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    Mapa Institute of Technology

    School of Architecture, Industrial Design & the Built EnvironmentMuralla St., Intramuros, Manila, 1002 Philippines

    (02) 247-5000

    A PROPOSED GENERAL HOSPITALWITH EMERGENCY COMPLEX

    A Thesis Presented to theSchool of Architecture, Industrial Design & the Built Environment

    Mapa Institute of Technology

    In Partial Fulfillment of the Requirementsin Architectural Design 9

    for the Degree of BACHELOR OF SCIENCE IN ARCHITECTURE

    Presented by

    Margarita Yap Pasion2011103148

    Architect Junar Pakingan Tablan, UAP, MSAEAdviser

    December 12, 2014

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    CHAPTER I.I

    The Problem and Its Background

    General Overview

    Finding the right hospital in the Philippines is not considered too difficult as

    there are a number of options to choose from. The Philippines has both private and

    public healthcare institutions. Most of the government hospitals provide quality

    healthcare in the same way private hospitals do.

    Although some people may have misconceptions, most of them are

    unfounded. The main difference between public and private hospitals is the

    facilities and technologies offered. Most of the public hospitals would not be

    equipped to the same standard as the private ones. However, some of the best

    doctors are serving in the government hospitals. Also, most Filipinos would seek

    advice from these government hospitals because fees are not charged. Private

    hospitals are located in key cities throughout the nation and there are also tertiary

    hospitals that have the latest in medical technologies. However, as you would

    expect, private hospitals are more expensive.

    Introduction

    A visit to a general hospital traumatizes many people. The basis for the fear,

    even more than lack of familiarity with procedures and a feeling of helplessness,

    may stem from the perception of invasion of ones personal space.

    During an emergency, a person is most vulnerable, both emotionally and

    physically. One factor is that a persons territorial limits are invaded by strangers

    who poke and push. Is it any wonder that a visit to the hospital can intimidate even

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    the strongest among the people? How, then, can architects break through this

    barrier for the doctors to examine and treat patients without arousing

    uncomfortability and anxiety?

    Patient s atisfaction is the buzzword. Its the difference between providing

    what a patient needs and what a patient wants. Once the patient walks in the

    hospital, the lobby or the receiving area should establish immediate rapport and

    put the patient at ease. First impressions are very important. Overcrowding, grimy

    spots on floors and walls, and other nauseating / disarranged sights may give

    patients a message that the hospital does not care about patient comfort. No doubt,

    its more a matter of heavy workloads. But perception is reality. It may subliminally

    suggest that the hospital is out dated on medical matters as well, which can lead to

    a lack of confidence and breed anxiety in the patient.

    Waiting is one of the frustrations that often accompanies a visit to the

    hospital. Regular patients who visit their doctors from time to time will accept

    waiting, realizing that doctors cannot always schedule appointments accurately.

    Some patients, however, especially those in an emergency situation, have a

    different attitude and are not willing to accept discomfort or inconvenience without

    complaints.

    Excessive waiting leads to anxiety and great worries, and hospitals that

    make a continual practice of overbooking are, perhaps without realizing it,

    offending their patients concluding their failure in medical service.

    Background of the Study

    Hospitals serve as the locus of health care delivery in the Philippines. Survey

    data shows that most households go directly to hospitals for treatment of illnesses.

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    With the breakdown of referral networks due to devolution, tertiary level hospitals

    which are designed to cater to more serious diseases are also accommodating cases

    that can be handled by lower level facilities. This leads to tertiary hospitals

    requiring more resources to be able to attend to all its patients.

    When most people need a hospital, they generally wind up at a big, public

    one. Public hospitals can't turn anyone away, so you're sure to receive treatment

    when you visit one. Because they are publicly funded and not for profit, they are

    usually a lot more affordable than private hospitals. Due to their size, they also

    usually have a lot more beds than private hospitals.

    As for the drawbacks of public hospitals, their sheer size is a big one.

    Although they have way more employees than private hospitals, patient-to-doctor

    ratios don't tend to be very good. You are almost certain to wait for a while when

    visiting the emergency room. Depending on the time of day and the nature of your

    emergency, you could wait for hours before being seen. There doesn't tend to be

    much in the way of personalized care because nurses are often overloaded with

    patients. After all, public hospitals can't refuse anyone, and they must accept

    patients who have been turned down by private hospitals.

    Statement of the Problem

    Hospitals are the most complex of building types. Each hospital is comprised

    of a wide range of services and functional units. These include diagnostic and

    treatment functions, such as clinical laboratories, imaging, emergency rooms, and

    surgery; hospitality functions such as food service and housekeeping, and the

    fundamental inpatient care or bed-related function.

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    In this study, the proposed general hospital seeks to answer the following

    questions:

    1. How will it solve the disarranged and nauseous condition of existing

    emergency departments of public hospitals in the Philippines?

    2. How will the proposed general hospital be effective in terms of healing

    quality as with a private medical institution?

    3. What will be the innovation/outstanding feature of this project compared

    to other hospitals?

    Project Goals, Objectives and Strategies

    The emphasis of the research is to (1) provide an architectural solution to

    the disarranged and tousled emergency department of general hospitals that leads

    to mistreatment and slow recovery of the patients; and (2) to offer the poverty-

    stricken people the same healing environment as with a private medical institution.

    The proposed general hospital is addressed to all public, especially to the urban

    poor whom lifestyles are hazardous and involves life-threatening activities in their

    everyday life.

    The study will focus more on the hospitals most direct and immediate reach

    of public which is the Emergency Department.

    Unlike any medical institutions, this project will have an emergency complex

    which will include facilities and amenities deemed necessary to cater the patients,

    their kin, and as well as the whole emergency team.

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    Significance of the Study

    The proposed study is aimed to be the Philippines first general h ospital that

    specializes in Emergency Medicine. It appears that the ultimate aim to create ahealing environment is not given attention by healthcare designers. With this

    research, proper designing of the facility could be further studied for future

    application towards a functional hospital with an efficient emergency complex.

    Scope and Limitation

    This study will only be limited on the architectural design and planning of a

    general hospital and it will be focused on the emergency facility: its structural

    design, functionality, space planning, and circulation that incorporate an effective

    healing quality. It will also be subjected to further exploring of new ideas

    concerning health facility designing.

    Assumptions

    Several methods of research will be used in completing the study. The

    researcher assumes that these methods will help and will be able to ensure a

    strong and successful outcome of the proposed project.

    Conceptual Framework

    The Problemand Analysis

    Data Gatheringand Methodsof Research

    Summary ofResults &Findings

    Formulation ofArchitectural

    SolutionsConclusion

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    Definition of Terms

    1. General Hospital - a hospital in which patients with many different types

    of ailments are given care.

    2. Emergency Department - a medical treatment facility specializing

    in acute care of patients who present without prior appointment, either

    by their own means or by ambulance. The emergency department is

    usually found in a hospital or other primary care center.

    3. Public Hospital - a hospital which is owned by a government and

    receives government funding. In some countries, this type of hospital

    provides medical care free of charge, the cost of which is covered by the

    funding the hospital receives.

    4. Healthcare Facility - in general, any location where health care is

    provided. Health facilities range from small clinics and doctor's

    offices to urgent care centers and large hospitals with elaborateemergency rooms and trauma centers.

    5. Health Services - include all services dealing with the diagnosis and treatment of

    disease, or the promotion, maintenance and restoration of health.

    6. Hospital - a health care institution providing patient treatment with

    specialized staff and equipment. The best-known type of hospital is the

    general hospital, which has an emergency department. A district hospital

    typically is the major health care facility in its region, with large numbers

    of beds for intensive care and long-term care.

    7. Innovation - is a new idea, device or process. Innovation can be viewed

    as the application of better solutions that meet new requirements, in

    articulated needs, or existing needs.

    http://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Ambulancehttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Primary_carehttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Governmenthttp://en.wikipedia.org/wiki/Clinichttp://en.wikipedia.org/wiki/Doctor%27s_officehttp://en.wikipedia.org/wiki/Doctor%27s_officehttp://en.wikipedia.org/wiki/Urgent_carehttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Emergency_roomhttp://en.wikipedia.org/wiki/Trauma_centerhttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Emergency_departmenthttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Intensive_carehttp://en.wikipedia.org/wiki/Emergency_departmenthttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Trauma_centerhttp://en.wikipedia.org/wiki/Emergency_roomhttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Urgent_carehttp://en.wikipedia.org/wiki/Doctor%27s_officehttp://en.wikipedia.org/wiki/Doctor%27s_officehttp://en.wikipedia.org/wiki/Clinichttp://en.wikipedia.org/wiki/Governmenthttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Primary_carehttp://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Ambulancehttp://en.wikipedia.org/wiki/Acute_(medicine)
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    8. Healing the process of the restoration of health to an unbalanced,

    deceased, or hurt person.

