POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 1

Chapter I

THE PROBLEM AND ITS SETTING

INTRODUCTION

Health is one of the vital keys for the success of any firm or organization. According

to Occupational Safety and Health Administration (OSHA), good health and safety

measures implemented in workplaces can cause workers to increase productivity, boost

morale, and reduce cost from losses cause by work related injuries and accidents. It is a

factor to be considered in many health and safety management plans in businesses.

Health mostly affects staffs, members or employees of a group. In response, firms and

businesses provides proper healthcare benefits by contracting healthcare providers or

institutions to give them the proper health maintenance.

A hospital is a health care institution providing patient treatment with specialized

medical team and nursing staff, and medical equipment (Wikipedia). They allow every

person to have access in any healthcare services they need for the purpose of improving

health or preventing disease. Hospitals are classified in different types in terms of many

aspects. One aspect is based on its objective type of hospitals and includes (1) General.

Meant to provide wide range of various types of healthcare, but with limited capacity; (2)

Specialty. Limited services within a particular condition (e.g. maternity or orthopedics type

of hospitals); and (3) A Teaching Cum Research Hospital. A type that is attached for

medical, nursing, dental or pharmacy education.

Other common classification of hospital is based on administration, ownership,

control or financial income which includes: (1) Governmental or Public. A hospital owned,

administered and controlled by the government, and a type that provides free care for
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patients; (2) Non-governmental or Private; Owned or controlled by an individual or group

of physicians or citizens or by private organization; (3) Semi-Governmental Hospital.

Hospitals run both by the government and private entity, and (4) Voluntary Agency. Not

for profit hospitals by the Voluntary Organizations.

Hospitals are usually funded by the public sector, by health organizations (for profit

or nonprofit), by health insurance companies, or by charities, including direct charitable

donations. Historically, hospitals were often founded and funded by religious orders, or by

charitable individuals and leaders (University of Perpetual Help System Molino Dalta,

Bacoor Cavite). These institutions are also the center of innovations when it comes to

methods, treatments, and procedures of providing health services to every people.

Furthermore, hospitals are also profitable infrastructures. They become landmark of the

community that provide extra value to businesses and areas around its vicinity.

According to Department of Health, there are approximately 1800 hospitals in the

Philippines. 70 are DOH funded hospitals, 1,071 are licensed private hospitals and the

721 are all public hospitals, (Philippines Health Service Delivery Profile, 2012).

Thirty percent (30%) of the Private Hospitals population uses the North American

Medical models as their core ideals and principle of providing healthcare system (Transfer

wise Content Team, 2017). This model of healthcare service is a uniform health system

that includes high cost service payment in exchange of good quality healthcare. It is

proven through patients’ testimonies and reviews that private hospitals implementing the

said model in their management and service has a higher medical service standard than

a public hospital. On the other hand, healthcare services in public hospitals are much

economical to most Filipinos. Subsidies from the government allows ordinary people to

access healthcare services for free which makes public hospitals more in demand.
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The World Health Organization (2012) described in their page that healthcare in

public hospitals in the Philippines is “fragmented”, means greatly affected by poor attention

given by government, resulting to significant problems that degrades public hospitals

healthcare quality.

The health system shortcomings, hospital deteriorations, inefficient healthcare

service, and hospital deficiencies are few of problems brought about by devolution cause

by lack of government attention. Possibly, those scenarios will led to the deterioration of

health providers like hospitals. In return, public hospital managers, and community leaders

are starting to make their move of giving solution to those problems, one of which is the

researching of suitable restorative techniques to reverse the effects of devolution.

Modernization is the process of transforming and adapting the existing building or

facilities to meet the growing demands of modern community (Jaroslaw Bakowski, Gdansk

Technical University, Poland). Hospital buildings as a specialized environment is one of

the types of infrastructures that requires modernization improvement or frequent upgrades

to have the ability to cope up with the never-ending needs for healthcare of people. As

documented hospitals are one of the most complex building types. Its complexity is

reflected in the breadth and specificity of regulations, codes, and oversight that govern

hospital construction and operations. The functional units within the hospital can have

competing needs and priorities. Considerations like idealized scenarios and strongly-held

individual preferences must be balanced against mandatory requirements, actual

functional needs (internal traffic and relationship to other departments), and the financial

status of the organization, should be properly evaluated to have a complete and

successful construction, planning or designing of its development.

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For 21st century, ways of developing, and improving different structures exist, and

includes: (1) Renovations, the process of restoring buildings to its optimum form. (2)

Expansions, enlarging in terms of capacity, area or limits; and (3) Multi-phase

constructions, methods of constructing either new, addition or renovation of buildings by

parts or with intervals. These trends are all combined to a single term “rehabilitation”, used

to describe most modernization projects of infrastructures that requires special

considerations and construction treatments.

In the case of existing, functioning hospitals (without the possibility of excluding

them from use, even temporarily) continuity of their work is one of the factors determining

the possibilities of functional transformation, and it is a very difficult condition to meet.

It is unacceptable when during construction works a department of the hospital

simply ceases its functioning or works on a limited basis. This mainly relates to diagnostic

and treatment departments, without which the functioning of other parts becomes

impossible. Hence one of the characteristics of modernization is either to carry them on

the principle of relocating the department (or ward, with appropriate functional links

between departments) or splitting a task into several modernization stages (allowing the

department to be left at the original place) or most likely fall as a multi-phase type of

construction.

The necessity for development can be obviously observed to most public hospitals.

People are starting to demonstrate their disappointments to government healthcare

institutions. Thereby, the government makes progress to develop public hospitals. Critics

suggest that the government should start with the provinces where population is high and

where the community needs it the most.

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BACKGROUND OF THE STUDY

Santa María (or Sta. Maria), officially known as the Municipality of Santa Maria

(Filipino: Bayan ng Santa Maria) is a first class highly urban municipality in the province

of Bulacan, Philippines. It is the most populous municipality in Central Luzon and the 6th

most populous in the Philippines. Santa Maria has a land area of 9,092 hectares with 24

barangays as its constituents. Currently, infrastructures that can be found in the

municipality are 10 bridges, 32 public elementary schools, 5 public secondary schools,

two tertiary institutions, a public wet and dry market, shopping mall, one government

owned hospital, 7 private hospitals, and plenty of supermarket and convenience stores.

The Rogaciano M. Mercado Memorial Hospital (RMMMH) is the only government–

run hospital in the town. It has a land area of 14, 256 sq. meters, and provides healthcare

services for the Santa Maria, Meycauyan, Marilao, Bocaue, Balagtas, Pandi, Norzagaray,

and San Jose del Monte.

