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Management St. Louis University Hospital of the Sacred Heart
Block 7B: Santos, Santos, Sembrano, Sison, Soliman, Symaco, Tababa, Tagal, Taganas, Tan.
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Outline Organizing Background Leadership Planning Controlling Summary
Organizational Structure Organization Units Span of Control Chain of Command Leadership ER Coronary and ICU Respiratory Care Unit Medical Unit Palliative Unit Controlling Feedforward Concurrent Feedback Summary Background General Info, Mission-Vision, Objectives Leadership: Management Style Leadership: Leadership Qualities Planning Mission Vision Strengths Weaknesses Opportunities Threats TOWS Matrix
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St. Louis University Hospital of the Sacred Heart
Associated with the Largest university north of Manila (SLU) with ~20,000 university students Opened in May 10, 1977 244-bed, 5-storey tertiary and teaching hospital 11 full/part time consultant, 40 resident physicians, 222 visiting/honorary consultants/physicians with 324 Administrative-Nursing Service Staff Accredited for Residency Training in Anesthesia, General Surgery, Medicine, Ophthalmology, Obstetrics and Gynecology, Pathology, Pediatrics and Radiology, as well as Internship Training in Medical and Radiologic Technology, Nursing, Pharmacy, Caregiver, and Occupational, Physical and Respiratory Therapy.
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General Information The medical services maintained by SLU-HSH include the: Emergency Room Outpatient Department Clinical X-ray Laboratory, Ultrasound Labor and Delivery Room Mother and Child Room Special Care Unit Operating-Recovery Rooms SICU/MICU/PICU/NICU Central Supply room Dietary Service Pharmacy Physical Medicine and Rehabilitation Respiratory Care Unit Medical Records and Ambulance Service.
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Vision The vision of the Saint Louis University is to be an excellent missionary and transformative educational institution zealous in developing human resources imbued with the Christian Spirit.
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Mission To develop students, as well as faculty and staff imbued with the institution's core values of competence, creativity, social involvement and Christian spirit.
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Mission-Vision “We envision the Saint Louis University-Hospital of the Sacred Heart as the prime regional tertiary teaching, research-oriented and social service institution with the highest standards and health care workers who recognize that the care of the sick is a great responsibility and a sacred trust. It is committed to raise the quality of care and the general standards of medical practice to produce highly competent, committed, creative and ethical professionals and to make available medical and allied services in an atmosphere of Christian compassion.”
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Objectives/Core Values
Christian Spirit Highest quality medical care and management; excellent medical service reflective of Christian value of selfless sharing Creativity Creative ways and means to operate and be self-reliant Center of excellence for research and training Competence Provide training program to develop competent, qualified and God-fearing health workers Provide competent an quality health care services Social Involvement Active role in medical outreach missions and community extension services Be a tertiary referral center
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Leadership: Management Style
Participative type Timely feedback on organizational performance Medical and paramedical personnel Patients The Saint Louis University-Hospital of the Sacred Heart has adopted a participative-type of management which allows a system of information that provides timely feedbacks on organizational performance gathered from all sectors of the hospital, including its patients. This system has the advantage of inspiring creativity and resourcefulness which encourages all concerned to use their talents and potentials to get the work done in the best possible way, while enhancing professional enrichment for the achievement of the hospital’s objectives.
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Leadership Qualities Imbued with the Christian Spirit
To provide the highest quality medical care and management for the people of the Cordilleras and neighbouring regions, upholding and maintaining a tradition of excellent medical service reflective of Christian value of selfless sharing.
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Leadership Qualities Creative and resourceful
To find creative ways and means to operate as a self-reliant unit and sustain long term growth and development. To be a centre of excellence for research and training for resident physicians, medical and paramedical staff and students.
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Leadership Qualities Competence
To provide a training program in the clinical departments to develop competent, qualified, and God-fearing health workers who possess adequate knowledge of medicine, professional integrity and ethical conduct and skills in investigative and critical thinking, teaching and leadership. To provide competent and quality health care services.