    9. Complex - a group of similar buildings or facilities on the same site.

    10. Department of Health the executive department of the Philippine

    government responsible for ensuring access to basic public health

    services by all Filipinos through the provision of quality health care and

    the regulation of all health services and products. It is the government's

    over-all technical authority on health.

    11. Medical Institution an institution created for the practice of medicine.

    12. Sustainable Design - is the philosophy of designing physical objects, the

    built environment, and services to comply with the principles

    of social, economic, and ecological sustainability.

    Acronyms

    1. DOH Department of Health

    2. PCEM Philippine College of Emergency Medicine

    3. AREMP Asosasyon ng mga Residente ng Emergency Medicine sa

    Pilipinas

    http://en.wikipedia.org/wiki/Executive_Departments_of_the_Philippineshttp://en.wikipedia.org/wiki/Politics_of_the_Philippineshttp://en.wikipedia.org/wiki/Politics_of_the_Philippineshttp://en.wikipedia.org/wiki/Public_healthhttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Societyhttp://en.wikipedia.org/wiki/Economyhttp://en.wikipedia.org/wiki/Ecologyhttp://en.wikipedia.org/wiki/Sustainabilityhttp://en.wikipedia.org/wiki/Sustainabilityhttp://en.wikipedia.org/wiki/Ecologyhttp://en.wikipedia.org/wiki/Economyhttp://en.wikipedia.org/wiki/Societyhttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Public_healthhttp://en.wikipedia.org/wiki/Politics_of_the_Philippineshttp://en.wikipedia.org/wiki/Politics_of_the_Philippineshttp://en.wikipedia.org/wiki/Executive_Departments_of_the_Philippines
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    CHAPTER I.2

    Review of Related Literature and Studies

    Related Literature

    The following article is a review about the Philippi ne General Hospitals Condition,

    taken from http://www.reviewstream.com/

    The Philippine General Hospital, the largest government hospital in the

    Philippines has been operating for almost 100 years. It is in a very

    conspicuous location along Taft Avenue, Ermita Manila. People are so

    familiar with this very popular hospital which is tagged as the biggest

    hospital for the poor people. However Ive seen many people who are

    not poor and yet going to this hospital because of the proven expertise

    of the doctors and all health care providers here.

    But one thing discouraging about this hospital is its inability to cope

    with the number of patients. Ive experienced this hospital so many

    times in the past and each time Id go to there, I could not help but pity

    the poor people who could not afford private hospitals. Indeed this

    hospital is the biggest in the country as according to record, it occupies

    10 hectares of land with 45 interconnected and stand-alone buildings,

    and 125,000 square meters of floor area.

    It has 19 clinical 1500 patient beds of which 1000 are for charity, 500

    are for paying patients and special units. However, the number of poor

    people different illness is overflowing and PGH could not give them

    immediate care. The poor patients have to bear the long queue at the

    admission before they could be admitted.

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    It will take you hours before you could be attended to because the

    patients are just too many that the health care providers could not

    really cope. Another discouraging thing about this government hospital

    is only the fact that patients have to pay for the medicine. Only the

    ward and the doctors services are free so if you dont have money to

    buy medicine you will die just the same.

    Ive witnessed many patients who died on that kind situation when m y

    mother was once admitted in that hospital. My mother once suffered a

    mild stroke and was rushed in this Hospital one time. While we arrived

    there at 5:00 pm my poor mother was only given the chance to have a

    room at past midnight.

    Even if we were actually not getting a free ward, no available pay room

    was given immediately to her either. It was disheartening to see my

    mother on a stretcher and yet could not be given immediate attention.

    And while we were on queue, many emergency cases on queue endedup at the morgue.

    It was really a terrible experience to see people dying without having

    given enough immediate attention. Another problem is that never

    ending queuing. It is not only during admission, even for all laboratory

    tests, the patients have to queue.

    It was really so hard. We had to bear the long queues for many times

    and the results even took too long. If there is one thing that really made

    me sad about this hospital this is the extremely slow procedures.

    Yes the doctors and staff are mostly nice but I wish they could be faster

    in serving and much more caring of their patients difficult state.

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    Despite the hard and long procedures to go through, this hospital can

    boast of the best doctors in town and has managed to acquire state-of-

    the-art medical equ ipment. Ive seen how the renovation of facilities has

    been undergoing over and again but despite this I have yet to see

    promptness in the way they deliver the medical services.

    Next is a review for the existing condition of St. Lukes Medical Center, BGC. Joyce

    Santos wrote:

    Around 8 am, my mom was admitted at the ER of this hospital for high

    blood pressure (200/105). They had her undergo an MRI. I arrived at

    the hospital around 11am. The doctor arrived shortly and told us the

    the MRI results revealed she was ok, there were areas in her brain that

    were cloudy but these could have been blockages that resolved on their

    own. Then he asked my mom if she wanted to be confined overnight for

    observation, we agreed. We waited for a room until 3pm. Around this

    time two doctors (1 consultant and 1 resident) came in and did a

    physical exam (some tapping here and there). Then the consultant said

    mom was ok. After a few minutes the resident doctor came back and

    told us mom was ok (AGAIN...) BUT they wanted her to stay at the

    Acute Stroke Unit (ASU).

    Naturally, me and my mom asked why. They could not give a

    categorical answer. They just kept repeating that she needs close

    monitoring. Note that a few hours ago my mom's attending physician

    informed us that my mom was free to go OR she could stay overnight

    IF SHE WANTS TO. My mom refused to be confined at the ASU. At this

    point, I noticed that the doctors were showing signs of agitation over

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    the issue. They even told us to get a private nurse if my mom insists to

    be admitted in a private room.

    Around 4pm, they wheeled my mom to undergo MRA (Magnetic

    Resonance Angiogram). The procedure costs roughly 19k. Since my

    mom was out of earshot, I talked to one of the doctors. I insisted they

    tell me the basis for their recommendation that my mom should be

    confined at the ASU. After persistent probing, the resident doctor

    reluctantly told me "she thinks" my mom suffered a mild stroke. I was

    beyond shocked. I angrily told them they should have told my mom or

    us relatives earlier and reminded them that the purpose of bringing my

    mom to the hospital was to seek medical opinion and treatment.

    My mom arrived from MRA, and I instantly saw she was beyond upset.

    She told me she overheard the doctors conversing about her being

    stubborn for refusal to be confined at the ASU. She wants to be

    discharged and just go home. I told the doctors my mom wants to bedischarged and that we will seek 2nd opinion at St. Luke's Quezon

    City. And because they could not do anything, they let us go after

    signing a waiver. The attending physician who initially told us we could

    go home or stay overnight for observation now told me he mentioned

    my mom suffered a mild stroke. I was no longer paying attention to

    their attempt of damage control. We just wanted to go home. My mom

    was admitted because of high blood pressure; but this hospital, staff

    and doctors were stressing my mom instead of making her feel better.

    End note: Through my mom's medical insurance (Intellicare), we were

    billed Php42k for my mom's stressful stay at the ER of this hospital. I

    was informed that my mom won't even be getting any prescription

    because of her refusal to be confined at their ASU. The results of the

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    MRA was not explained to her despite payment of 19k for the

    procedure. The doctors were unprofessionally conversing within

    earshot about my mom and her resistance to their baseless

    recommendations. I honestly thought this hospital is at competitive

    level with Asian Hospital. Well the answer is a big NO.

    Related Studies

    Ambulatory Care

    In the last 30 years or so, the health care industry has increasingly

    been moving toward greater emphasis on ambulatory care. The

    increasing availability of procedures that can be successfully

    completed without an overnight stay in the hospital has led to a

    proliferation of freestanding ambulatory care centers. Many of these

    centers are performing sophisticated surgeries and complicated

    diagnostic procedures. Frequently, these centers are not affiliated, or

    are only loosely affiliated with, other hospitals in the community. The

    emphasis on the ambulatory care had a profound effect on the

    healthcare industry, leading to the reduction in the number of

    hospital beds and, in many cases, closing of hospitals because of the

    reduced demand for overnight stays. At the same time, hospitals had

    to increase their own role in ambulatory care to remain competitive.

