of the Philippines

Republic
Department of Health
OFFICE OF THE SECRETARY

__
April 3, 2023
DEPARTMENT MEMORANDUM
No. 2023 -_ D131

TO : ALL UNDERSECRETARIES AND ASSISTANT

SECRETARIES OF THE FIELD IMPLEMENTATION

___
AND COORDINATION TEAM (FICT); DIRECTORS OF
CENTERS FOR HEALTH DEVELOPMENT (CHD);
MINISTER OF HEALTH BANGSAMORO _-

AUTONOMOUS REGION _IN MUSLIM MINDANAO

(MOH-BARMM); CHIEFS OF MEDICAL CENTERS,
HOSPITALS AND SANITARIA. EXECUTIVE
DIRECTOR: F_ SPECIALTY OSPITALS: AND
OTHERS CONCERNED

SUBJECT : Interim idelin n_th f the

Harmonized Hospital
Client Experience Surve HCES) Tool to Measure
Responsiveness

I. RATIONALE

Administrative Order No. 2020-0003, Strategic Framework on the Adoption of

Integrated People-Centered Health Services (IPCHS) in All Health Facilities, established the
IPCHS to ensure (1) organizational culture geared towards responsiveness, (2) client
engagement and empowerment, and (3) appropriate infrastructure and processes in health
facilities. Pursuant to Republic Act No. 11463, Malasakit Centers Act, IPCHS was adopted
by the Malasakit Program as part of the law’s mandate on two non-clinical outcomes for
patient care: financial risk protection and responsiveness. A standardized tool to measure and
monitor the responsiveness of health facilities was developed and implemented through the
Department Memorandum (DM) No. 2020-0426, Interim Guidelines on the Use of the
Standardized Client Experience Survey (CES) Tool to Measure Responsiveness issued on
September 8, 2020.

In the Republic Act (RA) No. 11032, Ease of Doing Business and Efficient
Government Service Delivery Act of 2018, under Section 20, all government agencies are
required to establish a feedback mechanism. Section 3 (b), Rule IV of the Implementing
Rules and Regulations (IRR) of the Act emphasizes that “All agencies shall embed feedback
mechanisms and client satisfaction measurement in
their process improvement efforts. The
agency shall report to the Authority the results of the Client Satisfaction Survey for each
service based on the guidelines to be issued by the Authority.”

On September 20, 2022, the Anti-Red Tape Authority (ARTA) issued Memorandum
Circular No. 2022-05, Guidelines on the Implementation of the Harmonized Client
Satisfaction Measurement (CSM), to promote the adoption of a harmonized and standardized
framework in measuring client satisfaction across all levels of the government to ensure
continuous improvement and enhancement of service promise towards a more meaningful

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ¢ URL: http:/Avww.doh.gov.ph; e-mail: dohosec@doh.gov.ph
 client-centered Citizen’s Charter. The Hospital Client Experience Survey (HCES) is
hereby
developed to respond to the need to harmonize the CES tool used by the health facilities and
the CSM tool issued out by ARTA, and hence, to avoid redundancies in the establishment of
feedback mechanisms in health facilities.

IL. SCOPE AND COVERAGE

These guidelines shall cover all DOH hospitals, medical centers, sanitaria,
Government-owned or controlled corporation (GOCC) hospitals, and hospitals of Local
Government Units (LGU) with Malasakit Centers.

Ill. GENERAL GUIDELINES

A. All DOH hospitals, medical centers, sanitaria, GOCC hospitals, and LGU
hospitals with Malasakit Centers shall utilize the revised HCES tool to measure
responsiveness in all frontline areas of the hospital. Non-frontline service areas
may utilize the CSM tool as guided by the ARTA MC No. 2022-05.

Other government and private hospitals may utilize the tool as a customer
feedback mechanism.

Hospitals shall submit their responsiveness report annually using the HCES
Online Report Generator.

Hospitals shall use the responsiveness reports generated for the Continuous
Quality Improvement (CQIJ) or its
equivalent as one of the metrics for quality and
people-centered care.

