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Healthcare QualityRaising the Bar in

2009 ANNUAL REPORT

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THE MEDICAL CITY

THE MEDICAL CITY: TOWARDS SERVICE AND LEADERSHIP

The Medical City (TMC), a tertiary health care institution owned and operated by Professional

Services, Inc. (PSI), has been operational since 1967. Through the years, it has learned tointegrate the science of medicine with that of business management. Hence, TMC boasts of

its world class standards of care, while remaining one of the most financially sound health care

organizations in the country. Its history reflects the collective aspiration and experience of its

forerunners, which has in turn shaped its character, and enabled it to stay the course towardsits vision and mission.

The Vision

To be a leader in shaping how Filipinos think, feel and behave about health and how health

services are accessed by and delivered to them, and to use such leadership to serve equity in

health, life and development.

The Mission

The pursuit of our vision is animated by the passion to keep our patient on center stage anddeliver service of greater worth, engaging strategic partners who share our vision and passion,

constantly proceeding from what we do best. In the process of carrying these out, we align

the interests of our employees, our professional staff and our shareholders with the interests

of those we serve.

CORPORATE VALUES

Excellent and compassionate service

We aspire to excellence and compassion in the provision of our services, achievingincreasingly superior performance through organizational synergy and continuous innovation.

Client partnership

We forge sustainable partnerships with enlightened and empowered clients - our patients,

physicians and payors - systematically creating opportunities for active engagement, informed

participation, and shared responsibility.

Primacy of the human resource

We invest in the personal and professional development of our staff, providing them with therequisite technology, capacity and voice to exercise their primacy as a resource in serving our

customers and creating value for our shareholders.

Integrity

We uphold personal and institutional integrity, consistently seeking alignment between the

values that we espouse, and the strategies, decisions and actions that we pursue.

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2009 ANNUAL REPORT

TABLE OF CONTENTS

02 Executive Message

09 Financial Performance

Feature Articles:

12 The New Intensive Care Paradigm

18 Prepared in Times of Crisis 24 A Solution to Every Problem

28 Managing the Supply Chain

30 Board of Directors

34 Executive Committee

36 Senior Management

37 Vice Presidents

37 Medical Directors

38 Assistant Vice Presidents

39 Financial Report

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THE MEDICAL CITY

LIVING OUT A

COMMITMENT

TO SERVICE

EXCELLENCE

At The Medical City (TMC), our vision of

leadership is founded on a commitment

to service excellence, which is, in its most

fundamental sense, a commitment to qualityand safety in patient care.

This commitment is enlivened by a culture

that has, over time, taken root at all levels

of the institution, and across the various

functions within. This culture, in turn, has been

developed and enriched over years of shared

values and experience, and has ultimately been

concretized in TMCs Quality Improvement and

Safety (QuIPS) Program.

EXECUTIVE MESSAGE 07

Augusto P. Sarmiento, MD

CHAIRMAN

Alfredo R. A. Bengzon, MD, MBA

PRESIDENT AND

CHIEF EXECUTIVE OFFICER

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THE MEDICAL CITY

EXECUTIVE MESSAGE 07

distinguishes and has distinguished TMCs

culture of quality.

Senior management, department managers,

clinical chairs and staff at all levels are all jointly

accountable for leading and accomplishing the

QuIPS Program. However, the organizational

unit directly charged with overseeing program

execution is the QuIPS Council. Headed by

the Manager of the Systems and Quality

Department (SQD), and operating under thesupervision of the Director of the Medical

Quality Improvement Office (MQIO), the QuIPS

Council is composed of representatives fromthe Medical Services Group, Patient Services

Group, Finance and Administrative Services

Group and Strategic Services Group. The

Council institutes quality and safety policies

and programs, supervises implementation,

and evaluates their impact and effectiveness.

Through its work, the Council promotes suchquality improvement principles as patient-

focus; improvements based on correct

information and current evidence; prevention

rather than correction; and the shift from aculture of blame to a culture of innovation.

Quality Acclaimed

Our endeavors have not gone unnoticed.

The Philippine Health Insurance Corporation

(PHIC), which administers the National

Health Insurance Program of the Philippines,

has awarded TMC with thePasasalamat sa

PartnersAward, in appreciation of our efforts

in promoting continuous quality improvement.

PHIC has recognized TMC as a Center ofExcellence, the highest hospital accreditation

level based on the enhanced quality standards

of the PHIC. TMC has also been tapped to

collaborate with PHIC in operationalizing

a radically new system for billing and

reimbursement that is based not on itemized

inputs, but on episodes, complexity andoutcomes of care.

By far, the most significant testamentto TMCs service quality was our

reaccreditation by the Joint Commission

International (JCI) in November 2009.

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2009 ANNUAL REPORT

By far, however, the most significant testamentto TMCs service quality was our reaccreditation

by the Joint Commission International (JCI)

in November 2009. Widely recognized as

the most prestigious accrediting body of

international healthcare organizations, JCI

prescribes compliance with 14 chapters

involving 323 standards and 1,193 measurable

elementscovering all aspects of hospital

organization and operations.

Preparations for reaccreditation weresystematic, rigorous and thorough.

As early as 2007, even as we had just

successfully hurdled our first accreditation

process, the JCI Compliance Committee was

established to ensure sustained adherence to

all Joint Commission standards. In 2008, theCommittee recommended the formation of

Task Forces to be focused on four of the most

challenging functional concerns: Medication

Safety, Team Communication, Documentation,

and Patient Education. Composed of medical,

allied medical and administrative staff, the Task

Forces worked tirelessly to lead the hospital

towards JCI-readiness.

