The Philippine Health Care Delivery

ANSWER
This chapter discusses related topics and the literature and studies reviewed; it also demonstrates the theoretical, conceptual, and analytical frameworks. The cited literature was bridged in the current study. Similarly, the cited literature was synthesized. The terms used in the study were defined for ease of use.

Examining Related Literature and Studies
Delivery of Health Care in the Philippines
The Delivery of Health Care in the Philippines. A healthcare system is a well-organized plan for providing health services. The provision of health care services to the public is referred to as the health care delivery system. Thus, a healthcare delivery system is a network of health facilities, and personnel tasked with providing health care to the public. In the Philippines, the health care system is a complex network of organizations that work together to provide a wide range of health services.

In the Philippines, the Department of Health (DOH) is responsible for the following components of the healthcare delivery system:
formulation and development of national health policies, guidelines, standards, and manuals of operations for health services and programs
issuance of rules and regulations, licenses, and accreditations
promulgation of national health standards, goals, priorities, and indicators
development of specialized health programs and services
The Department of Health’s primary function is to promote, protect, preserve, or restore people’s health through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services (E.O. No. 119, Sec. 3).
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“Health as a right,” says the DOH. Health for All Filipinos by 2000, and Health in People’s Hands by 2020.” While its mission is “DOH, in partnership with the people to ensure equity, quality and access to health care by making services available; arousing community awareness; mobilizing resources; and promoting the means to better health.

Healthcare facilities in the Philippines are classified as Level I, Level II, and Level III. The DOH directly operates rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units; puericulture centers operated by the League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society; private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees.

Level II (Secondary Level of Health Care Facilities) hospitals include emergency and regional hospitals and smaller, non-departmentalized hospitals. Services provided to patients in symptomatic stages of disease that necessitate moderately specialized knowledge and technical resources for adequate treatment. At the same time, the Level III (Tertiary Level of Health Care Facilities) services provided by medical centers and large hospitals are highly technological and sophisticated. These are the specialized national hospitals. This level of service is provided to clients with diseases that seriously threaten their health and require highly technical and specialized knowledge, facilities, and personnel to treat effectively.

Workers in health care are also classified. In the Philippines, there are three levels of health workers. There are three types of health workers: village or grassroots health workers, intermediate-level health workers, and first-line hospital personnel. Village or grassroots health workers are the community’s first point of contact and the first point of contact for health care. They provide simple curative and preventive health care measures, promote a healthy environment, and participate in activities to improve the community’s socioeconomic level, such as a food production program. These include barangay health workers, volunteers, and traditional birth attendants or his lot.

The intermediate level of health workers is the first point of contact for professional health care. They address health issues beyond the competence of village workers and provide front-line health workers with supervision, training, supplies, and services. These are the physicians, nurses, and midwives. At the same time, first-line hospital personnel provide backup health services for cases requiring hospitalization and maintain close contact with intermediate-level or village health workers. These are specialty physicians, nurses, dentists, pharmacists, and other health professionals.

Patients are constituents of the healthcare setting. A patient is anyone who receives healthcare services. According to Wikipedia, the patient is usually sick or injured and requires medical attention from a doctor, advanced practice registered nurse, veterinarian, or other health care provider. The word patient originally meant “one who suffers.” This English name is derived from the Latin word patients, the present participle of the deponent verb patior, which means ‘I am suffering,’ and is related to the Greek verb €ÎÎÎ1Î12 (= paskhein, to suffer) and its cognate noun €ÎÎ Î (= pathos) (en.wikipedia.org/wiki/Patient).

The duration and efficiency of care determine patients’ satisfaction with a healthcare encounter and how empathetic and communicative the healthcare providers are. It benefits from a positive doctor-patient relationship. Furthermore, even if there is a longer wait time, patients who are well-informed about the necessary procedures in a clinical encounter and the time it is expected to take are generally more satisfied. (Pulia, 2011)

Patient Contentment
Patient satisfaction is a complex mix of perceived needs, expectations, and care experience. “Quality healthcare” can refer to a wide range of services. It could be structural quality, which refers to aspects like the continuity of care, costs, accommodation, and accessibility, or process quality, which includes aspects like courtesy, information, autonomy, and competence. The term “service quality” refers to communication, signage, information provision, and staff interaction with patients. The three components of health care quality are interpersonal aspects of quality, amenities of care, and technical aspects of quality. The interpersonal component of quality is defined as the patient-provider interaction quality or the healthcare provider’s responsiveness, friendliness, and attentiveness.

