Chapter 1 - 5 Final

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 1
Chapter I
THE PROBLEM AND ITS SETTING
INTRODUCTION
Hospitals are the institution comprising of complex parts and functions that bring
forth healthcare services when accident, disasters or calamities happen. Over centuries,
hospitals are known for the provision of medical services that helps heal thousands of
patients suffering from different illnesses. Developing medicines, pioneering new medical
treatments and technologies, and investigating human diseases and deformities are few
of the works that these institutions are dealing and improving through years.
Today, hospitals are considered as a developing factor in most rising communities
creating opportunities and developing the economy and lifestyle. The benefits of this
institutions are also increasing in demand, making it susceptible to many deteriorations
cause by usage, that later on, can destroy the harmonic ambiance of the hospital, which
is essential in its purpose of healing patients.
Based on the book Hospital Incident Command System, Version IV (2006), stated
that most hospitals in third world countries, such as Philippines, are already operating at
maximum or high level capacity and are lacking of development such as facility increase,
building renovations, reconstructions, and structural design upgrades and updates, that
significantly affects human performance especially safety and health of employees,
patients and their families. Furthermore, the World Health Organization (2012) described
in their page that healthcare in most public hospitals in the Philippines are “fragmented”,
means greatly affected by poor attention given by government, resulting to significant

problems that degrades public hospitals healthcare quality. These results also happen
because of the negligence of most developers and community planners of the past from
considering middle and long-term effects and factors that can act and deteriorate the
structure of today.
People in many communities today, are now starting to ensure that these
institutions will be sustainable to provide services and prosperity in a longer span, by
means of developing its buildings, facilities, and resources using much efficient and
integrated methods.
BACKGROUND OF THE STUDY
Nowadays, developments of hospitals are often referred as modernization, which
is a term referring to construction approaches that has the purpose of transforming and
adapting the existing building or facilities to meet the growing demands of modern
community (Jaroslaw Bakowski, Gdansk Technical University, Poland). Among those
approaches, building rehabilitation is the most commonly used type of approach because
of its comprehensive and systematic procedure, making it suitable in most complex
projects. Furthermore, it also became a balanced approach because of the four
procedures it may include. These procedures are (1) renovation or restoration, (2)
remodeling or change of use of the structure or area, (3) new construction, and, (4)
demolition, reconstruction, or total removal. Those methods are used depending on which
is needed to accomplish the objectives, and, or which among those four are required to
solve the problems the situation provides.
But before a full rehabilitation can be done in a fully operational institution, it is
important to ensure first that the hospital is (1) has a site or temporary place to be held for
the departments that will be affected by the rehabilitation, (2) the facilities for the new
medical services to be added should be determined , and (3) hospital services and
facilities are still sustainable and adequate even if the construction of the changes starts.
In line with this, a preliminary proposal of constructing new medical facilities, rethinking of
hospital schematic flow, and maximizing space usage by constructing multi-storey
integrated buildings prepared for future improvements should be done before seeing the
bigger picture that rehabilitation holds.
Rogaciano M. Mercado Memorial Hospital (RMMMH).
The Rogaciano M. Mercado Memorial Hospital (RMMMH) is a general type
of hospital having current service areas vast enough to accommodate all its current
patients.
Currently, it is the only government–run hospital in the municipality of Sta.
Maria, Bulacan, Philippines. It has a land area of 9,845 sq. meters, and provides
healthcare services for the Santa Maria, Meycauyan, Marilao, Bocaue, Balagtas,
Pandi, Norzagaray, and San Jose del Monte.
The RMMMH being a 63-year-old public hospital may be subjected to
different issues and unsatisfied situations. In the near future, it may experience
and have (1) over capacities due to lack of buildings and facilities, (2) facility
deteriorations, (3) unused or undervalued free spaces and land areas, and (4) lack
of new medical services and equipment’s, which are the most common issues that
aged Philippine public hospitals are experiencing, that if not address properly, may
cause bigger problems.

