, the VRI has recorded 80 presentations - a 400% increase from the baseline.  We appreciate the passionate work of our department research officers for encouraging dissemination of completed research papers.
 
For the third target “at least ten (10) researches published in a peer-reviewed journal”, the VRI has recorded 6 publications as of November 30, 2024.
 
The VRI was able to release 437 technical review results for research proposals and 215 review results for case reports, totaling 652 protocols technically reviewed and endorsed to the VSMMC Research Ethics Committee from January 2024 to November 30, 2024.

OTHER SIGNIFICANT ACCOMPLISHMENTS

For the HIM.  The HIM prides itself in its struggles with close monitoring and timely reporting of patient census and hospital statistics; improvement in issuance of medical certificates; online requisition of patient health records; paperless certification of no pending charts for completion and 2023 Compendium of Hospital Statistics.
 
Monitoring the patient census at the OPD, as well as records retrieval and medical certificate issuances, trends can be helpful to formulating programs and plans.

Consistently monitoring ER consults and admissions help in logistics preparation and feedbacking to the ER healthcare team.  Establishing proper record-keeping at SugBUCAS in Carcar and Bantayan also provides us with real time feedback on our performance and the impact of the project.  Serving 4,360 patients at SugBUCAS Bantayan from April 2024 to October 2024, we identify that most common admissions are for IM and Pediatric consultations.  Likewise in SugBUCAS Carcar, we see that out of the 15,999 admissions, majority are from IM, General Surgery, Pediatrics and OBGYN.

 
HIM also closely monitors the turnaround time for issuance of death certificates, medical certificates, and livebirth certificates.  There is a breakthrough in the increasing number of medical certificates released and the decreasing turnaround time.
 
With digital transformation, one of the breakthroughs for 2024 is the implementation of the online requisition of medical documents which allow patients from geographically distant areas to request their medical documents in advance.
 
To improve chart completion, the HIM heavily relies on the department chairs and training officers to oversee resident physicians.  The HIM provides feedback through paperless communication and clearances sent to the official department email addresses.
 
With the importance of hospital statistics in research, patient care, decision-making and administrative control, the HIM launches the 2023 Compendium of Hospital Statistics as a reference to data that can be useful for hospital management.
 
The best practices of the Medical Social Service can be summarized into 4 points: Case Management Guidelines, Post-Discharge Follow up within 7 days from discharge, monitoring and case management of readmission within 15 days with social complications and conduct of health education and wellness campaign
 
For the MSS.  To patients, the Malasakit Center provided improved access to healthcare, reduced financial burden, timely medical intervention and improved patient satisfaction.
 

Services provided are in line with DOH standards despite providing services distant from VSMMC such as the telesocial services at SugBUCAS Carcar.
 

The General Inpatient Registry is the MSS contribution to electronic health records mandate of the DOH. Considering that patients needing special care also need case management, MSS provides post-discharge care services.
 

Initially piloted with the Center for Behavioral Sciences, the number of patients provided post-discharge services was increased to 1,933 patients.
 
We also take pride in consistently meeting the QOP targets that we set, with all patients evaluated, managed and provided with social work intervention.  Streamlining process flows also make work easier, such as utilization of standard forms and coordination for pre-admission services.

 
In order to make sure that the MSS staff are competent to deal with the difficult cases they face, training involves case conferences with the training core.

Considering that the social determinants of health are usually not medically-related, the MSS ventures into providing two activities for health education and livelihood training for our patients and their significant others.  Not limiting these activities to the hospital, the MSS partnered with community and school-based campaign for young adolescents regarding relevant health topics.

In order to boost morale and give credit where it is due, the MSS also recognizes best employee of the month based on set criteria and performance measures.
 
For the VRI.  To summarize the significant accomplishments and best practices of the VRI, it would be the following:

• organizing and training the technical reviewers of the VSMMC Research Technical Review Board (TRB) to help the VRI core staff to achieve 14-working day turnaround time of technical reviews. 
•  The second would be the appointment of the department research officers who are our coordinators to initiate, monitor and report research activities within the different clinical departments and specialty centers. 
• Protected time with supervision of their research mentors is what our resident physician trainees need to allow them to focus on their research requirements.
• The VRI provides research consultation and statistical services to assist researchers in improving their research proposals, inevitably changing and creating a culture of research.