    As the freestanding ambulatory facilities took an ever-increasing

    market share, many hospitals had to downsize, and in some cases,

    scale back even their surgical capacity. In many respects, this

    development has diminished the capacity of medical facilities to care

    for the casualties in the event of a disaster, because most of the

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    freestanding ambulatory care centers are not suitable for post-

    disaster emergency care. There are several reasons for this:

    They do not have dedicated emergency departments or

    adequate facilities and equipment to deal with trauma patients.

    They are not available or staffed on a 24-hour, 7 days-a-week

    basis.

    They are not adequately equipped with emergency

    communications systems.

    The staff is not experienced or well trained to care for the types

    of patients and injuries expected in post-disaster emergencies.

    Major Issues and Trends Impacting Health and Hospital Planning,

    Design, Construction, Operation and Maintenance

    Basic questions such as environmental, physical, mental and

    spiritual health and wellbeing are often overlooked in the rush todesign health and hospital facilities.

    Access

    If the public cannot reach a healthcare facility because of its location

    or lack of infrastructure, it might as well not exist. Easy access by

    foot, bicycle, scooter and motorcycle, public transportation (buses,

    jitneys, taxis, vans, trains, ambulance), automobile and/or helicopter

    is vital.

    Quality

    Once people arrive, there must be a high level of quality and

    competent care, qualified and available physicians and allied health

    professionals that are readily available and accessible. Quality care

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    can be measured and compared to national and international norms,

    average life spans and causes of illness and death.

    Alignment of care and expertise

    Designing and building health facilities without thoroughly thinking

    through the patient population and their health problems. The type of

    allied professionals needed, and the type and scope of health and

    hospital facilities needed is simply not solving the 'whole' problem.

    Care providers must develop comprehensive disease-fighting

    strategies, rather than just constructing new buildings. This requires

    an understanding of the causes of illness and death in a region of the

    world and how to prevent, diagnose and treat and rehabilitate people

    from the effects of these diseases.

    Funding, staffing and operating health and hospital facilities

    In some parts of the world more competition between health networks

    effectively lowers costs. In other parts of the world, collaboration and

    cooperative approaches work better in controlling costs. When

    designing and building health and hospital facilities one must keep in

    mind that the life cycle project costs over the years dwarf the original

    construction costs. In some cases, expensive health and hospital

    facilities have been built and a country has not budgeted for the

    operating costs, or coordinated and planned the allied health

    professionals or the proper staffing requirements.

    Demographics

    Trends in demographic facts and the life expectancy of population

    sectors have to be determined. Some regional populations are growing

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    at an accelerating rate, while others have a significant aged

    population and fewer births.

    Understanding the causes of and prevention of illness and death

    Different parts of the world face diverse threats to human existence,

    ranging from water-borne diseases to malaria and chronic diseases;

    each cause of illness and death requires a unique prevention and

    treatment approach. Many diseases can be prevented by undertaking

    proper and appropriate education and environmental measures.

    Numerous areas of the world have built an excellent system of

    curative care, but much more must be done to create an equally

    excellent system of preventive care. Health education in the home,

    community at large and particularly in the school systems is vital.

    Trends

    Patient safety

    One of the greatest issues in healthcare design and operation is

    patient safety, and a great amount of evidence demonstrates that

    planning and design decisions have a direct impact on this. Evidence-

    based design strategies to reduce safety concerns such as patient falls

    may include providing handrails, designing flush flooring transitions

    and requiring direct, unobstructed pathways to frequently-used areas

    such as bathrooms.

    Sustainability

    A hospital building is one of the highest consumers of energy, and

    sustainable design is essential in reducing the consumption of

    natural res ources and reducing a facilitys life cycle costs. It is vital

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    that the principles of lean design, lean operations and standardized

    design be applied to minimise waste of all types.

    Impact and opportunities of technology

    The changes that have occurred and will occur due to constantly

    accelerating rates of technological advances are enormous. These will

    include changes in:

    Communications

    Telemedicine

    Energy

    Innovations in facility planning and management

    Hand-in-hand with design, construction and operation there must be

    qualified innovations in facility management and planning such as

    Building Information Modeling and Integrated Project Delivery.

    Speciality facilities and / or departments

    Critical care inpatient hospitals will have speciality units for (ICU)

    Intensive Care Units, (CCU) Coronary Care Units, (MICU) Medical

    Intensive Care Units, (SICU) Surgical Intensive Care Units, recovery

    rooms, and emergency rooms that require specialised facilities and

    departments.

    Advances in research

    Genetic research and advances are in their infancy and will play a key

    role in preventing and predicting disease. New breakthroughs in the

    early detection of disease, new pharmaceuticals and treatment of

    disease will constantly change the way health and hospital facilities

    will need to be designed, built, managed and operated.

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    Conclusion

    The design of appropriate health and health facilities for large

    populations requires above all a broad understanding of the overall

    culture, specific health issues and available health professionals

    before appropriate facilities can be successfully planned,

    programmed, designed, built, operated and maintained.

    Related Projects

    St. Lukes Medical Center, Bonifacio Global City

    The Bonifacio Global City branch in Metro Manila opened on 16

    January 2010, and has become a favored hospital for politicians,

    businessmen, celebrities, and medical tourists. It also has several

    restaurants and basements. Located in the midst of business,

    commercial establishments, and residential communities, St. Luke's

    Medical Center-Global City has 14-story, 628-bed nursing tower with a

    helipad and a sprawling podium that houses the ancillary services. It

    also has a multilevel parking area with more than 1,100 slots.

    A Total Approach to Healing

    St. Luke's provides patients with the best quality healthcare by

    combining the most advanced medical equipment and technology with

    the expertise of the highly trained, skilled, and experienced physicians

    and professionals. On top of its unparalleled patient care, St. Luke's

    offers a wide range of support services to address patients' every

    possible need.

    http://en.wikipedia.org/wiki/Bonifacio_Global_Cityhttp://en.wikipedia.org/wiki/Metro_Manilahttp://en.wikipedia.org/wiki/Metro_Manilahttp://en.wikipedia.org/wiki/Bonifacio_Global_City
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    CHAPTER I.3

    Research Methodology

    Research Design & Instruments

    Basically, the design of research explores and describes the situation or

    experiences of people in different types of hospitals, events and their relationships

    as a case study. Moreover, research allows the exploration and understanding of

    complex issues and the life experience of a phenomenon for a person or group of

    people. Consequently, a hospital is a complex design and service to meet a variety

    of categories and type of end-users.

    Descriptive research method is used in this study. The research is focused

    on current problems and issues of existing public hospitals in the Philippines. Case

    study, interview, and survey are involved in the research design.

    As mentioned, the researcher used a walkthrough to observe behaviors and

    activities being done by hospital users. Environment and activities related to

    spatial-relationship and surrounding is used to determine the usability variables.

    The case study will be done by analysis of the space and movements of the hospital

    assessing different qualities of functions of environment.

    At the same time Interviews had been used to support patients and medical

    staff without disturbing their activities, and it took place in a personal meeting,

    according to the expressed wish of the researcher.

    Lastly, survey is involved to gather the patients satisfaction on the hospital.

    It will know in-depth personal information around the topic and related issues.

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    The methods aim to know the uses, new uses and misuses of design,

    recognized needs by getting the story behind a respondent s experiences.

    The Case Study

    Amang Rodriguez Medical Center, Marikina City

    Amang Rodriguez Medical Center (ARMC) is a 150-bed medical center

    located in Marikina City. It caters to residents of Marikina, Antipolo, part

    of Pasig and the municipalities of Cainta, San Mateo and Rodriguez in Rizal. It also

    serves as a research and training venue for health personnel in their chosen field of

    expertise.