E. All materials may be accessed through this link: https://bit.ly/IPCHS Tools

F. The summary of the revisions done in the tools may be seen in Annex A.
Iv. SPECIFIC GUIDELINES

A. Sampling Method
1. The hospital shall determine the minimum number of responses per service
based on the sample size calculator on the HCES Online Report Generator.
2. A quota sampling method shall be employed wherein the administration of the
HCES shall continue until the prescribed sample size has been reached.

B. Survey Administration and Collection

1. The hospital shall assign a unique control number on
all
printed and electronic
survey forms.
2. The survey tool shall only be given to
clients after each completed transaction
in the frontline service areas of the hospital as reflected in the Citizen’s
Charter. Accomplishment ofthe tool shall be self-administered and voluntary.
» The tool shall be administered from January to December of
each year.
4. The hospital may continue to administer and collect responses for the HCES
even when the minimum number of
responses has been reached.

Cc. Report Generation and Submission

1. The Quality Improvement Unit of the hospital or its equivalent shail facilitate
the encoding and analysis of the collected responses and ensure the
submission of the reports.
 The designated personnel-in-charge shall sign a non-disclosure form to ensure
the confidentiality of all data gathered from the HCES.
All collected and validated responses shall be encoded in the prescribed HCES
Online Report Generator. Invalid responses shall not be included in the
submission.
The accomplished HCES online report generator excel or google sheet file
shall be submitted to the Health Facility Development Bureau (HFDB)
through the submission link: https://bit.ly/HCES Submissions en or before
January 15.
The HFDBshall generate an Annual Responsiveness Report for dissemination
and for submission to the CART Secretariat on or before March 20.

D. Translation of the HCES Tool

1. The HCES tool may be translated into the appropriate language or
by the hospital as long as the intent of the question is retained.
dialect used

2. A copy of the translated form shall be submitted to the HFDB through the
IPCHS Program email at ipchs@doh.gov.ph.

E. Review of Forms and Processes

1. The HFDB and Malasakit Program Office (MPO) shall review the forms used
and the process for collecting the survey every three (3) years.
2. The hospitals and HFDUs may send their suggestions and input for the
improvement and more efficient implementation of the HCES tool through
email.

V. ROLES AND RESPONSIBILITIES

The following concerned offices shall perform corresponding roles and responsibilites
with regards to the implementation of the HCES tool:

A. The Health Facility Development Bureau shall:

1. Develop standard tools for cascading and training of HFDUs and concerned
hospitals on the use of the HCES tool and its
related processes.
2. Coordinate with HFDUs regarding the monitoring of data submissions.
3. Analyze data and process final reports based on the data collected annually.
4, Provide reviews and recommendations based on the result of the annual
reports.
5. Conduct implementation reviews to discuss and update the HCES tools and
annual reports.

B. The Malasakit Program Office shall:

1. Advocate and provide assistance on the dissemination and adoption of the tool
to hospitals implementing Malasakit Centers.
2. Utilize the generated reports to recommend areas for continuous quality
improvement in terms
Malasakit Program.
of service delivery and client experience linked with the

. Assist the HFDB in the implementation review to discuss and update the
HCES tools, processes and annual reports.

C. The Centers for Health Development and Ministry of Health — Bangsamoro

Autonomous Region in Muslim Mindanao through their respective Health Facility
Development Units shall:
1, Actively disseminate the information and tools related to the HCES to
concemed hospitals.
 Provide technical assistance and guidance on the adoption and implementation
of the HCES to all concerned hospitals and address frequently asked
questions.
Conduct orientations and demonstrations on the adoption and implementation
of HCES regularly or as needed.
Monitor submission and ensure that submitted hospital Responsiveness
Reports are timely and complete.
Provide feedback to the hospital on the validated and generated annual reports
of HFDB and provide technical assistance based on the recommendations.

D. All DOH hospitals, medical centers, sanitaria, GOCC hospitals, and LGU
hospitals with Malasakit Centers shall:
1, Ensure timely submission of HCES online report generator to the HFDB.
2. Ensure that the submitted information is correct and validated by the head of
the facility or personnel authorized by the management.
3. Utilize and adopt the HCES tool as a measure of responsiveness.
4. Utilize the responsiveness reports as a basis for decision making relative to
improving client experience.