Patient satisfaction is concerned with clinical interactions in specific healthcare settings, whereas responsiveness is concerned with the overall health system. Patient satisfaction encompasses medical and non-medical aspects of care, whereas responsiveness is limited to non-health-enhancing aspects of the health system. Patient satisfaction is a complex mix of perceived needs, individually determined expectations, and care experience.

Satisfaction is a subjective evaluation. It is a comparison of perceived performance versus aspiration. The basic idea behind assessing satisfaction is determining the extent to which aspirations are met about one’s self-perceived performance level. It is necessary to assess both aspirations and perceived performance. This is necessary because aspirations may be unrealistic given the available resources, and individual performance evaluations may differ significantly from actual or objective levels of achievement.

Factors relating to the patient. According to Thiedke’s (2007) study, patients’ demographic and social factors are minor in patient satisfaction. In contrast, others concluded that most demographics account for the variance in satisfaction rates. However, the literature does shed some light on how specific demographic factors influence patient satisfaction. The most consistent finding was that older patients are more satisfied with their health care, according to Haviland et al. (2006). According to studies on ethnicity, being a member of a minority group is associated with lower satisfaction levels. Most studies have found that people with lower socioeconomic status and less education are less satisfied with their health care. Kersnik et al. (2001) discovered that frequent visitors to a family practice had lower educational status, lower perceived quality of life, higher anxiety and depression scores, and were more satisfied with their family physician. Other research has linked lower satisfaction with care to worry, depression, fear, or hopelessness (Frostholm, 2005) and a psychiatric diagnosis such as schizophrenia, post-traumatic stress disorder, or drug abuse (Desai, 2005).

Factors related to the physician. According to the literature, physicians can increase patient satisfaction by improving patient interactions. Taking the time and effort to elicit patients’ expectations is one of the most important characteristics of a physician. According to a study conducted by Rao et al. (2005), when physicians recognize and address patient expectations, satisfaction increases not only for the patient but also for the physician; it may be helpful to remember that patients frequently arrive at a visit desiring information rather than a specific action. Furthermore, Bell et al. (2001) discovered that approximately a few patients had one or more unspoken desires during a visit with their physician. The most common desire was for a referral or physical therapy. Younger and less educated patients were more likely to have unmet needs during their visit, less symptom improvement, and a negative evaluation of their visit.
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Communication. Shaw and colleagues (2005) demonstrated that doctor-patient communication could influence satisfaction levels. Patients who presented to their family physician for work-related low-back pain reported higher levels of satisfaction than could be explained by symptom relief. In his study, these (2007) stated that physicians could improve patient satisfaction by relinquishing some control over the encounter. According to studies, when physicians demonstrated less dominance by encouraging patients to express their ideas, concerns, and expectations, patients were more satisfied with their visits. They were more likely to follow doctors’ advice. Thus, physicians’ medical decisions can have an impact on patient satisfaction. Patients preferred doctors who valued their social and mental well-being as much as their physical well-being.

Webster’s Dictionary defines communication as “the transmission or exchange of ideas, opinions, or information through speech, writing, or signs.” While spoken words contain critical content, their meaning can be influenced by the delivery style, which includes how speakers stand, speak, and look at a person (Joint Commission Resources, 2005). Collaboration in health care is defined as professionals taking on complementary roles and cooperating to solve problems and make decisions to formulate and carry out patient care plans.

Collaboration among physicians, nurses, and other healthcare professionals raises team members’ awareness of each other’s knowledge and skills, resulting in continuous decision-making improvement. One of the most powerful advocates of teamwork is trust, respect, and collaboration, which are characteristics of effective teams. Teamwork is considered endemic to a system in which all employees work toward a common goal and collaborate to achieve that goal. An interdisciplinary approach should be used when considering a healthcare team model. An interdisciplinary approach, as opposed to a multidisciplinary approach, in which each team member is only responsible for activities related to his or her discipline and formulates individual goals for the patient, combines a joint effort on behalf of the patient with a common goal from all disciplines involved in the care plan.

The collaboration of specialized services results in integrated interventions. The plan of care considers the various assessments and treatment regimens, and it packages these services to create an individualized care program that best meets the patient’s needs. The patient finds it easier to communicate with the cohesive team than with numerous professionals unaware of what others are doing to manage the patient.