The Medication Safety Task Force reviewedand reformed medication managementsystems and processes. It likewise offered

training courses for TMC physicians, nurses,

pharmacists and other staff on such important

issues as medication safety, rational drug use,

formulary use, medication reconciliation, and

adverse drug reaction monitoring.

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EXECUTIVE MESSAGE

The Team Communication Task Force designed

programs and mechanisms to promote effective

communication between the members of health

care teams, especially those deployed in high-risk

areas such as the Surgery Suite, Delivery Suite,

Ambulatory OR, Emergency Department andIntensive Care Unit.

The Documentation Task Force recommended

policies and processes to improve the generation

and management of information contained in the

patient chart. It conducted regular assessments

of the content, completeness, accuracy, legibility

and timeliness of the patient chart. It also

oversaw quality improvement activities related to

patient chart documentation.

The Patient Education Task Force directed its

efforts towards developing policies, programsand associated materials responsive to our

patients need for information and education; as

well as towards capacitating TMC staff in their

implementation. Of particular concern were

programs on patient and family rights, informed

consent, advance directives, and disclosure ofadverse events.

In addition, special programs were introduced in

response to specific quality and safety concerns.

Based on a root-cause analysis of all patient

falls over a twelve-month period, TMCs Falls

Prevention Program calls for all patients to

undergo a falls risk assessment upon admission,

upon transfer to another unit within the hospital,

after a change in status, after a fall, or on a

regular basis, as needed. Depending on thepatients fall risk, a specific Falls Prevention

Protocol is carried out. The program alsoencourages the participation of patients and

their families in fall prevention.

TMCs Get Wet Campaign was introduced to

educate staff on proper hand hygiene, and to

encourage its practice at appropriate times

in the care process. Hand washing has long

been recognized as the most effective way ofcontrolling and preventing the spread of infection

in a hospital setting, although it has been

notoriously difficult to perform consistently.

On a weekly basis, the CEO and other senior

managers conducted walkabouts around

selected areas of the hospital. Tagged as

Leadership Rounds, these walkabouts served as

the means to evaluate service levels first-hand,while communicating top-level emphasis

indeed, insistenceon quality.

Mock surveys were carried out at strategic time

intervals to assess compliance with standards,

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2009 ANNUAL REPORT

spot areas of weakness, and propose necessarycorrective action. Mock surveyors were selected

from among the internal staff, and the process

mimicked the actual survey. This enabled a real-

time evaluation of hospital performance while

also allowing personnel to practice relating andresponding to the surveyors.

Finally, organizational development initiatives

were undertaken to support and reinforce the

hardcore process and policy changes. TheQuality Award was launched to achieve broad-

based awareness on the quality and safety

policies of the hospital, and to celebrate those

units which have adopted and consistently

adhered to these policies. Similarly, a TMC

Superheroes Event was organized to encourage

staff to be Quality Superheroes in their own

specific work settings.

The actual accreditation survey came uponus quickly. Early on, we had adopted the

slogan Tested. Acclaimed. Ready. Now.

and we were.

As before, the survey was conducted by aseasoned team composed of a nurse team

leader, a physician and a hospital administrator.

The surveyors were meticulous and methodical.

During the five-day period, they reviewed

documents, inspected facilities, observed

operations, consulted patients, and interviewedstaff at all levels from the Chairman of the

Board to the janitors and security guards.

Over the course of the survey, the team

commended TMC on numerous best practices,

including our use of clinical practice guidelines

and pathways, our quality monitors, our

infection control program, our patient

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THE MEDICAL CITY

Augusto P. Sarmiento, MD

CHAIRMAN

Alfredo R. A. Bengzon, MD, MBA

PRESIDENT AND

CHIEF EXECUTIVE OFFICER

education materials, our environment of care

plan, our information management system, and

our acute stroke program, among others.

In the end, as we did in 2006, we performed

with distinction, garnering perfect scores in

standards on Patient and Family Education,

and Governance, Leadership and Direction, aswell as superior marks in standards on Quality

Improvement and Patient Safety, Prevention

and Control of Infection, and Anesthesia and

Surgical Care. Furthermore, TMCs sentinel

event policy has been featured in a Joint

Commission publication on understanding andpreventing sentinel events.

We now look forward to the next accreditation

process with excitement and anticipation. JCI

consistently demands from us only the best

that we can bring forth, and this best, we oweto our constituents, as well as to ourselves.

More than ever, we are convinced of the

rightness of our direction. Quality in TheMedical City is not just a way of doing; it is our

way of being. As we raise the bar of quality for

ourselves, so too do we for our industry, our

sector and our country, all for the benefit of the

patient partners who remain our true north.

EXECUTIVE MESSAGE

In the end, as we did in 2006, we performed with

distinction, garnering perfect scores in standardson Patient and Family Education, and Governance,

Leadership and Direction, as well as superior marks

in standards on Quality Improvement and Patient

Safety, Prevention and Control of Infection, and

Anesthesia and Surgical Care.