    The hospital was initially conceived in the minds of then Rizal Governor

    Isidro S. Rodriguez and the late Mayor Osmundo de Guzman of Marikina, who

    dreamed of a community hospital that would provide the necessary health services

    for the residents of Marikina and its adjoining towns. This gained the support of

    Senator Jovito R. Salonga who then sponsored a bill which was approved by

    Congress as Republic Act 3662 of 1964 which mandated the creation,

    establishment, operation and maintenance of Eulogio Rodriguez Sr. Memorial

    Hospital.

    http://en.wikipilipinas.org/index.php/Marikinahttp://en.wikipilipinas.org/index.php/Antipolohttp://en.wikipilipinas.org/index.php/Pasighttp://en.wikipilipinas.org/index.php/Caintahttp://en.wikipilipinas.org/index.php?title=San_Mateo&action=edit&redlink=1http://en.wikipilipinas.org/index.php?title=Rodriguez&action=edit&redlink=1http://en.wikipilipinas.org/index.php/Jovito_R._Salongahttp://en.wikipilipinas.org/index.php?title=Eulogio_Rodriguez_Sr._Memorial_Hospital&action=edit&redlink=1http://en.wikipilipinas.org/index.php?title=Eulogio_Rodriguez_Sr._Memorial_Hospital&action=edit&redlink=1http://en.wikipilipinas.org/index.php?title=Eulogio_Rodriguez_Sr._Memorial_Hospital&action=edit&redlink=1http://en.wikipilipinas.org/index.php?title=Eulogio_Rodriguez_Sr._Memorial_Hospital&action=edit&redlink=1http://en.wikipilipinas.org/index.php/Jovito_R._Salongahttp://en.wikipilipinas.org/index.php?title=Rodriguez&action=edit&redlink=1http://en.wikipilipinas.org/index.php?title=San_Mateo&action=edit&redlink=1http://en.wikipilipinas.org/index.php/Caintahttp://en.wikipilipinas.org/index.php/Pasighttp://en.wikipilipinas.org/index.php/Antipolohttp://en.wikipilipinas.org/index.php/Marikina
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    Construction started in 1965 and by May 15, 1966, it was blessed and

    inaugurated as the "Marikina Emergency Hospital" with an authorized bed capacity

    of 25. It was opened the following day to dispensary patients with Dr. Jose Paz,

    Senior Resident Physician from Morong Emergency Hospital, as Officer-in-Charge.

    How emergency room works:

    Emergency Room Patients

    One of the most amazing aspects of emergency medicine is the huge range of

    conditions that arrive on a daily basis. No other speciality in medicine sees the

    variety of conditions that an emergency room physician sees in a typical week.

    Some of the conditions that bring people to the emergency room include:

    Car accidents

    Sports injuries

    Broken bones and cuts from accidents and falls

    Burns

    Uncontrolled bleeding

    Heart attacks, chest pain

    Difficulty breathing, asthma attacks, pneumonia

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    Strokes, loss of function and/or numbness in arms or legs

    Loss of vision, hearing

    Unconsciousness

    Confusion, altered level of consciousness, fainting

    Suicidal or homicidal thoughts

    Overdoses

    Severe abdominal pain, persistent vomiting

    Food poisoning

    Blood when vomiting, coughing, urinating, or in bowel movements

    Severe allergic reactions from insect bites, foods or medications

    Complications from diseases, high fevers

    Understanding the ER Maze

    The classic emergency room scene involves an ambulance screeching to a

    halt, a gurney hurtling through the hallway and five people frantically working to

    save a person's life with only seconds to spare. This does happen and is not

    uncommon, but the majority of cases seen in a typical emergency department

    aren't quite this dramatic. Let's look at a typical case to see how the normal flow of

    an emergency room works.

    Triage

    When a person arrives at the Emergency Department, the first stop is triage.

    This is the place where each patient's condition is prioritized, typically by a nurse,

    into three general categories. The categories are:

    Immediately life threatening

    Urgent, but not immediately life threatening

    Less urgent

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    This categorization is necessary so that someone with a life-threatening

    condition is not kept waiting because they arrive a few minutes later than someone

    with a more routine problem. The triage nurse records vital signs (temperature,

    pulse, respiratory rate and blood pressure) . She also gets a brief history of your

    current medical complaints, past medical problems, medications and allergies so

    that she can determine the appropriate triage category.

    Registration

    After triage, the next stop is registration - not very exciting and rarely seen

    on TV. Here they obtain your vital statistics. You may also provide them with your

    insurance information, Medicare, PhilHealth or HMO card. This step is necessary to

    develop a medical record so that your medical history, lab tests, X-rays, etc., will all

    be located on one chart that can be referenced at any time. The bill will also be

    generated from this information.

    If the patient's condition is life-threatening or if the patient arrives by

    ambulance, this step may be completed later at the bedside.

    Examination Room

    Now is the exam room. Some emergency departments have been subdivided

    into separate areas to better serve their patients. These separate areas can include

    a pediatric ER, a chest-pain ER, a fast track (for minor injuries and illnesses),

    trauma center (usually for severely injured patients) and an observation unit (for

    patients who do not require hospital admission but do require prolonged treatment

    or many diagnostic tests).

    Once the nurse has finished her tasks, the next visitor is an emergency-

    medicine physician. He gets a more detailed medical history about your present

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    illness, past medical problems, family history, social history, and a complete review

    of all your body systems. He then formulates a list of possible causes of symptoms.

    This list is called a differential diagnosis. The most likely diagnosis is then

    determined by the patient's symptoms and physical examination. If this is

    inadequate to determine the diagnosis, then diagnostic tests are required.

    Diagnostic Tests

    When the tricky diagnosis of appendicitis is considered, blood tests and a

    urinalysis are required.

    The patient's blood is put into different colored tubes, each with its own

    additive depending on the test being performed:

    A purple-top tube is used for a complete blood count (CBC). A CBC

    measures: 1) The adequacy of your red blood cells, to see if you are

    anemic. 2) The number and type of white blood cells (WBCs), to

    determine the presence of infection. 3) A platelet count (platelets are a

    blood component necessary for clotting)

    A red-top tube is used to test the serum (the liquid or non-cellular half of

    your blood).

    A blue-top tube is used to test your blood's clotting.

    Diagnosis and Treatment

    When the emergency physician has all the information he can obtain, he

    makes a determination of the most likely diagnosis from his differential diagnosis.

    Alternately, he may decide that he does not have enough information to

    make a decision and may require more tests. At this point, he speaks to a general

    surgeon -- the appropriate consultant in this case. The surgeon comes to see you

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    Physicians must pass an all-day written exam and an all-day oral exam to

    become board certified in emergency medicine. As of 2001, there were

    approximately 32,000 emergency physicians practicing in the Philippines, of which

    17,000 were certified by the DO H.

    Emergency Nurse

    The emergency nurse comes to the team in a number of ways. One way is

    completing a four-year degree in college to obtain a BSN. (bachelor of science in

    nursing). Alternately, a nurse may complete a three-year diploma program (usually

    at a hospital) or a two-year associates degree program (usually at a community

    college). After completing any of these academic endeavors, the nursing graduate is

    eligible to take a licensing exam. After passing this exam, the nursing graduate

    becomes an RN (registered nurse) and can practice nursing. Many emergency

    nurses take an additional exam to become a CEN (Certified Emergency Nurse) .

    Physician Assistant

    Many emergency departments utilize physician assistants (PA). PAs work

    under the supervision of an emergency physician. They can examine, diagnose and

    treat patients (usually the less complicated ones) and review their findings with the

    physician. In most states, they can prescribe medications. Typically, a PA has at

    least two years of college (most have a four-year degree) and some health-care

    experience before completing a two-year program to become a physician assistant.

    An exam is required to become licensed.

    Emergency Department Technician

    Many emergency departments have emergency technicians who perform a

    variety of tasks depending on the institution and state laws. Some of these tasks

    may include taking your vital signs, drawing your blood, starting your IV,

    performing EKGs, transporting you to and from various tests, and providing aid

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    and comfort to family and friends. Training varies widely, but these technicians are

    often ambulance personnel or else are trained through the hospital.

    Unit Secretary

    This essential member of the team is one you don't hear about very often.

    He/she often handles the communication needs of the ER. A few important

    examples of important communication needs include the emergency physician

    needing to speak to the patient's family physician, families calling about their loved

    ones, family physicians needing to inform the emergency department about

    patients being sent in, or patients calling in needing medical advice. Also, he/she

    coordinates the ordering of diagnostic tests.

    Physicians in Training

    At teaching hospitals, you may be examined by an intern or resident.

    Teaching hospitals are hospitals that have training programs for physicians and

    are usually affiliated with a medical school. Interns are in their first year of training

    after graduating medical school. After the first year, the physician in training is

    called a resident. These physicians are supervised by an attending physician who

    usually has extensive experience in emergency medicine.

    Tools of the Trade

    Emergency Departments are stocked with a huge array of strangely named,

    oddly shaped, beeping and blinking equipment. Here's a quick look at a typical

    lineup.

    Stethoscope

    A stethoscope doesn't beep or blink, but it is an incredibly useful diagnostic

    tool. A stethoscope lets a nurse or physician listen to heart and respiratory sounds.

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    Suture Tray

    This tray contains the sterile equipment needed to place sutures (stitches) in

    a patient with a laceration. These include: needle holder (the instrument that holds

    the needle containing the suture material), forceps (used to hold the lacerated

    tissue), sterile towels (used to drape off the non sterile areas which are not being

    repaired), scissors, and small bowls (to hold antiseptic solutions).