It is important to note that fostering a team collaboration environment may present challenges such as additional time; perceived loss of autonomy; lack of confidence or trust in others’ decisions; clashing perceptions; territorialism; and a lack of awareness of one provider of the education, knowledge, and skills held by colleagues from other disciplines and professions. Most of these obstacles, however, can be overcome with an open attitude and feelings of mutual respect and trust. According to one study, improved teamwork and communication are among the most important factors in improving clinical effectiveness and job satisfaction among healthcare workers. (Flin and colleagues, 2003)

According to a thorough literature review, communication, collaboration, and teamwork do not always occur in clinical settings. For example, Sutcliff, Lewton, and Rosenthal (2004) discovered that social, relational, and organizational structures contribute to communication failures, which have been implicated as major contributors to adverse clinical events and outcomes. Another study found that patient care priorities differed among healthcare team members, and verbal communication between team members was inconsistent (Flin, 2003). According to other evidence, more than one-fifth of patients hospitalized in the United States reported problems with the hospital system, such as staff providing contradictory information and not knowing which physician is in charge of their care (Cleary et al., 2003).

We have been conducting original research for several years on the impact of physician and nurse disruptive behaviors (defined as any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse to physical or sexual harassment) and their impact on staff relationships, staff satisfaction and turnover, and patient outcomes of care, including adverse events, medical errors, compromises in patient safety, poor quality care, and links to preventable diseases. Many of these negative consequences can be attributed to poor communication, collaboration, and ineffective teamwork (Rosenstein et al., 2005).

Unfortunately, due to a culture of low expectations that has developed in many healthcare settings, many healthcare workers are accustomed to poor communication and teamwork. Because even conscientious professionals tend to ignore potential red flags and clinical discrepancies, this culture, in which healthcare workers have come to expect faulty and incomplete information exchange, leads to errors. They see these warning signs as routine repetitions of poor communication rather than unusual, concerning indicators. 2002 (Chassin)
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Although poor communication can have tragic consequences, a literature review reveals that effective communication can result in positive outcomes: improved information flow, more effective interventions, improved safety, increased employee morale, increased patient and family satisfaction, and shorter lengths of stay. Joint Commission Resources (Joint Commission Resources, 2005). According to Gittell and colleagues (2000), implementing systems to facilitate team communication can significantly improve quality. Effective staff communication promotes effective teamwork, continuity, and clarity within the patient care team. At its best, good communication fosters collaboration, fosters teamwork, and aids in preventing errors.

Physicians are at the top of the hierarchy in healthcare environments with a hierarchical culture. As a result, they may perceive the environment as collaborative and open, whereas nurses and other direct care staff perceive communication issues. Hierarchy differences can interfere with the collaborative interactions required to ensure that the appropriate treatments are delivered. When there are hierarchy differences, people at the bottom often feel uncomfortable speaking up about problems or concerns. Individuals at the top of a hierarchy who are intimidating can stifle communication and give the impression that the individual is unapproachable (Joint Commission Resources, 2005; Weick, 2002).

Staff who observe poor performance in their colleagues may be hesitant to speak up for fear of retaliation or the belief that speaking up will be futile. Relationships between those providing patient care can significantly impact how and even whether important information is communicated. According to research, physician-nurse disagreement frequently results in delays in patient care and recurring problems due to unresolved disputes. Several research findings have revealed a common trend in which nurses are hesitant or refuse to call physicians, even when patient care deteriorates. Intimidation, fear of engaging in a confrontational or antagonistic discussion, a lack of confidentiality, fear of retaliation, and the fact that nothing ever seems to change are all reasons for this. Many of these issues concern personality and communication style (Rosenstein. 2002). The main concern with disruptive behaviors is the frequency with which they occur and the potential negative impact they can have on patient care. According to our research, 17% of respondents to our survey research in 2004-2006 were aware of a specific adverse event resulting from disruptive behavior. One respondent’s quote exemplifies this point: “Poor communication” postop due to the disruptive reputation of physician resulted in delayed treatment, aspiration, and eventual demise.” 2005 (Rosenstein)

Time was spent. The length of a visit affects patient satisfaction, with satisfaction rates increasing as visit length increases. Time spent conversing during the visit was also associated with higher satisfaction levels. Physicians with high-volume practices were more efficient with their time. However, they had lower patient satisfaction rates, provided fewer preventive services, and were perceived as less sensitive in the doctor-patient relationship (as cited by Thiedke, 2007). Surprisingly, one study found that while physicians felt rushed 10% of the time, patients felt rushed only 3% of the time. Patient satisfaction was the same whether the physician felt rushed or not. This suggests that physicians may be more sensitive to feelings of being rushed and that their feelings may not accurately reflect the time spent during the visit. Lin et al. (2001)