Project Rationale. This research intends to plan and design a project or group of
projects that may be included in the rehabilitation of Rogaciano M. Mercado Memorial
Hospital in Santa Maria, Bulacan. Insight of the Chief of Hospital along with Hospital
related operational records (i.e. ALOS, and Occupancy rate) are the main factors to be
gather and consider in this research.
Project Location. The current RMMMH is held at 15 C De Jesus Street, Brgy.
Poblacion, Santa Maria, Bulacan, Philippines.
Figure 1. Location of Rogaciano M. Mercado Memorial Hospital
OBJECTIVES OF THE STUDY
This study aims to provide and produce a proposed structural rehabilitation for Sta.
Maria’s Rogaciano M. Mercado Memorial Hospital (RMMMH), thus different aims and
objectives should be accomplished.
Specifically, this study aims to do the following:

1. To determine the profile of RMMMH.
2. To analogize RMMMH structure profile compared to the acceptable standards.
3. To determine the problems and enhancements for RMMMH buildings and facilities.
4. To develop a Project Outline of the works that will be included in the rehabilitation
Project for RMMMH.
5. To provide Plans and Specifications for each works or phase included in the
rehabilitation procedure:
a. Project Outline
b. Recommendations
c. Project Estimate
i. Bill of Labor and Materials
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 the facilities, and even some improvements.”
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, modernize or
rehabilitate 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
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.
J. V. Paiva, and J. Aguiar e A. Pinho (2019) presented in their article, the five
categories of building values, which includes (1) Historical values, (2) deliberate
commemorative values, (3) age values, (4) use values and (5) art values. These values
are considered when executing different stages of valuations on buildings and facilities to
identify its possible problems and improvements and will greatly contribute in
accomplishing a complete rehabilitation process.
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.
CONCEPTUAL FRAMEWORK
INPUT
PROCESS OUTPUT
 Hospital Maps,
Information,
Data, Drawings, PROPOSED
STRUCTURAL
and Plans  Evaluation of REHABILITATION OF
Observation and ROGACIANO M.
 Observation and MERCADO
Interview Data
Interview Data’s MEMORIAL HOSPITAL
IN STA. MARIA,
 Tax Map Owned  Project planning BULACAN
by the and design
municipality of
Sta. Maria
FEEDBACK
Figure 2. Conceptual Framework
SCOPE AND LIMITATIONS OF THIS STUDY
This study will only focus and is limited in proposing a structural rehabilitation plan
and design of Rogaciano M. Mercado Memorial Hospital (RMMMH) in Sta. Maria, Bulacan,
thus an assessment should be first utilized to accomplish the study’s objectives.

Assessment will cover the methods such as observations and interviewing,
wherein Hospital administrator/s, and technical staffs knowledgeable about the subject
matters will be the respndents of this part. Additionally, the assessment will also cover
analogizations of RMMMH buildings, facilities, areas, systems, and some related functions
to determine and identify some necessary information needed to produce a complete Plan
and design of a structural rehabilitation project for RMMMH.
A clear and base-in-standard computations accompanied by systematic
procedures will also be utilized. Furthermore, the use of engineering software’s for much
immersive presentations will also be provided.
SIGNIFICANCE OF THE STUDY
The researcher’s purpose in conducting this project study is to help the RMMMH
improve and sustain its main function of giving a quality healthcare for its beneficiaries.
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.

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
Structural Rehabilitation – term defined here as a construction/ modernization approach
that includes assessment of related information’s, and structural valuations for the basis
of construction works that may include renovation, reconstruction, retrofitting, demolition,
and new constructions as a development/s for the subject of this study.
Valuation – termed as the process of assessing structures based on the standards,
aesthetics, and physical condition used for the purposed of determining the proper
construction approach for each facility, building, or structure.
Renovation - an act of restoring or the condition of being restored such as bringing back
to a former position or condition of a structure.
Reconstruction - establishes limited opportunities to re-create a non-surviving site,
landscape, building, structure, or object in all new materials.
Retrofitting – Retrofitting means 'providing something with a component or feature not
fitted during manufacture or adding something that it did not have when first constructed.
Demolition – refers to the process of efficiently tearing down of buildings and other man-
made structures.
New construction – New construction refers to site preparation for, and construction of,
entirely new structures and/or significant extensions to existing structures whether or not
the site was previously occupied.