    Orthopedic Equipment

    Most emergency departments have a generous number of orthopedic devices

    for many purposes. These include plaster and/or fiberglass materials to splint

    extremities that are fractured or severely injured. You'll also find pre-made splints

    for specific joints, such as knee immobilizers, aluminum finger splints, Velcro wrist

    splints, shoulder slings, air splints (for ankles), and cervical collars, as well as cast

    cutters to use when a cast has become too tight.

    Disposition

    Depending on a patient's specific medical condition, physicians will either

    admit the patient to the hospital, discharge the patient, or transfer the patient to a

    more appropriate medical facility.

    If you are discharged, you will receive discharge instructions (either written

    specifically for you or pre-printed) that explain your medications and other

    treatments. If medications are prescribed, you may receive a beginning dose if there

    are no pharmacies open in your area at that particular time. You will also be

    referred for follow-up care should your condition continue or worsen.

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    You may need to be transferred if your condition is better treated at another

    institution. You may have to sign a consent form if your condition or mental state

    allows.

    The modern emergency department performs an important role in our

    society. It really is a marvelous invention that has saved countless lives. Hopefully,

    the information in this article will help ease your fears should you need the services

    of an emergency department in the future.

    The Interview - Reynante E. Mirano, MD, FPCEM

    Dr. Ryan, as he is often called by his colleagues

    and friends is one of the pioneers of Emergency Medicine

    in the Philippines. As one of the founding members of

    the Philippine College of Emergency Medicine and Acute

    Care (PCEMAC), he worked tirelessly to promote and

    advance the practice of emergency medicine in our

    country. Notwithstanding humble beginnings, Doc Ryan finished his medical

    degree at the University of Santo Tomas and proceeded to complete his emergency

    medicine residency training at the Makati Medical Center.

    He recalls it was not easy to practice EM in the past. He juggled several

    duty shifts in between family activities and hospital administrative tasks. Early in

    his practice, he was entrusted with the care of the Emergency Department (ED) as

    chair of the S t. Lukes Medical Center (SLMC), Emergency Department

    Services. Recognizing the need to develop future EM specialists, he and his fellow

    EM consultants established the residency training program in SLMC. Since then, a

    long line of doctors have experienced his firm yet quiet leadership as well as his

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    warm and encouraging mentorship. His passion for teaching is reflected not only

    in the ED but also in the College of Medicine (SLMC-William H. Quasha Memorial)

    where he is clinical associate professor. In spite of his busy schedule, he has even

    found the time to educate and train health care professionals on disaster risk

    management as HOPE (Hospital Preparedness for Emergency) instructor and on

    resuscitation as Advanced and Basic Life Support Instructor.

    Stay focused and committed to your career, is his advice to younger

    consultants who he continues to inspire with his hard work and perseverance.

    Population and Sampling

    The study was conducted on 30 patients in the selected hospital. Study

    sample of 30 patients was selected using convenient sampling technique, where 30

    patients were selected from each hospital by taking 10 patients from each ward i.e.

    emergency (10), orthopedics (10) and maternity and pediatrics (10).

    Patients recruited who were of more than 18 years of age, conscious, had a

    stay of more than a week in hospital and were willing to participate in study.

    However, patients with sensory impairment, disoriented patients, patients with

    psychiatric illness and who were not willing to participate in study were excluded

    from study sample.

    This was a non-experimental study; however, permission was obtained from

    the medical director, competent authorities of the hospitals and departments.

    Furthermore, an informed consent was from each study subject and confidentiality

    of information and anonymity of subjects was ensured. The respondents were given

    freedom to participate or quit out the study without any harm or discrimination;

    furthermore, patients' comfort was maintained during survey.

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    CHAPTER I.4

    Summary of Findings and Analysis

    Presentation of Collected Data

    Patient satisfaction has become an important indicator to measure the

    quality of care rendered to the patients while in hospital. Healthcare

    institutes have often used patients' outcome as measures to evaluate the

    health care services provided to patients. Patient satisfaction surveys can

    help identify ways of improving nursing and health care services. However,

    in this scenario there is a lack of empirical evidences on this subject of

    inquiry. Therefore, this study was planned to assess the patient satisfaction

    with healthcare facilities. It was found that in government hospitals mean

    percentage of patients' satisfaction score was 67.6 percent of the total score;

    while in private hospitals mean percentage of patients' satisfaction score

    was 84.2 percent of the total score. This shows that patients in private

    hospitals were more satisfied with nursing care as compared to government

    hospitals; t-test was applied to see the statistical difference in these

    satisfaction scores, this difference of patients' satisfaction in government

    and private hospitals was found statistically significant (p

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    In government (91.8 percent) as well as private hospitals (99.3

    percent) patients reported high level of satisfaction with hospitals. This

    difference was found statistically significant (p

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    satisfaction score for different dimensions of nursing care ranged between,

    6.83 to 8.97 (maximum 12 for each category). Mean percentage of

    satisfaction score ranged between 56.9 to 74.6 percent, where lowest mean

    percentage of satisfaction score was observed for communication (56.9

    percent), followed by emotional support (60.8 percent), interpersonal

    relationship (68.8 percent), personnels' professional knowledge (68.8

    percent), availability (69.6 percent), attentiveness (70.9 percent),

    professionalism (70.9 percent); and highest mean percentage of satisfaction

    score was found for clinical skills of nurses (74.6 percent). In private

    hospitals the mean satisfaction score was higher in all the dimensions of

    nursing care as compared to government hospitals, which ranged between

    9.22 to 10.34 (maximum 12 score for each dimension), which was found

    statistically significant (p

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    hospitals. However, it was found communication and emotional support

    dimension of healthcare needs improvement to further enhance patients'

    satisfaction with nursing care in selected public and private hospitals.

    Qualitative Analysis

    Emergency Patients

    Walk in Patients

    Visitors

    Doctors

    Entersemergency

    facilityTriage LaboratoryTests

    TestResults Healing Pharmacy Release

    Enters

    hospital

    Goes todoctors'

    clinics

    Laboraroty

    TestsTest Results Pharmacy Out

    Enters hospital Nurse Station Goes to

    patient's roomGoes home

    Entershospital

    Goes toclinic

    Conducts rounds

    Goeshome

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    Nurses

    Quantitative Analysis

    There were total thirty-two items to collect data regarding patients'

    satisfaction with the general hospital, consisting of four items under each

    dimension/ category of satisfaction. Each statement was judged to rate on four

    points scale i.e. Highly satisfied, Moderately satisfied, Uncertain, dissatisfied and to

    each rating 3, 2, 1, 0 score was given respectively making a total maximum score of

    96 and minimum zero. Patients' overall score between 65-96 was considered highly

    satisfied with the overall condition of the hospital, score between 33-64 considered

    moderately satisfied and score between 0-32 was considered as undecided/

    dissatisfied. For each category maximum score was 12 and minimum was zero. For

    each individual category score between 9-12 was considered as highly satisfied,

    score between 5-8 was considered as moderately satisfied and score between 0-4

    was considered as undecided/dissatisfied.

    Content validity of the tool was established by seeking the inputs from 2

    experts from the field of emergency department and healthcare administration.

    Reliability of the data collection tool of patient satisfaction with nursing care

    interview schedule was computed on the data of 30 patients using split half

    technique; it was found reliable (r=0.89).

    Entershospital

    NurseStation

    Goes topatient's

    room

    Doesrounds

    Goeshome

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    After minimum of one week stay in hospital, patients were surveyed for data

    collection to know their satisfaction with the hospital using the questionnaire. Each

    patient was privately interviewed at their bedside as per their convenience and it

    took about 8-10 minutes to interview each patient. Furthermore, patients were

    interviewed in the absence of any of the healthcare provider of the institute but

    patients were given liberty to provide information in the present of their family

    members as per their choice.

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    Socio-demographic profile of the patients under study is presented in Table

    1. Total 1200 patients were selected form both government and private hospitals.

    Nearly half of the patients were in age group of 18 to 30 years, followed by about

    one fourth of the patients in the age group of 31 to 40 years. Nearly 20 percent of

    the subjects were in the age group of 46 to 50 years, which included 25 percent

    from private hospitals and 14.3 percent from government hospitals. 10 percent

    patients belonged to the age group of sixty plus, which included 13 percent from

    private hospitals and 6.5 percent from government hospitals. As per gender of

    patients, nearly equal number of male (53.8 percent) and female (46.2 percent)

    patients were included in the study. Majority of the patients i.e. 83.5 percent were

    married followed by 12.8 percent unmarried, 2.7 percent widow/widower and one

    percent divorced/ separated. Similar pattern was observed in both government and

    private hospitals.

