1

CHAPTER I

THE PROBLEM AND ITS BACKGROUND

Introduction

There is a wide variety of health systems around the world, with as many

histories and organizational structures as there are nations. Implicitly, nations must

design and develop health systems in accordance with their needs and resources,

although common elements in virtually all health systems are primary

healthcare and public health measures. In some countries, health system planning is

distributed among market participants. In others, there is a concerted effort

among governments, trade unions, charities, religious organizations, or other

coordinated bodies to deliver planned health care services targeted to the populations

they serve. However, health care planning has been described as often evolutionary

rather than revolutionary

The Philippines has a public medical system with the option to either choose

free, government-provided healthcare or purchase private healthcare. The public

healthcare system is delivered through public health and primary healthcare centers

linked to peripheral barangay (local town) health centers. Around 40% of the hospitals

in the Philippines are public. Doctors at public hospitals are well-trained, but there are

still a number that the technology and equipment used in public hospitals are not good

as good as private ones. So one has to make sure to ask around from local contacts to

get their opinion before one chooses the right hospital. When it comes to health care,

availability and accessibility vary depending on the location.

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School-based health clinics are created to provide comprehensive care for the

students they serve and are often the primary health care cornerstone for providing

care for adolescents. According to the 2015 National Census by the National

Assembly on School-Based Health Care (NASBHC) state survey, there are 1,709

school-based health programs across the country. Minority and ethnic populations

which have historically experienced health care access disparities comprise the

majority of students in schools with school-based health clinics.

Furthermore, the schools must have a medical and dental clinic for the delivery of

preventive and promotive health services and the treatment of minor ailment and

emergency cases. For instance, the big schools with 3000 or more students shall allocate a

room space of not less than 65 square meters as school clinic, divided into compartments

to suit the different health needs of students. Inside the school clinic, a lavatory or hand

washing facility with adequate and potable water supply shall be installed. Some of the

equipment and materials that must be present inside the clinic include basic medical and

dental equipment, stretcher, portable oxygen tank with regulator and other basic

drugs/medicines and dental supplies. Bataan Peninsula State University’ Medical and

Dental Clinic promotes welfare and health promotion among students and employees.

It also focuses on health promotion and education in order to uplift the standards of

well-being of the clientele.

Likewise, Pedroza (2015) reiterated that nursing is not just about the patient

and the surrounding factors. It is all about meeting people at the point of their deepest

need and providing them comfort. It’s not about transmission of one’s values and

practices to other people, it is all about the attitudes, characteristic, behaviors, and
 3

personal qualities on how to deal with them. It is not about just complying to care for a

person but actually being with the patients. When developing the care plan, the

healthcare team needs to consider the holism or holistic approach such as physical,

physiological, social, emotional, and spiritual needs of the patient.

School is an organized community and easy to reach for implementation of

health and health related program. Therefore, schools have both responsibility and

opportunity to help, protect, maintain and improve the health of the students. There is

an inter relation between the school and the homes of the students, as both greatly

facilitate an organized approach to health promotion, health appraisal, and health

restoration. Thus, it is apparent that an organized system of health care in schools

provides a frame work well suited to carry on an effective program of health which

can reach and benefit a large number of students.

Statement of the Problem

This study determined the level of delivery of health care services and

structured process among school clinics as antecedents to client’s satisfaction, which

can fundamentally serve as baseline for the enhancement of existing policies and

protocols.

Specifically this study seeks to answer the following questions;

1. How may the profile of the respondents is described in terms of:

1.1. Age;

1.2. Sex;
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1.3. Civil Status;

1.4. Highest Educational Attainment;

1.5. Marital Status; and

1.6 Student’s Program?

2. How the consciousness of students, teaching and non-teaching personnel be

measured in terms of delivery of health services such as:

2.1 Promotive;

2.2 Preventive;

2.3 Curative; and

2.4 Rehabilitative?

3. How may the structured process be described in terms of following clinic

related factors:

3.1 medical equipment;

3.2 medical supplies;

3.3 health services offered; and

3.4 organizational structure?

4.How may the level of client satisfaction be described in terms of:

4.1 clients’ availment of service;

4.2 nature of transaction;

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4.3 response time;

4.4 quality of response;

4.5 feedback about the staff;

4.6 satisfaction to the service; and

4.7 satisfaction to the outcomes?

5. Is there a significant relationship between the delivery of healthcare services,

structured process and clients care outcomes to the level of client satisfaction?