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2009 ANNUAL REPORT

PROFESSIONAL SERVICES, INC. AND SUBSIDIARIES

2009 FINANCIAL PERFORMANCE2009 2008 2007

PATIENT SERVICES REVENUE 3,381.9 3,222.9 2,686.9GROSS PROFIT MARGIN 39% 38% 35%EBITDA MARGIN 26% 25% 22%

OPERATING PROFIT MARGIN 17% 16% 13%AFTER TAX PROFIT MARGIN 14% 13% -15%

Our reputation for service quality served as the platform for another year of solid financial

performance. TMC registered a respectable revenue growth of 5%, despite the global

economys sluggish recovery from the recession. More importantly, all profitability metrics havedemonstrated consistent improvements, as aggressive marketing and sales initiatives, together

with investments in service development and enhancement, have been accompanied by robustand effective cost management.

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THE MEDICAL CITY

FINANCIAL PERFORMANCE

0

500

1000

1500

2000

2500

3000

3500

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2009 ANNUAL REPORT

FINANCIAL PERFORMANCE

To facilitate year-to-year comparisons, 2007 Earnings per Share was adjusted to

exclude the one-time loss on sales of investment property. Associated Income

Tax Rate was estimated at 30%.

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HE NEW INTENSIVE CARE PARADIGM

In 2007, TMC began development of a new model

for its Adult Intensive Care Service, which is thefirst of its kind in the Philippines. TMC Intensivist(Intensive Care Specialist), Dr. Jose EmmanuelJep M. Palo, who had completed his residency inInternal Medicine, and had undergone fellowshiptraining in Critical Care Medicine at the ChicagoMedical School of Franklin University (U.S.A), hadbeen exposed to this model while training abroad.Upon his return, he proposed that TMC take thelead in its adoption.

Akin to Emergency Care (ER), Intensive Care isa unit-based or area-based specialty rather thanan organ-based specialty, explains Dr. Palo. ERdoctors are expected to take care of anything thathappens in the ER. Similarly, we at Intensive Careare expected to be capable of providing supportwhether the problem is neurologic, cardiovascular,pulmonary, etc. Given their compromisedconditions, ICU patients are especially vulnerableto a wide range of life-threatening conditionscollapsed lungs, multiple organ failure, cardiac

arrest, and others. Our training prepares us to carefor the sickest patients from all specialties.

TMCS NEW ADULT INTENSIVE CARE MODELENHANCES CARE REGIMENS AND OUTCOMESIN AND OUT OF THE ICU.

Despite the Intensivists broad scope, integrating

their practice into day-to-day medical managementremains a challenge, as treatment still revolvesaround organ-based specialties at present. Intruth, the role of the ICU Specialist is not yetwell understood or appreciated. Intensive CareMedicine is not yet mature in the Philippines,says Dr. Palo. Only a few Adult Intensive CareSpecialists practice here.

But this was not a deterrent. Partnering with Dr.Jude Erric L. Cinco, a Canadian-trained Intensivist,

and working alongside Dr. Mediadora C. Saniel,then-Director of TMCs Medical Services Group,ICU Director Dr. Donato R. Maraon, and aspecially-assembled consultant team of Intensivistscomposed of Dr. Luis Martin I. Habana, Dr.Raymundo F. Resurreccion, Dr. Celina Z. Anchetaand Dr. Geraldine B. Jose, Dr. Palo designed a pilotSemi-Closed Adult Intensive Care Program, directedat improving the survival rates of TMCs most criticalpatients by increasing the Intensivists involvementin care. First off, the patients were classified into

2 groups, based on the severity of their illnessesas defined by international ICU guidelines. Careprotocols for each group were then formulated. Co-

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2009 ANNUAL REPORT

established to facilitate comparison.

The results were very impressivethanks to theService, survival rates of the ICU actually doubled,despite an increase in the average severity of thecase mix. With this initial data validating the successof their model, the team acquired the leverage andcredibility to spearhead other measures to furthermaximize the effectiveness of TMCs Adult Intensive

Care Service.

First, coverage of the Adult Intensive Care Servicein identifying and co-managing the hospitalshighest-risk patients was expanded.At first, it was involved mainly in cardiology,pulmonary and sepsis cases, but it was soonengaged in the management of patients sufferingfrom such threats such as Influenza A(H1N1) andleptospirosis, as well as those under the new livertransplant program.

Second, the Service introduced new therapies andprotocols and trained staff accordingly. Therapeutic

management by the Attending Physician and theIntensivist was prescribed for patients in Category 1,who were in more serious conditions. On the otherhand, referral to the Intensivist for those in Category2 was left to the discretion of their AttendingPhysicians. This departed from the open ICU modelthen in place, where involvement of the Intensivistin care was completely optional, regardless of thepatients state.

We knew from studies abroad that engagingIntensive Care Specialists in the ICU increasedpatient survival rates by about one and a half timesthat of the baseline performance, says Dr. Palo.We needed similar results in our ICU to prove thatthe Semi-Closed model would work better than theprevious open model arrangement.

This rate thus became the benchmark for theServices performance. The pilot was implemented

in both the ICU and Acute Stroke Unit for the nexttwo months. Data was collected from September2007 onwards, while 2006 baselines were

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THE MEDICAL CITY

StandardizedMortalityRa

tio(SMR)

HE NEW INTENSIVE CARE PARADIGM

THE MEDICAL CITY INTENSIVE CARE UNIT STANDARDIZED MORTALITY RATIOSeptember 2007 to December 2009

This chart shows ICU performance using standardized mortality ratios (SMR). The mortality rate (blue columns) predicted

through a standard scoring system reflects the severity of illness among admitted patients. The increase over time impliesthat more severe cases are being seen at our ICU. In contrast, the actual mortality rate (red columns) remains relatively

constant. The standardized mortality ratios (green dots) are the ratio of actual and predicted mortality; the lower, the better.

