A Typical Dilemma of Hospital’s Doctor-Client during Rain-Flood Situation and Recommendations for Hospital Administrators
A Typical Dilemma of Hospital’s Doctor-Client during Rain-Flood Situation and Recommendations for Hospital Administrators – September 15, 2012
Yesterday, September 15, 2012, Saturday, I had a scheduled operation at 7 am in the operating room of Manila Doctors Hospital. When I woke up at 6 am to get ready to go to MDH, it was raining at least in Makati where I reside. Although the downpour was not strong, I was still wary and wondering whether there would be flood on the road that would make it difficult for me to reach MDH. I decided to leave the house without checking PAGASA and MMDA tweets as I told myself, “Bahala na. I have a scheduled operation at 7 am. Patient is admitted and awaiting the operation. Initially, I was thinking of staying home because of the risk of road floods. I was rationalizing that since the patient is an HMO card-holder, I can easily cancel it. Extra hospital stay expenses can be charged to the HMO. However, I decided not to, as a postponement will extend the patient’s preoperative anxiety.”
I left my house at 630 am. As I drove towards Vito Cruz, I was encountering floods already. At this time, I was now hoping for an advisory from MDH. I saw a lot of cars turning back from the junction of Vito Cruz and South Super Highway. I assumed that area was flooded and not passable. At 6:47 am, I decided to text MDH Telephone Operator asking whether there was flood in MDH. If there was flood even in MDH, I might decide to turn back and stay home. See picture below.
When I reached the junction of Vito Cruz and South Super Highway near the railway tracks, I saw the flood was at a half-wheel level of a light-motor vehicle (car or sedan). I decided not to drive through the flood. I turned back and decided to try the Sta. Ana route. I met flood again at the junction of JP Rizal and Pasong Tamo, near the Sta. Ana race track. I decided not to proceed. At this time, I was still hoping I would get an advisory from MDH to help me make decision. Not receiving one and no answer yet to my text to the MDH telephone operator, I called up Dr. Ramon Pesigan as I assumed he was also on his way to or has reached MDH as he was my anesthesiologist for the patient whom we will operate at 7 am. He answered and told me he passed through South Super Highway coming from Alabang and said he was being slowed down by a high-level flood in Buendia. He said he was using a van and was optimistic he would be able to reach MDH.
I had to make a decision fast as it was 6:55 am already. The options were either to go back home or take another route. For one reason or another, probably, for the sake of the anxious patient awaiting an operation, seeing the downpour of rain was not strong, and I have a clinic from 9 to 11 am, I decided to take another route. Though a longer route and more gasoline expense on my part, I decided to take the EDSA – Roxas Boulevard – UN – MDH route. I went back to Makati, then Ayala Avenue, then EDSA, then Roxas Boulevard, then UN Avenue. Along the way, at about 7:05 am, when I was already in EDSA, I finally received an answer to my text from the MDH Telephone Operator. I was texted UN and Kalaw were flooded, below knee high. With this text from the MDH Telephone Operator, I decided to proceed just the same. There were pockets of flood along EDSA, near the Taft Avenue junction and also Roxas Boulevard. Fortunately, they were passable to light cars, like mine, Lancer box-type, 1987 model. When I reached Roxas Boulevard, Dr. Pesigan called me saying he had reached MDH and he advised me to take Roxas Boulevard (which I did) and then UN and to just stay in the middle of the UN Avenue as I approached MDH (as this street was also flooded).
I reached MDH at about 7:15 am and parked at the last parking space in front of the Convenience Store. Up to this time, I did not receive any MDH Advisory on the Perimeter Flood.
Upon arrival in MDH, I was met by the supervisor of the Security Services and he briefed me on the perimeter flood situation. He said he had informed the nurse supervisor on duty. I evaluated what were done by the people expected to take command of the situation. Before I went up to the operating room to operate on my breast cancer patient at 8 am, I fixed all the kinks. After I finished my operations at 9:30 am, I continued to fix things. Before I started my clinic, I endorsed to Mr. Larry Tenorio, the Saturday-Officer, my instructions to the supervisor of the security services what had to be done.