The RMMMH is a general type of hospital that do not just heal mere physical illness

which attacks the human body, but a much deeper and holistic healing of the entire human

person by providing quality healthcare service and therapeutic environment. The service

areas that RMMMH include are all the wards including medical and surgical for male and

female, pediatrics, chest unit and the maternity section. Other departments are out-patient

department (OPD), laboratory department, pharmacy department, central sterling and

supply department (C.S.S.D), X-ray department, operating departments, and

administrative offices. The roles of these departments are complementary and depict

what they call team-work in patient management, the patient always being at the center.

The Hospital since its establishment has demonstrated a very keen interest in the

staff recruitment and development of highly skilled and very dependable medical and
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paramedical personnel. Presently, their work force stands at 216 of which 130 are medical

staffs and 86 are administrative and utility personnel.

Many of its beneficiaries are satisfied with its performance and services given to

public. Its value is undeniably great due to the fact that it is one of the main factors of

development of life style and health in Santa Maria, and cities and municipalities nearby.

Due to many factors, RMMMH can also be subjected to unknown inefficiencies that can

deteriorate its great image. For that, the researchers will conduct the following rationale.

Rationale. This study intends to investigate and assess the whole RMMMH to be

able to accurately determine its condition, possible problems, and needs. The findings of

said investigations and assessment will be the basis for the plan and design of a proposed

development for Rogaciano M. Mercado Memorial Hospital.

Location. The current RMMMH is held at 15 C De Jesus Street, Brgy. Poblacion,

Santa Maria, Bulacan.

Figure 1. Location of Rogaciano M. Mercado Memorial Hospital

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OBJECTIVES OF THE STUDY

This study aims to provide and produce a proposed development for Sta. Maria’s

Rogaciano M. Mercado Memorial Hospital (RMMMH), thus an assessment and

investigation of its different aspects should be exploited first to make an accurate basis for

its development.

Specifically, this study aims to do the following:

1. To determine the current situations and conditions of RMMMH.

2. To determine the problems of RMMMH.

3. To determine the possible alternatives.

4. To determine the best alternative/s.

5. To implement the best alternative/s.

a. Plans and Specifications

b. Project Outline

c. Recommendations

d. Project Estimate

i. Bill of Labor and Materials

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THEORETICAL FRAMEWORK

The researchers will follow and use the following theories and methodology to

accomplish objectives of this study.

Customer Service Theory. Adam Smith (1776) states that “if a manager or owner

of a firm (e.g. hospital) wants his business to succeed, then he must meet the customer’s

needs. By doing so, meeting the customer’s needs would also mean meeting the

deficiencies of the firm itself, including staffs, facilities, and even the management.”

Furthermore, Smith includes features or elements that should be with the solution for those

deficiencies including: (1) Reliability: Whatever services the firm offers, it should be able

to perform those services in a reliable manner. (2) Flexibility: A firm needs to be able to

respond, not only to changing the industry and overall market conditions but also to the

changing needs of the customer. It is only by being responsive to the customer that a firm

can be flexible enough to stay afloat in any kind of economic atmosphere. (3) Aesthetics:

There are many tangible aspects that the firm should take care of, so that it can attract the

customer. One of those is that the firm should always create a welcoming ambience, which

many believe is on the decline in our social relationships.

Professor Jaroslaw Bakowski, faculty of Gdansk Technical University, Poland

presents in his published paper entitled “Modernization of Historic Healthcare

Buildings” four (4) conditions to be determined to successfully reconstruct, expand or

modernize an old healthcare building, specifically a hospital. The four (4) conditions to be

determined includes, (1) Factors influencing changes in the hospital, presenting

different structural part (e.g. Structural system, Installation equipment, Fire protection and

other safety-related issues) current status of the existing structure, that when analyzed

properly often leads to a successful reconstruction or remodeling of the internal or whole

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structure that is required. (2) The size of the hospital building – consolidation and steady

growth is related to the connected functioning of each facility inside the main building. (3)

A function relocating within the hospital building includes the idea of staging the

construction or making it in a multi-phase to prevent some functions from ceasing its work.

(4) Problems connected to reconstruction and expansion of hospitals, these indicate

a set of several characteristics that determines the architecture of the three [3] extra

objects: [1] size of the building, [2] repeatability of architectural composition, [3]

compactness.

These principles are not sufficient to drive a significant hospital development

planning process; thus, they can serve as a quick reference for project planners and

researchers as they present concrete procedure through the many analysis and

conceptual iterations required to provide a way of successfully developing a historical

healthcare building.
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CONCEPTUAL FRAMEWORK

INPUT PROCESS OUTPUT

 Preliminary Data

 Budget: Provincial  Evaluation of

Government of Preliminary Data PROPOSED
Bulacan DEVELOPMENT
OF ROGACIANO
 Architectural and
 Plan of Building M. MERCADO
Structural design
and Facilities of MEMORIAL
Present RMMMH HOSPITAL IN
 Construction SANTA MARIA,
Estimates BULACAN
 Land Title Owned
by the
municipality of
Sta. Maria

FEEDBACK

Figure 2. Conceptual Framework

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SCOPE AND LIMITATIONS OF THIS STUDY

This study will only focus and is limited on investigating and assessing the

Rogaciano M. Mercado Memorial Hospital (RMMMH). It covers the RMMMH present

conditions, historical background, systems, and integrity as a hospital. The researchers

will investigate and assess those aspects to identify the problem/s provided with proofs or

evidence, and the best solution/s to address the problem/s found. The aim of that work will

yield to the provision of proposed plan, design, and recommendations for the development

of RMMMH in Sta. Maria, Bulacan. In designing and planning, the researchers will refer to

different codes and standards implemented in the Philippines. In addition, this study will

also include creating a complete architectural, structural, plumbing and electrical plan. A

clear and base-in-standard computations accompanied by systematic procedures will also

be utilized. Furthermore, the use of engineering software will also be provided.

SIGNIFICANCE OF THE STUDY

This study aims to investigate and assess the Rogaciano M. Mercado Memorial

Hospital to provide a basis for its development. The researcher’s purpose is to help the

RMMMH improve and sustain its main function of giving a quality healthcare for its

patients. Specifically, the result of this study will benefit the following sectors:

To the Government, to increase the chance of giving more prosperous

development to the Sta. Maria’s Rogaciano M. Mercado Memorial Hospital (RMMMH).

