Pamantasan ng Lungsod ng Maynila (University of the City of Manila) Intramuros, Manila College of Nursing

In partial fulfillment of the requirements In Leadership and Management

An Analysis of the Strengths, Weaknesses, Opportunities and Threats of The Seamens Hospital

Submitted by: Cancio, Ma. Cristina R. BSN IV-4

Submitted to: Ms. Marietess Nicolas Nursing Management Professor

March 15, 2013

I.

INTRODUCTION

Seamens Hospital is a tertiary hospital owned by the Association of Marine Officers and Seamens Union of the Philippines located at Cabildo St. cor. San Jose St., Intramuros, Manila. It was a 100 bed capacity hospital that offers quality medical & dental services, including consultation, hospitalization, examinations, treatment & medicines to all qualified members, as needed, free-of-charge depending on the availability of service and supplies. The Seamen's Hospital does not handle medico-legal cases whether they are members or dependents. It will administer first aid treatment to the patient, who must then be transferred to any government hospital where a medico-legal officer/procedure is available. The hospital has the capability to treat general as well as complicated cases in its clinical departments as follows: o Department of Surgery o Anesthesiology General Surgery Orthopedics Thoracic Surgery Vascular Surgery Urology Lithotripsy Unit Neurosurgery Pediatric Surgery Laparoscopic Surgery

Department of Pediatrics General Pediatrics Allergology Cardiology Infectious Diseases Neonatology

Department of Medicine Internal Medicine Cardiology Dermatology Endocrinology Gastroenterology Neurology Nephrology Pulmonology Hemodialysis Unit Infectious Diseases

Department of Obstetrics and Gynecology Pre-natal check up Deliveries and C-sections Diagnostic and therapeutic management of gynecological cases

Department of Eyes, Ears, Nose and Throat Diagnostic, medical and surgical management of EENT

Department of Pathology Bacteriology Clinical Chemistry Clinical Microscopy Exfoliative Cytology Hematology Immunology Parasitology Phlebotomy Serology Hispathology Dental Department General Dentistry Occupational oral and dental examination

Department of Rehabilitation Medicine

Physical rehabilitation services

Department of Radiology Computerized Tomographical (CT) Scan Mammography Fixed X-ray examinations Mobile X-ray examinations Ultrasound Ultrasound with Doppler and 2-D echo examinations

Other Services Psychosometric Screening Section

Nursing Services Ambulance Services Dietary Pharmacy Dispenses medicines, prescribed by the Seamen's Hospital doctors, free-ofcharge, depending on availability.

Vision AMOSUP- Seamens Hospital envisions itself as a leading internationally recognized maritime medical center of excellence for healthcare delivery, training and research. Mission To provide the best available quality healthcare to AMOSUP members and their dependents.

II.

METHODOLOGY A. Research Locale This research was conducted at the male surgical ward of the Seamens hospital. It is a tertiary hospital that provides medical services for AMOSUP members and dependents which were located at Cabildo St. cor. San Jose St., Intramuros, Manila. The respondent was comprised of the head nurse of the male surgical ward. The ward itself has 17 bed capacity

equipped with air conditioning unit, comfort room and a television set to be found at the third floor of the building next to with the male medical ward. B. Instrumentation The researcher made used of structured interview on the head nurse of the male surgical ward and direct observation for identifying the strength, weakness, opportunities and threats of the Seamens hospital. The researcher made use of a self-made questionnaire. It was composed of the areas of standards of patient right and organizational ethics, patient care, leadership and management, human resource management, safe practice and environment, infection control, equipment and supplies, energy and waste management, and improving performance. C. Data Gathering Procedure The data gathered was carried out by the researcher of this SWOT analysis. It started by writing a communication letter for request to conduct SWOT Analysis. It was signed by the professor of Nursing Management and Leadership and the dean of the College of Nursing, and was extended to the Seamans Hospital last March 2, 2012. Upon approval of request, the researcher prepared and conducted the study last March 6, 2013. The researcher purposefully selected the head nurse from the male surgical ward to interview. It was followed consequently with direct observation of the ward with the head nurses in the male surgical ward. After the data collection, the researcher expressed gratitude to the head nurse and the team for cooperation. The collected data will be presented, analyzed and interpreted using the SWOT analysis. Results of the study will be classified as controllable, semi-controllable and non-controllable. Conclusions were drawn from the collected data III. RESULTS AND DISCUSSION

