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6.0 Administrative Design and Development of Maternal Death Control Management System and Maternal Care Service

Leadership - 

LEADERSHIP of the Maternal Death Control Management System and Maternal Care Service is the governing body of the System and Service.

The primary responsibility of LEADERSHIP is governance of the System and Service.


At the very start, the head should make clear who are the members of the highest governing body of the System and Service and spell out their position (role); functions (obligations, duties and responsibilities); and authority (power and privileges). 

These should be contained in publicized documents such as organizational chart and governance manual.


As they govern the System, the leaders should continually develop the concepts, policies and procedures, and evaluation systems of the 22 elements contained in the framework.

See System or Program Management.

Determinants of Authorized Functions and Services - 


FUNCTIONS means the officially authorized functions, both general and specific, of the Maternal Death Control Management System, Service and Team. 


–These have to be clearly and completely spelled out and publicized. 
–These will serve as the main steering wheel or compass for the system or program development as well as bases for interfacing with other departments in the hospital, and also for evaluation purpose.


The determinants of functions of the System, Service, and Team can be external and internal. 

  
The external determinants include 1) statutory and regulatory requirements (Laws, DOH, local gov’t, PRC, PMA, Specialty Societies and Boards, etc.); 2) quality and performance standards (such as PhilHealth Benchbook, Joint Commission International, Accreditation Canada International); and 3) community expectations.

The internal determinants include 1) hospital’s top management desires and decision (such as vision-mission and taking resources into consideration) and 2) coordination and integration system with other units in the hospital.

SERVICES means the officially authorized medical services, both general and specific, that the System, Service and Team will provide as dictated by the authorized functions. 


–These have to be clearly and completely spelled out and publicized. 
–These will serve as the bases for development, interfacing with other departments in the hospital, and also for evaluation purpose.

The determinants for services are the authorized functions.

Functions - 

The authorized functions of the Maternal Death Control Management System and Team consist of the following:

1. To strategize on how to control maternal death.
2. To formulate policies and procedures in controlling maternal death.
3. To deploy the design and development blueprint in controlling maternal death.
4. To supervise the implementation of the blueprint in controlling maternal death.
5. To evaluate and review the implementation outcomes of the blueprint and then formulate a continual improvement action plan.
6. To formulate and implement a documentation and an archiving plans.
7. To formulate and implement a management review and an independent audit plans.

Stated in the System or Program Management:

"As intended by the System or Program, maternal deaths control is not only controlling maternal deaths but also providing quality and safe maternal care services."

Thus, the additional authorized functions of the System and Service consist of the following:

1. To strategize on how to provide quality and safe maternal care services.
2. To formulate policies and procedures in providing quality and safe maternal care services.
3. To deploy the design and development blueprint in providing quality and safe maternal care service.
4. To supervise the implementation of the blueprint in providing quality and safe maternal care service.
5. To evaluate and review the implementation outcomes of the blueprint and then formulate a continual improvement action plan.
6. To formulate and implement a documentation and an archiving plans.
7. To formulate and implement a management review and an independent audit plans.

Services - 

The authorized services are:

Maternal Death Control Management System (to control the maternal deaths)

Maternal Care Services (to provide quality and safe maternal care services)

Services Outputs - 

Service outputs are the ultimate goals of the System and Service, namely,

Zero maternal mortality

Zero adverse events

Cost-efficient / value-based maternal care services (quality and safe maternal care services)

Valued-based service means that for every healthcare service rendered, on the part of the patient-clients, there is a perceived value for the money spent.


Value is usually defined as health outcomes over cost of delivery of the outcomes. 

In simpler terms, it means good health care delivery outcomes (good results) such as optimal mortality and morbidity rates; success treatment rates; and quality and safe services with reasonable costs and expenses.

Whole Hospital Concept and Design - 

The goals and objectives of the System, Service and Team should be aligned with Vision and Mission of the hospital.

Whole Hospital Governance Policies and Procedures - 

The System, Service and Team must consider, be aligned, respect, coordinate, collaborate and integrate the whole hospital’s governance policies and procedures when it makes its administrative policies and procedures. 

Examples: 

Policies and procedures on networking; indigency initiative; education of the public; availability of skilled health professionals; competency of health professionals; availability and safety of blood; availability and safety of essentials medicines; availability and safety of essential medical supplies; availability and safety of essential diagnostic equipment; availability and safety of treatment equipment; provision of quality and safe maternal care services; etc.

The administrative policies and procedures of the System, Service and Team should be aligned and integrated with those of the hospital.

Whole Hospital Operations Policies and Procedures - 

The System, Service and Team must consider, be aligned, respect, coordinate, collaborate and integrate the whole hospital’s operations policies and procedures when it makes its operations policies and procedures.