This can also embellish their image to the public because of the progression that can be

done to their one and only government-run hospital.

To the Patients, the findings of the study will yield to the development of public

healthcare given by the local government of the municipality of Sta. Maria.

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To the Citizens of Sta. Maria, Bulacan, the findings of this study will redound to

the credits of the people in the municipality itself. This can respond to the outgrowing

concerns of many citizens in the municipality about RMMMH. Furthermore, if RMMMH is

developed, the citizens will have a good quality healthcare, a strong economy, job and

opportunities and an ensured lifestyle.

To the Civil Engineers, to provide assistance to those who need information

about the current situation and problems of one of the public hospitals in the Philippines,

and some possible solutions to public hospital’s problems. It can also be used as their

guidelines if it will be materialized in the near future.

To the Researchers, to enable them to access information that can be useful

during discussions or talk concerning subjects about construction, or other related topics

and lessons that may include structural enhancement techniques. Also, it can provide new

ideas and knowledge for strategically inclined projects and can show a different stand

point for the use in their future endeavors.

DEFINITION OF TERMS

Assessment – process of evaluating or making judgement about the facts, information,

or conclude scenario presented.

Construction - process of constructing a building or infrastructure.

Department of Health (DOH) - department in Philippines that is responsible for ensuring

access to basic public health services to all Filipinos through the provision of quality

health care and regulation of providers of health goods and services.

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Engineering - the application of knowledge in the form of science, mathematics, and

empirical evidence, to the innovation, design, construction, operation and maintenance of

structures, machines, materials, devices, systems, processes, and organizations.

Eschewing - the renovation and redecoration of something, especially a building.

Euro code - a means to prove compliance with the requirements for mechanical strength

and stability and safety in case of fire established by European Union law. A basis for

construction and engineering contract specifications.

Expansion - Refers to process of becoming larger or more extensive.

Health - Defined by the World Health Organization (WHO), is "a state of complete

physical, mental and social well-being and not merely the absence of disease or infirmity.

Healthcare - the maintenance or improvement of health via the prevention, diagnosis, and

treatment of disease, illness, injury, and other physical and mental impairments in human

beings. It includes work done in providing primary care, secondary care, and tertiary care,

as well as in public health.

Hospital - A health care institution providing patient treatment with specialized medical

and nursing staff and medical equipment.

In-patient - A patient who stays in a hospital while under treatment.

Investigation – process of gathering information, proofs, evidence about something to be

able to conclude or explain.

Medical Staff - Refers to physicians and dentists who are approved and given privileges

to provide health care to patients in a hospital or other health care facility. Medical staff

personnel may work full time or part time and may be employed by the facility or granted

admitting privileges to practice.

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Modernization - refers to a model of a progressive transition from a 'pre-modern' or

'traditional' to a 'modern' society.

Multi-phase - procedure consisting of or involving more than one phase, stages or

aspects.

Occupational Safety and Health Administration (OSHA) - an institution responsible for

worker safety and health protection.

Out-patient - a patient who receives medical treatment without being admitted to a

hospital.

Public Hospital - a public hospital or government hospital is 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 government

reimbursement

Rationale - explanation of controlling principles of opinion, belief, practice, or phenomena.

Refurbishment - renovation and redecoration of something, especially a building.

Rehabilitation - process of making possible a compatible use for a property through

repair, alterations, and additions while preserving those portions or features which convey

its historical, cultural, or architectural values.

Remodeling - generally work to change the appearance, structure, or function of a room.

In other words, a remodel works to improve upon or transform the existing design and

layout of a room. Remodeling refers to “changing” or “transforming” a building or home.

Renovation - restore to a good state of repair.

RMMMH - Rogaciano M. Mercado Memorial Hospital, the only public hospital in Sta.

Maria, Bulacan.

Senescence - condition or process of deterioration with age.

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WHO - World Health Organization, a specialized agency of the United Nations that is

concerned with international public health.

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Chapter II

REVIEW OF RELATED STUDIES AND LITERATURES

This chapter includes the review of related literature and studies both local and

foreign. It contains articles that are related to hospital development which contributes

information to the research.

MODERNIZATION OF HISTORIC HEALTHCARE BUILDINGS, Jaroslaw Bakowski,

Gdansk Technical University, Poland, (2017).

The practice of transforming and adapting the existing healthcare facilities to meet

the growing demands of modern medicine applies not only to buildings of historical value

but also for those structure whose greatly in need for development. Of course, one can

set a time point from which healthcare facilities specifically hospitals, erected mostly with

industrialized technologies, undergo upgrades for better or worse effect. Existing

healthcare buildings or facilities, including historic ones, or built fairly long, to be

refurbished and adapted to meet the growing demands of modern medicine.

Modernizing now is a must; the enactment of the Local Government Code which

devolved certain public services like health has led to such deterioration precisely for lack

of appropriate funding and able management. As a result, health care delivery especially

in hard to reach areas has suffered. “The problems brought about by devolution led to the

deterioration of health services particularly in far-flung areas where services are needed

most. Of the 41,000 villages in the Philippines, only one fourth have health units. The

villages lacked staff, equipment, and medicines (Martina C, 22 Jan 2017).

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Freedom in building a new space facing constraints arising only from the functional

and technological requirements is conducive to creating new, even innovative solutions.

Expansion of the hospital, especially historic, brings more challenges: first of all, the

principle decision on the extent of change and intervention must be taken. It translates to

determine whether its architecture presents such characteristics for which a decision on

respecting them is obvious. The main criterion is always the assessment and reference to

real cultural and historical values of the building.

Different essential principles such as the four (4) main considerations to be

determine to successfully reconstruct, expand or modernize an old healthcare building,

specifically hospital is given in this study by Professor Jaroslaw Bakowski, of Gdansk

Technical University, Poland. The four (4) considerations to be determined are, (1)

Factors influencing changes in the hospital, presenting different structural part (e.g.

Structural system, Installation equipment, Fire protection and other safety-related issues)

current status of the existing structure, that when analyze properly often lead to a

successful reconstruction or remodeling of the internal or whole structure that is required.

(2) The size of the hospital building – consolidation and steady growth is related to the

connected functioning of each facility inside the main building. (3) A function relocating

within the hospital building includes the idea of staging the construction or making it in

a multi-phase to prevent some functions from ceasing its work. (4) Problems connected

to reconstruction and expansion of hospitals, these indicate a set of several

characteristics that determine the architecture of the three [3] extra objects: [1] A size of

the building, [2] A repeatability of architectural composition, [3] A compactness.