Remodeling – refers to the process of changing the structure use by changing its
components based on its new function.

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).

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.

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

Architectural and Structural reference is also presented in this study.

Figure 4. Architectural Reference Data
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
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).
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
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
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.
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)
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.
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
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
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).
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.
Hospital Architectural Designs
The Somali Republic Bernandin University in Somalia, presented different
schematics and example of architectural designs of different facilities and hospital.
Presented below are some of the examples of their designs of hospital parts, specifically
Inpatient division designs:

Parts and Components of the Inpatient Division:
 Inpatient wards. 11.5 m2 /bed – 8 m2 /bed
 WCs
 Nursing station. Not less than 12 m2 for 30 patients.
 Treatment rooms. 10 – 15 m2 for 60 patients.

Day rooms. 0.7 m2 /bed and not less than 15 m2
 Nurses Lounge. Not less than 12 m2
 Storage. 8 – 12 m2
 Kitchen. 12 m2
 Doctor room. 15 m2
 The most suitable beds in the hospital is 20 – 40 patient / unit.
 Most common type: Nightingale ward
o Nightingale ward – contains a large room without subdivisions for patient’s
occupancy. About 24 to 34 beds usually arranged along sides of the ward
is placed here.
Figure 5. Example of a Nightingale Ward
Figure 6. Space Recommendations per Patients

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.

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 7. Bulacan Medical Center

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.

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 8. Philippine General Hospital (PGH)

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 9. Santa Ana Hospital (Manila)

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 10. Ospital ng Manila
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.
Figure 11. 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.
Figure 12. 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.

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

Chapter III
RESEARCH METHODOLOGY
RESEARCH DESIGN
To justify and make an accurate outcome in proposing a multi-phase structural
rehabilitation for Rogaciano M. Mercado Memorial Hospital (RMMMH), it is important to
properly identify the suitable approach to be used in conducting the research, thus a
Quantitative approach is used to emphasize objective measurements and the statistical,
mathematical, or numerical analysis of data collected.
The data will come from thoughts and ideas of administrative officers (i.e. chief of
hospital, MPDO and ME head), or by manipulating pre-existing statistical data using
computational techniques. The said approach focuses on numerical information’s and
generalizing it across groups of people to explain a particular phenomenon. Furthermore,
the use of different analyses, and data processing techniques will yield on having a
conclusion/s that will justify further works.
Descriptive method is used to gather information, process and analyze the data,
and to provide the output required. The methods such as Interviewing, observations,
calculations, and analyses is assumed by the researcher to be the best or simplest
methodology that will satisfy our research objective. Documentation are also 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 and accomplished this study’s objectives – hence, the researcher
would be utilizing a research procedure with four (4) main steps.
Step 1 – Data Collection
This step is about collecting the following data or preliminary information’s about
the hospital which includes:
 Workload data (e.g. Clinic attendances, delivery rate, surgery done per
month etc.)
 Utilization data – Bed Occupancy Rate (BOC), Average Length of Hospital
Stay (ALOS), Occupational Therapy (OT) waiting time etc.
 Physical Space Inventory (e.g. No of blocks, wards, OT’s, delivery rooms
etc.)
 Previous plan, design, and Master plan.
 Aerial Photograph and Land Title
 As Built Drawings / Floor Plans
 Interview ideas and thoughts of Administrative officers such as the chief of
hospital, Municipal Planning and Development Office head, and Municipal
Engineering office head.
Step 2 - Conceptual Direction for Hospital Development
The identification of trends and direction in public hospital developments,
establishment of conceptual direction of the proposed hospital development based on