There were a lot of lessons learned here in terms of the advisories to be given by MDH staff, including doctor-clients like me.
Before I go into the details of the lessons learned, let me just say, my narration describes the typical dilemma faced by doctor-clients of a hospital when there is a rain-flood situation. (Note: this is also a dilemma faced by patient-clients who want to go to a hospital in the face of rain-flood situation.) I recommend all hospital administrators to take this dilemma seriously to give value-added services to their doctor- and patient-clients and also to avoid business opportunity losses. I could have turned back and had my operation and clinic cancelled. These cancellations constitute business opportunity loss for the hospital (of course, also on myself, in my clinic). Larry told me there were operations cancelled on the morning of September 15 because of the floods. Physicians will appreciate it very much if hospitals give them at least timely information of the hospital perimeter flood to assist them in making decision during a rain-flood situation whether to proceed to the hospital and how to advice their patients going to their clinics. When I was in the MDH Telephone Operators’ Booths, I overheard a lot of inquiries from doctors, asking about the rain-flood situation around the hospital and whether they were passable to vehicles, light and SUVs, etc.
Now to the lessons learned and recommended actions:
- The security guards on duty should be the ones to initiate an MDH advisory and its updates on the perimeter flood so as to promote timely advices. Mr. Gerardo Ramos, head of the MDH Security Services, or his second-in-command or his supervisor-on-duty should be authorized to issue an MDH Perimeter Flood Advisory through the MDH Telephone Operator. NOTE: MDH Perimeter Flood Advisory is different from CODE WATER Activation and Deactivation.
- Whenever there is rain during the night and early morning, the Security Services should issue an MDH Perimeter Flood Advisory at 500 am. This is to advise all managers and all doctor-clients so that they will be guided on what to do in terms of going to MDH.
- Whenever there is rain lasting for more than one hour and is continuing, the Security Services should issue an MDH Perimeter Flood Advisory soon after the hour of observation. This is to advise all managers and all doctor-clients so that they will be guided on what actions to take in anticipation for a rain-flood situation.
- The SMS template of the advisory should be as follows (concise and choose one as appropriate to the situation):
MDH Perimeter Flood Advisory: As of xxxxH, mm/dd/yy, NO floods in UN and Kalaw. Security Services Head Gerardo Ramos
MDH Perimeter Flood Advisory: As of xxxxH, mm/dd/yy, NO flood in UN. Kalaw flood is NOT passable to cars and vans. Security Services Head Gerardo Ramos
MDH Perimeter Flood Advisory: As of xxxxH, mm/dd/yy, NO flood in UN. Kalaw flood is passable to vans but NOT to cars. Security Services Head Gerardo Ramos
MDH Perimeter Flood Advisory: As of xxxxH, mm/dd/yy, UN flood passable to cars. Kalaw flood is NOT passable to cars and vans. Security Services Head Gerardo Ramos
MDH Perimeter Flood Advisory: As of xxxxH, mm/dd/yy, UN flood passable to cars. Kalaw flood is passable to vans but NOT to cars. Security Services Head Gerardo Ramos
MDH Perimeter Flood Advisory: As of xxxxH, mm/dd/yy, UN flood passable to cars. Kalaw flood is passable to cars. Security Services Head Gerardo Ramos
NOTE: If UN and Kalaw are NOT passable to cars, CODE WATER is activated. SMS template is different .
MDH Code Water Activation: As of xxxxH, mm/dd/yy, floods in UN and Kalaw NOT passable to cars and vans. Name of Incident Commander
MDH Code Water Activation: As of xxxxH, mm/dd/yy, floods in UN and Kalaw passable to VANS only. Name of Incident Commander
5. Updates on the advisory should be given at least one every hour in case of flash floods and as soon as the floods have subsided.
