MDH Task Force SARS
An Evaluation Report cum Reflection
June 2, 2003
Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg
Chair, MDH Task Force SARS
The third objective of the MDH Task Force SARS is to evaluate the MDH SARS prevention and control program, the first being to formulate hospital-wide policies and strategies and the second, being to supervise and coordinate the implementation of formulated policies and strategies.
With the global SARS epidemic more or less under control and with the Philippines being removed from the list of areas with recent local transmission by the World Health Organization on May 20, 2003, the MDH Task Force SARS thinks it can now make its evaluation.
This evaluation report will consist of the following:
Outcome of the MDH SARS prevention and control program
(output)
As formulated in the organizational primer of the MDH Task Force SARS, the outcome criteria and parameters will consist of the following:
Prevention:
NO SARS patient admitted in MDH
Control:
If there is a SARS patient in MDH,
NO staff infected with SARS
NO client (patient) infected with SARS
No mortality from SARS
As of June 2, 2003,
there is NO SARS patient admitted in MDH.
There were 2 SARS suspects, 2 undetermined SARS, and 2 asymptomatic SARS who were detected and screened at the MDH Emergency Room (MDH-ER). All were foreigners. One SARS suspect (an Indian) went home on his own despite medical advice to be conducted to a DOH SARS Center (DOH was notified though) and another SARS suspect (a Korean) was conducted to San Lazaro Hospital. The undetermined and asymptomatic SARS were either conducted to San Lazaro Hospital or went home despite medical advice.
Preparedness in SARS prevention and control (output)
A Level 3 preparedness was achieved by May 16, 2003, about 6 weeks after the 1st organizational meeting of the MDH Task Force SARS on April 4, 2003.
Level 3 preparedness means completely prepared with policies, strategies, and procedures; physical facilities; and training and with at least a drill. Drills were conducted in the MDH-ER, Floor 11, Department of Radiology, and Department of Laboratory.
Processes of the MDH Task Force SARS (throughput)
As formulated in the organizational primer of the MDH Task Force SARS, the goal is to effectively and efficiently manage, in terms of prevention and control, SEVERE ACUTE RESPIRATORY SYNDROME (SARS) in Manila Doctors Hospital (MDH).
With NO SARS patient admitted in MDH (which is a parameter for effectiveness); with a Level 3 preparedness (which is another parameter for effectiveness) achieved within 6 weeks, with 4 meetings, and at a cost of PhP 200,000.00 (which are parameters for efficiency), the consensus of the members of the MDH Task Force, using benchmarking with other institutions and other reasons, was that the goal has been achieved. Unless proven otherwise, no other hospitals in the country have achieved level 3 preparedness (Philippine Daily Inquirer, May 23, 2003). The PhP 200,000.00 was spent mainly for the construction of the isolation room in the MDH-ER and the personal protective equipment. The room can still be used for other infectious diseases aside from SARS.
The processes identified that contributed to effectiveness and efficiency of the MDH Task Force SARS consisted of the following:
1. Unity of command coupled with support from top management
2. Systematic and decisive way of problem-solving and utilizing multisectoral cooperation and empowerment
These processes will be amplified in the reflections of the Chair of the Task Force SARS.
Organization of the MDH Task Force SARS (input)
All sectors in the hospital that would be primarily involved in the management of SARS patients, in case there would be, were included in the MDH Task Force SARS. This was the prerequisite for a multisectoral cooperation and which led to the achievement of goal and objectives of the MDH Task Force SARS.
1. To continue to be vigilant against SARS until all affected countries in the world, particularly China and Taiwan, have controlled the SARS epidemics. Monthly reminder will be given to MDH-ER and Admitting Section Personnel, the hospital’s main lines of prevention and control of SARS in MDH.
2. To institutionalize the MDH Anti-SARS Preparedness Program to make it, particularly the quality system procedures, applicable to other kinds of serious infectious diseases that can threaten hospital’s operations and stability in the same magnitude as that of SARS.
My reflection will consist of restating and then amplifying on the processes that I think contributed to effectiveness and efficiency of the MDH Task Force SARS.
