IDENTIFYING ONE'S GOAL AND PROGRAM OF STUDIES

                Reynaldo O. Joson, MD, MHA, MHPEd
                          July 17, 1996

Part I. Assessment of Field of Service

1.1 Identifying existing conditions

     Field of service: Chief
                       Division of Head and Neck, Breast, Soft
                         Tissue, and Esophageal Surgery
                       Department of Surgery
                       Philippine General Hospital
                       University of the Philippines Manila

     Since 1994, I have been serving as the chief of the Division 
of  Head  and Neck, Breast, Soft Tissue, and  Esophageal  Surgery 
(Division),  of  the  Department of  Surgery  of  the  Philippine 
General Hospital (Hospital) and College of Medicine (College)  of 
the University of the Philippine Manila (University).  

     The  vision, mission, goal, and objectives of  the  Division 
integrate   those  of  the  Hospital,  College,  and  University.  
Briefly stated, these are:

          Toward the Service of the Filipino People

          Service, Teaching, and Research

               on the domains of the Division -

                    head and neck, breast, soft tissue and 
                     esophageal surgical diseases

     The  Division  has 6 consultants, 2 fellows, and  about  6-7 
rotating   residents   to   fulfill  its   service   duties   and 
responsibilities in the Hospital.  It has 27 beds in the Hospital 
which  has  a 1000-bed capacity.  Annually, it  has  about  1,000 
operations and about 5,000 patient consultations. 

     The   Division   has   an   annual   teaching   duties   and 
responsibilities  to 2 fellows, about 24-28 residents, and  about 
640 medical students.

     The  Division's  operating expenses are  shouldered  by  the 
Hospital,  College,  University, and the consultant  staff.   The 
consultant staff supports a secretary and a telephone line in the 
Division's office.

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     What  seems to work advantageously in the present set-up  is 
the  dedication and perseverance of the consultant staff to  stay 
with the Division, Hospital, College, and University despite  the 
low  salary  and inadequate logistic support for  the  Division's 
operations.

     What  seems not to work advantageously is that  the  vision, 
mission,  goals,  and objectives of the Division  are  not  fully 
achieved.

1.2 Analyze reasons for existing conditions

     Essentially, the reasons for the existing condition (vision, 
mission,  goals,  and  objectives are not  fully  achieved)  lies 
mainly in the organization of the Division.

     There is an organizational chart and there are some policies 
on how to treat patients.

     There  are no formal, structured, and  systematic  operating 
procedures  on  how  to implement the various  functions  of  the 
Division  such  as  teaching  (fellows,  residents,  and  medical 
students);  service (in the operating rooms, outpatient  clinics, 
and  wards);  and research.  Anything goes is the policy  of  the 
day.   As  long  as  there are no  complaints from  patients  and 
administration, the status quo remains.

     There  is no system in organizing, leading, and  controlling 
the  consultant  staff.   There is lack  of  coordination.   Past 
division  chiefs  tend  to become  inactive  after  their  terms.  
Consultant staff tend to work only when asked to.

     Majority  of the consultant staff are lacking in  managerial 
skills.  

1.3 Identify ideal conditions or dreams

     1.3.1  The  Division must have an  effective  and  efficient 
               organization.   This will serve as the  foundation 
               and prerequisite for achievement of all Divisional 
               activities.

     1.3.2  The Division must have consultants who are  not  only 
               specialists   in   treating  patients   but   also 
               competent  in teaching, research, and  management.  
               This will facilitate achievement of the Division's 
               objectives  of  service, teaching,  and  research.  
               With  all  the consultants being  competent  as  a 

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               manager, the organization of the Division will  be 
               effectively  and  efficiently  maintained  at  all 
               times, from one chief to the next.

     1.3.3  All consultant staff including those who have  become 
               chiefs  before should contribute actively  to  the 
               attainment of the objectives of the Division.

1.4 Identify needs to change conditions

     What  is needed to bring about the desirable  conditions  is 
essentially  a  technical  change in  the  organization,  meaning 
changes  in  the  means.  The ends  of  the  organization,  which 
represent  the  vision,  mission, goals, and  objectives  of  the 
Division,  will remain the same.