 
The VRI is one of the most collaborative of offices, considering that with only 7 core staff, it is highly dependent on the inputs of its research technical reviewers and the monitoring and reporting of its department research officers. 
 
The VRI was able to conduct its own research podium presentation, pitch to policy contest, case report poster contest, and bioethics poster contests during the VSMMC Medicine Week last September 2024.
 
Furthermore, the VRI also co-hosted, with the help of the Office of Strategy Management, with the Nutrition Center of the Philippines the Nutrition and Multi-Morbidity Symposium last October 2024, at the Marco Polo Plaza, Cebu.

The VRI identifies its provision of protected time for research as one of its best practices. This activity provides an avenue and opportunity for researchers to work solely on their research every Wednesday, under the authority of Hospital Personnel Order.”
 
The VRI further identifies the research consultation and statistical services provisions as one of its best practices. Alongside this, the VRI also recognizes the efforts of the best-performing Technical Review Board Members on a quarterly basis. Ultimately, the VRI continues to inculcate the celebration of wins (may it be big or small) through its salo-salo culture.
 

LEARNING AND REFLECTIONS

For the HIM.  Teamwork makes the dream work.  The most successful of all health programs is the one that is inclusive and involves as many stakeholders as possible.  This is true in the implementation of the electronic health records with the need for interdepartmental collaborations and communication, as well as training and continuing education.
 
For the MSS.  It is also important to remain humble and to accept that we are still a work in progress.  We accept both praise and complaints from our patients and stakeholders in order to identify gaps where we can continue to improve.
 
For the VRI.  We learn from past experiences.  Knowing that research, the word itself, can strike fear in any Sottonian, we hope to provide an enabling environment for research by finding champions and enthusiasts, by providing ample opportunity and time to engage in research activities, and by communicating with one another how we can help researchers find their way.
 

TRANSFORMATION AGENDA

For the HIM.  Digital transformation is the process of using digital technologies like the hospital information system and electronic health records, to change how the hospital operates and engages with patients and other stakeholders.  There is a lot of work waiting for us to accomplish digital archiving of all paper-based documents, logbooks, imaging and laboratory results, in order to fully implement paperless electronic health records for the whole hospital.
 
For the MSS.  On the other hand, disruptive innovation is the process of making our services more accessible, affordable, and simpler for a wider audience, like tele-social services, post-discharge monitoring and assigning our social workers where the patients are, even to the point of utilizing social media and technology to reach out to our indigent and financially incapacitated patients.

For the VRI. Transformational change is a type of change that occurs when an organization makes a fundamental change in how they operate. It's often triggered by changes in an organization's environment. This type of change can be challenging, but it can also lead to significant improvements in performance.  The VSMMC Research Institute aims to provide an enabling environment for research, for a transformational change in research culture.
 
In  CONCLUSION,  Information may be the oil of the 21^st century, and analytics the combustion engine, but it is through digital transformation and disruptive innovation that we effect transformational change.  
 
 

Gaea Bliss

I've always wanted to have a baby for as long as I can remember, but this is not God's will for me... so I just help other women have their babies, just like Glenda had Gaea Bliss.  As I held her sleeping form in my arms, I realize that I have missed this train.  My motto before was "habang mas regla, may pag-asa!"  But starting July 2024, I officially lost all hope of biologically having my own babies.  My womb wept for the last time for the babes left unborn.

 

ALAS PONDER

We had a reunion dinner with my pandemic executive assistant Mimi.  RJ and Gil were discussing my work schedule, that I would ontinue working until late into the nfight, sometimes extending til dawn.  ALAS PONDER means the usual time that I would stop working is until I get exhausted or energy empty batt or lights out "ponder"

So for 2025, I think I need to be more forgiving of myself as I accept that I cannot possibly do everything.  My word for 2025 would be DELEGATE.