VI. TRANSITORY PROVISION

Implementation of the HCES tools shall be initiated in the third quarter of 2023. The
second quarter of 2023 shall serve as a transition period for cascading and capacity building
activities to be provided by the HFDB withthe assistance of HFDUs.

VII. REPEALING CLAUSE

DM No. 2020-0426, Interim Guidelines on the Use of the Standardized Client

Experience Survey (CES) Tool to Measure Responsiveness, is hereby repealed. All other
related issuances inconsistent with or contrary to the provisions of this memorandum are also
repealed, rescinded, revised, or modified accordingly.

For your information and strict compliance.

yn
By Authority of the Secretary

LILIBETH C. DAVID, MD, MPH, MPM, CESO I

Undersecretary of Health
Health Policy and Infrastructure Development Team
 ANNEX A.
Summary of
Revisions

Hospital Client Experience Survey Revisions

1. The survey tool has been harmonized with the CSM
to
reflect the following:
Additional questions concerning the Citizen’s Charter.
a.
b. Integration of the eight (8) Service Quality Dimensions namely:
i. Responsiveness
ii. Reliability
iii. Access and Facilities
iv. Communication
v. Costs
vi. Integrity
vii. Assurance
viii. Outcome
of.
c. Additional question related to the overall satisfaction with the service availed
2. Target sample size shall be computed using the prescribed calculator included in the HCES online
report generator using the following parameters:
a. Annual number of transactions per service;
b. Confidence interval of 95%; and
c. Margin of Error of 5%
3. Overall Scoring for Responsiveness was revised as follows:

Average of the three (3) strategies of the

Integrated People Centered Health Services
0-1.99 Poor
2-2.99 Fair
3-3.99 Satisfactory
4-5 Outstanding

4. The overall scoring in compliance with the Authority’s CSM rating was adopted in a separate
analysis also found in the HCES Online Report Generator.
5. Corresponding revisions were made on the HCES Online Report Generator based on the changes
madein the survey tool.
 ANNEX B.
Sample Hospital Client Experience Survey (HCES) Form

Control No:

HOSPITAL CLIENT EXPERIENCE SURVEY (HCES) FORM

This survey will serve as a basis to help us to improve our services for you to have a better experience
the facility because you are important to us. Any comments or suggestions you provide through this survey
in
will be highly-appreciated and will be treated with utmost confidentiality.

INSTRUCTIONS: Put a check (V) mark on the appropriate answers:

The Respondent of this O Patient O Companion
(Family/Relative)
O Business
(visited for business purposes)
O Employee
Survey Form:
Age: Sex: O Female 0 Male Religion: 0 Catholic Muslim O Others (Specify):

O Primary O Secondary O Vocational

Educational Attalnment
O College e O No Formal Education
Postgraduate/Masters
Name
of Hospital: Date of Consultation/Visit:

Choose one: O Medical Social Work Department/Malasakit Center

O Emergency Room O Information & Admitting Section
O Inpatient Services O Cashier/Accounting
Point of Entry
‘

O Outpatient Department 0 fae

Other administrative offices (Specify)
i ‘ ‘

Department Visited: O Pharmacy

Choose one:O Request for Medical Records

O Consultation O Request for Psychosocial Assessment/Intervention
O Admission O Request for Financial Assistance
Service Availed O Laboratory O Counseling (i.e Nutrition and Dietetics)
O Radiology O Other services (Specify)
O Discharge

ee
O Settlement of Fees
rate
doiyoulvisit this
Choose
ait

one: O 4-6x a year

O First Time 0 7-11x a year
O 1-3x a year O >12x a year

The Citizen’s Charter is

an official document that reflects the services of a government agency/office
including its requirements, fees, and processing times among others.