The regression line (solid green line) shows a downtrend in the SMR, indicating improvement in performance over time.

ICUMortality(%)

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2009 ANNUAL REPORT

hypothermia protects the neurologic functionsof patients who have suffered cardiac arrest bylowering their body temperatures and temporarilyplacing them in a managed comatose state.Without it, most comatose survivors of cardiacarrests are unable to fully recover. TMC is now thefirst and only Philippine hospital to offer therapeutichypothermia routinely, and has provided this life-saving service to twenty one patients (21) since itsintroduction in September 2007. The Service has

worked with the Philippine Heart Association andother hospitals, encouraging them to adopt theprocedure as well.

Advanced mechanical ventilation procedureswere also introduced for patients whose lungs are

so compromised that no oxygen can enter theirbloodstream. Prone positioning was first tried inTMCs ICU in 2007, and the procedure saved thelife of a patient with severe double pneumonia.This and other techniques, such as lung recruitmentmaneuvers (that shock open fluid-filled collapsedlungs with short bursts of high pressure) and AirwayPressure Release Ventilation (which allows a patientwith severe lung injury to breathe at alternatelyhigh and low pressures to improve air exchange),

are increasingly being offered by TMCs ICUIntensivist team.

The Sepsis Alert Protocol, based on early goal-directed therapy for sepsis, was developed bya multidisciplinary team led by Dr. Irmingarda P.

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THE MEDICAL CITY

Gueco, Section Head of Nephrology. Early goal-

directed therapy for sepsis stops the onset of majorinflammation borne from infection that leads tovarious complications and, ultimately, multi-organfailure. The University of the Philippines-PhilippineGeneral Hospital (UP-PGH) has since adopted asimilar protocol, following TMCs example.

Third, multidisciplinary rounds were instituted.This entailed the medical, nursing and ancillarypersonnel, who were involved in the patientsday-to-day care, to convene on a daily basis. For

each patient, current problems were reviewedand emerging threats were identified, carerecommendations and contingency plans wereformulated, and checklists were used to ensurethat each patient received appropriate care. Theserounds also served as a regular venue for teachingthe principles of critical care to trainees of all levels.

Fourth, the Service assisted the ICU Clinical Directorand Nurse Manager in reviewing and improvingICU policies and protocols. The Sedation Protocol

for patients undergoing mechanical ventilation wasrevised in accordance with international guidelines.

Patient monitoring documentation was updated

to better capture all the elements of complexcare. Measurement of illness severity in relationto patient survival was also continued, as this wasessential in monitoring the most important metricof an ICUits ability to save lives.

Lastly, in advancing the paradigm that IntensiveCare is a process, and not just a room, theService enhanced hospital-wide resuscitationand rescue services by providing high-fidelitysimulation training for housestaff and nurses, and

by supervising medical trainees during real crises,wherever the patients were located.

TMCs Intensivist service proved invaluable incaring for the victims of 2009s various health crises- the pulmonary patients of the Influenza A(H1N1)pandemic, and the kidney- and other organ-failurepatients of the leptospirosis outbreak followingTyphoon Ondoy (international name: Ketsana) and contributed significantly to the impressiveoutcomes achieved by the hospital, which were

better compared to the national averages.

HE NEW INTENSIVE CARE PARADIGM

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2009 ANNUAL REPORT

After two-and-a-half years and 2,500

admissions, survival rates continue to

remain steady even as the Service takeson increasingly difficult cases. Simply

put, more and sicker patients are being

saved.

The Adult Intensive Care Service continues to build

on its achievements. Dr. Palo has since been namedChairman of the Code 99 Committee, the hospitalunit that ensures proper and prompt resuscitationprocedures. In April, a workshop was completed tolay the groundwork for a Rapid Response Systemthat mobilizes a multi-disciplinary team to care forcritically-ill patients outside the ICU. The goal ofthis system is to reduce unexpected, preventabledeaths to zero.

The countrys very first Critical Care Fellowship

is also underway, under the stewardship of Dr.Jude Erric L. Cinco. Two post-residency traineesare now learning the principles, techniques andprocedures of multidisciplinary critical care. Thesefirst candidates are expected to graduate in 2012.

All in all, the value of the reforms implemented inTMCs ICU has been amply validated. After two-and-a-half years and 2,500 admissions, survivalrates continue to remain steady even as the Servicetakes on increasingly difficult cases. Simply put,

more and sicker patients are being saved.

Many ICUs all over the world have a specialist

approach to care: Cardiology Units take careof heart patients, Neurology Units have strokepatients, and so on, says Dr. Palo. But whatabout patients who have problems with more thanone organ system? What about those with sepsis,which hits various organs at the same time; orcardiac patients whose other organs fail after theirheart stops? When a hospital has Intensive CareSpecialists working in and out of the ICU, all thesepatients are promptly and effectively served; andthis really makes a world of difference.

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THE MEDICAL CITY

PREPARED IN TIMES OF CRISIS

TMCS HOSPITAL INFECTION CONTROL COMMITTEEDEMONSTRATES FORESIGHT, VIGILANCE ANDINNOVATION AMIDST 2009S HEALTH CRISES.

