Rationalizing Hospital Human Resources: DOH Hospital Rationalization under EO 366

1. Rationalizing Hospital Human Resources: DOH Hospital Rationalization under EO 366 ALEXANDER A. PADILLA Undersecretary of Health Chairperson Change Management Team Good afternoon! I will be presenting hospital human resources in the light of the DOH Rationalization Plan under EO 366. Good afternoon! I will be presenting hospital human resources in the light of the DOH Rationalization Plan under EO 366.

2. Executive Order 366 Directing a Strategic Review of the Operations and Organizations of the Executive Branch and Providing Options and Incentives for Government Employees Who May be Affected by the Rationalization of the Functions and Agencies of the Executive Branch At present, we are mandated by Executive Order 366 ��to �complete the rationalization program for the DOH�.At present, we are mandated by Executive Order 366 ��to �complete the rationalization program for the DOH�.

3. The DOH began as a Board on Health under the new republic established in 1898. We have taken a long stride since then. In 1982, the DOH structures and operations were synchronized with a shift to a parliamentary form of government � hence the Ministry of Health. Under EO 119 in 1986, agencies and programs in the DOH were clustered into Public Health Services, Hospital and Facilities Services, Standards and regulations, and Management Services. Field Offices composed of the Regional Health Offices and Hospital Facilities. Likewise, EO 292 reverted the �Ministry� into a �Department� as the country returned into a Presidential form of government. On August 1992, Memorandum Order 27 was issued by the Office of the President to streamline and improve operations in relation the passage of the Local Government Code (RA 7160). Unfortunately, the restructuring did not push through in keeping with the devolved set up. Finally in 1999, the DOH went through the Rationalization and Streamlining Plan Phase I implementation under EO 102. The DOH began as a Board on Health under the new republic established in 1898. We have taken a long stride since then. In 1982, the DOH structures and operations were synchronized with a shift to a parliamentary form of government � hence the Ministry of Health. Under EO 119 in 1986, agencies and programs in the DOH were clustered into Public Health Services, Hospital and Facilities Services, Standards and regulations, and Management Services. Field Offices composed of the Regional Health Offices and Hospital Facilities. Likewise, EO 292 reverted the �Ministry� into a �Department� as the country returned into a Presidential form of government. On August 1992, Memorandum Order 27 was issued by the Office of the President to streamline and improve operations in relation the passage of the Local Government Code (RA 7160). Unfortunately, the restructuring did not push through in keeping with the devolved set up. Finally in 1999, the DOH went through the Rationalization and Streamlining Plan Phase I implementation under EO 102.

4. PHASE IN Plans for hospitals include: Further upgrading and specialization of services specially for secondary level health facilities Corporate restructuring either as individual corporate hospitals or merging of geographically accessible DOH hospitals as one corporation Increase staffing based on new standards PHASE OUT Plan include: Entrusting/decentralizing primary and secondary services or lower level facilities to the local governmentPHASE IN Plans for hospitals include: Further upgrading and specialization of services specially for secondary level health facilities Corporate restructuring either as individual corporate hospitals or merging of geographically accessible DOH hospitals as one corporation Increase staffing based on new standards PHASE OUT Plan include: Entrusting/decentralizing primary and secondary services or lower level facilities to the local government

5. BASIS OF PROPOSED HOSPITAL STAFFING DBMs Approval of Standard Staffing for Hospitals. Classification of Hospital (Teaching & Training, Research etc.). Percentage of primary and secondary cases. Hospital Conversion Plan. Needed position based on Authorized Bed Capacity (ABC) per Republic Act. The proposed Hospital Staffing is based on the following criteria: The classification of hospital � teaching & training� research� special or specialty hospital� Percentage of primary and secondary cases as a determinant to specialty needs� number of staff� and skill mix Hospital Conversion Plan such as Sanitaria to General Hospitals� hospitals for corporatization Health worker to bed ratio based on the authorized bed capacityThe proposed Hospital Staffing is based on the following criteria: The classification of hospital � teaching & training� research� special or specialty hospital� Percentage of primary and secondary cases as a determinant to specialty needs� number of staff� and skill mix Hospital Conversion Plan such as Sanitaria to General Hospitals� hospitals for corporatization Health worker to bed ratio based on the authorized bed capacity