    In present study two-third of urban patients visited both public (61.7%) and

    private (61.8%) hospitals, while rural patients constituted only 37.2% in public

    hospitals and 38.3% in private hospitals. However, few patients (1.0%) from slums

    only visited public hospitals. As preferences of health care facility was concerned,

    majority of the Filipino were seeking their health care from private hospitals and

    little less than fifty percent were seeking their health care from government

    hospitals. About 50 percent of the patients seeking inpatient services in

    government hospitals, while only 6.8 percent of them were seeking health care from

    private hospitals.

    Majority of patients in government hospitals, i.e. 87.6 percent were metric or

    below educated, whereas in private hospitals only 66.6 percent patients were in

    this category. In government hospitals there were only 4.3 percent patients who

    were graduates or above, while in private hospitals this category included 17.3

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    percent patients. Higher number of patients (38.3 percent) were illiterate, who were

    seeking care in government hospitals as compared to private hospitals (20.5

    percent). Nearly equal number of nonworking people were seeking health care from

    government and private hospitals. Higher number of non-skilled people were

    seeking health care from government hospitals (40.7 percent) as compared to

    private hospitals (24.2 percent). More number of professionals/businessmen were

    seeking health care from private hospitals (17.8 percent) as compared to

    government hospitals (2.5 percent). Distribution of patients as per selected socio-

    demographic variables such as age, religion, educational status and occupation

    was not homogenous in selected public and private hospitals.

    Mean patients' satisfaction score with nursing care in selected hospitals may

    be perused from Table-2. It was found that in government hospitals mean

    percentage of patients' satisfaction score was 67.6 percent of the total score; while

    in private hospitals mean percentage of patients' satisfaction score was 84.2

    percent of the total score. This shows that patients in private hospitals were more

    satisfied with nursing care as compared to government hospitals; t-test was applied

    to see the statistical difference in these satisfaction scores, this difference of

    patients' satisfaction in government and private hospitals was found statistically

    significant (p

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    Level of patients' satisfaction with nursing care in selected government and

    private hospitals is illustrated in Table-3. It was found that 91.8 percent of the

    patients were satisfied with nursing care in government hospitals (48 percent

    highly satisfied, and 43.8 percent moderately satisfied), while in private hospitals

    99.3 percent patients were satisfied with nursing care (68.5 percent highly

    satisfied, and 30.8 percent moderately satisfied). In government (91.8 percent) as

    well as private hospitals (99.3 percent) patients reported high level of satisfaction

    with nursing care. However, there were more number of patients dissatisfied with

    nursing care in government hospitals (8.2 percent) as compared to private hospitals

    (0.7 percent). This difference was found statistically significant (p

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    Mean satisfaction score of patients with different dimensions of nursing care

    is depicted in Table-5. It was found that in government hospitals satisfaction score

    for different dimensions of nursing care ranged between, 6.83 to 8.97 (maximum

    12 for each category). Mean percentage of satisfaction score ranged between 56.9 to

    74.6 percent, where lowest mean percentage of satisfaction score was observed for

    communication (56.9 percent), followed by emotional support (60.8 percent),

    interpersonal relationship (68.8 percent), Nurses' professional knowledge (68.8

    percent), availability (69.6 percent), attentiveness (70.9 percent), professionalism

    (70.9 percent); and highest mean percentage of satisfaction score was found for

    clinical skills of nurses (74.6 percent). In private hospitals the mean satisfaction

    score was higher in all the dimensions of nursing care as compared to government

    hospitals, which ranged between 9.22 to 10.34 (maximum 12 score for eachdimension), which was found statistically significant (p

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    Need Analysis

    Computation of the Unmet Bed Need. The following steps should be used in

    determining the Unmet Bed Need, which is the maximum number of beds that the

    proposed hospital may be allowed to put up.

    1. Determine the Projected Primary and Secondary Catchment Population (P) of

    the proposed hospital.

    1.1. The Primary Catchment Area is the municipality/urban district for Level 1

    Hospital; the rural district/city for Level 2 Hospital; the province for Level 3

    Hospital; and the region for Level 4 Hospital.

    1.2. The Secondary Catchment Area/s is/are other geographic area/s that have

    access or contiguous to the Primary Catchment Area.

    2. Determine the Inventory Hospital Beds (IHB), which is the number of

    existing beds being provided by existing government and private general

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    hospitals plus the number of beds being proposed by previous applicants for

    license to operate. Hospital beds being provided by special hospitals,

    hospitals under the Department of National Defense, penitentiary hospitals,

    and special research centers (i.e. Research Institute of Tropical Medicine)

    shall be excluded from the Inventory Hospital Beds.

    3. Determine the Bed-to-Population Ratio (BPR), or the ratio of Inventory

    Hospital Beds to the Projected Primary and Secondary Catchment

    Population.

    BPR= IHB/P X 1,000

    3.1. If the BPR is more than 111,000, the proposed hospital cannot be given

    a Certicate of Need.

    3.2. If the BPR is less than 111,000, proceed with the computation of theUnmet Bed Need.

    4. Determine the Projected Bed Need (PBN) or the projected total number of

    hospital beds needed for the primary and secondary catchment

    population by multiplying the Projected Primary and Secondary

    Catchment Population (P) by the bed-to-population ratio of 1:1,000.

    PBN = P x 1/1,000

    5. Compute for Unmet Bed Need (UBN) by subtracting the Inventory Hospital

    Bed from the Projected Bed Need. using the formula:

    UBN = PBN - IHB

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    CHAPTER I.5

    Conclusions and Recommendations

    Based on the empirical study on the last chapter, the building design

    and planning greatly affects the healing process of patients.

    The researcher recommends that the future public hospitals should

    be designed to meet the patients satisfaction.

    CHAPTER III

    Site Identification and Analysis

    Site Selection Process

    Criteria for Site Selection

    Criteria for the selection of site are evaluated thoroughly by the

    researcher. The following are the main characteristics that the site should

    have:

    1. The locale must be densely populated

    2. The site should be high enough that it is not prone to flooding

    3. The site should have an adequate lot area for the proposed general

    hospital

    Site Option Description (at least 3 sites)

    The first proposed site is located in Las Pias , along Alabang-Zapote

    Road. Lot area is 30,992 sqm or approximately 4 hectares. Land use is in

    industrial and the market value is 154,960,000 pesos.

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    The second proposed site is located in Marikina City , along

    Sumulong highway. 11,661 sqm. Its land use is commercial.

    The third proposed site is in Pasay City . Its land use is commercial.

    Lot area is 53161 sqm. It is situated along Diosdado Macapagal Avenue.

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    Site Selection and Justification

    The researchers choice will be the site in Las Pias because first of

    all, there are no near hospitals near the vicinity. Second, it is flood resilient.

    Third, it satisfies the major site criteria of having an adequate size for the

    proposed general hospital. And lastly, the location is very accessible by

    everyone since it is along a highway which is the Alabang-Zapote road.

    Site Evaluation and Analysis

    The Macro Settings

    Metropolitan Manila, commonly known as Metro Manila, the National

    Capital Region (NCR) of the Philippines, is the seat of government and the most

    populous region and metropolitan area of the country which is composed of

    the City of Manila and the cities of Caloocan, Las

    Pias, Makati, Malabon, Mandaluyong, Marikina ,Muntinlupa, Navotas, Paraaque,

    Pasay, Pasig, Quezon City, San Juan, Taguig, and Valenzuela, as well as

    the Municipality of Pateros.

