Pamantasan ng Lungsod ng Maynila(University of the City of Manila)

Intramuros, Manila

College of Nursing

In partial fulfillment of the requirementsIn Leadership and Management

An Analysis of the Strengths, Weaknesses, Opportunities and Threatsof The Seamen’s Hospital

Submitted by:

Cancio, Ma. Cristina R. BSN IV-4

Submitted to:

Ms. Marietess Nicolas Nursing Management Professor

March 15, 2013

I. INTRODUCTION

Seamen’s Hospital is a tertiary hospital owned by the Association of Marine Officers’ and

Seamen’s 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

Anesthesiology

General Surgery

Orthopedics

Thoracic Surgery

Vascular Surgery

Urology

Lithotripsy Unit

Neurosurgery

Pediatric Surgery

Laparoscopic Surgery

o Department of Pediatrics

General Pediatrics

Allergology

Cardiology

Infectious Diseases

Neonatology

o Department of Medicine

Internal Medicine

Cardiology

Dermatology

Endocrinology

Gastroenterology

Neurology

Nephrology

Pulmonology

Hemodialysis Unit

Infectious Diseases

o Department of Obstetrics and Gynecology

Pre-natal check up

Deliveries and C-sections

Diagnostic and therapeutic management of gynecological cases

o Department of Eyes, Ears, Nose and Throat

Diagnostic, medical and surgical management of EENT

o 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

o Department of Rehabilitation Medicine

Physical rehabilitation services

o 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

o Other Services

Psychosometric Screening Section

o Nursing Services

Ambulance Services

Dietary

Pharmacy

- Dispenses medicines, prescribed by the Seamen's Hospital doctors, free-of-

charge, depending on availability.

Vision

AMOSUP- Seamen’s 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 Seamen’s 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 Seamen’s 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 Seaman’s 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 Seamen’s 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

patient’s 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

patient’s 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

hospital’s communication purposes.

Human resource management needs improvement due to the nurse- patient’s 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 Seaman’s Hospital provides training for basic- life support, Mother’s 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 1 0 0 0 2 3

Lack of functional

beds

1 1 0 0 1 3

Understaffing2 1 2 0 2 7

Lack of

contingency plan 1 0 2 2 1 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 cost-

effective method of increasing productivity.

3. Managers should at times evaluate their staff’s 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 Opportunities

1. The institution’s policies and procedures

set responsibility and respect to protect

the patient’s 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 institution’s medical

equipment and services is facilitated and is

appropriate to patient’s 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.

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 hospital’s 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 client’s 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 HEAD NURSE

STRENGTHS

1. What advantages / assets do you have? “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 hospital’s

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 don’t 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 staff’s absences.”

2. Have you lost key / significant staff? “Yes, some of them used to migrate abroad.”

3. Are external economic factors affecting “Yes, some of the stocks became limited

you? 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