On April 29, 2009, the World Health Organization(WHO) reported a significant clustering of flu-likeillnesses associated with exposure to swine, andpromptly warned the public of a pending epidemicin Mexico and the US. This development alerted theTMC Section of Infectious Diseases headed by Dr.Maria Fe R. Tayzon, who is likewise the Chair of itsHospital Infection Control Committee (HICC). TheHICC immediately commenced close surveillanceof patients at TMCs Emergency Room (ER) and

the Medical Arts Towers doctors clinics. It alsolaunched a comprehensive awareness campaignto educate TMC frontline healthcare workers, inanticipation of the A(H1N1) strain reaching ourcountry. True enough, the Department of Health

(DOH) reported the appearance of the deadlystrain a few days later, and Dr. Tayzon combinedforces with Nurse Victoria I. Ching, TMCs InfectiousDiseases Surveillance Coordinator, to formulate andinitiate a masterplan for dealing with the virus. Twoimmense tasks were at handalerting the publicon the impending outbreak, and preparing TMCto respond effectively to the A(H1N1) cases in thedays and months to come.

My concern was to keep the virus from spreadingand causing panic among the patients and staff ofthe hospital, says Dr. Tayzon.

On May 4, TMC launched its first A(H1N1) forum,

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Oplan Sagip Bayan, inviting speakers from keyagencies, including Dr. Jade F. del Mundo,then Undersecretary of Health, Dr. Enrique A.Tayag, Head of National Epidemiology under theDOH, Dr. Remigio M. Olveda, Director IV for theResearch Institute of Tropical Medicine (RITM) andDr. Nerissa N. Dominguez, National ProfessionalOfficer for Communicable Disease Surveillanceand Response of the Philippine WHO office inthe Philippines. Before an audience composedof local hospitals administrators, business andcommunity leaders, and the media, Dr. Tayzon andthe speakers relayed information on the disease,the magnitude of the crisis, and the associatedpandemic preparedness plan.

On May 12, an Influenza A(H1N1) PandemicPreparedness Task Force was organized, under thestewardship of Mrs. Virginia B. Alano, Senior VicePresident Patient Services Group and Dr. EugenioF. Ramos, Head Medical Services Group. The TaskForces duties and responsibilities were as follows:

Draft and implement policies for managingInfluenza A(H1N1) cases in TMC and its satelliteclinicsAct as the oversight committee and conduct

audit of Influenza A(H1N1) cases managed atTMC

Coordinate with the different departments andunits involved in the management of InfluenzaA(H1N1) casesCoordinate and network with the Department ofHealth, Local Government Units and other non-

government agencies involved in the evaluationand management of Influenza A(H1N1)Gather and analyze confirmed casesEducate the internal and external community

The WHOs algorithm of key medical and safetyprocedures was adopted. Use of protective gearwas strictly required of all staff directly involvedin patient care. Special triaging and isolationstrategies were implemented to manage patienttraffic and limit exposure. Proper collection and

handling of specimens was also emphasized.

During the first days of the alert, testing of allspecimens was centralized with the RITM. As thedemand for testing began to overwhelm the RITM,Dr. Raul V. Destura, Consultant Director of TMCsMicrobiology Laboratory, set up and securedapproval from the DOH for an in-house A(H1N1)testing lab, the only such private facility in thecountry at the height of the pandemic betweenJune to July 2009.

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Even as manuals were being developed on policiesand procedures in A(H1N1) management, interimguidelines were issued in response to new and

evolving knowledge about the virus. A dynamic,nimble and decisive organization was critical inmanaging the complex situation, and TMCs HICCoperated as such.

At first, the virus was limited human-to-humantransmission; then in a matter of three weeks, full-blown community outbreaks were confirmed, Dr.Tayzon explains. In the beginning, the guidelinesprescribed admission for everyone who showedsymptoms of A(H1N1). Soon, however, the hospital

approached full occupancy. To address thesecapacity limitations, we identified and prioritizedthe population segments which were at greatestrisk. We managed this by constantly reviewingand updating our guidelines in response to thetransmission patterns we observed.

A Fever Clinic was established to serve adult

and pediatric A(H1N1) cases under observation,thereby protecting other ER patients fromexposure to the virus. The Fever Clinic was run by

specially-trained ER doctors, nurses and health careworkers, who also coordinated admissions withthe hospitals Intensive Care Unit as the patientsconditions warranted.

A Communications Center was set up to respondto telephone queries, facilitate admissions, receiveand release A(H1N1) test results, and providehome care instructions to individuals who hadinfluenza-like symptoms and patients for discharge.The Center served a critical role in disseminating

accurate and timely information on A(H1N1) as thevirus spread throughout the country.

A series of forums was organized, each forumfocused on a specific target audience patientsand family members, corporate clients, and schoolofficials. The latter group benefited especially fromthe forums, as schools became hot beds for the

On the whole, TMCs pro-active approach

to facing the threat of A(H1N1) resulted in

significantly better patient outcomes. Case

fatalities were limited to 0.63%, substantially

lower than the global rate of 4-7%.

PREPARED IN TIMES OF CRISIS

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2009 ANNUAL REPORT

virus. TMC shared with the schools its algorithmsfor managing cases under observation, helpedschools administration in creating guidelines forparents on how to manage confirmed and suspectcases, and guided them in setting up their own

Communications Centers to serve students, facultyand staff.