the institution leadership, and analogizing hospital data compared to its capacities and
limits, are the scope of this step.
Step 3 – Planning and Analysis
This step will include:
(1) Site Analysis – a way of determining opportunities & constrains of site for
future development, by Identifying site conditions requiring corrective action,
and determining the best use of the Hospital’s land resources.
(2) Existing Building Analysis - Assessment of adequacy and appropriateness of
existing plan and its structural systems in accommodating current and future
developments based on its performed tasks and set of standards.
(3) Facility Development Concept - Developing projected space, facilities
requested, and other aspect requirements.
Step 4 – Design and Output
Provision of plan and designs based on computations, codes, provisions, and
analysis, and Preparing of a project outline, project estimates, and bill of labor and
materials, are the main focus of this step. Additionally, a list of recommendations of the
strong points that is not included here but seen by the researchers to further improve the
subject of this study if analyze in another way are also provided as output.
FLOW CHART
Step 1: Data Collection
Collecting Hospital Data's
Step 2: Conceptual Direction for Hospital

Development
Interviewing the Chief of Hospital Assessment of Hospital Data's
and other Administrative officers of compared to its capicities and
RMMMH. limits.
Step 3: Planning and Analysis

Existing Building Facility Development
Site Analysis
Analysis Concept
Step 4: Design and Output

Plan and Design of Project Bill of Labor
Proposed Project Outline
Facility/ies Estimate and Materials
Figure 14. Flow Chart
RESPONDENTS OF THE STUDY
The Administrative and related firm Head officer’s thoughts and ideas are seen by
the researchers to be valuable for the accomplishment of this study’s objectives, making
them the respondent/s who have been invited or requested to participate in this particular
endeavor and have actually taken part in its accomplishment, and will be subjected for the
interview or consultation method of gathering their information’s in mind.
The information’s they will provide will serve as basis for the planning and design
of the proposed facility or facilities and other construction works that will be included in the
structural rehabilitation of RMMMH.
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, different hospital planning and development
guidelines, engineering software, and safety standard and procedures requirements.
Interview. It can be defined as a qualitative research technique which involves
“conducting intensive individual interviews with a small number of respondents to explore
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.
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:
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
 National Structural Code of the Philippines
DATA PROCESSING
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 computation for capacities and other information to be presented in
percentage will be applied by these:
𝐟
𝐏 = 𝐧 × 𝟏𝟎𝟎 Where: P = percentage
f = frequency
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. This will be used to sum-up alike information’s and
interpret I as a whole. Formula:
∑𝒙
̃=
𝒙
𝒏
Where 𝑥̌ is the arithmetic mean.
∑ 𝑥 is the summation of the variables, and
𝑛 is the number of all variables
3. Other Operations
Other information’s can be computed and interpreted using normal
operations.
Chapter IV
PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA
This chapter overseen the presentation, analysis and interpretation of the data
obtained by the researchers. This study aims to provide engineering solution to the current
problems of the RMMMH, specifically in the form of structural rehabilitation as a
development. The researchers studied the personal ideas of the managing bodies of
RMMMH along with the data of the hospital to obtain the problem and provide the in-
demand solution. Presented next were the data gathered and analyzed by the researchers
to obtain the objectives broadcast in the objectives of the study.
Table 1. List of RMMMH Facilities and their Status
Facilities Remarks Facilities Remarks
Out Patient
Active X-Ray Room Active
Department
Hospital Canteen Active Doctors Quarters Active
Under
Laboratory Lobby Active
Renovation
Pediatric Ward Recommended

Active Dormitory
Room 1 for Demolition
Pediatric Ward Recommended

Active Operating Room
Room 2 for Renovation
Pediatric ICU
(Intensive Care Active Male Service Toilet Active
Unit)
Female Service
Nurse Station 1 Active Active
Toilet
Nurse Station 2 Active Annex O.B. Room Active
Garden Active Pharmacy Active

Private Surgery
Active Admitting Room Active
Wards
Office of Chief of
Waiting Area Active Active
Hospital
Administrative
Active Conference Room Active
Office
Chief of Nurse
Active Male Ward Active
Office
Medical Ward Active Female Ward Active
Male Surgery Ward Active I.C.U. Isolation area Active
Female Surgery
Active Morgue Active
Ward
Recommended
Nurses Station 1 Active Multi-purpose Hall
for Demolition
Storage Room Active Medical Ward 2 Active