I need to develop my staff enough to trust them to take over even important functions at work.

WORLD AIDS DAY 2024

It's the eve of WORLD AIDS DAY 2024, an event usually celebrated on December 1 every year to remember those who have died of AIDS and to continue to support those living with HIV.

T1.  After 4 decades of the HIV pandemic, why do you think the HIV infection continues to spread?

T2.  What issues and concerns do you think people living with HIV face everyday?

T3.  Knowing that stigma and discrimination against HIV still exists, how should we celebrate World AIDS Day?

I fear no death for You are at my side

 

What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.

- Albert Pike

Remembering one who has lived life for others.  No matter how lowly and humbly life is lived, when it is lived in the service of people, the small acts of charity will never be forgotten.

Empowering POGS Members to Maximize the Benefits of UHC

Allow me to share here the speech I gave during the Plenary Session for POGS Organization of Government Institutions and the POGS Service Delivery Network for the 2024 POGS Annual Convention and 78th Anniversary Celebration on November 15, 2024 at the PICC.

      

      I greet everyone from the queen city of the south, Cebu.  To provide context, I am a medical specialist from the regional tertiary referral hospital Vicente Sotto Memorial Medical Center.

GOVERNMENT HOSPITALS INUNDATED WITH PATIENTS
The photo shows the situation back in 2015 when our 6-bed labor room accommodated more than 60 parturients.  Imagine that the next patient would simply be offered that empty stool while in labor.  Just like other government hospitals, we were inundated with patients.

In May 2015, our training officer Dr Helen Amorin assigned me to review the maternal mortality reports for the month in preparation for the POGS Cebu quarterly maternal M&M conference.  There are 31 days of May and I was shocked to discover that we had 29 maternal deaths for that month.  Naturally, during the M&M conference, one of our POGS luminaries demanded that “since there are soooo many maternal deaths, we should investigate this hospital!” 

      This is because when patients are for emergency CS, they refer to Sotto.  When the patients have financial constraints, they refer to Sotto.  When patients are in critical condition, they refer to Sotto.  Every ambulance that transports each patient seems to shout “Sotto! Sotto! Sotto!”
This is where it all began.
 
PERINATAL STATISTICS
In 2016, our perinatologist Dr Kristina Dosdos started a joint conference between the Department of Obstetrics and Gynecology and the Department of Pediatrics called the Perinatal Statistics.  We noted that
·     more than 40% of our admissions were low risk pregnancies, which could be managed at primary and secondary level facilities.
·     One of our former residents Dr Princess Lorezo conducted a research on decision to delivery interval. Turn around time for cesarean section delivery is more than 12 hours on average!  

     MATERNAL PERINATAL STATISTICS

     In 2017, we started the Maternal Perinatal Statistics, inviting the City Health Officer and the Cebu Provincial Hospital to listen to our data presentation in the hopes of finding solutions.

    

     QUARTERLY MATERNAL PERINATAL STATISTICS

      By 2018, we started the Quarterly Maternal Perinatal Statistics where all government hospitals present their accomplishment reports, census of referrals and maternal and perinatal deaths.  We would also flash the top ten referring facilities!
 

NO ONE HOSPITAL CAN DO IT ALONE
Allow me to mention to acknowledge their contribution to the success of this endeavor the anatomy of Cebu HealthCare Provider Network

• CEBU – 1 apex DOH hospital, Vicente Sotto Memorial Medical Center
• 3 DOH hospitals - Eversley Childs Sanitarium and General Hospital, Saint Anthony Mother and Child Hospital and Cebu South Medical Center
• 4 Cebu provincial hospitals – CPH Bogo, CPH Danao, CPH Balamban and CPH Carcar
• 3 city hospitals – Lapulapu City Hospital, Mandaue City Hospital and Cebu City Medical Center
• There are also 12 district hospitals and 5 apex private hospitals.