    Located at 1440' N 1213 E, Metro Manila is situated on an isthmus bound

    by Laguna de Bay to the south-east and Manila Bay to the west. The metropolitan

    area lies on a wide flood plain composed mainly of alluvial soil deposits. The area is

    bounded by Bulacan to the north, Rizal to the east, Laguna to the south

    and Cavite to the southwest. The swampy isthmus on which the

    western metropolitan area partly lies has an average elevation of 10 meters. The

    http://en.wikipedia.org/wiki/National_Capital_Regionhttp://en.wikipedia.org/wiki/National_Capital_Regionhttp://en.wikipedia.org/wiki/Philippineshttp://en.wikipedia.org/wiki/Regions_of_the_Philippineshttp://en.wikipedia.org/wiki/Metropolitan_areahttp://en.wikipedia.org/wiki/Manilahttp://en.wikipedia.org/wiki/Caloocanhttp://en.wikipedia.org/wiki/Las_Pi%C3%B1ashttp://en.wikipedia.org/wiki/Las_Pi%C3%B1ashttp://en.wikipedia.org/wiki/Makatihttp://en.wikipedia.org/wiki/Malabonhttp://en.wikipedia.org/wiki/Mandaluyonghttp://en.wikipedia.org/wiki/Marikinahttp://en.wikipedia.org/wiki/Muntinlupahttp://en.wikipedia.org/wiki/Navotashttp://en.wikipedia.org/wiki/Para%C3%B1aquehttp://en.wikipedia.org/wiki/Pasayhttp://en.wikipedia.org/wiki/Pasighttp://en.wikipedia.org/wiki/Quezon_Cityhttp://en.wikipedia.org/wiki/San_Juan,_Metro_Manilahttp://en.wikipedia.org/wiki/Taguighttp://en.wikipedia.org/wiki/Valenzuela,_Philippineshttp://en.wikipedia.org/wiki/Pateros,_Metro_Manilahttp://en.wikipedia.org/wiki/Isthmushttp://en.wikipedia.org/wiki/Laguna_de_Bayhttp://en.wikipedia.org/wiki/Manila_Bayhttp://en.wikipedia.org/wiki/Flood_plainhttp://en.wikipedia.org/wiki/Bulacanhttp://en.wikipedia.org/wiki/Rizal_(province)http://en.wikipedia.org/wiki/Laguna_(province)http://en.wikipedia.org/wiki/Cavitehttp://en.wikipedia.org/wiki/Metropolitan_areahttp://en.wikipedia.org/wiki/Metropolitan_areahttp://en.wikipedia.org/wiki/Cavitehttp://en.wikipedia.org/wiki/Laguna_(province)http://en.wikipedia.org/wiki/Rizal_(province)http://en.wikipedia.org/wiki/Bulacanhttp://en.wikipedia.org/wiki/Flood_plainhttp://en.wikipedia.org/wiki/Manila_Bayhttp://en.wikipedia.org/wiki/Laguna_de_Bayhttp://en.wikipedia.org/wiki/Isthmushttp://en.wikipedia.org/wiki/Pateros,_Metro_Manilahttp://en.wikipedia.org/wiki/Valenzuela,_Philippineshttp://en.wikipedia.org/wiki/Taguighttp://en.wikipedia.org/wiki/San_Juan,_Metro_Manilahttp://en.wikipedia.org/wiki/Quezon_Cityhttp://en.wikipedia.org/wiki/Pasighttp://en.wikipedia.org/wiki/Pasayhttp://en.wikipedia.org/wiki/Para%C3%B1aquehttp://en.wikipedia.org/wiki/Navotashttp://en.wikipedia.org/wiki/Muntinlupahttp://en.wikipedia.org/wiki/Marikinahttp://en.wikipedia.org/wiki/Mandaluyonghttp://en.wikipedia.org/wiki/Malabonhttp://en.wikipedia.org/wiki/Makatihttp://en.wikipedia.org/wiki/Las_Pi%C3%B1ashttp://en.wikipedia.org/wiki/Las_Pi%C3%B1ashttp://en.wikipedia.org/wiki/Caloocanhttp://en.wikipedia.org/wiki/Manilahttp://en.wikipedia.org/wiki/Metropolitan_areahttp://en.wikipedia.org/wiki/Regions_of_the_Philippineshttp://en.wikipedia.org/wiki/Philippineshttp://en.wikipedia.org/wiki/National_Capital_Regionhttp://en.wikipedia.org/wiki/National_Capital_Region
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    eastern area lies on a ridge gradually rising towards the foothills of the Sierra

    Madre and overlooks the Marikina River valley, which is part swamp.

    The Pasig River bisects the isthmus and links the two bodies of water. From

    Laguna de Bay, it enters Taguig, and flows east-west

    through Pateros, Pasig, Makati, Mandaluyong and Manila before draining in Manila

    Bay. Its main tributary, the Marikina River, originates in the Sierra Madre

    mountain range in Rodriguez to the northeast of the city. The Marikina River runs

    north-south and meets with the Pasig in Pateros. Traversing the course of the

    Marikina River is the Marikina Valley Fault System, part of the seismically activenetwork of fault lines surrounding Metro Manila, placing it at serious risk

    of earthquakes.

    Under the Kppen climate classification system, Metro Manila is split

    between a tropical wet and dry climate and a tropical monsoon climate. Manila,

    which features less rainfall than Quezon City, has a tropical wet and dry climate

    while Quezon City features a tropical monsoon climate. Together with the rest of

    the Philippines, Metro Manila lies entirely within the tropics. Its proximity to

    the equator means that the temperature range is very small, rarely going lower

    than 20 C or higher than 38 C. However, humidity levels are usually very high,

    making it feel much warmer. It has a distinct, albeit relatively short dry

    season from January through May, and a relatively lengthy wet season from June

    through December.

    The Micro Setting

    Las Pias, officially the City of Las Pias is a city in the National Capital

    Region of th ePhilippines with a population of 552,573 as of the 2010 Census. It is

    bounded to northeast by the Paraaque; to the southeast by Muntinlupa; to the

    west and southwest by Bacoor; and to the northwest by the Manila Bay. Half of its

    http://en.wikipedia.org/wiki/Marikina_Riverhttp://en.wikipedia.org/wiki/Pasig_Riverhttp://en.wikipedia.org/wiki/Taguighttp://en.wikipedia.org/wiki/Pateros,_Metro_Manilahttp://en.wikipedia.org/wiki/Pasighttp://en.wikipedia.org/wiki/Makatihttp://en.wikipedia.org/wiki/Mandaluyonghttp://en.wikipedia.org/wiki/Manilahttp://en.wikipedia.org/wiki/Marikina_Riverhttp://en.wikipedia.org/wiki/Rodriguez,_Rizalhttp://en.wikipedia.org/wiki/Pateros,_Metro_Manilahttp://en.wikipedia.org/wiki/Marikina_Valley_Fault_Systemhttp://en.wikipedia.org/wiki/Earthquakeshttp://en.wikipedia.org/wiki/K%C3%B6ppen_climate_classificationhttp://en.wikipedia.org/wiki/Tropical_savanna_climatehttp://en.wikipedia.org/wiki/Tropical_monsoon_climatehttp://en.wikipedia.org/wiki/Manilahttp://en.wikipedia.org/wiki/Quezon_Cityhttp://en.wikipedia.org/wiki/Equatorhttp://en.wikipedia.org/wiki/Dry_seasonhttp://en.wikipedia.org/wiki/Dry_seasonhttp://en.wikipedia.org/wiki/Wet_seasonhttp://en.wikipedia.org/wiki/Metro_Manilahttp://en.wikipedia.org/wiki/Metro_Manilahttp://en.wikipedia.org/wiki/Philippineshttp://en.wikipedia.org/wiki/Para%C3%B1aquehttp://en.wikipedia.org/wiki/Muntinlupahttp://en.wikipedia.org/wiki/Bacoorhttp://en.wikipedia.org/wiki/Manila_Bayhttp://en.wikipedia.org/wiki/Manila_Bayhttp://en.wikipedia.org/wiki/Bacoorhttp://en.wikipedia.org/wiki/Muntinlupahttp://en.wikipedia.org/wiki/Para%C3%B1aquehttp://en.wikipedia.org/wiki/Philippineshttp://en.wikipedia.org/wiki/Metro_Manilahttp://en.wikipedia.org/wiki/Metro_Manilahttp://en.wikipedia.org/wiki/Wet_seasonhttp://en.wikipedia.org/wiki/Dry_seasonhttp://en.wikipedia.org/wiki/Dry_seasonhttp://en.wikipedia.org/wiki/Equatorhttp://en.wikipedia.org/wiki/Quezon_Cityhttp://en.wikipedia.org/wiki/Manilahttp://en.wikipedia.org/wiki/Tropical_monsoon_climatehttp://en.wikipedia.org/wiki/Tropical_savanna_climatehttp://en.wikipedia.org/wiki/K%C3%B6ppen_climate_classificationhttp://en.wikipedia.org/wiki/Earthquakeshttp://en.wikipedia.org/wiki/Marikina_Valley_Fault_Systemhttp://en.wikipedia.org/wiki/Pateros,_Metro_Manilahttp://en.wikipedia.org/wiki/Rodriguez,_Rizalhttp://en.wikipedia.org/wiki/Marikina_Riverhttp://en.wikipedia.org/wiki/Manilahttp://en.wikipedia.org/wiki/Mandaluyonghttp://en.wikipedia.org/wiki/Makatihttp://en.wikipedia.org/wiki/Pasighttp://en.wikipedia.org/wiki/Pateros,_Metro_Manilahttp://en.wikipedia.org/wiki/Taguighttp://en.wikipedia.org/wiki/Pasig_Riverhttp://en.wikipedia.org/wiki/Marikina_River
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    land area is residential and the remaining half is used for commercial, industrial

    and institutional purposes. The present physiography of Las Pias consists of three

    zones: Manila Bay, coastal margin and the Guadalupe Plateau. Like neighbouring

    Muntinlupa, Las Pias has banned the use of plastics and styrofoam in packaging.