The Seamens Hospital commits itself to provide quality and responsive health care service by institutionalizing standards of standards of patient right and organizational ethics, patient

care, leadership and management, human resource management, safe practice and environment, infection control, equipment and supplies, energy and waste management, and improving performance which will be considered assets of the institution. The Patients Rights and Organizational Ethics are observed in this institution. In respect to patients rights, informed consent is obtained prior to the care that the patient must receive. The patient also receives written statements of their rights laminated and posted on the walls of the wards. The staff also follows policies and procedures addressing the patient needs for confidentiality, privacy, security, religious counseling and communication. Compliance to codes of professional conduct is also observed in the institution as evidenced by the presence of a disciplined staffs. The Physical set- up and access of the hospital plays an important role in giving care for patients. Upon observation, the entrance and exit signs are clear and prominent. The title of the male surgical ward itself is located when upon entering through a glass transparent door in line with the male medical ward. The entrance and exit of the ward is minimally obstructed. The lack of space on the ward is also observed, this lack of space may affect the patients comfort and privacy. There is also a lack of functional beds. The hospital also provides alternative passageways like ramps for patients with special needs. In this way patient, visitors and staff can efficiently and safely move within the confines of the organization. Upon entry, patients receive prompt and immediate attention. The physician discusses the treatment needed to the patient and to the family considering the extent of the disease, benefits and possible effects of the option of the treatment, noting its costs. The traditional way of charting documentation and hourly rounds is observed in this ward. Prescriptions are verified and patients are identified before medications are administered. Medications are given free depending on its availability.

The attendance to orientation or information dissemination activities is observed through the unity of the team headed by the head nurse. The communication or dissemination plans for policies and procedures is also managed. The hospital also composed of pager for the hospitals communication purposes.

Human resource management needs improvement due to the nurse- patients ratio of 1:13, which is quite high for a normal nurse patient ratio. Understaffing might affect the performance of the nurse due to increased workload. The institution address inadequate staff due to absences, leaves, resignation and increased patient load by sending the nurse on duty to overtime and to fulfill the shift. The reduction of the skilled and competent nurses resulted from migration or change in ward appointment. On the other hand, nurses and doctors are more flexible and are more receptive to learn new trends in health care unlike traditional nurses and doctors.

With regards to safe practice and environment, the medical equipments are provided with operation manuals. The laminated instructions and emergency drills are also posted on the wards walls for fire and emergency preparedness. Patients, staff and other individuals within the institution are provided a safe environment of care.

Procedures on cases of isolation of nosocomial infections are handled by the Infection control department. The institution provides room for isolation and treatment for these cases. Infection control procedures on isolation and universal precautions are also done in this institution. The hand hygiene is observed at all times. Immunization of the nurses is also monitored to provide protection. The disposal of sharps is made possible by puncture proof containers. There are also procedures for treatment of needle stick injuries.

The Seamans Hospital provides training for basic- life support, Mothers lactation, IV therapy and others. This ensures the updated license and certificates of training of their staffs with regards to handling of specialized equipment and doing procedures in need of training.

The hospital also practices the segregation of waste. The black, green and yellow are properly labeled with computerized readable font size. Issuance on waste disposal is also observed. There is also a proper management of temporary storage areas prior to hauling for disposal.

For the improvement of performance of care, patient/staff satisfaction is established in this institution. Also they are monitoring the policies for the quality improvement program.

Identified Problems: 1. Crowding 2. Lack of functional beds 3. Understaffing (1:13 patient-nurse ratio) 4. Lack of contingency plan

Prioritization Tool

A scale of 0, 1, and 2 is used to grade the problems according to specific criteria. The higher the total score means the problem being the priority problem among the other problems.

CRITERIA Problems Urgency to solve Time bound Availability of resources Ability of staff to solve problem Threats that arises from the problem Total Score

Crowding Lack of functional beds Understaffing

1 1

0 1

0 0

0 0

2 1

3 3

2 Lack of contingency plan 1

1 0

2 2

0 2

2 1

7 6

Table 1. Problem Prioritization Table

The scale uses the following correspondents: 1. Urgency to Solve: 0= not urgent 1= to some extent 2= Very urgent 2. Time bound 0= long time to solve 1= can be solved at some time 2= can be solved quickly 3. Availability of resources to solve problem: 0 = do not have the resources 2= have the resources available 4. Ability of staff to solve problem 0 = problem cannot be solved easily by the staff 2 = problem can be solved easily by the staff 5. Threats that arises from the problem 0 = mild threats 1 = moderate threats 2= severe threats

Table 1 shows the ranking of the problems identified based on specified criteria as presented above. The result of the total score showed that understaffing was chosen as the priority problem of the hospital followed by lack of contingency plan, cording and lack of space.

IV.

RECOMMENDATIONS The nursing profession has conventionally focused on the enhancement of the provision quality care. Nurses should ensure safe and quality care at all times, therefore considering the short supply of nurses. Understaffing tends the nurses to work overtime which may be considered unsafe to the practice. Understaffing is one of the most common problems that were experience by the nurses in the Philippines.

An alternative way to balance minimum staffing standards is the relevance of handling the autonomy to the nurses to them nurses. It is giving them the preference of managing their work schedule raising the job satisfaction leading to better quality care. On the other hand, the problem addressing the provision of quality health care while working understaffed.

To endorse sufficient staffing standards and to propose strategies to assist nurses in dealing with problems when working understaffed, the researcher came up with the following actions:

1. The nurse manager must consider adequate number of staffs in the unit who are capable of providing the quality services, taking into consideration clients needs.