On the whole, TMCs pro-active approach to facingthe threat of A(H1N1) resulted in significantlybetter patient outcomes. Case fatalities werelimited to 0.63%, substantially lower than theglobal rate of 4-7%.

The organizational, policy formulation, processdesign and staff development initiatives pursued in

line with the A(H1N1) pandemic helped the HICCto respond to the other health crisis that hit MetroManila, this time in September 2009. TyphoonOndoy (international code name: Ketsana) caused amonths worth of rain to fall within 12 hours, leavingmany locations underwater. As large numbers ofpeople were forced to struggle through, and even

MEMBERS OF THE A(H1N1) PANDEMIC PREPAREDNESS TASK FORCE

Dr. Maria Fe P. Raymundo-Tayzon Hospital Infection

Control Committee

Ms. Cristela A. Villa-Real Nursing Services

Ms. Victoria I. Ching Hospital Infection

Control Committee

Dr. Mediadora C. Saniel Infectious Disease Speciali

Dr. Marissa M. Alejandria Infectious Disease SpecialiDr. Raul V. Destura Infectious Disease Speciali

and Microbiology Lab

Dr. Regina P. Berba Infectious Disease Speciali

Ms. Aura J. Guinto Special Services, Ambulato

Mr. Alejandro M. Calado, Jr. Housekeeping

Ms. Jovita San Diego Medical Arts Tower

(Administration)

Ms. Melita C. Perez Marketing

Ms. Nina V. Posadas Corporate Communications

Dr. Florianne F. Valdes Center for Patient Partnersh

Mr. Edmongino J. Camacho Center for Patient Partnersh

Ms. Judith S. Betita Human Resource

Dr. Blesilda E. Concepcion Professional Staff

Development OfficeDr. Rolando A. Balburias Emergency Room and

Center for Wellness

& Aesthetics

Engr. Mary Ann E. Artates Safety

Dr. Liza Mary P. Palencia Emergency Room (Residen

Dr. Alejandro G. Dela Cruz Emergency Room (Residen

Dr. Chairmaine D. Calianga Emergency Room (Residen

Engr. Philip L. Tan Facilities

Mr. Samuel A. Carbonel Security

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THE MEDICAL CITY

This multi-disciplinary assessment enabledphysicians to act within a crucial six-hour windowto stabilize the patient and decide on initiationof renal replacement therapy. Such earlyintervention averted the need for dialysis in manypatients and was central to TMCs success inleptospirosis management.

The team also introduced innovations in dialysisprescription. The initial cases were so severeand so unique that Dr. Gueco and her teamof Nephrologists came up with their own careprotocol. The regular dialysis regimen wasrevised to address the specific conditions of the

No

data

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1

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UNILAB 1 1

Refused 1

Positive 21 2 2 5 9 149 223 50 51 37 35 19 10 4 1 2 1 1 1 1

Not applicable 35 104 150 181 51 38 15 25 5 3 6 2

No Result 9 2 1 2 1 1 5 4

Negative 35 1 2 6 2 5 5 9 12 87 85 23 36 48 80 36 30 34 22 11 15 19 15 12 6 6 2 4 4 5 3 3 2 2 1 2 1 1

Cancelled 1

No.ofCUOs

TMC A(H1N1) PERFORMANCE (MAY DECEMBER 2009)

live around, unsanitary flood waters, a leptospirosisoutbreak ensued.

The influx of patients was unparalleled in TMChistory as many locations within its catchmentarea were submerged. There was growingconcern over the strain on hospital operationsand resources. The HICC, together with TMCsInfectious Diseases and Nephrology specialistsheaded by Section Chief Dr. Irmingarda P. Gueco,quickly formed another Task Force to establish andmonitor hospital care protocols, requiring that allpotential leptospirosis cases be assessed by bothan Infectious Disease Specialist and a Nephrologist.

UNILABRefused

PositiveNot ApplicableNo ResultNegativeCancelled

1,940 Cases Under Observation (CUOs)

1,291 (66.54%) Swabbed Cases Under Observation

624 (48.33%) Positive Cases

4 (0.63%) TMC Case Fatality

(versus Global Rate of 4 7%)

49 (1.35%) TMC HCWs Positive for A(H1N1)

(versus Global Rate of 25 38%)

PREPARED IN TIMES OF CRISIS

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2009 ANNUAL REPORT

leptospirosis patients. The shortened but morefrequent treatments also served to maximize the

capacity of TMCs Hemodialysis unit.

It was a unique strategy, continues Dr. Tayzon.We didnt just copy what everybody else wasdoing. The team saw the need to revise the standardprotocol and adapt it to our specific needs.

This innovation in care management, borne fromthe A(H1N1) experience, resulted in significantpositive patient outcomes; kidney failure waspreempted, and recovery was quick for those who

were dialyzed very early. As a result, TMCs successrate in treating leptospirosis patients bestednational performance: a 5% mortality rate in TMCcompared to the national average of 10%.

In support of local government disastermanagement efforts, TMC signed a Memorandumof Agreement with the City of Pasig to set up aspecial Charity Ward. TMC took in referrals fromthe local hospital network of patients suffering fromacute diarrhea, dehydration, pneumonia, bacterialwounds, simple fractures, viral and skin infections,and other Ondoy-related malaises.