6. Based on the findings, what policy or protocol may be enhanced?

Significance of the Study

This study is deemed significant to the following:

University Students. The findings of the study may provide essential

information to the students who are the end users of the health care services of the

university. Through the findings, they may be informed on how crucial the compliance

of the school with the health services. Likewise, the study may educate the students on

the importance of personnel, clinic and school related factors in improving the level of

compliance. With this, they may see and qualify better management practices that may

help sustain the development and improvement of its health care services.

Clinic Staff. The present study may help the university clinic adopt a more

progressive management system of the health services based in the standards of the

Department of Health. By understanding the factors that affect the level of services,

the clinic may be able to include in their development plan for the provision of health
 6

care services. Through the findings, the clinic can adopt sound management and best

practices that can further boost the performance of the clinic as well as improvement

of the services it offer.

Teaching and Non-Teaching Personnel. The Teaching and Non-Teaching

personnel will benefit from the findings of this study. It will provide freedom to

express the concerns and feedback in term of the delivery of health care services in the

University.

Nursing Schools. The study may be helpful for colleges and schools of nursing

to enhance the capabilities of the nursing students on safe and effective care on their

clients. Also, they can help students to boost their confidence, improve their

communication skills, develop further holistic approach, and be remolded to be more

patient-centered as their knowledge expands about quality of service. The output of

the study may serve as a good basis on how nursing students will integrate effective

and safe practice in the bedside.

Department of Health. The study also aims to influence the health department

and other educational institutions to work in teams because it will improve quality

nursing care when they work well together and if they use well-planned and

standardized processes. In addition, the present study also believes that the

organization can improve the quality and safety of healthcare in the Philippines.

State Universities and Colleges. The present study may help the state

universities in assessing the health services of school clinics. The findings may help

the school to identify and determine the policies and guidelines that can further

increase the clinic’s compliance to the safety and quality standards of health care
 7

services. By knowing so, the school may improve the development plan and allocating

special attention to the school health services. The suggestions and recommendations

of the present study may be incorporated to the policies and guidelines. Also, the study

may help the school come up with orders and institutional policies that altogether

geared towards improving the health services being delivered to the students and the

academic community.

Future Researchers. The study will allow the future researchers to utilize the

findings in their future endeavor thus will facilitate effective data gathering and

successful conduct of the future study.

Scope and Delimitations

The study was conducted in all of the campuses of Bataan Peninsula State

University (i.e. Main, Balanga, Orani, Dinalupihan, Abucay and Bagac) that availed

the services of BPSU Health Services Unit in any form. The respondents were chosen

regardless of age, sex, civil status, highest educational attainment, marital status and

student’s degree program.

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Notes in Chapter I

Pedroza, S. (2015). Catholic universities amplify call for “Religious Inclusiveness”.

Retrieved from http://www.xu.edu.ph/xavier-news/25-2015-2016/1627-
catholic-universities-amplify-call-for-religious-inclusiveness. Retrieved: 09
November 2015

World Health Organization. Global Status Report on Sanitation and Communicable

Diseases. 2015 Department of communicable diseases: profile and vision. New
Delhi: World Health Organization, Regional Office for South-East Asia; 2015.
Available from: www.searo.who.int/LinkFiles/CDS_profile.pdf [accessed
11July 2015.
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CHAPTER II

THEORETICAL FRAMEWORK

This chapter presents the relevant theories, review of related literature and

studies, conceptual framework, paradigm of the study, research hypothesis, and the

operational definition of terms used in the study.

Relevant Theories

This study is anchored on Kurt Lewin’s (1943) Three Step Change Theory,

Edgar Woolard’s (1994) System Theory, Amitai Etzioni’s (1975) Compliance Theory

and Dorothy E. Johnson’s Behavioral System Model (1968). The first theory that has

bearing on the present study is Lewin’s (1943) Three Step Change Theory. It views

behavior as a dynamic balance of forces working in opposing directions. Driving

forces facilitate change because they push employees in the desired direction.

Retraining forces hinder change because they push employees in the opposite

direction.

The first step in the process of changing behavior is to unfreeze the existing

situation or status quo or the equilibrium state which is necessary to overcome the

strains of individual resistance and group conformity. The second step in the process

of changing behavior is movement where it is necessary to move the target system to a

new level of equilibrium. Three actions that can assist in the movement step include:

persuading employees to agree that the status quo is not beneficial to them and
 10

encouraging them to view the problem from a fresh perspective, work together on a

quest for new, relevant information, and connect the views of the group to well-

respected, powerful leaders that also support the change. The third step is refreezing

which needs to take place after the change has been implemented in order for it to be

sustained or “stick” over time. It is the actual integration of the new values into the

community values and tradition.