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Theoretically, using these considerations will produce a successful development

plan of any hospitals.

HOSPITAL DEVELOPMENT: A STRUCTURAL, ARCHITECHTURAL, AND

MANAGEMENT ASSESSMENT, University of Perpetual Help System Dalta Master’s

study, (2015)

This study presents significant amount of information’s about hospital

development, specifically in the aspects of structural and architectural development.

According to this study, a hospitals should have certain common attributes, (1) An

efficient hospital layout, (2) medical needs and (3) modes of treatment will continue to

change, (4) hospitals must be easy to clean and maintain, (5) area access inside and out,

(6) a complex system of interrelated functions requiring constant movement of people and

goods, (7) general safety concerns of all buildings, (8) significant impact on the

environment and economy of the surrounding. These hospital attributes become one of

the major considerations in planning the appropriate design of common hospitals.

Figure 3. Hospital Attributes

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Architectural and Structural reference is also presented in this study.

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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 21
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Figure 4. Architectural Reference Data

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Trends for Hospital as a Specialized Environment

Hospital is the place intended not only for patients. Patient expectation in health

care continues to increase and this is something that needs to be managed adequately in

order to improve outcomes and decrease liability. Understanding patients’ expectations

can enhance their satisfaction level. In the environment of the Emergency Department,

with the acutely ill, serious and time-dependent issues as well as high level of stress,

managing patient expectations can indeed be challenging (Fatimah Lateef, 2011).

Obviously, it is a strong simplification – the patient is its main and the most sensitive user

and the whole activity of the hospital is based on solving his or her health problems. Still,

the hospital is additionally a place of work for professionals of different specialties, a

troublesome production plant, and a significant part of the infrastructure of the city taking

an advantage of its resources and aggravating it with dangerous waste. Basic

requirements for hospitals always focused one thing – the fastest and the most

effective healing of the patient. Currently, according to George J Mann, Joseph G

Sprague, and Ronald L Skaggs, these are the trends that the hospital should observed,

adapt and consider in planning and design of hospitals: (1) New channels for continuous

care, the widely acknowledged focus on disease prevention and wellness continues to be

tremendously important. Non-communicable ailments such as heart disease, stroke and

chronic respiratory diseases are becoming more prevalent, and chronic diseases continue

to account for many healthcare costs. In response to this, forward-thinking healthcare

providers are expanding their services beyond the physical walls of hospitals and clinics.

With strong informational and educational components, these services include virtual

consultations, remote monitoring of vital signs, access to online medical records and

targeted community health screening events, those can be shortly explained as modern
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applications of technologies to enhance health services. (2) Crafting better-performing

facilities through research, more than ever, healthcare designers are responsible for

crafting environments that provide quantifiable improvements in organizational

effectiveness and patient outcomes and satisfaction. A cornerstone of this practice is

evidence-based design, characterized by the use and generation of scientific evidence in

order to support decision-making for more predictable outcomes. This framework is used

to systematically analyze the outcomes of particular types of designs for areas such as

patient rooms, nurse stations and surgical suites. An evidence-based healthcare design

should result in demonstrated improvements in the organization’s clinical outcomes,

economic performance, productivity, and/or customer satisfaction. (3) 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. (4) Sustainability,

a hospital building is one of the highest consumers of energy, and sustainable design is

essential in reducing the consumption of natural resources and reducing a facility’s life

cycle costs. It is vital that the principles of lean design, lean operations and standardized

design be applied to minimize waste of all types.

On the other hand, two main trends for constructing the hospital can be observed:

(1) one implying filling the hospital with possible resources, technical equipment and

apparatus to the maximum extent and providing sufficient space for medical procedures

(technologization trend) or (2) one concerning creation of favorable conditions for staying,

using non-physical therapies or providing the friendly environment (a humanization trend).

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The design of appropriate health and health facilities for large populations requires

above all a broad understanding and consideration of the overall culture, specific health

issues and available health trends before appropriate facilities can be successfully

planned, programmed, designed, built, operated and maintained.

Essential of Parking Structure of Hospital

Today, hospitals and health systems face unprecedented challenges in reducing

costs while improving quality, efficiency, sustainability, and staff and patient satisfaction.

Yet, they also have another challenge – and opportunity – that is frequently overlooked:

parking structures. While it can seem like there is never enough convenient parking –

especially on high-density, landlocked urban hospital campuses – recent innovations in

design and technology can alleviate parking shortages with attractive, sustainable,

affordable solutions that improve the user experience (Mark Toothacre, 2018). Parking is

one of the main factors considered in modernizing. Changes in capacity or having

aesthetic amenities of facilities will increase the number of the hospital’s beneficiaries and

without adding enough space for that increase will cause another big problem (Ayrshire

and Arran).

Patients, families, physicians and staff all want to get in and out of their healthcare

facilities as quickly as possible and expect convenient, safe parking. Most hospital

executives and planners understand that a good parking facility is essential to any

campus, and offers another way to differentiate themselves from other providers.

Consequently, more hospitals are eschewing the simple, drab asphalt parking lots and

dreary concrete parking structures of the past and developing facilities that combine
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function with design. The trend for a developer today is to go beyond the traditional way,

“Hospitals today want parking structures that are customer-centric, so they’re building in

amenities that will enhance users’ experiences as well as improve safety and security,

(Wadell, 2018).

Among the newest amenities are carpool van and alternative energy parking stalls,

charging stations for electric cars, valet parking, shuttle services, and pay-on-foot systems

and charge card readers at exit lanes that replace slower, less flexible kiosk pay systems.

But the ultimate convenience for busy, time-pressed patients and staff are automated

parking display systems that indicate parking availability on a floor-by-floor and stall-by-

stall basis. Many hospitals also offer convenient pedestrian bridges and well-planned

stairways and elevators. Surveys by Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS) find that patients who are offered extra amenities from

their hospital are more likely to rate the hospital favourably and to recommend the facility

to their friends and family (Mark Toothacre, 2018).

The Impact of Facility Design on Patient Safety

Recent attention in health care has been on the actual architectural design of a

hospital facility, including its technology and equipment, and its effect on patient safety.

To address the problems of errors in health care and serious safety issues, fundamental

changes of health care processes, culture, and the physical environment are necessary

and need to be aligned, so that the caregivers and the resources that support them are
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set up for enabling safe care. The facility design of the hospital, with its equipment and

technology, has not historically considered the impact on the quality and safety of patients,

yet billions of money are and will be invested annually in health care facilities. This

provides a unique opportunity to use current and emerging evidence to improve the

physical environment in which nurses and other caregivers work, and thus improve both

nurse and patient outcomes.

