How to establish and develop a tertiary hospital or medical center
Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg
2003
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)
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:
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.