The theory is relevant to the present study since it states the new policies at

place, for instance the provisions of PD 856 or the Code of Sanitation. The school

clinic may undergo reinforcement of new patterns and institutionalize them through

formal and informal mechanisms including policies and procedures. Since the study

deals with the compliance of the school with PD 856, the theory becomes important

since the latter illustrates the effects of forces that either promote or inhibit change

while restraining forces oppose change. Hence, change will occur when combined

strength of one force is greater than the combined strength of the opposing set of

forces.

Another theory that is relevant to the present study is Woolard’s (1984) System

Theory which states that a system is composed of regular interacting or interdependent

group of activities/parts the emergent relationship of which form the whole. This

resembles the school as a form of organization which is composed of various parts

working collaboratively to achieve its end - the school’s mission and vision. It has

many circular, interlocking, sometimes time-delayed relationships among its

 11

components. These components and how they behave with one another are important

in determining its behavior as the individual components themselves. This is true in a

school which is also a system that has various parts - students, staff, teachers,

administration and the community working hand in hand to efficiently and smoothly

operate all its mechanics. Hence, the many parts of a school as a system are

determining factors on the over-all structure of the system.

The relevance of the theory to the present study lies on the premise that the

school clinic is a system run by various parts so is the former part of a bigger

organization that is the school. The system theory encourages a closer look at the

organization as a whole and as a part of the larger environment as the school embraces

the provisions of PD 856. The compliance of one may influence the compliance of all

or even the implementation of the provisions in PD 856. The activity of any part of an

organization affects the activity of every other part.

Another theory that has relevance to the present study is Etzioni’s (1975)

Compliance Theory. It classifies organizations by the type of power they use to direct

the behavior of their members and the type of involvement of the participants. These

organizational powers come in three types namely: coercive, utilitarian, and

normative, and relates these to three types of power can be useful in obtaining

subordinates ‘cooperation in organizations. However, the relative effectiveness of each

approach depends on the organizational participant’s involvement. Accordingly,

people can be placed on an environment continuum that ranges from highly negative
 12

to highly positive. When an organization employs coercive power, participants usually

react to the organization with hostility, which is alternative involvement. Utilitarian

power usually results in calculative involvement; that is; participants desire to

maximize personal gain. Finally, normative power frequently creates moral

involvement; for instance, participants are committed to the socially beneficial features

of their organizations.

The theory is relevant to the present study since some organizations employ all

three types of power, but most tend to emphasize only one, relying less on the other

two. School officials who attempt to use types of power that are not appropriate for the

environment can reduce organizational effectiveness. Schools tend to be normative

organizations. Different goals require the application of specific kinds of power. As

such, the theory may shed light as to how school clinic accepts the challenges of PD

856 and how the school reacts to the law as fundamental to ensure the safety and

security of the students and personnel.

Another theory that is relevant to the study is Johnson’s Behavioral System

Model. It advocates the fostering of efficient and effective behavioral functioning in

the patient to prevent illness and stresses the importance of research-based knowledge

about the effect of nursing care on patients.

Johnson’s Behavioral System Model is a model of nursing care that advocates

the fostering of efficient and effective behavioral functioning in the patient to prevent
 13

illness. The patient is identified as a behavioral system composed of seven behavioral

subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and

achievement. The three functional requirements for each subsystem include protection

from noxious influences, provision for a nurturing environment, and stimulation for

growth. An imbalance in any of the behavioral subsystems results in disequilibrium. It

is nursing’s role to assist the client to return to a state of equilibrium.

All the theories are relevant to the present study since they state that the

compliance of an organization or school or school clinic to the provisions of PD 856

categorically explains what Lewin states that organization views behavior as a

dynamic balance of forces working in opposing directions. Likewise, the changes that

compliance to PD 856 brought can be useful in underpinning the factors that affect

such compliance. Finally, the way the school clinic and school administration respond

to changes, the theory of compliance explains that school organizations are classified

by the type of power they use to direct the behavior of their members and the type of

involvement of the participants.

Related Literature

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-

subsidized 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
 14

throughout the Philippines, meaning that there should be few language barriers

preventing expats from accessing healthcare

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 centers 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 subsidizes 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 enroll 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 practicing 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
 15

most expat standards. The relative affordability of private healthcare can be seen in the

increasing popularity of the Philippines as a medical tourism destination.