Kitchen Active Recovery Room Active
Office of Chief of
Laundry Room Active Active
Clinic
Records Room Active Records Room Active
Pediatric Ward O.B. and Maternity
Active Active
Building room
Medical Ward Active Parking Area Active
The Table 1 shows the list of RMMMH facilities established inside the premises of
RMMMH along with their status of whether active or operationally working, thus if not
active, the remarks will be the recommendation set forth by the chief of hospital.
Figure 15. Areas of RMMMH
4930.21 m2
2523.5 m2
292.49 m2
1400.62 m2
191.6 m2
Figure 15 presents the RMMMH areas base on remarks of the chief of hospital
showed in Table 1.
Table 2. Number of Personnel’s in RMMMH
RMMMH Personnel’s Number / Population
1. Doctors 28
2. Nurses 107
3. Administrative 86
officers,
Helpers, Cook,
Etc.
Total 221
RMMMH for the year 2019 have Medical personnel’s which includes doctors and
nurses with the number of 28 and 107 respectively, presented in the table above. It is also
an institution that have supporting members like the Administrative officers, Helpers,
Cook, etc. with a population of 221.
Figure 16. Graphical Representation of Table 2.
RMMMH PERSONNEL
Doctors, 28,
13%
Administrative
Officers, cook,
helpers, etc., 86,
39%
Nurses, 107,
48%
Figure 17. RMMMH Types of Accommodation

RMMMH USED TYPES OF ACCOMMODATION

10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
2011 2012 2013 2014 2015 2016
CHARITY 7852 8963 8373 7303 7452 7981
PHILHEALTH 3789 4582 4504 5784 5193 4862
PAY 1036 1168 1034 859 927 986
CHARITY PHILHEALTH PAY
Figure 17 presents the available types of accommodation in RMMMH. The charity
type of accommodation from 2010 to 2015 have been used by 7852, 8963, 8373, 7303,
7452, and 7981 times respectively and for which dominates the chart. The next is the
PhilHealth type with 3789, 4582, 4504, 5784, 5193, and 4862, respectively making it the
second to dominate. The least will be the Pay type of accommodation with 1036, 1168,
1034, 859, 927, and 986, numbers which can be concluded as the lowest among the three
types.
Table 3. RMMMH Bed Occupancy Rate
Daily Daily
OPD & Bed
Number of In- Number of
Year ER Occupancy
Out- Patients Out-
Patients rate
Patients Patients
2008 - - - - 155.95 %
2009 - - - - 127.62 %
2010 - - - - 131 %
2011 - - - - 142.9 %
2012 - - - - 139.42 %
2013 - - - - 104.72 %
2016 94,135 155 12,784 35 126.6 %
2017 103,343 170 12,952 35 136.7 %
2018 101,618 167 15,117 41 138.7 %
Table 3 present the Bed Occupancy rate of RMMMH from year 2016 to 2018. Bed
Occupancy rate is the rate at which the bed capacity of RMMMH is used or the ratio
between the daily number of In-patients and Out-patients divided by the bed capacity of
the hospital. It shows that the Bed Occupancy Rate at the year 2016, having total patients’
number of 94,135 from Out-patient Department and emergency room added by 12, 784
total in-patients cause a 109.3 % Bed occupancy rate or a 9.3 % over-capacity rate. For
year 2017, a bed occupancy rate of 118 % and overcapacity rate of 18 % is seen. While
the most recent or for the year 2018, the capacity rate is 120.4% and over capacity rate
of 20.4 %.
Figure 18. Graphical Representation of Table 3
RMMMH BED CAPACITY RATE

180
155.95
160 142.9 139.42 136.7 138.7
140 127.62 131 126.6
Percentage
120 104.72
100
80
60
40
20
0
2008 2009 2010 2011 2012 2013 2016 2017 2018
Year
RMMMH BED CAPACITY RATE