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Leadership Qualities Social Involvement
To take an active role in medical outreach missions and community extension services geared for the marginalized members of the community and far flung areas of the region. To be a tertiary referral center where other hospitals, medical facilities and satellite medical systems in surrounding localities can avail of the services of highly trained, ethical and competent medical specialty and sub-specialty professionals.
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Leadership Challenges
Personality differences of medical personnel and staff Occasional undermanning of the department Also seen as an opportunity for learning for residents and medical students Financial constraints Funds for miscellaneous fees come from monthly collections from the consultants and physicians as well as from payments from PGIs
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Planning
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Mission-Vision “We envision the Saint Louis University-Hospital of the Sacred Heart as the prime regional tertiary teaching, research-oriented and social service institution with the highest standards and health care workers who recognize that the care of the sick is a great responsibility and a sacred trust. It is committed to raise the quality of care and the general standards of medical practice to produce highly competent, committed, creative and ethical professionals and to make available medical and allied services in an atmosphere of Christian compassion.”
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Strengths Most number of admitted patients
Varied cases in the hospital provides good exposure for training Department heads are young, dynamic and open to change Competent consultants serving as administrative heads in different parts of hospital Adequately trained residents, with 100% passing rate in diplomate exams and success in their subspecialty trainings Some even designated as chief fellows Has all the major subspecialties, with board certified staff, ensuring good quality of health care Good professional relationship among physicians, nurses and paramedical staff
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Weaknesses Lack of financial support from the hospital
Low attendance from consultants in department activities and meetings Mostly the same people participating Lack of transparency regarding income generated by department for the hospital Physical set up and facilities not yet ideal Department occasionally undermanned
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Opportunities Has the bargaining power to accept an additional resident when occasional undermanning of the department arises Attends conferences for continuing medical education
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Threats Hospital incurs some financial loss (e.g.patients giving promissory notes) Consultants also affiliated with other hospitals Most consultants have only a visiting status Receive an honorarium No security of tenure Not qualified for benefit claims
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Strengths Weaknesses Opportunities Threats
Most number of admitted patients Varied cases provides good exposure for training Department heads are young, dynamic and open to change Competent consultants as administrative heads Adequately trained residents with 100% passing rate in their diplomate exams and success in their subspecialty training Has all the major subspecialties, with board certified staff, ensuring good quality of health care Good professional relationship among physicians, nurses and paramedical staff Has the bargaining power to accept an additional resident when occasional undermanning of the department arises Attends conferences for continuing medical education Lack of transparency when it comes to the income generated by the department for the hospital Physical set up and facilities not yet ideal Occassional undermanning of the department Threats Consultants also affiliated with other hospitals Most of the consultants are visiting consultants who only receive an honorarium with no security of tenure and not qualified for benefit claims Lack of financial support from the hospital Low attendance from consultants in department activities and meetings, with the same people participating Hospital incurs some financial loss, such as patients giving promissory notes
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Organizing
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Organizationl Structure
Board of Trustees President VP - Administration VP - Finance VP – Academic Affairs Dean – College of Medicine Medical Director Hospital Administrator Dean – College of Natural Sciences Dean – College of Nursing Dean/OIC – Affiliate School Chief of Clinics Asst. Chief of Clinics Anesthesia Lab Med/Pathology Medicine OB - Gynecology Ophthalmology Otorhinolaryngology Pediatrics Radiology Surgery Business Office Dietary Housekeeping Information/Admitting Linen/Laundry Medical Records Nursing Service Pharmacy Phys Med/Rehab Respiratory Care Unit Social Service Hospital Chaplain Job Descriptions to be provided by Charvee
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Organizational Units Board of Trustees President Vice President
Administration Finance Academic Affairs Medical Director Hospital Administrator Services Departments Sections Job Descriptions to be provided by Charvee