A plan or drawing produced to show the look and function or workings of a building,

garment, or other object before it is built or made. The Design in plans can have different

connotations in different fields of application, but there are two basic meanings of design:

as a verb and as a noun. Design is the intentional creation of a plan or specification for

the construction of an object or system or for the implementation of an activity or process

(Wikipedia). According to Henriksen and colleagues, the design of a facility/structure with

its fixed and moveable components can have a significant impact on human performance,

especially on the health and safety of employees, patients, and families.

Cognitive psychologists have identified the physical environment as having a

significant impact on safety and human performance. Understanding “the

interrelationships between humans, the tools they use, and the environment in which they

live and work” is basis to any study of the design a health care facility and its effect on the

performance of the nurses and other caregivers who interface with the facility and its fixed

(e.g., oxygen and suctioning ports on the wall of a patient room) and moveable (e.g., a

patient bed) equipment and technology.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 30

Humans do not always behave clumsily and humans do not always do errors, but

they are most likely to do so when they work in a badly conceived and designed health

care setting.

Organizational or system factors that can potentially create the conditions

conducive for errors are called latent conditions. According to Reason, latent conditions

are the inevitable “resident pathogens” that “may lie dormant within the system for a long

time, only becoming evident when they combine with other factors to breach the system’s

defences. Latent conditions can be identified and remedied before an adverse event

occurs”. Examples of latent conditions are: (1) poorly designed facilities, including the

location of technology and equipment; (2) confusing procedures; (3) training gaps; (4) staff

shortages or improper staffing patterns; and (4) poor safety culture. A specific example of

a latent condition effecting patient safety would be the impact of low lighting levels in the

medication dispensing areas that are associated with some medication errors but not

others. These and other conditions occur at what Reason describes as the “blunt end,”

where administrators, the work environment, and resources determine the processes of

care delivery. Latent conditions are present in all organizations and can be unintentionally

created by those who are responsible for designing systems. Thus, ensuring adequate

staffing, creating ways to prevent the hazards of latent conditions, providing enforcing

policies, and allocating efficiently the utilities and structural amenities will enough solutions

to atleast minimize the risk (Rockville, 2008).

Healthcare in the Philippines, Allianz Care, (2019)

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 31

Overall, the healthcare system in the Philippines is of a high standard. Filipino

medical staff are expertly trained, but the facilities may not be as impressive as those

found in high-end US or European hospitals. The quality of the Philippines’ state-

subsidised public healthcare, although good, varies widely between rural and urban areas.

Private healthcare in the Philippines provides much more consistent care and facilities

tend to be better equipped than public ones. English is also spoken throughout the

Philippines, meaning that there should be few language barriers preventing expats from

accessing healthcare (Allianz Care, 2019).

Doctors and nursing staff in public hospitals are highly proficient, however public

healthcare in the Philippines faces some limitations. Despite having achieved universal

healthcare, the Philippines still struggles with unequal access to medical care. As such,

the standard of public healthcare in the Philippines generally varies from excellent in urban

centres to poor in rural areas. Public healthcare also faces strain both from treating the

large number of Filipinos who rely on public healthcare and from the trend of Filipino

medical staff migrating to Western countries. This has resulted in understaffing in some

hospitals and patients may experience delays in treatment.

Public healthcare in the Philippines is administered by Philhealth, a government

owned corporation. Philhealth subsidises a variety of treatments including inpatient care

and non-emergency surgeries, although it does not cover all medical treatments and

costs.

Enrolling with Philhealth is mandatory for expats who are employed in the

Philippines. Philhealth contributions are derived from employers, employee salaries and

the state. Expats can voluntarily enrol with Philhealth if they have residency status.
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 32

Private healthcare services are well-established and growing in the Philippines.

Although doctors in private hospitals are as good as doctors practising in the public sector,

private facilities are much better equipped and treatment is typically faster. Private

services are considered to be expensive by locals, but are relatively cheap by most expat

standards. The relative affordability of private healthcare can be seen in the increasing

popularity of the Philippines as a medical tourism destination.

There are numerous pharmacies in the Philippines and many 24-hour pharmacies

can be found in major cities and attached to most hospitals. Pharmacies are staffed by

accredited pharmacists who maintain the state’s strict guidelines on the sale of

prescription drugs.

Although most medicine is available in the Philippines, some prescription medicine

may not be available in the country, so expats should ensure that they either bring the

necessary medication with them, or that alternatives can be prescribed in the Philippines.

911 is the general national emergency number in the Philippines.

The quality of ambulance services differs significantly and this problem is

compounded by the lack of strict policies governing how emergency services operate. This

may result in slow response times and poor pre-hospital treatment. The public emergency

system also directs most serious emergencies to designated public facilities which may

delay emergency care.

Private ambulances generally have highly proficient staff and better equipment

while also promising faster response times. Private ambulance services are often secured
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 33

through monthly subscriptions, or their services are included as part of a medical

insurance package. Many private hospitals also have their own ambulance services.

Impact of Aging Structures

In an era of an exceedingly specialized workforce and sophisticated equipment’s,

the small struggling hospitals has no place. These kinds of infrastructures, which in any

case most residents bypass for their acute care given and offered, are the ones that is

being deteriorated caused by lack of attention given for their developments. A scholar

would say that these structures need to be redesigned and reconfigured to befit in the

current age so that they can survive and play an important role within the healthcare

hierarchy (Garthwaite and Pam, 2017).

Public buildings such as town halls and parliament buildings could be expected to

last for 100 to 200 years. Whereas private structures such as offices and dwellings

perhaps may be used for up to 50 to 60 years. BS 7543 of 1992, defines the ‘normal’ life

of a building as 60 years. But the new Euro codes, (e.g. BS EN 1992-1-1 of 2008), assume

this period to be a lower one of 50 years. Socio-economic considerations impinge on the

above durations. Some of which tend to reduce the lifespan of buildings, while others

increase them. The changing needs of various owners, and indeed the changing face of

the city or area in which the building is located may cause a building to be obsolete even

before it ceases to be serviceable. In the context of the above proneness to change, most

investors or builders may not want to invest in a building with an excessive service life. On

the other hand, owners sometimes try to use an existing building over and above its

service life, because demolition and reconstruction may force them to comply with new
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 34

planning regulations. Once a building exceeds a certain lifespan, the owner, or even other

interested parties, may wish to prolong its life further, if it is considered a national heritage.