The Philippine health care system has rapidly evolved with many challenges

through time. Health service delivery was devolved to the Local Government Units

(LGUs) in 1991, and for many reasons, it has not completely surmounted the

fragmentation issue. Health human resource struggles with the problems of

underemployment, scarcity and skewed distribution. There is a strong involvement of

the private sector comprising 50% of the health system but regulatory functions of the

government have yet to be fully maximized.

Based on a survey by the Social Weather Station in 2006, majority of Filipinos

specifically the low income households prefer to seek treatment in a government

hospital if a family member needs confinement. Affordability is the main reason for

going to a government medical facility, while excellent service is the main reason for

going to a private medical facility (Department of Health, 2010). The net satisfaction

with services given by government hospitals has slightly improved from +30 in 2005

to +37 in 2006. Excellent service and affordability are the main reasons for being

satisfied whereas poor service is the main reason for being dissatisfied with the

services given by government hospitals (Social Weather Stations, 2006).

The country’s health profile depicts a distinct epidemiologic and demographic

transition characterized by double burden of diseases consisting of communicable

diseases (which require major public health intervention) and non-communicable

diseases (which need expensive curative and chronic-care intervention). This scenario

makes the country’s health profile a “hybrid” or combination of health situations

 16

found in both developed and developing countries. Similar to Sub-Saharan Africa,

many regions in the Philippines are still struggling to eliminate hunger and infectious

diseases while continually battling on non-communicable diseases (NCDs) as

experienced in developed countries. The health status of the country therefore can be

best described to be at the crossroads of infectious and non-communicable diseases.

Health reforms in the Philippines build upon the lessons and experiences from

the past major health reform initiatives undertaken in the last 30 years. The adoption of

primary health care (PHC) approach in 1979 promoted participatory management of

the local health care system. The goal was to achieve health for all Filipinos by the

year 2000. It emphasized the delivery of eight essential elements of health care,

including the prevention and control of prevalent health problems; the promotion of

adequate food supply and proper nutrition; basic sanitation and adequate supply of

water; maternal and child care; immunization; prevention and control of endemic

diseases; appropriate treatment and control of common diseases; and provision of

essential drugs. To implement PHC, EO 851 was issued in 1983 integrating public

health and hospital services (World Health Organization, 2015).

In 1999, the health sector reform agenda was launched as a major policy

framework and strategy to improve the way health care is delivered, regulated and

financed. With a battle cry of “Kalusugan Para sa Masa”, it was PHILIPPINE

HEALTH SYSTEM Page | 17 designed to implement the reform package in the

convergence sites. The five reform areas are: 1. public health; 2. hospital; 3. local

health systems; 4. health regulations and 5. Health financing (Department of Health,

2014). It was during this time that the DOH underwent a major organizational reform
 17

to pursue its new role as a result of the devolution. At the local level, the

municipalities were joined together to form interlocal health zones (ILHZs) to

optimize sharing of resources and maximize joint benefits from local health initiatives.

The operational framework of health sector reforms was adopted in 2005 and

was called FOURmula One for Health (F1). The objective was to undertake critical

reforms with speed, precision and effective coordination directed at improving the

efficiency, effectiveness and equity of the Philippine health system in a manner that is

felt by the Filipinos especially the poor. The F1 organized health reform initiatives

into four implementation components, namely: financing, regulation, service delivery

and governance (DOHAO 2005- 0023). This time also marked the enactment of two

pieces of legislation: the Universally Accessible Cheaper and Quality Medicines Act

of 2008 and the Food and Drug Administration Act of 2009. However, despite the

important progress made, successive reforms have not succeeded in adequately

addressing the persistent problem of inequity.

Differences in access to healthcare services and the resulting adverse health

outcomes are major public health priorities. The Institute of Medicine and the

Department of Health and Human Services have identified the need for strategies to

improve access to healthcare services and to support the improvement of health

outcomes. The literature documents health disparities associated with healthcare

access and health outcomes from a geographic perspective. Place of residence,

location of healthcare services, and geography in general are important factors in the

analysis of health.
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Geographical information systems (GISs) are an emerging technology in the

analysis of health from a geographical or location context. As a type of information

technology, GISs are potentially powerful assessment tools for the investigation of

healthcare access, health outcomes, and the possible resulting health disparities. Their

ability to integrate health data with mapping functions allows for visualization,

exploration, and modeling of health patterns. Application of GIS technology using

health data can help in describing and explaining disparities in healthcare access and

health outcomes.