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Job Description Ma. Lourdes W. Jacinto, MHA, Hospital Administrator
Immediate Supervisor: University President Subordinate Staff: Heads and personnel of the different sections of the SLU-HSH Together with the Medical Director, shares the ultimate responsibility for the strategic direction, the quality of service provided and financial well-being of the hospital
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Job Description Servando T. Liban II, MD, FPNA, Medical Director
Immediate Supervisor: University President Subordinate Staff: Medical Staff, heads and personnel of the different medical sections of the SLU-HSH Together with the Hospital Administrator, shares the ultimate responsibility for the strategic direction, the quality of service provided and financial well-being of the hospital
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The Department of Medicine
Headed by the Chair of the Department Organizational Structure Dynamic and open to change Department Level Though control is centralized, interaction between medical personnel and staff is flexible and adaptive. “We adapt to the personalities and needs of our residents and consultants.” Formal With defined roles
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Job Description Dr. Rosemarie Dominguez, Chair of the Department
Handling and ensuring the quality of patient care by consultants, residents, clerks, interns, paramedical staff and administrative personnel Oversee the finances of the department Manage conflicts in the workplace Assess and evaluate staff in terms of performance Assist the Medical Director and Hospital Administrator in carrying out the objectives and policies of the hospital
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Span of Control Widest control is Department of Medicine with:
7 units, namely: ER, OPD, Palliative, ICU, Coronary, Respiratory, and medical ward 14 sections, namely: Cardiology, Gastroenterology, Pulmonology, Tropical Medicine and Infectious Diseases, Endocrine, Nephrology, Hematology-Oncology, General Medicine, Neurology, Rehabilitation Medicine, Dermatology, Psychiatry, and Occupational and Industrial Medicine
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Chain of Command Head Body Chairman of Department of Internal Medicine
Services Sections Cardiology, Gastroenterology, Pulmonology, Tropical Medicine and Infectious Diseases, Endocrine and Metabolism, Nephrology, Hematology-Oncology, Diabetes, General Medicine, Neurology, Rehabilitation Medicine, Dermatology, Psychiatry, Occupational and Industrial Medicine
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Delegation Empowerment
Depends on specialization, credentials, and suitability to job. Empowerment Encouragement of medical personnel and staff to use their talents and potentials to get the work done in the best possible way and in line with the achievement of the hospital’s vision, mission, and objectives
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Centralization The responsibility of decision-making lies on the Chairman of the Department All Departments and Services adhere to the policies and standards stated in the Manual of Procedures and Guidelines of SLU-HSH.
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Departmentalization No overlapping between units because of specificity of function and services; However, different departments come together when needed in the management of a patient
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Matrix Structure Hospital Administrator and Medical Director
Fiscal Services Proper allocation and management of finances Medical Services Committed to quality patient care Nursing Service Effective collaborative care General Services For support service to patient care Ancillary Services Technical support Owned and Corp-Managed Units Specalized technical support provided by external corporations
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Team Processing The decision making is based on the policies and guidelines of the hospital, with the need for approval from the highest rank. However, the administration is open to the opinions of its employees and patients via feedback
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Units of the Department
BACKGROUND AND LEADERSHIP STYLES
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ER
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ER The leadership style in the Emergency Room is of the Authoritarian Type. ER Resident Physician Senior House Officer Due to time constraints and the nature of the situations in the ER, it is essential that: the personnel act in a manner that is swift, and maximizing manpower, without wasting any time, to prevent complications and mortalities. Both ER Resident Phys and SHO oThe leadership style in the Emergency Room is of the Authoritarian Type. The power relies basically revolves on the ER Resident Physician and the Senior House Officer, who oversees everything. Due to time constraints and the nature of the situations in the ER, it is essential that the personnel act in a manner that is swift, and maximizing manpower, without wasting any time, to prevent complications and mortalities. The Resident Physician therefore, and his subordinates such as the Head Nurse should have the clinical eye to determine if a certain case is of the Emergency, Urgent, or Non-Emergency Type. All the other staff members could just follow the orders given by the superiors as needed.