Linear (RMMMH BED CAPACITY RATE)
Figure 18 contains the visual representation of Table 3, along with the previous
Bed Capacity Rate from RMMMH.
Table 4. First Interview Responses
Statements
Respondents
1 2 3 4 5 6 7 8
1. Mr. David Rawland M.
Agree Agree Disagree Disagree Agree Agree Disagree Abstain
Domingo, M.D.
2. Mrs. Fortunata A. Lorenzo Agree Agree Abstain Agree Agree Abstain Abstain Abstain
3. Engr. Carmelita G.
Agree Agree Agree Agree Agree Agree Abstain Abstain
Guevarra
Statements:
1. RMMMH has a Problem with its Facilities
2. RMMMH lacks in bed capacity.
3. RMMMH has a Management Problem
4. The hospital's facilities are old.
5. RMMMH needs developments.
6. The hospital needs to increase its services.
7. The Hospital lacks man power.
8. The Hospitals budget is too low.

The Table above presents the answer of the three respondents of this study to
the statements asked to them during the interview. Each response represents the
situation of RMMMH in the perspective of the people managing and maintaining
the hospital.
Table 5. Second Interview Response
Respondents Statements
1 2 3 4
1. Dra. Marietta M. Agree Agree Abstain Agree
Katipunan, MBAH
2. Mrs. Fortunata A. Agree Agree Abstain Agree

Lorenzo
3. Engr. Carmelita G. Agree Agree Agree Agree

Guevarra
Statements:
1. Build an In-patient Ward Building with Bed capacity of 100.
2. Build an Eye Center to increase scope of service.
3. Remodel unused and deteriorated areas
4. Demolition and remodeling of unused buildings and areas.
The table above shows the response of the respondents for the second
interview, an interview with which the suggested solution of the previous chief of
hospital are included in the statements.
Estimated Construction
The estimated cost of the proposed In-patient Ward Building and Eye
center will cover the building cost and land acquisition cost. It has a total cost of
PHP 28,714,121.08.
Bill of Materials
INPATIENT WARDS
ITEM NO. ITEM/ DESCRIPTION SUB TOTAL (P)

1 GENERAL REQUIREMENTS 68,146.80
2 DEMOLITION/REMOVAL 63,000.00
3 SITE WORKS 293,106.06
4 CONCRETING WORKS 4,235,043.42
5 MASONRY WORKS 726,833.02
6 ARCHITECTURAL WORKS 3,669,813.41
7 ELECTRICAL WORKS 4,662,169.20
8 PLUMBING WORKS 2,260,184.40
9 FIRE PROTECTION SYSTEM 6,774,933.60
TOTAL DIRECT COST 22,753,229.91

CONTIGENCY (CONT.) 568,830.75
CONTRACTORS OVERHEAD & PROFIT (O&P) 1,865,764.85
Evat 3,022,539.06
Wtax 503,756.51
28,714,121.08
EYE CENTER FACILITY
ITEM NO. ITEM/ DESCRIPTION SUB TOTAL (P)

1 GENERAL REQUIREMENTS 68,146.80
2 SITE WORKS 46,153.90
3 WALL CONCRETE FOOTING 61,161.63
4 COLUMN FOOTING 24,574.54
5 SLAB ON FILL 184,474.44
6 BEAMS 271,636.13
7 COLUMN 127,116.16
8 MASONRY 149,510.63
9 ROOFING 173,093.08
10 ELECTRICAL WORKS 2,331,084.50
11 PLUMBING WORKS 2,260,184.40
12 FIRE PROTECTION SYSTEM 6,774,933.60
TOTAL DIRECT COST 12,472,069.81

CONTIGENCY (CONT.) 311,801.75
CONTRACTORS OVERHEAD & PROFIT (O&P) 1,022,709.72
Evat 1,656,789.75
Wtax 276,131.63
15,739,502.66
Possible Source of Budget
 Primary Source
• Provincial Government of Bulacan
 Secondary Source
• Municipality of Santa Maria Bulacan
 Other Sources
• Local Officials
According to Mr. David Rawland M. Domingo, previous Chief of
hospital of RMMMH, there is already a budget for the idea of building
an eye center in RMMMH given by a congressman. From that he
insisted that if that budget runout or another major project is in need
to be made, the helping hands of local government officials are
reliable enough to be a possible source of fund.
 Donations, Private Sectors or Investors