    Related Laws and Ordinances

    GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER

    HEALTH FACILITIES

    A hospital and other health facilities shall be planned and designed to observe

    appropriate architectural practices, to meet prescribed functional programs, and to

    conform to applicable codes as part of normal professional practice. References

    shall be made to the following:

    P. D. 1096 National Building Code of the Philippines and Its

    Implementing Rules and Regulations

    P. D. 1185 Fire Code of the Philippines and Its Implementing Rules

    and Regulations

    P. D. 856 Code on Sanitation of the Philippines and Its

    Implementing Rules and Regulations

    B. P. 344 Accessibility Law and Its Implementing Rules and

    Regulations

    R. A. 1378 National Plumbing Code of the Philippines and Its

    Implementing Rules and Regulations

    R. A. 184 Philippine Electrical Code

    Manual on Technical Guidelines for Hospitals and Health Facilities

    Planning and Design. Department of Health, Manila. 1994

    http://en.wikipedia.org/wiki/Manila_Bayhttp://en.wikipedia.org/wiki/Plasticshttp://en.wikipedia.org/wiki/Styrofoamhttp://en.wikipedia.org/wiki/Styrofoamhttp://en.wikipedia.org/wiki/Plasticshttp://en.wikipedia.org/wiki/Manila_Bay
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    Signage Systems Manual for Hospitals and Offices. Department of

    Health, Manila. 1994

    Health Facilities Maintenance Manual. Department of Health, Manila.

    1995

    Manual on Hospital Waste Management. Department of Health,

    Manila. 1997

    District Hospitals: Guidelines for Development. World Health

    Organization Regional Publications, Western Pacific Series. 1992

    Guidelines for Construction and Equipment of Hospital and Medical

    Facilities. American Institute of Architects, Committee on Architecture

    for Health. 1992

    De Chiara, Joseph. Time-Saver Standards for Building Types.

    McGraw-Hill Book Company. 1980

    1 Environment: A hospital and other health facilities shall be so located that it is

    readily accessible to the community and reasonably free from undue noise, smoke,

    dust, foul odor, flood, and shall not be located adjacent to railroads, freight yards,

    children's playgrounds, airports, industrial plants, disposal plants.

    2 Occupancy: A building designed for other purpose shall not be converted into a

    hospital. The location of a hospital shall comply with all local zoning ordinances.

    3 Safety: A hospital and other health facilities shall provide and maintain a safe

    environment for patients, personnel and public. The building shall be of such

    construction so that no hazards to the life and safety of patients, personnel and

    public exist. It shall be capable of withstanding weight and elements to which they

    may be subjected.

    3.1 Exits shall be restricted to the following types: door leading directly outside the

    building, interior stair, ramp, and exterior stair.

    3.2 A minimum of two (2) exits, remote from each other, shall be provided for each

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    floor of the building.

    3.3 Exits shall terminate directly at an open space to the outside of the building.

    4 Security: A hospital and other health facilities shall ensure the security of person

    and property within the facility.

    5 Patient Movement: Spaces shall be wide enough for free movement of patients,

    whether they are on beds, stretchers, or wheelchairs. Circulation routes for

    transferring patients from one area to another shall be available and free at all

    times.

    5.1 Corridors for access by patient and equipment shall have a minimum width of

    2.44 meters.

    5.2 Corridors in areas not commonly used for bed, stretcher and equipment

    transport may be reduced in width to 1.83 meters.

    5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas

    located on the upper floor.

    5.4 A ramp shall be provided as access to the entrance of the hospital not on thesame level of the site.

    6 Lighting: All areas in a hospital and other health facilities shall be provided with

    sufficient illumination to promote comfort, healing and recovery of patients and to

    enable personnel in the performance of work.

    7 Ventilation: Adequate ventilation shall be provided to ensure comfort of patients,

    personnel and public.

    8 Auditory and Visual Privacy: A hospital and other health facilities shall observe

    acceptable sound level and adequate visual seclusion to achieve the acoustical and

    privacy requirements in designated areas allowing the unhampered conduct of

    activities.

    9 Water Supply: A hospital and other health facilities shall use an approved public

    water supply system whenever available. The water supply shall be potable, safe for

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    drinking and adequate, and shall be brought into the building free of cross

    connections.

    10 Waste Disposal: Liquid waste shall be discharged into an approved public

    sewerage system whenever available, and solid waste shall be collected, treated and

    disposed of in accordance with applicable codes, laws or ordinances.

    11 Sanitation: Utilities for the maintenance of sanitary system, including approved

    water supply and sewerage system, shall be provided through the buildings and

    premises to ensure a clean and healthy environment.

    12 Housekeeping: A hospital and other health facilities shall provide and maintain

    a healthy and aesthetic environment for patients, personnel and public.

    13 Maintenance: There shall be an effective building maintenance program in

    place. The buildings and equipment shall be kept in a state of good repair. Proper

    maintenance shall be provided to prevent untimely breakdown of buildings and

    equipment.

    14 Material Specification: Floors, walls and ceilings shall be of sturdy materialsthat shall allow durability, ease of cleaning and fire resistance.

    15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be

    maintained for patients and personnel, male and female, with a ratio of one (1)

    toilet for every eight (8) patients or personnel.

    16 Fire Protection: There shall be measures for detecting fire such as fire alarms in

    walls, peepholes in doors or smoke detectors in ceilings. There shall be devices for

    quenching fire such as fire extinguishers or fire hoses that are easily visible and

    accessible in strategic areas.

    17 Signage. There shall be an effective graphic system composed of a number of

    individual visual aids and devices arranged to provide information, orientation,

    direction, identification, prohibition, warning and official notice considered

    essential to the optimum operation of a hospital and other health facilities.

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    18 Parking. A hospital and other health facilities shall provide a minimum of one

    (1) parking space for every twenty-five (25) beds.

    19 Zoning: The different areas of a hospital shall be grouped according to zones as

    follows:

    19.1 Outer Zone areas that are immediately accessible to the public: emergency

    service, outpatient service, and administrative service. They shall be located near

    the entrance of the hospital.

    19.2 Second Zone areas that receive workload from the outer zone: laboratory,

    pharmacy, and radiology. They shall be located near the outer zone.

    19.3 Inner Zone areas that provide nursing care and management of patients:

    nursing service. They shall be located in private areas but accessible to guests.

    19.4 Deep Zone areas that require asepsis to perform the prescribed services:

    surgical service, delivery service, nursery, and intensive care. They shall be

    segregated from the public areas but accessible to the outer, second and inner

    zones.19.5 Service Zone areas that provide support to hospital activities: dietary service,

    housekeeping service, maintenance and motorpool service, and mortuary. They

    shall be located in areas away from normal traffic.

    20 Function: The different areas of a hospital shall be functionally related with

    each other.

    20.1 The emergency service shall be located in the ground floor to ensure

    immediate access. A separate entrance to the emergency room shall be provided.

    20.2 The administrative service, particularly admitting office and business office,

    shall be located near the main entrance of the hospital. Offices for hospital

    management can be located in private areas.

    20.3 The surgical service shall be located and arranged to prevent non-related

    traffic. The operating room shall be as remote as practicable from the entrance to

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    provide asepsis. The dressing room shall be located to avoid exposure to dirty areas

    after changing to surgical garments. The nurse station shall be located to permit

    visual observation of patient movement.

    20.4 The delivery service shall be located and arranged to prevent non-related

    traffic. The delivery room shall be as remote as practicable from the entrance to

    provide asepsis. The dressing room shall be located to avoid exposure to dirty areas

    after changing to surgical garments. The nurse station shall be located to permit

    visual observation of patient movement. The nursery shall be separate but

    immediately accessible from the delivery room.

    20.5 The nursing service shall be segregated from public areas. The nurse station

    shall be located to permit visual observation of patients. Nurse stations shall be

    provided in all inpatient units of the hospital with a ratio of at least one (1) nurse

    station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size

    to allow for work flow and patient movement. Toilets shall be immediately

    accessible from rooms and wards.20.6 The dietary service shall be away from morgue with at least 25-meter distance.

    21 Space: Adequate area shall be provided for the people, activity, furniture,

    equipment and utility.

    Site Development Options

    Site Analysis

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    The blue arrow marks the flow of rain water

    Proposed Site Development Plan (with massing)