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Hospital Administrator
Medical Director Chief of Clinics CIC - ER CIC - MOR Medicine Pediatrics Surgery OB - Gyne EENT Head Nurse Clinical Instructor Charge Nurse Student Nurses Student Caregivers Staff Nurses Nursing Aides Transport Aides Patients
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Medical Unit
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Description 47-bed facility at 2nd floor of Hospital Annex III
Bed capacity 8 beds (private rooms) 12 beds (semi-private ward) 9 beds (female medical ward) 9 beds (male medical ward) 5 beds (female respiratory ward) 4 beds (male respiratory ward) For stable patients who still require confinement and monitoring
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Mission-Vision Christian service
Charity cases are provided with quality care and are accepted to the section of the unit which they can afford. Provision of admission kit Separation of male and female patients in the charity unit Constant monitoring of patient vital signs Prompt distribution of food and is personalized depending on the recommendation of the Dietary Department. Daily cleaning of the ward and its facilities Assurance of a 24-hour security
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Mission-Vision Research Education
Head nurse and staff collect cases and data of predominant cases commonly seen in the ward. Education Regular training such as BLS/ACLS and mini-lectures. TNA (Training Needs Assessment) is given to the nurses once a month Invited for the morbidity and mortality audits
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Objectives To coordinate and provide quality care to all patients receiving services at the Medical Unit To monitor and maintain stability of patient health conditions
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Hospital Administrator
Organizational Chart 17 Staff Nurses 3 Junior Residents Head Nurse Senior Resident Medical Unit Section Head Hospital Administrator Medical Director Three IM residents and 17 nurses provide the care for patients admitted for this ward.
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Leadership Unit is hierarchical, with the head nurse assigning duties to and managing the staff nurses. She trusts the staff nurses’ capabilities to manage their patients and accomplish their work satisfactorily. She describes her leadership as strict but not too authoritarian.
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Medical Unit
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Medical Unit
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Coronary and ICU
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Objectives To coordinate and provide quality care to all patients receiving services at the Coronary Unit and MICU To stabilize, coordinate and provide quality care and safety to cardiac patients
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Organizational Chart Coronary and MICU Section Head
Hospital Administrator Medical Director Junior Resident Senior Resident Staff Nurses Head Nurse Nursing Aides Ward Clerks Consultant Staff
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Leadership Unit is hierarchical, with the Head Nurse assigning the duties for each of the staff nurses Strategy would vary from person to person and between levels. The head of the Section as well as the Head Nurse practice strict and authoritative type of leadership.
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Coronary Care Unit
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Palliative Unit
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Description 20-bed facility located at the 1st floor of Hospital Annex III For admission of terminally ill patients, mostly cancer patients undergoing chemotherapy There are two wards, basic private rooms, semi-private rooms and suites. One resident and two nurses work in shifts to provide care for patients in the unit.
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Organizational Chart
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Leadership Head consultant has a strict and authoritative type of leadership Head consultant can also exhibit a mixed-type of leadership, adept in shifting from autocratic to democratic type when needed The hierarchy of position and seniority are observed strictly by the medical personnel. The head consultant has a strict and authoritative type of leadership though also elicits and is open to suggestions from her subordinates regarding certain concerns of the unit. The head consultant also exhibits a mixed-type of leadership, adept in shifting from an autocratic type of leadership, to a democratic type of leadership when needed. However, the hierarchy of position and seniority are observed strictly by the medical personnel.
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Palliative Unit
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Palliative Unit
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Palliative Unit
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Palliative Unit
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Respiratory Care Unit
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Description provides both therapeutic and diagnostic respiratory services. It is located at the third floor of the Annex III building of the hospital It is open 24 hours daily with 3 personnel in the morning, 2 during the afternoon and 1 at night.
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Organizational Chart Caregivers Trainees Post-Graduate
Chief Respiratory Therapist Staff Respiratory Therapist CIC Section Head Hospital Administrator Medical Director
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Leadership Leadership in the unit is of the democratic type although the hierarchy is still observed the chief respiratory therapist, practices an accommodating type of leadership welcoming suggestions from the staff that he leads when challenges are encountered in the unit, he tries to iron things out first at his level before elevating it to the department chair.