The studies reviewed demonstrated the use of GISs to investigate various

aspects of healthcare access and health outcomes, including environmental variables of

Lyme disease, sociodemographic variables and teen pregnancy, geographical

disparities in breast cancer mortality by racial groups, PCP and AIDS prevalence, and

factors of a leptospirosis disease outbreak. The literature reviewed shows effective

integration and analysis of health data using GIS technology.

Poor communities suffer a higher burden of disease due to inequities in access

to services and health status. Since financing for local government units often vary and

the benefits package for insurance plans may be unfavorable, some communities face

difficulties accessing public health services. Shifting the responsibility of healthcare

from the federal government to the local governments has increased local authority

and has made communities susceptible to lack of access to basic services.[2] In

addition, most healthcare payments are made out of pocket, especially when receiving

care from privately owned institutions. Barangay health stations serve as primary
 19

public health facilities and are staffed by doctors, nurses, midwives, and barangay

health volunteers.[3]

There is no requirement in the Philippines for causes of death to be medically

determined prior to registration of a death, so national statistics as to causes of death in

the Philippines cannot be accurately substantiated. In the provinces, especially in

places more remote from registries, births and deaths are often not recorded unless

some family need arises, such as entry into college. When there is no legal process

needed to pass on inheritance, the recording of deaths is viewed as unnecessary by the

family.

Structural Requirements. According to Tepher (2018), there are two building

systems. The first building mode was conceived as structural frame like beams and

columns, exterior skim with doors, windows, and roof, heating and cooling, ventilating

systems, and electrical system which includes computer and phone networks. The

second building model includes the skin - the stuff that kept out the elements,

including roofing, siding, windows, exterior doors, gutters, caulk in cracks and joints,

and so forth; structure-held up the building. Hence, there is a separation of structure

from space dividing systems was important because it allowed for future addition or

removal of interior walls and doors, as program needs change; systems (services)

provided comfort and communications to the user of the building. Proper separation of

systems and allowance for future system expansion and replacement were essential to

good building design; and space dividers-walls, doors and so forth.

Relatively, Kowalski (2015) mentioned that there are many schools that have a

large number of old, worn out buildings since many of these do not have the
 20

significant features like the control of thermal environment, adequate lighting, good

roofs, and adequate space, which were necessary for a good environment. School

buildings that could adequately provide a good learning environment were essential

for student success. As a matter of fact, the deterioration of a building is brought by its

age since most of the buildings have gone past its average age of 42 years old. As

such, many of these buildings require major repair or renovation or inadequate to

house current student populations. Condition of school facilities related to the age,

maintenance, and compliance with safety, health, and special needs regulations.

Moreover, there are reasons why school buildings like clinics have been

suffering from distraught and wreck. National Center for Educational Statistics (2015)

discussed some of the factors that contributed to school building conditions. One of

the reasons is the deferred maintenance and renovation. This is brought by the decision

overlooking the maintenance and modernization of old school facilities versus the

instructional programs because of insufficient funds which is an overarching problem

of many SUC’s in the Philippines. The second problem is overcrowding which is in

effect the result of the condition that the number of students in the school was larger

than the number of students the school was designed to accommodate.

Generally, Lackney and Picu (2015) suggested the design and management of

school facility should provide a sense of ownership, security, and safety,

personalization, privacy, control, and sociality spaciousness or crowdedness.

According to the Section 5 of the Implementing Rules and Regulations (IRR) of

Presidential Decree No. 856 there are structural requirements in the establishments of

school buildings including school clinics for the promotion of the physical and
 21

emotional environment in schools. One of the general structural requirements states

that orientation and construction of the building shall be in such a way to receive the

maximum amount of natural light in the classrooms and a satisfactory amount along

corridors and stairways. There should also be a healthful air condition that must be

provided through effective ventilation either natural or mechanical ventilation.

The IRR of PD 856 states that there must be adequate protection against fire

and other life and health hazard. The sanitary facilities shall be properly designed and

installed. Also, the school buildings, premises and other facilities shall be aesthetically

designed. Likewise, there are also specific structural requirements with regards to

flooring which says that floor or all rooms must be smooth, easily cleaned and in good

condition. Those floors which are constructed of concrete or other impervious

materials must be resistant to wear and corrosion and must be adequately graded and

drained. The floors in the toilet rooms must be made of impervious materials.