Chapter V
SUMMARY OF FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS
SUMMARY OF FINDINGS AND CONCLUSIONS:
1. Profile of RMMMH
 Hospital Age: 63 years old, established in the year 1956 and operates until
today.
 Buildings: not build at the same time, some are old and some are new
structures.
 Total lot Area: 9,845 sq. meters
 Bed Capacities:
o 2009 – 2011: 100 Bed Capacity
o 2012 – present: 150 Bed Capacity.
 Total Floor Area: 7,467 sq. meters.
o Infrastructures Area: 6,074 sq. meters
o Parking Area: 1,393 sq. meters
o Unused or need to be rehabilitated areas: 2523.5 sq. meters
In January 29, 2019, the researchers conduct an interview with (1) Head of
Municipal Planning and Development Office, Mrs. Fortunata A. Lorenzo, (2) Head
of Engineering Department, Engr. Carmelita G. Guevarra, and (3) Former Chief of
RMMMH, Dr. David Rawland M. Domingo.

Table 4 in chapter 4, presents the statements and responses of the first
interview of the three respondents named above.
From the outcome of the first interview, the researchers found out that the
RMMMH have many unused areas and sites recommended for renovations,
remodeling, and demolition presented in Table 1, and Figure 15. It is confirmed
from visual observations and testimony of the previous chief of hospital Dr. David
Rawland M. Domingo.
The researchers conclude that those areas that has no use or any functions
anymore, should be remodel or use as a site for construction of new buildings or
an expansion of an existing one.
2. Analogizing RMMMH Structures
From chapter 2, Related studies about Hospital Development, it is found out
that the structure design of RMMMH buildings are still in line with the safe
standards, but its capabilities and opportunity to improve will be low or will be
complex because of its structures age, size, and style.
For its Bed capacity, the RMMMH are found to be lacking in beds. They
have a straight overcapacity rate from the year 2008 to 2013 and year 2016 to
2018. Bed capacity is an important parameter in measuring the capability of the
hospital to accommodate the significant number of patients. The researchers seen
that the reason for these overcapacities of RMMMH is due to type of service and
accommodation the RMMMH gives, which are “Charity”, “PhilHealth” and “Semi
Pay” type of accommodation, which are way cheaper than the “Pay” type of
accommodation in private hospitals. The basis for this conclusion is in chapter 4,
Figure 17, RMMMH types of Accommodation.
As a conclusion, RMMMH has over capacities, it means that they are
accommodating bigger number of patients above their capacity which in turn
sacrifices the quality of healthcare and comfort with respect to the space and
structure capacity. And so, what they need is an increase in facilities, to cope up
to the surplus of patients, and have enough space for unexpected events.
3. Problems and Enhancement for RMMMH
The researchers concluded from the first interview that the free spaces and
unused areas found can be remodel or change its use. That conclusion become a
start-up for having another interview with the respondents happened on August
13, 2019. The second interview is conducted to know the perception of the
respondents about the proposed solutions and also to gather their insights and
ideas about that topic. The interview summary or the relevant statements are
presented in chapter 4, Table 5.
The solution presented by the researchers in the statements of the second
interview are: (1) Demolition of unused buildings, specifically the two buildings
included in the “area recommended for rehabilitation” which is the multi-purpose
chapel and dormitory building as shown in Figure 19.

Figure 19. Location of Multi-Purpose Chapel and Dormitory
(2) Proposed Construction of In-Patient Ward Building at the site of the multi-
purpose chapel and Dormitory, to increase the bed capacity of RMMMH by 100,
and to reduce the spreading of infectious diseases in areas with over capacity of
patients.
(3) Proposed construction of Eye center connected to the existing Operating
Room of RMMMH. The Eye center needs to be near the operating room to
lessen the travel time and distance of the patients after undergoing especially
sensitive operations of its patients. The Eye center will also improve the scope of
specialty of the hospital.

