When the management of provincial and district hospitals was transferred to the provincial government, the quality of health services deteriorated.

      In an effort to turn things around, the provincial government expanded the membership of the Provincial Health Board (PHB) from 5 to 23, to include all health-related organizations in the area. With more than 50% of its members coming from civil society, transparency and accountability were musts at all levels of decision-making. A Special Personnel Selection and Promotion System was also installed for health workers to participate directly in the hiring of new employees and the promotion of deserving hospital staff. However, complaints on the indifference of the hospital staff continued to pour in.

      The local government then launched QSIP in May 1998 in one provincial hospital and three district hospitals. It started with several focus group discussions trying to identify the problem and come up with innovative solutions. One of the suggestions, which was later put into effect, is the installation of a performance management system that would tie a staff’s evaluation to customer feedback. In line with this, the Service Excellence Council was established to assist the PHB in monitoring the program’s implementation.

       Other measures included imposing a standard customer friendly duty board for all hospitals in the province. Health workers adopted a dress code, which would ensure easy identification and ease of movement. A Drug Supplementation Program resolved problems of periodic medicine shortages in hospitals.

      After two years, a review of patients’ comments saw a marked changed from complaints to commendations. Survey results indicated high satisfaction ratings. Records from the provincial accounting office showed a 131.5% increase in hospital revenues from 1997 (P1,103,600) to 1999 (P4,236,200) due to increased patronage of public hospitals where patients were more willing to pay for quality services rendered. There were less people going to hospitals only in advantaged stage of illness. They sought treatment and were given attention at an early stage.

      Other positive effects include the increased awareness on customer service management, improved confidence in internal and external customer surveys, employee empowerment due to a fair system of incentives, better linkages with community-based organizations, improved two-way referral system from primary to tertiary care, and increased networking and coordination among health agencies.