Examples: 

Policies and procedures on networking; indigency initiative; education of the public; availability of skilled health professionals; competency of health professionals; availability and safety of blood; availability and safety of essentials medicines; availability and safety of essential medical supplies; availability and safety of essential diagnostic equipment; availability and safety of treatment equipment; provision of quality and safe maternal care services; etc.

The operations policies and procedures of the System, Service and Team should be aligned and integrated with those of the hospital.

Interfacing Units' Operations Policies and Procedures - 


The System, Service and Team must consider, be aligned, respect, coordinate, collaborate and integrate the interfacing units’ (such as other clinical departments and non-medical departments) operations policies and procedures when it makes its operations policies and procedures.

Examples: 

Policies and procedures on networking; indigency initiative; education of the public; availability of skilled health professionals; competency of health professionals; availability and safety of blood; availability and safety of essentials medicines; availability and safety of essential medical supplies; availability and safety of essential diagnostic equipment; availability and safety of treatment equipment; provision of quality and safe maternal care services; etc.

The operations policies and procedures of the System, Service and Team should be aligned and integrated with those of the different units of the hospital.

DOH Licensing and Structural Requirements - 

There is compliance to DOH Guidelines in the Planning and Design of a Hospital and Other Health Facilities; Safe Hospital Initiative – structural, non-structural, and functional indicators; Building Code; Fire Code; local government requirements; etc.

Physical Structure - 

This refers to a geographical space or area in the hospital to construct for the System and Service to receive patient- and physician-clients requesting for services and to house the staff who will perform the functions of the System and Service. 

Service requirements as dictated by the authorized functions is the first determinant of the PHYSICAL STRUCTURE.

The other determinants of the PHYSICAL STRUCTURE are the following: 
1) statutory and regulatory requirements; 
2) DOH Licensing Requirements (DOH Guidelines in the Planning and Design of a Hospital and Other Health Facilities and Safe Hospital Initiative – structural, non-structural, and functional indicators); 
3) Building Code; 
4) Fire Code; 
5) Local government requirements; 
6) SPECIALTY (OB-GYN or Maternal Care Service) requirements particularly on training and research; 
7) human resource program; 
8) equipment and material program; 
9) data / documents / records program; 
10) budget program; 
11) risk management program; 
12) business development program; 
13) quality standards; 
14) community expectations; 
15) efficiency; 
16) case load; and 
17) owners’ wants.

See DOH Requirements

Administrative Order No. 2012-0012 : Rules and Regulation Governing the New Classification of Hospitals and Other Health Facilities in the Philippines

DOH Requirements for Birthing Facilities in Hospital or Medical Center

Assessment Tool for Licensing a Hospital (see attached files)

Guidelines in the Planning and Design of a Hospital and Other Health Facilities  

Annual Hospital Statistical Report (see attached files)

DOH Requirements for Birthing Homes

Assessment Tool for Licensing a Birthing Homes (see attached file)

Licensing Requirements for Birthing Homes (updated 03/18/2014)


http://www.bhfs.doh.gov.ph/images/issuances/hospital/annex_d_ao_0012.pdf

Annual Statistical Reports for Birthing Homes (see attached files)

Application for Permit to Construct a Health Facility (see attached files)

Application for License to Operate (see attached files)

Forms:


Adverse / Sentinel Events Reporting

Corrective Maintenance of Equipment


Maintenance and Monitoring of Physical Facility 

List of Personnel and Equipment (see attached file)

Policies and Procedures / Clinical Practice Guidelines / Clinical Pathways - 

This refers to the operations and patient management processes that are needed to facilitate achievement of the functions and goals of the System, Service and Team. 

They provide order; promote standardization; facilitate communication; promote effectiveness and efficiency; and provide a guide to present and future staff, among other things.

See Program Management

See Deployment, Education and Implementation

See Evaluation, Review and Continual Improvement

See Documentation and Archiving

See Management Review and Independent Audit

See 

Implementing Reforms Towards Rapid Reduction in Maternal and Neonatal Mortality - 2009

Maternal Newborn Childhealth and Nutrition (MNCHN) Services Manual of Operations - 2011 (see attached file)

Service Pathways

Clinical Practice Guidelines

Clinical Pathways

Prenatal Check-ups

Postnatal Check-ups

Pregnant Patients for Normal Vaginal Delivery

Pregnant Patients for Ceasarean Section

To be developed in the near future.

 

Equipment and Material Program - 

There is the identification, acquisition, and maintenance of equipment and materials needed to facilitate an effective and efficient functioning of the System and Service.


