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!

Post-tweetchat on the Art of Negotiation

 

One of the main illustrations during the chat is from Dr Remo Aguilar @bonedoc on the Principled Negotiation.

The Art of NEGOTIATION

 

I saw this post of Dr Tony Leachon on my feed, knowing that those personalities engaging in a friendly handshake have been political opponents in the past election.  The caption tells us to never fear to negotiate.

This is an inspiring photo of how people have the capacity to agree to disagree, and to set aside their differences to cooperate towards the same goal.  I also wonder why our politicians find it difficult to negotiate for continuity of good programs.  The common practice is to stop all programs of the previous administration in favor of new projects that bear the new administration's stamp of approval and branding.

Negotiation is defined as a discussion aimed at reaching an agreement.  The United Nations discuss negotiation as a way of coping with disagreement, with varying views and with different objectives.  Harvard Business School Online lists the following skills needed to negotiate professionally: (1) communication; (2) emotional intelligence; (3) planning; (4) value creation; (5) strategy and (6) reflection.  Sometimes, at work we don't need to be friends, but we need to be negotiate professionally to reach an agreed strategy or way to move forward.

Join us tonight at 9PM MLA time on #HealthXPH to discuss the Art of NEGOTIATION:

T1.  What is your understanding and/or definition of a good negotiation?

T2.  What factors, in your experience, contribute to a successful negotiation?

T3.  Can you tell us a story of a negotiation that you had done in the past?  What went right/wrong?

Boundaries

A lack of boundaries invite a lack of respect.  

You get what you expect.

You deserve what you tolerate.

I saw this video on my feed and it aptly illustrates that nobody can disrespect you if you do not allow it.  Maybe it's a part of our culture that we were raised to be hospitable, to be welcoming of people, to be caring even to a point where we get uncomfortable just to address the needs of others.  There should be a point where we say NO.  This is as far as I go.  Your rights should not step on my rights.  I have rights too.  I have a boundary.  I deserve respect.