The SMS template should include the word “update” in the heading to imply that a previous advisory has been sent.
The contents should contain such words as “still,” “now,””no more,” and the like to imply an update from a previous advisory. For examples:
MDH Perimeter Flood Advisory Update: As of xxxxH, mm/dd/yy, NO more flood in UN. Kalaw flood is now passable to vans but NOT yet to cars. Security Services Head Gerardo Ramos
MDH Perimeter Flood Advisory Update: As of xxxxH, mm/dd/yy, NO more flood in UN. Kalaw flood is still NOT passable to cars and vans. Security Services Head Gerardo Ramos
6. The doctor-clients should be advised where to park in case they cannot pass through a flooded Kalaw Street to go to their usual Kalaw 1 parking lot.
7. Until the time the SMS system of the hospital is improved in terms of fast transmittal of SMS, the MDH Telephone Operator should prioritize whom to text.
General policy on prioritization:
SMT members (Division heads to transmit SMS to their middle managers)
SP-DPC members (Members to transmit SMS to their team members)
Doctors who are scheduled to have patient-service activities in the hospital
Operating Room Complex
Laboratory Medicine – Frozen Section
Doctors who will hold clinic in the next several hours
Active over courtesy medical staff
8. Although I have not seen it, I was told a member of the senior management team text-blasted the presence of Code Water in MDH on September 15, 2012, which was NOT indicated. I recommend all members of the senior management team be educated on the Code Water to avoid confusion.
Last September 10, 2012, I sent this message to the MDH SMT on OLETE (Online Learning cum Evaluation Test Exercise) on Rain-Flood-Wind Emergencies for Incident Commanders in MDH.
For the MDH Managers, I suggest they take the QuizStar where they can see their correct and wrong answers right after the test.
Here are the instructions:
Get into the Internet.
Under Student Login Page, click “Students, get started”
Place your first name; last name – middle name; username; passwords.
Then, click “register.”
Then login your username and password.
Then click “Search”
In the box, under quiz title, enter the following:
“Rain-Flood-Wind Emergencies for Incident Commanders of MDH”
Click “exact match” then “register.”
Then, “go to test” then “take.”
Then, take your test.
Note: The above recommendations were derived from the following observations / experiences during the September 15, 2012 flash flood.
The SMS message should be short, limited to 160 or even 100 characters, to facilitate quicker transmittal. In the above SMS, I suggested removing “Good morning” and “be safe.” I also suggested using abbreviations for the street names, UN and Kalaw.
I received this SMS at 750 am, too late the hero. I had reached MDH without the help of this advisory.
Note: After I decided to empower the Head of Security Services to transmit the SMS MDH Perimeter Flood Advisory.
I received this advisory at 750 am after I advised the telephone operator on how to prioritize the SMS transmittal.
Sample of an hourly update made by the supervisor of the Security Services of MDH. Note the words “update” and “still.”
I received this update at 1025 am. Quick transmittal already.
Last update. I received this update at 1207 pm. Very timely. Note the word “now.”
On September 5, 2012, I made a blog entitled:
I made the following recommendations:
1. MDH can send such kind of SMS advisory on MDH perimeter flood even outside a CODE WATER situation. To the doctors, who are MDH clients also, and particularly to those who park in Kalaw 1 Parking Lot, this is a value-added service.
2. Somebody in authority should act fast in sending the SMS advisory as the flood situation can change quickly, for better or for worst. In this particular event, it was for the better as the flood subsided quite fast after 7:30 am.
3. Doctors should be advised where to park in case of flood in Kalaw that hinders entry to Kalaw 1 Parking Lot. (Note: quite a number of doctors, particularly those who don’t park in Kalaw 2 Parking Lot, don’t know what is Kalaw 2 Parking and where it is. There is a need for knowledge management on this.]