With the key message that “NO ONE HOSPITAL CAN DO IT ALONE!”  The problem was the high maternal mortality in Cebu, most dying in VSMMC.  So the objective of the Quarterly Maternal Perinatal Statistics was to assess and develop strategies to strengthen the referral systems in order to reduce maternal and perinatal mortality in Cebu:

1.   Create technical working group that meets during quarterly maternal-perinatal statistics agreeing to a NO-BLAME culture
2.   Establish the real-time online referral system
3.   Improve functionality of peripheral hospitals to schedule elective CS at their convenient time. 
4.   Develop agreements on two-way referrals for the implementation of the Central Visayas Health Referral System

      Most of the complaints of the hospitals were difficulty contacting VSMMC telephone line to refer, lacking manpower, no computer and internet connections.  I distinctly remember that it was Dr Mona Yiu who demanded for a real time communication system between hospitals.  The hospital chiefs were convinced to find ways to decongest VSMMC in order to allow us to accommodate more of their patients needing tertiary, critical and intensive care.

      ELECTRONIC REFERRAL SYSTEM
It was the DOH Central Visayas Center for Health Development that was successful in developing a program for the electronic referral system following guidelines in the Central Visayas Health Referral System Manual. 

I am glad that Dr Joy Novero presented that this system is being used even in private hospitals like UCMED.  Dr Veloso was one of the representatives of POGS Cebu during the QMPS.
But having the technology is not enough, because we need buy in of the end users. 

Pag ayaw, may dahilan.

What did we do?  VSMMC as the tertiary referral hospital stopped tolerating.  We get what we expect.  We deserve what we tolerate.  We stopped accepting walk-in patients.  We stopped accepting patients who were not referred thru the electronic referral system.  We stopped accepting patients who were low risk. 

It needed POLITICAL WILL AND GOOD GOVERNANCE.  We were fortunate to have genuine humanistic leadership in the person of our BIG BROTHERS Dr Gerardo M Aquino Jr, our medical center chief and Dr Jaime Bernadas, our DOH Regional Director.

Gone are the patient referrals “TO HOSPITAL OF CHOICE”  For referral of patients from hospitals, we utilize the Central Visayas electronic health referral system.  For referral of patients who are at home in emergency situations who need transport to the nearest available hospital, we have the DOH 711 emergency healthline.  Currently, our DOH7 is working on developing the Telemedicine Program for electronic health records across all government health facilities with interoperability.

COVID19 PANDEMIC
This strong working relationship between our hospitals in the Service Delivery Network and HealthCare Provider Network was sorely tested during the COVID19 pandemic.  Dire need mandated compliance with the electronic referral system guidelines.  With the systems in place, we were able to provide more beds for severe and critical COVID19 patients at VSMMC.

This year, the technical working group for the healthcare provider network crafted the guidelines for referral based on functional capacity of health facilities.  The DOH Central Visayas Center for Health Development released a memorandum on the levels of care with different diagnosis and cases to guide decision-making on who to refer, when to refer, where to refer and which cases should be prioritized for referral to VSMMC as the tertiary end-referral hospital.  No matter if the doctors argue online, at least the patient is in a hospital that can provide monitoring and care.  All for patient safety.

IMPACT on BETTER HEALTH OUTCOMES, STRONGER HEALTH SYSTEM, ACCESS TO ALL LEVELS OF CARE

In 2017, Dr Dosdos reported that we had 95 maternal mortalities that year.
In 2020, we had 60 maternal mortalities.
By 2023, we were down to 31 maternal mortalities for the whole year, less than 1% of all admissions.

Today, if you need to be admitted, you don’t need to know anyone to have access.  You might need to wait, but eventually you will be accommodated.  The DOH 711 emergency healthline and the electronic health referral system will help make sure that THE RIGHT PATIENT IS AT THE RIGHT FACILITY AT THE RIGHT TIME ALL THE TIME.

Kay kami sa Sotto, kalidad nga serbisyo among garbo. 
Quality service is our pride.

Lavander and Mint

I miss Dr Helen Amorin.  She was my mentor, ally and biggest fan/supporter.  We would spend 30 minutes over the phone discussing strategies and she would give me advice like an older sister.