INSTRUCTIONS: Put a check mark (V) your answer to

the Citizen’s Charter (CC) questions.
cc1 Which of the following best describes your awareness of a CC?
0 1. | know what a is but
and | saw this office’s CC.
CC

O 2.
0 3.
|

|
know what a
learned the
of
isonly when
CC

CC
| did NOT

| saw
see this office’s CC.
this office’s CC.
0 4. | do not know a is and
what CC | did not see one in this office. (Answer ‘N/A’ on CC2 and CC3)
cc2 If aware of CC (answered 1-3 in CC1), would you say that the CC
of this office was ...?
O 1. Easy to see O 4. visible at
Not all
O 2. Somewhat easy to see O5.N/A
O 3. Difficult to see
CC3 If aware of CC (answered codes 1-3 in CC1), how much did the CC help in your transaction?
you
0 Helped very much
1. D 3. Did not help
O 2. Somewhat helped O4.N/A
 Not
Strongly Agree Neither agree Disagree Strongly
INSTRUCTIONS: Put a check mark
on the column thatfor
best corresponds
(/)
to
agree
5
nor disagree
3
disagree
1
Applicable

your rating each item NIA

A. Infrastructures and Process

1.The waiting areas were clean, orderly, and
comfortable.

2. The toilets and bathrooms inside the facility

were kept clean, orderly and with a steady water
supply.

3. The patients’ rooms were kept clean, tidy, and

comfortable.

4. The steps (including payment) | needed to do

for my transaction were easy and simple.(SQD3)

5. The office followed the transaction’s

requirements and steps based on the information
provided.(SQD2)

6. | easily found information about my transaction

from the office or its
website.(SQD4)

7. |
spent a reasonable amount of time for my
transaction.(SQD1)

B. Client Engagement and Empowerment

8. The medical condition, procedures and

instructions were discussed clearly.

9. Our sentiments, cultural background, and

beliefs were heard and considered
treatment procedure.
in
the

10. We were given the chance to decide which

treatment procedure shall be performed.
11.|
got what | needed from the hospital, or
(if
denied) denial of request was sufficiently
explained to me.(SQD8)

12. paid a reasonable amount

|
of
fees for my
transaction.(SQD5)
***Tfservice was free, mark the ‘N/A’ column)

C. Culture of Responsiveness
13. was treated courteously by the staff, and (if asked for help) the staff was helpful. (SQD7)
|

***NOTE: Put a check mark (J) on N/A ifyou did not interact with the staff

Doctor

Nurse

Midwife

Security

Radiology Staff
 Not
Strongly Agree Neither agree Disagree Strongly Applicable
INSTRUCTIONS: Put a check mark (V) agree nor disagree disagree
on the column that
best corresponds to 5 4 3 2 1

your rating for each item © © & @ @ Wik

Pharmacy Staff

Laboratory Staff

Admitting Staff

Medical Records

Billing Staff

Cashier

Social Worker

Food Server

Janitors/Orderly

14. treated fairly, or “walang palakasan”,

| was
during my transaction. (SQD6)
***Tf online:
I am confident my online transaction was secure.
15. am satisfied with the service that | availed.
|

(SQD0)
Ifapplicable, please the name of any remarkable
Suggestions on how we can further improve our services
(optional) hospital staff you would like to commend, as
well as your
reason.

— Thank you! —
 ANNEX C,
Confidentiality and Nondisclosure Agreement

Il,
, agree with the following statements:

I have read and understood [insert Health Facility’s Name] Privacy Policy.

I understand that may come in contact with confidential information during the course of preparing and
I
consolidating the reports for the Client Experience Survey. As part of the condition as the
personnel-in-charge for this report, I hereby undertake to keep in strict confidence any information found in
the survey. I will do this in accordance with the [insert Health Facility’s Name]’s privacy policy and
applicable laws, including those that require mandatory reporting.

I will not divulge any confidential information that may be gathered about the client through the survey
form.

I also agree to never remove any confidential material of any kind from the premises of [insert Health
Facility’s Name], unless, authorized as part of my duties, or with the expressed permission of direction to do
so from [insert Health Facility’s Name].

(Print Staff Name)

(Signature of Staff)

(Signature above Printed Name of Witness)