Technical abilities/quality. Healthcare quality has two distinct facets in healthcare delivery: technical quality (also known as quality) and functional quality. Technical quality refers to the accuracy of medical diagnoses and procedures, generally understood by professionals but not by patients. According to Jaipur (2003), patients perceive functional quality as how services are delivered. Perceptions of available quality may influence future decisions to return to a facility for service. Some empirical evidence suggests that patients’ quality judgment is related to technical quality, as evidenced by outcomes such as risk-adjusted mortality among hospitalized patients with medical conditions (Lin et al., 2002).

Technical quality cannot be achieved without the technical skills of healthcare personnel. Chang et al. (2006) conducted a study that looked at patients’ assessments of their physicians’ technical skills and the effect on satisfaction, but the results were contradictory. However, Fung et al. (2005) discovered that participants strongly preferred physicians with high technical skills when forced to make a choice. According to Otani et al. (2005), patients value a physician’s ability to make the correct diagnosis and craft an effective treatment plan more than his or her “bedside manner.”

Factors related to the system. Patient satisfaction is more than the patient’s demographics and the physician’s abilities. It is also influenced by the system that provides care. According to Otani’s (2005) findings, while patients’ primary concern is their doctor, they also value the team with whom the doctor works. According to one study (Wolosin et al., 2005), while physician care was the most influential to patients’ satisfaction, the compassion, willingness to help, and promptness of the physician’s staff came in second. In another large survey database, nurses were the second most important source of satisfaction, trailing only the issue of access to care. According to Think, patients who had remained in practice for more than 15 years attributed their loyalty to their physician first and the “team concept” second (2007). Patient satisfaction is influenced by effective referrals (Roseanne et al., 2006). One study examined referrals from the perspectives of the family physician, the referral physician, and the patient and discovered that satisfaction with the referral’s outcome was higher when the referral was initiated by the family physician (Bekkelund et al., 2005). Similarly, a study of patients treated for recurring headaches found that those who self-referred to a neurologist were less satisfied than those their primary doctor had referred. According to a survey of cancer patients, they highly value their family physician and want to keep in touch with him or her even if they are receiving cancer treatment elsewhere (cited by Thiedke 2007).

According to Donahue et al. (2005), one of the pillars of family medicine, continuity of care, has suffered under managed care. Norman and colleagues (2001). While it is unclear to what extent patients value continuity of care in general, it is clear that patients whom their physician has followed for more than two years are more satisfied with their care – particularly when they can see their physician (Gary et al., 2004). (2005). Beach et al. (2005) discovered that patients who reported being treated with dignity and being involved in decision-making were more satisfied and more likely to follow their doctor’s advice. Stelfox et al. (2005) discovered an inverse relationship between satisfaction and risk management episodes in patient satisfaction surveys of inpatient physician performance. Furthermore, physicians can find practical takeaway lessons in the literature, such as the following: treat patients with dignity and include them in decision-making; work as part of a team; elicit patients’ concerns; and dress semiformally and always smile. Finally, while it may not be as simple as the preceding lessons, find joy in what you do. Patients are more satisfied with the care provided by physicians who report high levels of professional satisfaction. (Haas and colleagues, 2000).

The art studies of Thiedke (2007), Haviland et al. (2006), Frostholm (2005), and Desai (2005) were analyzed to see if there is a significant relationship between demographic profile and patient satisfaction. Rao et al. (2005) and Bell et al. (2001) studied physician-related patient satisfaction factors. Patient satisfaction was attributed to recognizing and meeting patient expectations, whereas Bell et al. (2001) investigated the desire for a referral or physical therapy as the reason for patient satisfaction.

Shaw and colleagues (2005), Thiedke (2007), Flin et al., 2003, Sutcliff, Lewton, and Rosenthal (2004), Chassin (2002), and Rosenstein et al., 2005 demonstrated that doctor-patient communication could influence satisfaction rates. According to a thorough literature review, communication, collaboration, and teamwork do not always occur in clinical settings. Sutcliff, Lewton, and Rosenthal (2004) found that social, relational, and organizational structures contribute to communication failures, which have been linked to adverse clinical events and outcomes.