2. Staff development, through team building and providing a reliever, it is costeffective method of increasing productivity.

3. Managers should at times evaluate their staffs contentment with the present scheduling system. Helping the staff to have autonomy over scheduling, shift preference, and staffing policies, managers can improve employees job satisfaction. Choosing the most suitable scheduling option in the specific ward will be needed.

APPENDICES

SWOT ANALYSIS Strengths 1. The institutions policies and procedures set responsibility and respect to protect the patients right in line with the initiation of quality care. 2. The hospital documents and follows policies and procedures for addressing patient needs for confidentiality, privacy, security, and communication. 3. Physical access to the institutions medical equipment and services is facilitated and is appropriate to patients needs. 4. Patients receive immediate assistance and attention by qualified health professionals. 5. All patients are correctly identified by their charts and are unique to each patient. 6. All patients who are to be given treatments are given with informed consent. 7. Good collaboration in the health team 8. Care is delivered in a timely, safe, appropriate and coordinated manner, according to care plans (hourly rounds) 9. Drugs are administered in a standardized and systematic manner and given free depending on the availability of the drugs and medications. 10. Staffs are united and aware of their leadership and management team. Opportunities 1. Patient satisfaction in the quality of care rendered 2. Staff development, nurses are provided with trainings like BLS trainings and IV therapy. 3. Young and accommodating staffs provided with seminars about new trends in health care 4. Good maintenance of up-to- date technology as evidenced by medical equipments that aid treatment for complicated cases.

11. Staffs are versatile and flexible. 12. Systematic dissemination and communication of protocols and procedures in the hospital 13. Presence of centralized protocol for staff recruitment, selection, appointment and responsibilities 14. Presence of operating manuals of certain medical equipments 15. Implementation of emergency and safety programs (electrical safety, fire, emergency and disaster preparedness, etc) 16. Presence of adequate lighting and ventilation for patient safety and comfort (airconditioned) 17. Presence of procedures on infection control and case containment of nosocomial infections 18. Implementation of waste disposal and segregation program 19. The hospitals funds are regulated

Weakness

Threats

1. Inadequate personal education to patients and families about continuing management plan upon discharge. 2. The physical set- up of the wards are crowded affecting the clients privacy and comfort. 3. Understaffing (1:13 patient-nurse ratio)

1. The hospital only caters medical services for the members and dependents of the union 2. Nurses who have a heavy workload due to understaffing may experience anxiety, stress and burnout, which can be a contributing factor for poor performance.

4. Lack of contingency plan to address inadequate staff due to absences, leaves, resignations and increased patient load.

3. Nurses who have a heavy workload may not have enough time to perform procedures tasks safely and efficiently, and may reduce their communication with physicians and other health professionals

Table 1. SWOT Analysis

RESEARCHER STRENGTHS 1. What advantages / assets do you have?

HEAD NURSE

As a head nurse of this ward, the members of my team is versatile and flexible. We are all around nurses that ensure the provision of quality nursing care to our patients.

2. What unique resources do you have access to?

We the have access to the hospitals equipment like the infusion pump, cardiac monitor etc.

3. Do you consider your team strong? Why? (experience, skills, knowledge)

Yes! United we stand, Divided we fall. The nurses here are skilled and competent and they always ensure that patients are always provided with quality care.

4. What are the capabilities of your staff?

They are all trained very well and can do all the necessary procedures.

5. How is the availability of the clinicians? (skills, number, location)

All the clinicians are specialized and trained. They always do their rounds and are always available when needed.

6. How much is the given budget to the unit? Do you handle your funds well?

The Nursing service is the one responsible for the budget or funding for the unit expenses.

WEAKNESSES 1. What could you improve? First thing that should be improve is the area for better space for the comfort and privacy of the patients, second is the charts holder, it is better to be replaced, third is increasing the

number of functional beds and hospitals equipment.

2. In what areas do other institutions have the edge?

That may be difficult to answer since I am not a member of other institutions.

3. So you lack manpower?

I think so; there are only 3 nurses per shift and a nurse patient ratio of 1:13 because the nurses are to take care of the patients in both Male surgical ward and Male medical ward.

4. Do you have cash flow / financial problems?

We dont have cash flow in the area since it is funded.

OPPORTUNITIES 1. What are the good opportunities facing you? We have good opportunities with regards to staff development, the hospital provides the necessary and up to date trainings and seminars.

2. What interesting trends are you aware of?

I am aware of the latest trends in the field of nursing. The use of computer technologies in the hospital

THREATS 1. What obstacles do you face? We just lack some functional beds and there is a lack of space. Sometimes, we also face some problems due to the staffs absences.

2. Have you lost key / significant staff?

Yes, some of them used to migrate abroad.

3. Are external economic factors affecting you?

Yes, some of the stocks became limited during those times.

OTHER THINGS TO CONSIDER: 1. When does the hospital give supplies? The supplies and medicines are given daily.

2. How many staff nurses are in the unit?

There are 3 nurses per shift.

Table 2. Interview