Furthermore, the IRR of PD 856 states that the walls and ceilings of the school

clinics shall be smooth, tight and in good condition. It shall have surfaces of light

colors and flat finish. Ceilings and overhead structures shall be painted with light color

and shall have a reflection factor for at least 80%. Upper walls shall be painted with

light color and walls adjacent window areas shall be as near as white as practicable

with reflection factor of not less than 50%. Lower walls up to the base board line, on

the other hand, shall have a darker shade than the upper wall and a reflection factors

between 25% to 40%. Finally, all wall and ceiling surfaces shall have a flat non-glare

producing finish of washable paint or equivalent finish.

 22

As to lighting, the IRR of PD 856 noted that the general standards of

illumination provided shall permit effective inspection and cleaning and shall be of

sufficient intensity appropriate to the purpose for which any room or place is used.

Ventilation shall be provided which shall be effective and suitable to maintain

comfortable condition and must be adequate to prevent the air from becoming

excessively heated, prevent condensation and the formation of excess moisture on

walls, ceilings and for the removal of objectionable odors, fumes and impurities.

Safety Requirements. Hunter (2016) noted that the physical environment of the

school plays a critical role in keeping students safe which means that the structure

should provide an inviting environment in which children can be protected from

threats and learning can take place. Identifying particular physical building factors or

conditions, such as lighting, color, classroom size, air conditioning and determining

how they affect student can be very complex. As mentioned by Hunter (2006), the

environmental conditions in schools, which included the inoperative heating system,

inadequate ventilation, and poor lighting, affected the health and learning as well as

the morale of students and the staff. Sustainable schools and the good qualities of

lighting, site planning, indoor air quality, acoustics, healthy building materials, and the

use of renewable energy benefited student achievement.

As such, Tanner and Lackney (2016) noted that the design of school

environments must include the principles for site and building educational space,

principles for shared school and community facilities, community spaces, principles

related to the character of all spaces, and principles related to site design and outdoor

learning spaces. Teachers must be given an opportunity to influence school design that
 23

incorporated creating learning spaces throughout the interior as well as the exterior of

a school. They must be able to create physical environments that are conducive to

learning.

According to Bly (2015), in order to protect the safety of our schools,

educators need to create a healthy, nurturing, and normal school environment, where

students felt connected, safe, valued, and responsible for their behavior and learning,

while at the same time, provided sufficient security. Buildings that are poorly

maintained, dirty, unattractive, crowded, and unsafe send powerful negative messages

to teachers and students. The physical plant and the architecture reflect important

beliefs as to what schools are about and the meaning they hold for students and the

community.

Specific Requirements for Personnel, Students and School Health Services. The

IRR of PD 856 provides the access of teaching and non-teaching personnel of the

school to annual physical, medical and dental check-up. The same is true and must be

done also among students of the school. Periodic immunizations that maybe necessary

or required shall be provided in coordination with the local health office. Guidance

and counselling services for the promotion of physical, mental and emotional health of

students shall be provided by the school.

Furthermore, the schools must have a medical and dental clinic for the delivery

of preventive and promotive health services and the treatment of minor ailment and

emergency cases. For instance, the big schools with 3000 or more students shall

allocate a room space of not less than 65 square meters as school clinic, divided into

compartments to suit the different health needs of students. Inside the school clinic, a
 24

lavatory or hand washing facility with adequate and potable water supply shall be

installed. Some of the equipment and materials that must be present inside the clinic

include basic medical and dental equipment, stretcher, portable oxygen tank with

regulator and other basic drugs/medicines and dental supplies.

There must be referral system for health, medical and dental services

established in the school in coordination with local health office, government or

private hospitals and clinics for handling complicated cases. The IRR also suggests

that a presence of health personnel in the school clinics shall be required for the

duration of time when classes are going on. Moreover, the IRR notes that first aid kit

shall be available in every faculty room. Only teachers trained in the first aid shall do

first aid measures or cases like these must be referred to the health personnel of the

school clinic.

Responsibility of the School Administrator. According to Kowalski (2016), it is the

cogent administrative responsibilities of school administrators to maintain and develop

school buildings. One of the most essential responsibilities for them is to provide

adequate facilities. With unstable increase of enrollment in many school districts,

superintendents had to engage in continuous construction. Hence, school facilities

management is the application of scientific methods in the planning, organizing,

decision-making, coordination and controlling of the physical environment of learning

for the actualization of the educational goals and objectives. This involves among

other things, collective decision making in relation to selection of site for

establishment of new schools, design and construction of new school plants including

grounds, renovation and modernization of old plants, provision of equipment for

 25

academic and non-academic activities, maintenance of all facilities and review of

management practices and processes.

