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How to establish and develop a tertiary hospital or medical center


Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg



Definition of terms:


Establish – means building the structure and furnishing it with facilities


Develop – means formulating, implementing and constantly improving the system


Hospital or medical center – one that has both inpatient (confinement) and outpatient (ambulatory) facilities


Tertiary hospital or medical center – means hospital or medical center based on DOH standards – see DOH standards (generally, one that has sophisticated medical services not only in terms of diagnostic facilities but also treatment capabilities)


Establishment of a tertiary hospital/medical center


Do a feasibility study – in terms of need and financial viability (sustainability included)


Need – for a tertiary hospital/medical center in the community where it is being planned


How many tertiary hospital/medical centers presently in existence in the community?


If there is none, there is a need for one in an urban community.  However, the next thing to consider is viability/sustainability.  Will the citizenry of the community avail and afford to avail the services of the tertiary hospital/medical center to be built?


If there are already existing tertiary hospitals/medical centers, the initial questions to answer are:

-         Is there room for another one? Are the existing hospitals/medical centers (supply) inadequate in terms of demand for hospital confinement?

-         If the present suppliers can meet the demand, can you offer a better alternative (in terms of a better tertiary hospital/medical center) for the citizenry of the community that will be attractive and competitive enough to be financially viable and sustainable?

Better in the sense of better structural set-up, facilities, and quality management system.

Financial viability and sustainability


Consider the following:

1.      Cost of fulfilling the standards required by DOH and PhilHealth

2.      Culture of the community in terms of perception and practices with regards to tertiary hospitals/medical centers

(Do they prefer tertiary hospitals/medical centers over lower level centers/clinics/indigenous health practitioners? Do they prefer going to other cities for their sophisticated health care needs? etc.)

3.      Economic conditions in the community and economic capability of the citizenry for services of a tertiary hospitals/medical centers

4.      Presence of a physician-force to patronize your tertiary hospital/medical center  (adequate and willing at least, if not committed, generalist physicians and specialist physicians to refer patients to the center as well as help manage, build reputation, and market the hospital and its services)

5.      Presence of existing and potential financiers

6.      Location of the tertiary hospital/medical center – accessible to target clients, convenient to go to, with a “captured-client location” by virtue of proximity to clients in constant need of  medical services.



Once a decision is made to establish a tertiary hospital/medical center in a certain location, the next decisions to make are:


  1. Architectural and functional design
  2. Phases of operation



The architectural and functional design will be influenced by the following:

      The concept and vision-mission-goal-objectives of the center

      The functional requirements of the hospital based on

                  The concept and vision-mission-goal-objectives of the center

            Requirements of DOH and other regulatory agencies including international standards


in considerations of the culture of the community, economic capability of the clients, culture of the physician-force, and existing logistics.


The phases of operation will be influenced primarily by the availability of capital (logistics) and marketing strategies, like a particular service should be initially completed to attract clients to the center (example, physicians’ clinic or a specialty medical service unique in the community such as a wellness program).


While the construction of the new hospital is being made, recruitment, selection, motivation and training of physician-managers should be made already.