6. No person will be laid-off or demoted in keeping with existing Civil Service Commission (CSC) rules on reorganization. The worst scenario is redeployment within the DOH system whether it be in the Central Office, CHDs, or DOH Hospitals. As such, one continues to be part of DOH whose services can be counted towards retirement and where security of tenure, given adequate behavior and performance, remains assured. Appointments will be generic in nature with no specific areas of assignment to provide equal opportunities for career path and growth and development (MO VII positions to Director I; or all hospital heads as Chief of Hospital l/ll/lll/lV). Except for USEC and ASEC positions, it is further proposed that appointments be carried by the Secretary of Health. Career Executive Service eligibilities shall however still be required and appointment to ranks still by the Board/President. Hopefully, this will avoid/lessen politics and/or distortion in partisanship Heads of agencies shall have a fixed term of three (3) years and be rotated thereafter. No person will be laid-off or demoted in keeping with existing Civil Service Commission (CSC) rules on reorganization. The worst scenario is redeployment within the DOH system whether it be in the Central Office, CHDs, or DOH Hospitals. As such, one continues to be part of DOH whose services can be counted towards retirement and where security of tenure, given adequate behavior and performance, remains assured. Appointments will be generic in nature with no specific areas of assignment to provide equal opportunities for career path and growth and development (MO VII positions to Director I; or all hospital heads as Chief of Hospital l/ll/lll/lV). Except for USEC and ASEC positions, it is further proposed that appointments be carried by the Secretary of Health. Career Executive Service eligibilities shall however still be required and appointment to ranks still by the Board/President. Hopefully, this will avoid/lessen politics and/or distortion in partisanship Heads of agencies shall have a fixed term of three (3) years and be rotated thereafter.

7. In general, there is no upgrading for entry level positions, however, for some professions, entry level positions will have to be upgraded as required by law (Nurse I position from SG 11 to SG 15 as embodied in the Nursing Act 2004). The grouping of functions will reflect Fourmula One for Health as Framework for health reforms The changes in structure and staffing requirement in the DOH shall have corresponding changes in the allocation particularly in the Personnel Services (PS). This is guided by the principle that the personnel budget shall not exceed the present Personal Allocation Service. As a knowledge organization, the DOH structure shall be built with fewer boxes, a flatter organization with easier dispatch of expertise. In general, there is no upgrading for entry level positions, however, for some professions, entry level positions will have to be upgraded as required by law (Nurse I position from SG 11 to SG 15 as embodied in the Nursing Act 2004). The grouping of functions will reflect Fourmula One for Health as Framework for health reforms The changes in structure and staffing requirement in the DOH shall have corresponding changes in the allocation particularly in the Personnel Services (PS). This is guided by the principle that the personnel budget shall not exceed the present Personal Allocation Service. As a knowledge organization, the DOH structure shall be built with fewer boxes, a flatter organization with easier dispatch of expertise.

8. �Medical Specialist� as an occupational nomenclature shall be used for hospitals facilities. �Medical Officer� on the contrary will be used in the public health sector except for Medical Officer trainees and for service. To appreciate the heirarchy of positions in the hospital, the designation of the �next in line� in the absence of the Chief is as follows: The Chief Medical Professional Staff� the Chief Nurse� The Administrative Officer� the Chief Training Officer� and the Department Heads Performance based budgeting is desired for all hospitals. Somehow, its outcome will determine the approval of additional or a decrease in human resources needs. Outsourcing of services like janitorial, security is like wise desired. It is hoped that this mechanism be expanded to include other services which are not primary mandates of the hospital like laundry and linen, ambulance services, etc� �Medical Specialist� as an occupational nomenclature shall be used for hospitals facilities. �Medical Officer� on the contrary will be used in the public health sector except for Medical Officer trainees and for service. To appreciate the heirarchy of positions in the hospital, the designation of the �next in line� in the absence of the Chief is as follows: The Chief Medical Professional Staff� the Chief Nurse� The Administrative Officer� the Chief Training Officer� and the Department Heads Performance based budgeting is desired for all hospitals. Somehow, its outcome will determine the approval of additional or a decrease in human resources needs. Outsourcing of services like janitorial, security is like wise desired. It is hoped that this mechanism be expanded to include other services which are not primary mandates of the hospital like laundry and linen, ambulance services, etc�

9. Part Time Medical Specialists are allowed to go on private practice even without a permit from the head of agency. For Full Time Medical Specialists, a permit to private practice is necessary. The Hospital (Chief) shall be responsible and accountable to the performance of their staff. Henceforth, the hospital shall at all times, recruit and select competent and qualified hospital personnel and ensure the quality of hospital services. For hospital of the DOH, automatic licensing shall be a mechanism to maintain and sustain health care delivery, hospitals, however, may be downgraded or upgraded based on the compliance to licensing requirements. This will also determine the number and category of human resources required by your hospitals. Under the rationalization, qualification standards for Chiefs of Hospitals is under review. Career Executive eligibilities shall however remain as a requirement for Chiefs of Hospitals. Also under the rationalization plan, hospitals remain to be under the administrative supervision of the CHDs Part Time Medical Specialists are allowed to go on private practice even without a permit from the head of agency. For Full Time Medical Specialists, a permit to private practice is necessary. The Hospital (Chief) shall be responsible and accountable to the performance of their staff. Henceforth, the hospital shall at all times, recruit and select competent and qualified hospital personnel and ensure the quality of hospital services. For hospital of the DOH, automatic licensing shall be a mechanism to maintain and sustain health care delivery, hospitals, however, may be downgraded or upgraded based on the compliance to licensing requirements. This will also determine the number and category of human resources required by your hospitals. Under the rationalization, qualification standards for Chiefs of Hospitals is under review. Career Executive eligibilities shall however remain as a requirement for Chiefs of Hospitals. Also under the rationalization plan, hospitals remain to be under the administrative supervision of the CHDs