Figure 20. Location of Proposed Eye Center and Existing Operating Room (O.R.)
These solutions are the improved version of the ideas given to us by the
former Chief of Hospital, Dr. Rawland M. Domingo, in the first interview. He gave
these ideas with their corresponding problem to be solve. For that, the researchers
take acknowledge of his ideas to be the most reliable because of his position as
the main manager of RMMMH. From Chapter 4, the Table 5 presents the response
of the other respondents about these solutions.
4. Project Outline
The major product and output of this research is to provide a proposed
structural rehabilitation plan and design for RMMMMH in Sta. Maria, Bulacan,
thus, its project outline will contain the works, advantages and disadvantages,
locations, project information, project rationale, etc. all connected and essential
to the understanding of the whole proposed project.
See Appendix A. Project Outline.
5. Plans and Design
Another major output of this research are the plans and designs of the
“included works” in the Proposed structural rehabilitation of RMMMH. Plans will
consist detailed drawings, specifications, and models attached in Appendix B. As
for Design of the “works included”, it will be composed of design calculations
presented in Appendix C.
Recommendation
In light of the aforementioned findings and conclusions of the study, the
following recommendations were drawn:
1. A follow-up study on how to make a longer-term rehabilitation plan using the
concepts and findings developed by the researchers.
2. A study about application of modern machines and trends in improving
RMMMH Drainage system.
3. A study about the application of transportation routing system and construction
of outpost and a centralized medical communication room to improve medical
service delivery of RMMMH, as part of its modernization program.

4. Study and design a method on how to renovate all the One storey RMMMH
buildings and facilities to become Two storey Roof Deck Finish Single Building.
APPENDIX A
APPENDIX B
APPENDIX C
APPENDIX D
APPENDIX E

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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 1

THE PROBLEM AND ITS SETTING

Today, hospitals are considered as a developing factor in most rising communities

institutions are also increasing in demand, making it susceptible to many deteriorations

is essential in its purpose of healing patients.

significantly affects human performance especially safety and health of employees,

means greatly affected by poor attention given by government, resulting to significant

institutions will be sustainable to provide services and prosperity in a longer span, by

BACKGROUND OF THE STUDY

Nowadays, developments of hospitals are often referred as modernization, which

community (Jaroslaw Bakowski, Gdansk Technical University, Poland). Among those

of its comprehensive and systematic procedure, making it suitable in most complex

projects. Furthermore, it also became a balanced approach because of the four

solve the problems the situation provides.

But before a full rehabilitation can be done in a fully operational institution, it is

hospital schematic flow, and maximizing space usage by constructing multi-storey

bigger picture that rehabilitation holds.

Rogaciano M. Mercado Memorial Hospital (RMMMH).

The Rogaciano M. Mercado Memorial Hospital (RMMMH) is a general type

Currently, it is the only government–run hospital in the municipality of Sta.

Pandi, Norzagaray, and San Jose del Monte.

The RMMMH being a 63-year-old public hospital may be subjected to

cause bigger problems.

projects that may be included in the rehabilitation of Rogaciano M. Mercado Memorial

gather and consider in this research.

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

Poblacion, Santa Maria, Bulacan, Philippines.

Figure 1. Location of Rogaciano M. Mercado Memorial Hospital

OBJECTIVES OF THE STUDY

objectives should be accomplished.

Specifically, this study aims to do the following:

1. To determine the profile of RMMMH.

2. To analogize RMMMH structure profile compared to the acceptable standards.

Project for RMMMH.

i. Bill of Labor and Materials

accomplish objectives of this study.

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, modernize or

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

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

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

accomplishing a complete rehabilitation process.

These principles are not sufficient to drive a significant hospital development

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

Figure 2. Conceptual Framework

SCOPE AND LIMITATIONS OF THIS STUDY

thus an assessment should be first utilized to accomplish the study’s objectives.

Assessment will cover the methods such as observations and interviewing,

and design of a structural rehabilitation project for RMMMH.

A clear and base-in-standard computations accompanied by systematic

immersive presentations will also be provided.

SIGNIFICANCE OF THE STUDY

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

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

done to their one and only government-run hospital.