Indeed, thanks to the foresight, cooperation andcommitment of its staff, TMC has certainly proventhat it can address the greatest of challenges,responding efficiently and effectively to the publicsneed for quality health care, even in times ofoverwhelming crisis.

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THE MEDICAL CITY

A SOLUTION TO EVERY PROBLEM

TMCS CARDIOVASCULAR CENTER IMPROVES SERVICEEFFICIENCY THROUGH ENTERPRISE AND INNOVATION.

Nurse Bethzaida C. Faylogna, Assistant Manager ofTMCs Cardiovascular Center, had long been awareof a recurring problem in her department: the delayin the release of echocardiogram results to patients.On a daily basis, the Center releases patient testreports from four service areas: Treadmill, Vascular,24 hours Holter and Ambulatory Blood PressureMonitoring, but despite their best efforts, 20%of final reports could not be released to theirpatients earlier than 5 days after the procedure.

These delays caused great inconvenience to thepatients, stress for the staff, and reflected in theDepartments inefficiency.

The problem was not just long-standing; it wasworsening, as the Centers patient volumesincreased over time. Decisive and effective actionwas clearly required.

As a first step, Nurse Faylogna reviewed her unitsworkflow in an effort to understand the problem

better. She uncovered that the main cause fordelay was the manual and tedious process of reportgeneration, approval and finalization.

PREVIOUS RESULT GENERATION PROCESS

Step 1: Test is conducted. Step 2: Technician encodes the valuesin the computer and prints thereport.

Step 3: Technician delivers the worksheet(with printed report values and theDVD recording of test) to CardiologyFellow in the reading room.

Step 4: Cardiology Fellow views the studyand manually writes interpretation.

Step 5: Cardiology Fellow places

interpretation in the designatedfolder of the CardiologyConsultant.

Step 6: Cardiology Consultant views thestudy, reviews the initial interpretationof the Cardiology Fellow, and signsthe report.

Step 7: Cardiology Fellow forwards thesigned manual report to theCenters Clerk.

Step 8: Center Clerk encodes the report.

Step 9: Center Clerk delivers final report toCardiology Fellow for signature.Step 10: Cardiology Fellow reviews and

signs the report.Step 11: Transport Orderly files final

reports, pending release topatients.

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2009 ANNUAL REPORT

years, Nurse Faylogna was painfully aware of the

less-than-subtle hierarchy that was operative here first the doctor, and then everyone else.

Yet, Nurse Faylogna gathered up her courage andpushed forward with resolve. Over a period of sixmonths, she worked with the doctors in learningand adopting the new network system. To furthersimplify the result-generation process, electronicresult templates were created. Doctors could simplycopy and paste text from the result templates ontothe final report, and encode additional descriptions

as needed. In time, all 46 of the Centers doctorshad transitioned to the new system.

The process changes freed Center staff to attendto other important administrative duties, suchas responding to customer inquiries, organizingprocedure schedules, and managing unitdocumentation. As use of paper and printing werekept to a minimum, supply costs were reduced.Most importantly, reports were finally released topatients in a more timely manner 2 working days

after the tests vs. 5 working days after the tests.In fact, the department used to receive about 20customer calls a day just to follow up on the release

If upon review, the Cardiology Fellow and/or

Consultant uncovered an error in the report, theprocess would have to be repeated in part or inwhole. The entire process would have taken twodays to complete, provided all went well, but inreality, some cases could drag on for up to five days.

Nurse Faylogna thus initiated two majorprocess changes.

She collaborated with the hospitals IT Departmentin designing and implementing an automated

system for storing, retrieving and updating alldiagnostic test results. These electronic files weremuch easier to generate, access and edit comparedto their hard-copy counterparts.

The second change was a far greater challenge.To streamline the process flow even further, shewould have to persuade Consultants and Fellowsto encode the readings themselves. She fearedthat the doctors would consider this task menialand beneath them. She was even more concerned

about the likely negative reaction of the doctorsto receiving this directive from a nurse like herself.Having worked in the health care sector for many

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THE MEDICAL CITY

A SOLUTION TO EVERY PROBLEM

40

20

0

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Average

35 29 36 32 35 28 28 24 25 21 21 20 28

30 27 25 24 20 20 22 10 9 8 5 5 7

5 8 7 3 4 2 4 3 3 3 2 2 3

2007

2008

2009

AVERAGE PATIENT WAITING TIME - CLAIMING OF RESULTS

(IN MINUTES)

GENERATION OF OFFICIAL RESULTS AT CARDIOVASCULAR CENTER

BEFORE AFTER

20% of procedures not interpreted on the same day 2% of procedures not interpreted on the same day

Average of 4 complaints per month due to delayedrelease

1 complaint received in the last 6 months

Average of 30 minutes of waiting time when picking-up

results

Average of less than 5 minutes waiting time when

picking-up results

Average of 20 corrections by Cardiology Fellows per day Average of 4 corrections by Cardiology Fellows per day

Operating Expense equivalent to 18% of Gross Revenue Operating Expense equivalent to 16% of Gross

Revenue

80 % of results released within target time of two

working days after procedure

99% of results released within target time of two

working days after procedure

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2009 ANNUAL REPORT

As it does every year, the Therapeutics Committeeperformed its review of TMCs formulary, the definitivelist of medicines stocked in the hospital pharmacy.The drugs are listed under three categories: essential

drugs, as defined by the World Health Organization(WHO); life-saving drugs or drugs which are used inresuscitation; and specialty drugs, which TMCs clinicaldepartments recommend as essential to the practiceof the various specialties and subspecialties.