Likewise, Luke (2017) stated that facilities management is a process that

ensures that buildings and other technical systems support the operations of an

organization. Also, facilities management as the practice of co-ordination of the

physical workplace with the people and the work of the organization; it integrates the

principles of business administration, architecture and the behavioral and engineering

sciences. Hence, the physical aspects of a school need to reflect the vision for reform:

examples of students’ work displayed on the walls, clean, bright spaces that exhibit

pride in the schools’ appearance, classrooms that allow for flexibility in different

seating arrangements and adequate resources for both students and teachers.

Furthermore, a school clinic must be maintained as prescribed in the RA 856.

Alongside with this, the school administrator must report the occurrence of notifiable

diseases and disease outbreaks in the school to the local health office. He should also

guide the health authorities in the conduct of inspection. With the help of community

partners, the school leader must assist the local health officer in the campaign for the

promotion of health and the prevention and control of diseases.

According to Lackney and Picus (2018), the management of school facilities

lasted a lifetime, while planning, designing new construction for schools took only two

or three years. Administrators needed to establish and monitor facility maintenance

programs for their school. This maintenance program included preventive, deferred,

repair or upkeep, and emergency maintenance. Responsibility for this facility

management lies with the school site. School sites evolved over time with changing
 26

needs for outdoor education and recreation, but these changes were largely superficial

and respect the original site characteristics and placement of the buildings.

Staff-Related Factors

Educational Attainment. As mentioned by Bulach et al. (2018), the educational

qualification of a person spells a lot of difference in the discharge of duties and

responsibilities in the workplace. As such, educational attainment is one of the

requirements when applying for a job. This is to see whether the job for which a

person applied is congruent to the educational or professional background of the

applicant. The same is true among health care related positions which need to be filled

up by qualified people in the field like nursing position by a qualified nurse, medical

positions like doctors and dental positions like dentist.

According to the World Health Organization (2018), the dynamic purpose of

health promotion in the SUCs or any higher education institutions (HEIs) is to support

the success of the students. In the higher education setting, good health enables student

success through the creation of health-supporting environments including both the

physical and the social aspects of our surroundings. In consonance with the health

objectives of the school clinics that is to expand protective factors and campus

strengths, and reduce personal, campus and community health risk factors, qualified

health-related professionals must be hired. Hence, these professionals must possess the

specific competencies that make them best suited to support student success through
 27

the practice of prevention – that is, by preventing the development of personal and

campus population-level health problems, while enhancing individual, group, and

institutional health and safety.

In most settings, Champoux (2015) pointed out the health care professional

being hired must have the adequate knowledge on the job they applied for. They

should know how to develop strategic plans for health promotion that support the

unique missions and values of 26 institutions of higher education. Likewise, they

should examine and address campus and community health issues at all levels of the

socio-ecological model – intrapersonal, interpersonal, institutional, community, and

public policy. They should also know how to engage and collaborate with

interdisciplinary partners like doctors, dentists and nurses. They should also know how

to apply accepted theoretical frameworks and planning models that address individual

and community health, conduct population-based assessments of health status, needs,

and assets. Implementing evidence-informed health promotion initiatives with fidelity

to maximizing effectiveness and using accepted quantitative and qualitative methods

for assessment and program evaluation are also expected to be accomplished by the

nurses.

By and large, Lunenburg, and Ornstein (2015) pointed out that hiring of

qualified school clinic personnel will increase their effectiveness by having the

academic degrees, training and preparation, experience, and continuing professional

education to complete these highly complex tasks. Regardless of position level, all

qualified health promotion professionals should be competent in conducting needs

assessments, selecting priority health issues and measurable behavioral objectives,

 28

designing and implementing evidence- and theory-based initiatives, evaluating

effectiveness, and reporting outcomes. As such, there are two levels of personnel in

the school clinic namely: director-level health promotion professional and staff-level

health promotion professional.

According to Epstein (2018), since the director provides direct oversight of all

health promotion activities that address priority student health issues and support the

missions of the HEIs, he must have a minimum of an advanced degree in public

health, health promotion, health education, or other related discipline from an

accredited institution. They are recommended to have years of full-time professional

health promotion work experience.

However, St Leger (2016) posited that there are employees who have spent so

many years in the job and hence, become wary and inefficient in the conduct of their

duties. These are people who after becoming accustomed with their work find it a

routine and non-challenging anymore. This means that these people are not exposed to

challenges and are not given proper empowerment throughout the years of their career.