Ever since I joined VSMMC in 2013, she had been providing me with strength to DARE institute changes for reform in the Department of Obstetrics and Gynecology. 

We started with changing the admission guidelines to the 12-hour obstetrician-on-duty, adopting the system from PGH with residents assigned to the OB Admitting Section, ER Gynecology, Labor Room, Delivery Room, and Operating Room. This provided additional accountability to the consultants and residents in charge.

Then we scheduled additional conferences like the staff conference, sonologic surgico-pathologic conference, mortality conference, grand rounds, pre-op/post-op conference.  We also had quarterly trophoblastic conferences, perinatal statistics, joint OBGYN-IM conference and mutli-disciplinary conferences as needed.

I was happy to know that there was somebody who was as passionate and hard-working as I am, probably even more... so that the busyness of daily operations didn't seem too overwhelming.  My main concern then was difficulty waking up early for these conferences, but mam Helen would always give me an early wake up call when I was needed for those special events.

We also had time to disconnect and have a social dinner or coffee with blueberry cheesecake.  She always knew my favorite!  When shd ventured into soap-making, she gifted me with peppermint-scented bath soap which brought me a lot of comfort.  Mam Helen preferred LAVANDER and I would remember to pick up small stuff for her when I would see Lavander.  Lavander-scented showers refresh her and make her happy.

Together, we were the dynamic duo.  When we had a series of three (3) non-puerperal uterine inversion, she would operate abdominally and I would be her vagina girl.  We were Helen A and Helen M.  She was the early one and I would be the night duty.

Yesterday, I was part of a plenary panel discussion for the POGS Organization of Government Institutions, telling the story of the Central Visayas Electronic Health Referral System.  I couldn't tell the story without starting from where it all began... and I just had to mention Dr Helen Amorin, who asked me to review the 29 maternal mortalities for the month of May in 2015.

I had to explain that most ambulances transported patients to Vicente Sotto Memorial Medical Center (VSMMC) which was most often the hospital of choice.  The audience laughed when I told them that to me the ambulance sirens sounded like "Sotto, Sotto, Sotto!"

More importantly, the audience seemed to be attentive to the unfolding of OUR STORY.  The realization that "no hospital can do it alone" and that it is actually the strong working relationship between hospital healthworkers that make sure THE RIGHT PATIENT is at the RIGHT FACILITY at the RIGHT TIME ALL THE TIME.

I miss mam Helen.  She was proud of me when I described the Program for Young Parents before the DOH National Staff Meeting in 2014.  I'm sure she would have been proud of OUR STORY when I narrated it to the POGS Annual Convention in 2024.

Layo pa 'ta pero layo na 'ta.

This one's for you, mam Helen!  Helen A and Helen M, lavander and mint!

The Growth Journey

I found this illustration on my facebook feed.  I realize that in order to grow, we need to get out of our comfort zone and do it.  Do it scared! Do it even if you're not sure what you're doing!

While we continue to learn as lifelong learners, we continue to face challenges by acquiring new skill sets.  The willingness to learn is one of the most important characteristics of a growing person.

Take courage!

Blind man:  Have mercy on me, I beg you!  I want to see!

Jesus:  Stand up, your faith has healed you!

Often we are preoccupied with our worries and struggles that we cannot be disturbed to help those blind people sitting along the roadside asking for help.

Kuya Gil is an example of how we can truly be instruments of God's healing despite our own poverty and handicaps.

On the anniversary and project leaders meeting of the Enfantes Du Mekong, the message of the Bamboos to the scholars are "Take courage and get up.  Jesus is calling you!"

Bartimeus was important to Jesus because he said "Call him" asking the people to bring Bartimeus instead of just ordering Bartimeus to "Come here".  In the same way, the children matter not only to EDM but also to God.  Volunteers are the instruments that God use to bring the children closer to Him and closer to restoration of their sight and the restoration of their faith in humankind.  People are gifts.  People live for other people.  That faith in humankind can save lives!

Padayon, ninong Gil!