The different materials of construction that are used in a building will give rise to different

rates of deterioration. In general, steel and reinforced concrete will tend to deteriorate

faster than masonry; and timber in internal environments.

Heat and moisture are environmental factors that tend to accelerate deterioration.

Likewise, if steel embedded concrete and structural steel are subjected to a chloride

environment, inclusive of proximity to the coast, this situation will significantly enhance

corrosion (W.P.S. Dias, 2013).

Buildings change during their life-cycle. From construction handover they become

operational space. Eventually they become less effective as technology, processes, or

fashions change, until functional obsolescence is reached. The process of refurbishment

or adaptation may provide to prolong further the period/s of its operation. Finally,

senescence and decay ensue, followed by demolition and in some cases, redevelopment

is needed (Mansfield, 2008).

Hospital Renovation Challenges, Widmer, (2018)

Any renovation comes with its own set of challenges, but renovating a hospital is

a bit more complex than adding a new kitchen island. However, with the right preparation,

it is certainly possible to prepare for the most common challenges faced by hospital

administration as well as the construction personnel that are involved in the project. With

62% of healthcare facilities projecting that they will increase the instance of hospital

renovation in the next 2 years, it is essential that these challenges be addressed

(Hepacart, 2016).
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 35

Today, most of hospitals are experiencing the four (4) most common challenges

occurring during renovations: [1] Choosing the Right Team (Challenge). A renovation

project is only as good as the team that takes it on, but it is not always easy to find a team

that fits both the budget and the expertise requirement of the project. Solution: (1) Find a

Balance. The team that guarantees they will work the fastest may not be the team with

the best design experience. The team that will come on board for the lowest price is may

not be the team that can meet your deadlines. Picking the right players is the key to

building any successful team. Simple as it seems, the process is not just about selecting

the best available for each role. It is about getting the right blend to form the team best

suited to undertake the particular job in hand. The best way to find the right team is to

determine your must haves (perhaps the hospital renovation absolutely needs to be

complete by a certain date or definitely needs to look a certain way) and find a team that

can offer those while still balancing their ability to meet your projects and other goals. [2]

Creep of Schedule and/or Scope (Challenge). Construction projects can often be faced

with the challenge of creep. That is when the project begins to push past the schedule

and/or scope limits of the original plan. Solution: (2) Plan for the Long Term. A hospital

renovation should never be considered in a vacuum. Rather, it should be a part of a long-

term plan for the facility. When you can look at the renovation in terms of a bigger picture,

it is easier to organize the renovation from the outset and ensure that the project does not

go beyond scope. Schedule creep can be more challenging, but one way to mitigate that

possibility is to consider a design-build delivery system from the outset. When a single

hospital contractor is able to both design and build the renovation, there is a better chance

of staying on schedule.
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 36

Related Projects:

1. Bulacan Medical Center (BMC)

Location: Malolos, Bulacan

Bulacan Medical Center (BMC) is a Level 3- DOH Accredited tertiary, teaching and

training hospital located at the center of Malolos City, Bulacan. It was initially built merely

as a 25-bed capacity as Bulacan Provincial Hospital whose main objective is to deliver

quality health care for Bulakeños. With the passage of the Republic Act No. 7169 on 1991,

otherwise known as the Local Government Code, devolution of health services was

mandated, hence the transfer of the jurisdiction of the Bulacan Provincial Hospital to the

Local Government Unit. Since then, full support from the Provincial Government of

Bulacan was extended to the hospital. From a mere 25-bed capacity it has a grown into a

300-bed capacity hospital.

Continuous expansions and renovations were initiated by different leaderships.

Long term medical manpower development program resulted to the accreditation of the

four major departments, Medical, OB-Gyne, Pediatrics and Surgery. Each Department

has clinical ward minimum of 50 beds each to address the needs of their respective

patients.

There are also special areas: Operating Room, Recovery Room, Medical and

Neurological Intensive Care Units (ICU), Neonatal ICU (NICU), Pediatric ICU (PICU),

Labor Room (LR) and Delivery Room (DR), available wherein patients can be provided of

the necessary medical treatment, equipment and facilities.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 37

Significance. Modern facilities with brand new equipment were provided

continuously by the Provincial Government handling the hospital. New treatments and

services can now be done in the BMC due to its technologizations and modernizations.

Furthermore, Bulacan Medical Centre made an impact in the province of Bulacan by being

the sole tertiary state-owned hospital in the province.

Figure 5. Bulacan Medical Center

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 38

2. Philippine General Hospital (PGH)

Location: Metro Manila

The Philippine General Hospital (PGH) is a tertiary state-owned hospital administered

and operated by the University of the Philippines Manila, the University of the Philippines

System's Health Sciences Centre. It is the largest government hospital administered by

the university, and is designated as the National University Hospital.

It is the biggest hospital in the country with a 1,500-bed capacity. It is a mixed-use

hospital, with 1,000 beds for indigent patients and 500 beds for private patients, and offers

some of the lowest rates for patients and is generally known as the hospital for indigent

patients.

PGH Manila occupies 10 hectares in UP Manila, having only 120,000sqm of hospital

service area for its 1,500 patients. Its basic design is 2 floor pavilions spread out in 6

hectares, augmented by the 7 floor Central Block, and the 3-storey Outpatient building

within it. PGH Diliman is vertically designed needing less land area. This makes

construction and maintenance more efficient.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 39

Significance. Planning the structure of PGH Diliman necessitates knowledge of the

surrounding hospitals. Considerations of hospitals near the place it is held is analysed to

perfectly develop its current state and its master plan for future developments and

maintenance. PGH developer’s dedication of making an impact in the community by

creating a high-class public hospital is inspiring from the intent up to the infrastructure as

its product.

Figure 6. Philippine General Hospital (PGH)

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 40

3. Santa Ana Hospital (Manila)

Location: Santa Ana, Manila

Santa Ana Hospital was built by the City of Manila with the help of Lucio Tan's Tan

Yan Kee Foundation. The said hospital, according to city engineer Armand Andres, sits

on an 8,000-square-meter lot with a floor area of at least 5,000 square meters and has a

500-bed capacity. The opening of the said hospital, constructed by the Freyssinet (F.F.

Cruz) Filipino Corp., marks the fruition of Lim’s vision since he became mayor in 1992, of

building one city hospital giving free medical services for the poor residents for each of

Manila’s six districts.

The hospital building was completed in April 2010, opening on April 28. Santa Ana

is ten stories high, is fully modernized and has a capacity of 500 inpatient beds.