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Respiratory Care Unit
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Controlling
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Feedforward
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Licence and Accreditation
Licensed by the DOH Bureau of Health Facilities and Services Accredited by the Philippine Health Insurance Corporation and Employees’s Comepensation Commission A member of good standing of the Philippine Hospital Association and the Private Hospitals Association of the Philippines Has close to 50 accredited HMOs, Government and Private Corporations
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Licence and Accreditation
A Center that both teaches and treats An Institution that cures and nurtures Anesthesia Internal Medicine Obstetrics and Gynecology Ophthalmology Pathology Pediatrics Radiology Surgery Medical/Radiologic Therapy Nursing Pharmacy Occupational/Physical/ Respiratory Therapy Caregiver Job Descriptions to be provided by Charvee
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Manual of Procedures Given to all staff member before he starts to work and present in all units as reference Ensures quality service is rendered Specific guidelines in place for procedures to be made Regularly evaluated whether these standards are practiced
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Job Hiring Has specific criteria for each position before hiring a health care provider Knowledge Skills Personal Qualities Nature of Work Responsibilities Expected Duration and Type of Training Expected Board certification if needed
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Job Hiring For Residency Training
All applicants accepted for pre-residency for 2 months 3 to 4 accepted based on their performance in: Written Exam Oral Exam Psychological Test Interview Work in the Ward (as evaluated by a resident, nurse and paramedical professional)
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Concurrent
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Concurrent Ensures there is continuous training and development among health care providers: Spending for staff who would go for local or international conferences Various conferences held within the department to encourage critical thinking
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Feedback
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Morbidity and Mortality Audits
To ensure good clinical practice To critically analyze the circumstances that surrounded an outcome, recommend process improvement, initiate appropriate action for process improvement and oversee the progress Admitting conferences done once or twice a month to assess how a resident managed the patient.
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Consultant Evaluation
Evaluated by the department chair regarding their performance and participation in hospital activities Criteria for evaluation: Hospital – 30% Department – 70% Attendance in morning conferences – 15 % Attendance in department meetings – 15% Attendance to conferences – 10% OPD rotation – 15% Resource speaker, lecturer or moderator – 10% Payment of department dues – 5%
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Evaluation by Patients
Patients are asked to evaluate how satisfied they are with the health care service given to them by filling up an evaluation form to be submitted by the patient upon discharge.
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Control by the Chair The Chair adheres to a personal form of constructive criticism wherein she takes time to talk to her staff so as to provide feedbacks. There is no peer evaluation but this could be helpful in improving the staff’s performance.
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Summary
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Leadership A Participative style for the whole hospital
Though control is centralized, interaction between medical personnel and staff is flexible and adaptive. Leadership styles vary for each unit of the department
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Planning Strengths Weaknesses Opportunities Threats
Most number of admitted patients Varied cases provides good exposure for training Department heads are young, dynamic and open to change Competent consultants as administrative heads Adequately trained residents with 100% passing rate in their diplomate exams and success in their subspecialty training Has all the major subspecialties, with board certified staff, ensuring good quality of health care Good professional relationship among physicians, nurses and paramedical staff Has the bargaining power to accept an additional resident when occasional undermanning of the department arises Attends conferences for continuing medical education Lack of transparency when it comes to the income generated by the department for the hospital Physical set up and facilities not yet ideal Occassional undermanning of the department Threats Consultants also affiliated with other hospitals Most of the consultants are visiting consultants who only receive an honorarium with no security of tenure and not qualified for benefit claims Lack of financial support from the hospital Low attendance from consultants in department activities and meetings, with the same people participating Hospital incurs some financial loss, such as patients giving promissory notes
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Organizing Organizational Structure Job Descriptions Chain of Commands
Span of Control Delegation Empowerment Centralization Departmentalization
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Controlling Feedforward Concurrent Feedback
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Conclusion The Department of Medicine is able to achieve its objectives through the joint action of its medical staff and paramedical personnel by adhering to the SLU HSH’s policies and mission-vision.
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Conclusion The Department of Medicine is able to achieve its objectives through the joint action of its medical staff and paramedical personnel by adhering to the SLU-HSH’s policies and mission/vision. Leadership The participative type of leadership is supportive of a harmonious andproductive working environment which encourages participation from the different units and sections of the department. Controlling The Chairman adheres to a personal form of constructive criticism wherein she takes time to talk to her staff so as to provide feedback. There is no peer evaluation, but this could be helpful in improving the staff’s performance. Recommendations
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Recommendations The group recommends that:
The Department recheck the organizational charts of its units because the different sections are not headed by the department chair. The Department request for more financial transparency from the hospital administration.
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Thank you for your kind attention!
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