The program has to take into account the key functions and services of the System and Service, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system.

Essential Diagnostic and Treatment Equipment - 

Determine the types and number of essential diagnostic and treatment equipment needed to render quality and safe maternal care services.

Maintain and continually improve the types and number.  Do corrective maintenance. Do preventive maintenance.  Do indicated calibration.

Essential medicines and medical supplies - 

Determine the types and quantities of essential medicines and medical supplies needed to render quality and safe maternal care services.

Maintain and continually improve the types and quantities.

Blood -

Determine the amount of blood reserve needed to render quality and safe maternal care services.

Maintain and continually improve the blood reserve initiative.

Data / Documents / Records Program -  

There is the identification, acquisition, and maintenance of data, documents, and records needed to facilitate an effective and efficient functioning of the System, Service and Team. 

The program has to take into account the key functions and services of the System, Service and Team, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system.

see Documentation and Archiving 

Determine the documents needed to establish.

Determine the records needed to accomplish.

Determine the data needed to collect.

Human Resource - 

There is the identification, acquisition, and maintenance of staff (all skilled health professionals) needed to facilitate an effective and efficient functioning of the System and Service.

The program has to take into account the key functions and services of the System and Service, statutory and regulatory requirements, and other objectives like business development and requirements of the System and Service.

The basic requirement is adequacy of human resource both in number and competency. 

The number of staff needed is dependent on a lot of factors, primary of which are: Department of Health hospital licensure requirements; workload / caseload; Department of Labor and Employment requirements; wishes of the owners for cost-efficiency at the same time promoting customer delight.

Determine the quantities and types of skilled health professionals needed to render quality and safe maternal care services.

Maintain and continually improve on the quantities and types.

Provide continuing professional program.


Provide training in multi- or transdisciplinary patient management of pregnant patients.

Business Development Program -

There is a program that will develop the business of the System and Service to make it viable and sustainable.

The objective of the program is to attract new patient-clients and maintaining previous patient-client base. 

Another objective of the program, particularly in private hospitals, is to attract new physician-clients and maintaining previous physician-client base. 

The basic strategies in a business development program are marketing, public relations, and reputation enhancement.

Determine the number of pregnant patients that will constitute maximal utilization of existing services.

Develop a program that will promote positive net income to maintain quality and safe maternal care services.

Promote a brand that will attract pregnant patients.

Risk Management Program -

There is a planned and systematic process or program to reduce and/or eliminate the probability of a “risk” that usually results in injuries, losses, and legal suits.

The more common types of risks in a hospital are the following: 

1) Risk for natural disasters (earthquake, flood, tsunamis, fire, etc.); 
2) Risk for man-made disasters (fire, felony, bomb threat, terrorism, etc.); 
3) Risk for medico-legal suits (arising from patient care); 
4) Risk for non-medico-legal suits (not arising from patient care); and 
5) Risk for tarnished reputation.

Develop a preparedness program against natural disasters; man-made disasters; technological disasters; medico-legal suits; and tarnished reputation.

IT-enabled Program -  IT-ENABLED SYSTEM refers to the use of computing technology, such as hardware, software, networking, and Internet for the following purposes:

1) to promote efficiency in the performance of functions and accomplishment of services; 
2) to manage information of the System, Service and Team – getting, storing, protecting, processing, transmitting as necessary, and later retrieving as necessary;
3) to create interconnection with other units in the hospital for timely communication, coordination and collaboration in the accomplishment of services of the unit; and 
4) to communicate with the patient- and physician-clients both in and out of the hospital.

Develop an IT-enabled program for data, documents, and records management,

Develop an IT-enabled program for quality and safe maternal care service.

Develop an IT-enabled program for diagnosis and treatment.

Budget -

There is a program that projects future income and expenses of the System, Service, and Team which are reflected in a document (budget) and to use the projected future income and expenses (budget) as a guide for day-to-day performance and financial evaluation at planned intervals. 

The usual expected outputs of the program are achievement of financial targets; effective and efficient utilization of resources; and controlled expenses.

Determine the logistic requirements for the quality and safe maternal care services.

Convert to peso values.

Ensure availability of funds for capital expenditure.

Ensure availability of funds for operating expenditure.

Architectural Design / Engineering / Construction - 

There is the establishment of the PHYSICAL STRUCTURE needed by the System, Service and Team which has to take into account all the other elements identified in the framework, particularly the functions and services requirements.

Regular Performance Evaluation and Continual Improvement Program -

There is appraising extent of accomplishment of the System, Service and Team in its authorized functions and business plans at planned intervals (quarterly, biannually, and annual) and to determine areas of improvement and to act on them.