Significance. Santa Ana multi-story and fully modernized building will provide the

people within its vicinity great prosperity in terms of high-quality healthcare and a known

landmark of their community.

Figure 7. Santa Ana Hospital (Manila)

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 41

4. Ospital ng Maynila

Location: Metro Manila

The Ospital ng Maynila Medical Center (Hospital of Manila; abbreviation: OMMC)

is a 300-bed non-profit tertiary, general and training hospital in Malate, Manila, Philippines.

It is the laboratory hospital of health science students (students of medicine, nursing and

physical therapy) enrolled at the “Pamantasan ng Lungsod ng Maynila”, one of the

Philippines' universities.

As hospital operated and maintained through taxes paid by Manila residents,

OMMC has for its primary concern the admission and treatment of patients who are bona

fide residents of the city. Furthermore, it is responsible for the provision of an integrated

community health program and research activities.

Significance. Its population prepared multi-story building and specialized facilities

is one of the main assets of “Ospital ng Maynila”. It allows this public hospital to maintain

its good services without any problem of shortage in capacity.

Figure 8. Ospital ng Manila

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 42

5. Christiana Hospital, 2010 Project

Location: Newark, DE

The Christiana Hospital, a 906-bed, 1.3-million-square-foot, modern facility in Newark,

Delaware, is providing a non-profit health care services to all of the U.S. state of Delaware

and portions of seven counties bordering the state in Pennsylvania, Maryland and New

Jersey. The system includes two hospitals in Delaware, Wilmington Hospital and

Christiana Hospital, as well as the Eugene du Pont Preventive Medicine & Rehabilitation

Center, the Helen F. Graham Cancer Center, the Center for Heart & Vascular Health,

Visiting Nurse Association and a wide range of outpatient and satellite services.

A Christiana Hospital project in 2010 is a 299,000 square foot addition to the Christiana

Medical Campus. An expansion, designed by architects at Wilmot/Sanz, will develop the

hospital’s clinical capabilities along with adding a new medical education center capable

of providing this teaching hospital with the latest techniques and learning tools.

Structurally the building has been designed essentially into two separate buildings. These

two buildings consist of a three-story education wing using steel construction and an eight

story clinical tower that takes advantage of reinforced concrete construction.

Significance. The Christiana Hospital is built in the middle of Newark city, Delaware.

Its expansion structure is built above its existing medical school. The construction is well

managed that allows it to minimized losses and incapability’s of some departments due to

construction.
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 43

Figure 9. Christiana Hospital, 2010

6. La Paz Medical Center In Bata Equatorial Guinea

 120 beds hospital including:

 4 Operating theatres, 12 beds ICU

 2 labor and delivery rooms

 8 beds new born nursery

 Two 38 bed wards

 Surgical and internal radiology institute including CT, X-Ray,

Fluoroscopy, Mammography and Ultrasound

 Dialysis unit

 Gastroenterology institute

Significance. Has great exterior architectural design. Usage of green engineering

to provide illumination in the building with natural sunlight by using more glass panels.
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 44

Figure 10. La Paz Medical Center In Bata Equatorial Guinea

7. University of Texas M.D., Anderson Cancer Center

Location: Houston

Summary: The M.D. Anderson Cancer Center is one of the nation's highest-rated

hospitals for cancer care, which is the main reason why this world-class facility was in

desperate need of more patient beds. “We're beyond 100% occupancy,” says Susan

Lipka, the hospitals associate VP for capital planning and management services.

Fortunately, the existing 12-story Alkek Hospital Tower, completed in 1998, had

been designed by Dallas A/E firm HKS to accommodate a 10-story vertical expansion. In

2007 the hospital opted to put a massive 500,000-sf addition atop the tower, thereby

adding 208 new patient rooms (each 40 sf larger than those in the existing hospital) and

providing shell space for another 200 or so patient rooms.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 45

Significance. A Building Team consisting of HKS, structural engineer Walter P

Moore, and contractor McCarthy Building Companies was hired under a design-build

contract to complete the $220 million project. There was just one hitch. The hospital

decided that if a 10-story addition was good, a 12-story one would be even better. That

meant adding two extra floors, at 45,000 sf each, while the existing facility was not only

occupied, but operating at more than 100% capacity.

Figure 11. University of Texas M.D., Anderson Cancer Center

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 46

Chapter III

RESEARCH METHODOLOGY

RESEARCH DESIGN

To justify and make an accurate outcome in proposing a development for

Rogaciano M. Mercado Memorial Hospital (RMMMH), it is important to properly identify

the suitable approach to be used in conducting the research.

A Quantitative approach is used to emphasize objective measurements and the

statistical, mathematical, or numerical analysis of data collected. The data’s will come from

questionnaires, and surveys, or by manipulating pre-existing statistical data using

computational techniques. This approach focuses on numerical data and generalizing it

across groups of people or to explain a particular phenomenon. Furthermore, the use of

different analyses, testing’s, and processing of the data’s as input to come up with a

conclusion are also under this type of approach.

Descriptive method is used to gather information, process and analyze data, and

to provide the output required. Interviews, observations calculations, analysis, and surveys

will also be used to gather information from professionals, RMMMH patients, and RMMMH

staffs. Documentation are provided for stronger factual basis.

RESEARCH PROCEDURE

An accurate step by step process should be implemented to be able to present a

well-managed proposal – hence, the researcher would be utilizing a research procedure

with three main phase.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 47

The first phase is consist of three (3) parts. Part 1 is the assessment of structure

and facilities. The use of Non-Destructive Testing’s (NDT), such as Rebound Hammer

test, Ground Penetrating Radar test and FEMA Scoring will be used to find out the

condition of RMMMH building and facilities. Part 2 is about knowing the perception and

ideas of RMMMH beneficiaries. Survey method will be the method to be used to gather

the ideas and thoughts of its patients and staffs, while personal interviewing method will

be utilized to know the perception of implementing agencies and related offices regarding

the RMMMH. Part 3 is about assessing the historical background of RMMMH. Analysis of

the RMMMH operational statistics and previous developments will be the scope of this

part. Furthermore, the preliminary data’s to be gathered in the stated three (3) parts will

be subjected to further investigations about its effects and relationship towards RMMMH’s

performance as a healthcare provider.

Finishing first phase will yield to having data’s comparable to the standards and

interpretations, and will bring the researcher’s identification of RMMMH problem/s.

The Second phase is now about addressing the problem/s that is found in the First

phase. Researching and interviewing of professionals will be the methods to be used to

identify the possible alternatives for each problem/s. Determining which among the

alternatives is the best will be known after subjecting each of the alternatives in Strengths,

Weaknesses, Opportunities and Threats (SWOT) and Cost analysis.