10. HOSPITALS CONVERSION OF THE FOLLOWING POS. F R O M T O Medical Center Chief II 27 Chief of Hosp. IV 27 Med. Center Chief I 26 Chief of Hosp. IV 27 Chief of Hosp. III 26 Chief of Hosp. IV 27 Chief of San. III 26 Chief of Hosp. III 26 District Health Off. II 26 Chief of Hosp. III 26 A highlight of the Hospital Rationalization Plan is to reclassify Chief of Hospital positions for a more comprehensible career track and succession planning. As such, the conversion of all position titles to Chief of Hospital as lisited.A highlight of the Hospital Rationalization Plan is to reclassify Chief of Hospital positions for a more comprehensible career track and succession planning. As such, the conversion of all position titles to Chief of Hospital as lisited.

11. HOSPITALS CONVERSION OF THE FOLLOWING POS. F R O M T O Chief of Hosp. II 25 Chief of Hosp. II 25 Chief of San. II 25 Chief of Hosp. II 25 Chief of Hosp. I 24 Chief of Hosp. I 24 Chief of San. I 24 Chief of Hosp. I 24 Entry level Chief of Hospital positions shall start at SG 24 up to SG 27.Entry level Chief of Hospital positions shall start at SG 24 up to SG 27.

12. HOSPITALS District Health Officer I pos. under the Public Health of CHD - Metro Manila will be abolished, if with incumbent it will be declared CTI DHO I pos. in hospital will be converted to CMPS position Creation of Lactation Specialist position HEPO III, SG - 18 East Avenue Medical Center to be included as Corporate Hospital Specific changes in nomenclature are the District Health Officer in a few regions like CHD � Metro Manila. If the position is vacant, it shall be abolished or declared CTI (co-terminus with incumbent) if with a warm body. The position shall be converted to a Chief medical professional Staff position. To strengthen the breastfeeding law/program of government, a lactation specialist position shall be created for all hospitals. And last, as a proposal to the Rat Plan, East Ave. Medical Center shall be included as a corporate hospital in the cluster of corporate hospitals in Quezon City.Specific changes in nomenclature are the District Health Officer in a few regions like CHD � Metro Manila. If the position is vacant, it shall be abolished or declared CTI (co-terminus with incumbent) if with a warm body. The position shall be converted to a Chief medical professional Staff position. To strengthen the breastfeeding law/program of government, a lactation specialist position shall be created for all hospitals. And last, as a proposal to the Rat Plan, East Ave. Medical Center shall be included as a corporate hospital in the cluster of corporate hospitals in Quezon City.

13. In as much as the Hospital Rationalization Plan requires more study and resources, we have requested to the DBM to separate the Hospital Rationalization Plan with that of the Central office and the Centers for Health Development. As to the need for administrative support staff, a contract of service (job order) has been requested with the DBM pending approval of the Hospital Rationalization Plan. Hiring shall however be within the authorized staffing pattern consistent with the DBMs database of plantilla positions in hospitals. The contract of service shall automatically terminate within one month after the approval of the Rat PlanIn as much as the Hospital Rationalization Plan requires more study and resources, we have requested to the DBM to separate the Hospital Rationalization Plan with that of the Central office and the Centers for Health Development. As to the need for administrative support staff, a contract of service (job order) has been requested with the DBM pending approval of the Hospital Rationalization Plan. Hiring shall however be within the authorized staffing pattern consistent with the DBMs database of plantilla positions in hospitals. The contract of service shall automatically terminate within one month after the approval of the Rat Plan

14. HOSPITAL PROPOSAL UPDATES Transfer of employees in the DOH hospitals Note: TPDH - due to devolution Malacanang Clinic - due to Approved Rationalization Plan of the Office of the President Central Office and CHD employees whose functions may be determined as redundant will have the option of transferring to the hospitals. Central Office and CHD employees whose functions may be determined as redundant will have the option of transferring to the hospitals.

15. HOSPITALS This is a complicated structure of the Hospital Rationalization for a teaching and training non-corporate hospital. This is a complicated structure of the Hospital Rationalization for a teaching and training non-corporate hospital.

16. ORGANIZATIONAL STRUCTURE Essentially, it has four major departments. The Medical, Nursing, Finance and Administrative Services. A corporate hospital will have a CEO for its management.Essentially, it has four major departments. The Medical, Nursing, Finance and Administrative Services. A corporate hospital will have a CEO for its management.

17. A summary of the proposed Rat plan shows the increases in the number of positions and its cost allocation.A summary of the proposed Rat plan shows the increases in the number of positions and its cost allocation.

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20. There is a total of 45,508 proposed positions as against an existing 21,459 positions (difference of 24,049 positions) with a total cost of Php 5,969,425,908.00 or an additional PS of Php 3,240,517,841.00 (existing hospital PS Php 2,728,908,066.00)There is a total of 45,508 proposed positions as against an existing 21,459 positions (difference of 24,049 positions) with a total cost of Php 5,969,425,908.00 or an additional PS of Php 3,240,517,841.00 (existing hospital PS Php 2,728,908,066.00)