Jaipur (2003) and Lin et al. (2002) researched technical quality (also known as quality in fact) and functional quality. While the study by Chang et al. (2006), Fung et al. (2005), and Otani (2005) focused on the technical skills of health workers. The study of Otani (2005) also focuses on system-related factors such as the teamwork of other health professionals. Wolosin et al. (2005) emphasize compassion and willingness to help the healthcare professions. Backlund et al. (2005) and Roseanne et al., 2006 revealed referrals as influencing patient satisfaction. According to Donahue et al. (2005) and Norman et al. (2001), continuity of care contributes to patient satisfaction. (Gary et al. 2005, Beach et al., 2005; Stelfox et al., 2005; and Haas et al., 2000) discovered that patients who reported being treated with dignity were more satisfied.

The Study Bridged Gaps
While most of the literature reviewed concerned whether there is a relationship between demographic profile and patient satisfaction, physician-related factors addressing patient expectations, such as the desire for a referral or physical therapy, were the reason for patient satisfaction. According to a thorough literature review, communication, collaboration, and teamwork do not always occur in clinical settings. Technical quality, technical skills of health workers, communication and teamwork of other health professionals, compassion and willingness to help, and patients who reported being treated with dignity were studied as factors influencing patient satisfaction. However, no research on the same topic or recommendations for a quality management program of healthcare services at Dr. Fernando B. Duran Sr. Memorial Hospital has been conducted (DFDMH).

Theoretical Structure
This research will be based on Linder-Expectation Pelz’s Fulfillment Theory (1982). The consumer model’s expectations play a role in determining satisfaction with healthcare. Linder-work Peltz’s on the interaction of patient expectations and perceptions is particularly influential in this regard. Linder-viewed Peltz’s expectations affect satisfaction independent of other variables (i.e., regardless of fulfillment), leading to the conclusion that this is not to say that expressions of satisfaction have little to do with the qualities of the service provided or the care offered and clearly “engendering positive expectations” must not be confused with intentionally misleading patients. Nonetheless, the assumption that satisfaction is entirely the result of an evaluation alone may not apply in all situations.

In this regard, Zeithaml et al. (1990) observed that, while consumers ultimately judge the quality of services based on their perceptions of the technical outcome provided and how that outcome was delivered (process quality), many professional services are highly complex, and a clear outcome is not always obvious. This is certainly true in many healthcare scenarios where judging the technical quality of the service—the actual competence of the provider or the efficacy of the outcome—is difficult. The patient may never know whether the service was performed correctly or even if it was required. According to Williams (1994), the greater the perceived unexplained or technical nature of the treatment, the more likely it is that many service users will not believe in the legitimacy of their expectations or evaluations (Zelthaml et al., 1990).

Furthermore, if a service user makes their first contact with the system, they may have expectations formed through previous experience. In both cases, a patient may wish for the health professional to take a paternalistic role in the relationship (‘doctor knows best’) while remaining a passive partner. Donabedian (1980) defines healthcare quality as a “trilogy” of “structure, process, and outcome” ( Zeithaml et al., 1990). However, Shaw (1984) contends that service users who cannot effectively judge the technical quality of the outcome will base their quality judgments on structure and process dimensions such as physical settings, problem-solving abilities, empathy, time-keeping, courtesy, and so on.

This research is based on Lydia Hall’s Care, Core, and Cure theory. The CARE movement emphasizes hands-on bodily care and the belief that a caring touch and thorough assessment are therapeutic. This nurturing component, also known as “mothering” the patient, is performed to comfort the patient and assist them in meeting their needs. The “motherly” care provided by nurses and medical staff may include, but is not limited to, providing comfort measures, patient teaching activities, and assisting patients in meeting their needs where assistance is required. The staff members assist the patient or family in accepting and adapt to the emotional and other stresses that the condition may bring. It also allows for expressing feelings and assists the patient/family work through it. Thus, it is used when the patient receives care and instruction at each stage of the nursing process, providing him or her with physiological and psychosocial comfort.

According to the theory, the CORE is the person or patient to whom nursing care is directed and required. The core (patient) has goals that he or she has set for himself or herself, which must be met. Furthermore, the “core” acted on his feelings and value system. The term “core” in Hall’s theory refers to therapeutic communication to help the patient understand his condition and his life. The goal is to assist patients in understanding their roles in the healing process. Thus, it is realized when the patient can express his or her feelings about the procedure and participates in exploring these feelings, thereby assisting him or her in recovering faster.