The last phase would be the implementation of the best alternative in the form of a

proposed development for RMMMH which includes Plans and Specifications, a Project

Outline, Project Estimate, and Recommendations.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 48

FLOW CHART

Fig. 12. Flow Chart - Gives an overview of the process used to accomplish research

objectives
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 49

POPULATION OF THE STUDY

Respondents are those persons who have been invited to participate in a particular

study and have actually taken part in the study (L.M. Given, 2008).

To determine the number of respondents, the researchers will use the Slovin’s

formula with a percentage of accuracy of 95% to calculate the sample size:

𝑁
𝑛=
(1 + 𝑁𝑒 2 )

Where:

n= number of sample

N= total population

e= error tolerance

The population of the study consisted of three (3) groups of respondents. These

groups is where the researchers will gather the data’s to be analyzed.

The first group was the involved professionals (e.g. Bulacan Provincial Engineer,

Sta. Maria MPDO head) from different firms, sectors, and departments related with the

subject of this study.

The second group was the 216 RMMMH Staff consisting of (130) RMMMH Medical

staffs (e.g. doctors, nurses), and (86) RMMMH Administrative personnel’s (e.g. cook,

utilities, admin officers) base on the 2019 number of personnel records of the hospital.

And lastly, the patients of the Rogaciano M. Mercado Memorial Hospital composed

by Out-patients, and In-patients both found within the hospital’s vicinity.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 50

The 50 percent of the factual basis for this research will come from one of the three

groups of respondents which is the professionals and persons involved and the other half

will come from the perceptions of other type of respondents.

SAMPLING TECHNIQUE

According to Walter A. Shewhart and Samuel S. Wilks, “In stratified sampling, the

population is partitioned into regions or strata, and a sample is selected by some design

within each stratum. The design is called stratified random sampling if the design within

each stratum is simple random sampling”. The researchers will used this sampling

technique in conducting the survey wherein hospital staff, and patients of RMMMH will be

the respondents of this method. In addition, involve persons and professionals will not be

administered to this sampling due to the fact that they’re number can be directly

administered to interviews and survey.

RESEARCH INSTRUMENT

To be able to supply necessary information for strengthening of the foundation of

this study, different instruments will be used such as formal consultation to professionals

and persons involved in the said project, survey questionnaires, different hospital planning

and development guidelines, engineering software, and safety standard and procedures

requirements. Furthermore, Non-Destructive testing techniques will also be used to

determine structural information, which are essential to accomplishing this research aims

and objectives.

Interview. It can be defined as a qualitative research technique which involves

“conducting intensive individual interviews with a small number of respondents to explore

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 51

their perspectives on a particular idea, program or situation.”(C. Boyce & P. Neale, 2006).

The format of the interview would be semi-structured wherein we, the researchers, would

prepare a set of questions to be answered by interviewees at the same time, we can also

ask additional questions to make the idea more profound.

Questionnaire. It is a written set of questions that are given to people in order to

collect facts or opinions about something. Different sets of questionnaires will be

developed for different groups of respondents.

Different Hospital planning and development guidelines. It is an utmost

precedence to develop the structural a design for the development of Rogaciano M.

Mercado Memorial General Hospital (RMMMH) in accordance to the policy made for the

provisions of hospitals and other health facilities by the governing authority.

Engineering Software. In this project, advance engineering software will be used

for the entire conception of the structural plan. Software like STAAD will be a tool for the

computation of shear, moment and reactions due to the load present on the building. This

will help the researchers design the beams, columns, slab and trusses efficiently and

effectively. It is also used to determine whether the designed structural element/s is/are

suitable for the structure and help the researchers to redesign and meet the required

standards if there is a failure. Meanwhile, software like AutoCAD and SketchUp will also

be used for architectural and conceptual design. (K.G. Baccol, F.D.F. Cuison, C.J.C. Del

Rosario, A.D. Ricardo, & M.P.S. Samaniego, 2018)

Safety standard and procedures requirements. The structural and management

enhancement design for Rogaciano M. Mercado Memorial Hospital (RMMMH) will be

liaising with the governing authority to ensure the compliance of every standard. While

fulfilling the said design, the following codes and standards would be obeyed:
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 52

A. For Design Clearances

 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

 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

 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

B. For Structural Design

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 53

 National Structural Code of the Philippines

Non-destructive testing techniques. Non-destructive testing (NDT) is widely used

for quality control in the fabrication of process plant, infrastructures, and equipment. It is

a set of techniques used to evaluate the structural integrity of structures and detect any

flaws that can compromise their safety or functionality. Some of these testing techniques

can be the Rebound Hammer test– this test can be used to evaluate the quality of concrete

near the surface. While test results do not directly correlate to strength of concrete, a site-

specific calibration on concrete cores can be used to predict the concrete strength on-site.

These test is important to the determination of current structural condition of RMMMH

buildings and facilities.

DATA PROCESSING AND STATISTICAL TREATMENT

The data gathered will be collated manually and categorized following the order of

the objectives presented in Chapter 1. Statistical programs like Microsoft Excel will be

used to process the information. Data will be presented, analyzed and interpreted using

the following statistical tools:

1. Frequency and Percentage

The distribution of personal related variables given by the selected

respondents will be determined through this.

𝐟
𝐏 = 𝐧 × 𝟏𝟎𝟎 Where: P = percentage

f = frequency
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 54

n = total number of respondents

2. Arithmetic Mean

It is the sum of all the numbers in a group and divided by the number of

items in the group of numbers. Formula:

∑𝑥
𝑥̃ =
𝑛

Where 𝑥̌ is the arithmetic mean.

∑ 𝑥 is the summation of the variables, and

𝑛 is the number of all variables

3. Weighted Mean

This is the average wherein every quantity to be averaged has a

corresponding weight. These weights represent the significance of each quantity

to the average. Statistically, the weighted mean is calculated using the following.

Formula:

𝚺𝐟𝐖
𝐖𝐌 = 𝐍
Where: w = weight of each item

f = item frequency

WM = weighted mean

N = number of respondents

4. Likert Scale

To interpret the data using the weighted mean, the scores were converted

and have given description as follows:

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 55

RANGE QUALITATIVE DESCRIPTION

1.00-1.79 Outstanding

1.80-2.59 Very satisfied

2.60-3.39 Satisfied

3.40-4.19 Dissatisfied

4.20-5.00 Very dissatisfied