The Therapeutics Committee then engaged theleadership of TMCs medical staff in encouragingdoctors to limit their prescription drugs in theformulary.

Simultaneously, the Task Force decided on a policyto limit the number of brands purchased per drugto a maximum of two, as opposed to the previousmaximum of four. The Pharmacy and PurchasingDepartments, which monitored historical drugconsumption, defined the necessary inventory andorder quantities per drug.

The Purchasing Department then implementedcontract procurement and competitive biddingstrategies to increase efficiency of the purchasing

process and boost negotiating power with suppliers.The Department maximized the cost benefits bysecuring lower prices, and included provisions on priceprotection in contracts with vendors.

The IT Department was engaged to in automating therequisition process, specifically the purchase requestsmade by the Material Management (Warehouse)Department, and the purchase orders processed

IMPROVING SUPPLY CHAIN MANAGEMENT

(in million pesos)

18%SAVINGS 20%SAVINGS

Purchases Savings

400,000,000

300,000,000

200,000,000

100,000,000

02008 2009

188.63M

33.04M

336.58M

67.39M

TMC decided to share these benefits directly

with its patient-partners. In June 2009, the

hospital announced a major price rollback,

offering a 20% discount for a wide range of

medicines.

by the Purchasing Department. This automation

eliminated the need for tedious and duplicate manualefforts and reduced physical paperwork.

Resulting gains were substantial. By year-end 2008,TMC had saved P24,781,798 in procurements costs,18% of the total. Actual savings for 2009 amountedto P67,387,449 or 20% of the total amount spent onsupplies.

TMC decided to share these benefits directly with itspatient-partners. In June 2009, the hospital announced

a major price rollback, offering a 20% discount fora wide range of medicines. This was in addition tothe price reductions already mandated under theMedicine Price Reduction Act of 2009.

The success of TMCs Medication Management andUse Task Force is clear proof that good medicine andgood management do mix and in this mix, bothhospital and patient win.

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THE MEDICAL CITY

BOARD OF DIRECTORS

Augusto P. Sarmiento, MDCHAIRMAN

Jose Xavier B. GonzalesTREASURER

Alfredo R. A. Bengzon, MD, MBAPRESIDENT AND CEO

Mitos SisonADVISER

Juan Y. Fuentes, MDADVISER

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2009 ANNUAL REPORT

Atty. Ma. Romela M. BengzonCORPORATE SECRETARY

Francis P. HernandoDIRECTOR

Pote P. VidetDIRECTOR

Venancio I. Gloria, MDDIRECTOR

Blesilda E. Concepcion, MDDIRECTOR

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THE MEDICAL CITY

BOARD OF DIRECTORS

Herminio J. Germar, MDDIRECTOR

Mediadora C. Saniel, MDDIRECTOR

Rev. Fr. Roberto C. YapDIRECTOR

Eugenio Jose F. Ramos, MDDIRECTOR

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2009 ANNUAL REPORT

Rolando B. Hortaleza, MDDIRECTOR

Mona Lisa B. dela CruzDIRECTOR

Alberto L. BuenviajeINDEPENDENT DIRECTOR

Teodoro L. Locsin, Jr.INDEPENDENT DIRECTOR

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THE MEDICAL CITY

EXECUTIVE COMMITTEE

Augusto P. Sarmiento, MDCHAIRMAN

Benita J. MacalagaySVP, FINANCE, ADMINISTRATIVE AND MANAGEMENT SERVICES

Alfredo R.A. Bengzon, MD, MBAPRESIDENT AND CEO

Atty. Ma. Romela M. BengzonCORPORATE SECRETARY

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THE MEDICAL CITY

SENIOR MANAGEMENT

Eugenio Jose F. Ramos, MDHEAD, MEDICAL SERVICES GROUP

Benita J. MacalagaySVP, FINANCE, ADMINISTRATIVEAND MANAGEMENT SERVICES

Virginia B. AlanoSVP, PATIENT SERVICES GROUP

Margaret A. BengzonHEAD, STRATEGIC SERVICES GROUP

Alfredo R. A. Bengzon, MD, MBAPRESIDENT AND CEO

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2009 ANNUAL REPORT

VICE PRESIDENTS

Cristela A. Villa-RealNURSING SERVICES DIVISION

Lina A. MarananCORPORATE PLANNING ANDNETWORK DEVELOPMENT

Mercedes G. Gonzales, MDMEDICAL MANAGEMENTAND SERVICES DEVELOPMENTOFFICE

Blesilda E. Concepcion, MDPROFESSIONAL STAFFDEVELOPMENT OFFICE

Jose M. Acuin, MDMEDICAL QUALITYIMPROVEMENT OFFICE

MEDICAL DIRECTORS

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THE MEDICAL CITY

Judith S. BetitaHUMAN RESOURCE DIVISON

Herminia F. FresnozaADMINISTRATIVE SERVICESDIVISION

Sylvia R. NacpilFINANCE SERVICES DIVISION

Marilyn R. AtienzaSPECIAL SERVICES DIVISION(FLAGSHIP PROGRAMS)

Aura J. GuintoSPECIAL SERVICES DIVISION

Leticia E. CarolinoNURSING SERVICES DIVISION

ASSISTANT VICE PRESIDENTS

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2009 ANNUAL REPORT

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THE MEDICAL CITY