The processes are the following:
1. Strong leadership with unity of command coupled with support from top management
2. Competent leadership with systematic and decisive way of problem-solving and utilizing multisectoral cooperation and empowerment
Unity of command coupled with support from top management
I was the acting Medical
Director when the MDH Task Force SARS was created by my Hospital Director. The members of the Task Force were
identified by the Hospital Director. They
came from different departments or sectors of the hospital. Each member had his/her own immediate
superior other than me.
At the outset, I
emphasized to the members of the Task Force that on matters involving SARS,
they were to report to me. I was their
immediate superior. They just have to
inform their customary superiors what they were doing in the Task Force
SARS. My directive had the blessings of
the Hospital Director. This contributed
to the unity of command.
There were several actual
and in-the-offing problems that occurred in which the unity of command did the
trick. Without expounding on the
details, there were the incidents involving the medical interns and the COMET;
Housekeeping; Laboratory, and Nursing Service.
Systematic and decisive way of problem-solving and
utilizing multisectoral cooperation and empowerment
SARS is a medical
problem. As such, one would tend to
think it should be solved in a medical way, namely, diagnosis followed simply
by treatment. The problem of SARS
involves more than one person and more than one department. It is an epidemic
or at least has the potential of an epidemic in the community and in the
hospital. The problem involves and cuts
across the whole hospital. Thus, management of the SARS problem goes beyond the
clinical expertise of a physician or an infectious disease specialist. It has
to be managed in a systematic and decisive way of problem-solving as well as
utilizing multisectoral cooperation and empowerment. It needs a physician-manager, a competent one.
Upon appointment as Chair
of the Task Force SARS, I called for an organizational meeting. Before going to the meeting, I already
formulated the initial draft of the organizational primer of the Task Force
with the goal, objectives, and evaluation criteria and parameters clearly
stated but the strategies left blank (though I had some idea) for my members to
suggest and contribute. During the
first meeting, after agreeing on the goal, objectives, and evaluation parameters,
I asked each of the members what they thought should be their roles and what
and how they could contribute to the prevention and control of SARS in
MDH. Such questioning with
corresponding response elicited was the first step towards a multisectoral cooperation
and empowerment and this was part of the whole scheme of systematic and
collaborative problem-solving.
As Chair of the Task
Force, I provided the members a framework to work on – the organizational
primer, general policies and a very clear and specific management action
plan. I empowered the competent and
cooperative ones by giving them importance and blanket authority. I motivated them with my credibility,
sincerity, and other tools. Needless to
say, there were occasions that I had to use controls to keep the management
action plan on track. In the end, an
empowered multisectoral cooperation was the major factor in the effective and
efficient accomplishment of the goal and objectives of the Task Force.
A major problem or
challenge that I had to solve or face was the refusal tendency of staff to take
care of SARS patients even suspected SARS patients. Partly, I asked help and support from Mancom. Partly, I sought advice from DOH and
medicolegal officers. In the end, I had
to make decisions on the strategies. I decided and succeeded using
non-confrontational and persuasive approach. Non-confrontational approach, in
the sense, I kept the issue on a low key.
I did not create special group of personnel to manage SARS patients. I used existing set-up with the usual
routine of rendering hospital services but with special training on SARS
prevention and control in those departments and staff with great possibility of
being involved. Persuasion approach,
in the sense, that I reminded the staff of the humanitarian duty of the health profession
and convinced them that they would be properly and adequately protected with
safety devices and assisted by the top management if ever they get infected
with SARS.
Recommendations to Top Management:
Give recognition and
appreciation to the members of the MDH Task Force SARS during the anniversary
celebration or in any appropriate occasion.
Give special recognition
to ER staff because they were the ones who were in the frontlines and who
successfully prevented the hospital from having SARS patients.
Acknowledgement:
Thanks to all members of
the MDH Task Force SARS
Thanks to Hospital
Director
Thanks to Medical
Director
Thanks to all hospital
staff
Special thanks to:
Dr. Kelly de Leon – ER Coordinator
Dr. Melecia Velmonte – Infection Control Committee Chair and MDH
SARS Consultant
Ms. Merie Modesto – Infection Control Nurse
Eng. Antero Parocha – Coordinator for Maintenance Department,
Housekeeping, Linen, and Security