     Technical   changes   will  include   improvement   of   the 
organizational  setup and people within the  Division,  everybody 
including the chief.

1.5 Identify constraints

          - Senior staff
               difficulty anticipated in younger staff's  attempt 
               to  bring in those who have been chiefs before  to 
               participate actively in manager and organizational 
               development.
          
          - Part-time appointment of consultant staff
               All  are part-time staff.  Majority are busy  with 
               private  practice  and with  other  organizations.  
               This may be a factor in an attempt to involve  all 
               the consultant staff in the organizational change.

          - Lack of incentives
               The  Division, Hospital, College,  and  University 
               cannot  offer  more incentives to  the  consultant 
               staff.    The   consultants   have   low   salary, 
               contribute  to  the  Division's  operating  funds, 
               and earn  a  living  mainly  outside the Division.
               To ask the consultants to contribute more time and 
               effort  to the Division without incentives at that 
               may be difficult.

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1.6 Choose priorities

     What are needed to bring about the desirable conditions are:

     Improvement  in the organizational setup and  people  within 
the  Division, concentrating initially on the younger  staff  but 
without prejudice to the more senior staff.  

II. Goals and Commitment

2.1 Actual Commitment

2.1.1 Identify present role and functions

               Role: Chief
                     Division  of  Head and  Neck,  Breast,  Soft 
                         Tissue, and Esophageal Surgery
                     Department of Surgery
                     Philippine General Hospital
                     College of Medicine
                     University of the Philippines

               Functions:
                     1. Manager
                     2. Teacher
                     3. Physician
                     4. Researcher

2.2 Future Commitment

2.2.1 Identify future role and functions

     Same as present role and functions.  In addition,

     CHANGE AGENT

          Functions:
               1. Improvement of the organization of my Division
               2. Put  up a pilot or change model in my Division
                    for the other divisions in the Hospital with
                    the same problems to follow

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2.2.2 Identify goals and commitment

     GOALS: To  improve the organization of my Division

            To establish a model of planned change in my Division
               for other divisions in the Hospital to follow

     COMMITMENT: To  improve  my Division using the principles of  
                 organizational  development and planning for  it 
                 to best achieve its objectives, not only  during 
                 my terms as chief but also beyond my term  until 
                 I am forced into retirement by government rules.

III. Program of Studies

3.1 Identify needs to achieve goal and commitment

          Competencies in
     
               Organization planning and development
     
               Promoting change

               Instructional development and technology

3.2 Identify in SAIDI programs means to achieve goal

          Doctoral Program

               Organization planning and development

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3.3 Trace personal program of studies
               
                                                       Unit

                                                 Theory  Field 
                                                         Research

DOD 1.1 Philosophy of Organization Development    3         -

DOD 1.2 Philosophy and Theory of Planned Change   2         2
     
DOD 1.3 Philosophy of Structured System of 
          Organization                            3         2

DOD 1.4 Consultant Roles and Skills               2         2

DOD 1.5 Action Strategies and Programs            4         2

DOD 1.6 Organization Problem Diagnosis            3         2

DOD 1.7 Organization Planning                     4         2

DOD 1.8 Decision-making                           3         -

MOD/MIT 3.1 Developing Evaluation Plan            2         -

MOD/MIT 3.4 Cost Analysis                         2         -

MOD/MIT 5.4 Administration of Personnel           2         -

MOD/MIT 6.1 Persuasion                            2         -

MOD/MIT 6.2 Dissemination and Diffusion of
               Innovation                         2         -

DOD 9.9a Research Methods                         6

DOD 9.9b Statistics                               6

DOD 9.9c Dissertation Seminar or Proposal Module}  
                                                }14
DOD 9.9d Doctoral Research                      }

 
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3.4 Project time lines

                      1996      1997      1998      1999    2000

OD&P                  -----------------------   

Field Research        -----------------------          

Cognate Area          -----------------------

Research              -----------------------   

Dissertation                    ---------------------------------

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