This suggests that the school administration or the workers themselves failed to

address their changing needs related to the job and emerging trends and issues that

confront school-based health services or school clinic to make the latter more

responsive to the needs of the students and school personnel. It means that what they

lack is empowerment and continuous inspiration coming from the school

administration so that they will be given adequate avenues to develop and improve

themselves professionally and personally.

 29

Eligibility. In the workplace, Leurs et al. (2017) pointed out that eligibility is one of

the requirements which is looked upon any person applying for a job or seeking for

promotion in the work. Eligibility comes in different ways and each job requires a

certain level or kind of eligibility. For most positions in the public or government

organizations or institutions, eligibility is being considered for one to be promoted to a

higher rank or level. There are actually positions in the government that calls for a

certain type of eligibility which is mandated or being asked for the position. Hence, it

is important that the workers in the government offices like the SUCs take further test

like civil service examinations to allow for further professional growth and personal

development among the employees.

Basically, Frabutt et al. (2016) stated that the lack of knowledge and skills

among school clinic personnel is a significant barrier to improving quality in health

care. This means that they lack basic skills and knowledge in how to assess evidence,

plan improvements, manage projects and analyze data. Hence, training health

professionals in quality improvement has the potential to impact positively on

attitudes, knowledge and behaviors. It can be as effective as providing financial

incentives for improving the quality of health care since trainings and seminars aimed

to teach health professionals about methods or skills that could be used to improve

quality.

Interestingly, Bumett-Zeigler and Lyons (2014) stated that education and

training can have an impact on the attitudes, knowledge, skills and potentially the

behaviors of those who take part, hence, beneficial to the professional growth of the

school clinic personnel. It is important not to assume without question that training in
 30

quality improvement is the best or only method for helping professionals improve the

quality of health care. There is mixed evidence about the effect of training on

outcomes. Training that includes a practical focus, such as implementing quality

improvement projects or work-based learning, may be more likely to result in tangible

change. Hence, quality improvement becomes a dynamic concept underpinning

service planning and provision among school clinic personnel.

Clinic-Related Factors
Medical Equipment. As mentioned by Alfred et al. (2015), learning cannot take place

where facilities are not provided. As such, the provision of facilities such as building

and equipment is of utmost importance. The school facilities must meet the needs of

the school community by following various standards in terms of material resources.

For instance in the school clinic, the drugs, medical supplies and equipment have a

significant impact on the quality of patient care and account for a high proportion of

health care costs that is delivered to the school. Thus, essential medical supplies and

equipment must be present in the clinic. Also, it is essential that the equipment and

facility in the clinic must be properly used and maintained.

In order to manage the equipment in the school clinic, Stephan et al. (2017)

mentioned that procurement of medical supplies and equipment is one of the essential

parts of it. It should be followed by effective storage, stock control, care and

maintenance. These are critical in health services if the school clinic wishes to provide

quality health care services to the students and employees of the school. In the area of
 31

maintenance support and technical back up, the following aspects must be considered

namely utilities, skills and training, technical back up and consumables, accessories

and spare parts. Likewise, selecting supplies and equipment must be given bigger

attention in as much as the fact that a much wider range of different brands and items

to choose from exists in the market. If these are followed strictly, it will lead into the

procurement of medical equipment for school clinic that are appropriate because they

are technically suitable, compatible with existing equipment, spare parts and

consumables are available, or because staff have been trained to use them.

On the other hand, Auger (2015) noted that the school clinic must be checked

as to the presence of utilities needed to use an item of equipment. The use, cleaning

and maintenance of the equipment must also be considered. On top of it, the clinic

personnel must have the skills and training required in maintaining the equipment.

Those who are in-charge of the equipment must have a master copy of all items and

update this list each time an item is received and issued. They should also keep their

own working copy and update their own list of all the equipment and supplies they

receive and include items damaged, broken or sent for repair. Hence, an inventory

should be carried out at regular intervals to check the condition and location of

supplies and equipment in use and in stock. Checking the inventory of stock is an

important part of stock control and helps to identify purchasing requirements.

Medical and Dental Supplies. The school clinic, according to Carbonaro and Covay

(2014), must be equipped with considerable number of supplies that will cater to the

needs of the students and the teaching and non-teaching personnel of the school. These

supplies are provided by the university every year and are refurbished when the need
 32

arises. Hence, critical to the supplies in the school clinic are materials, equipment and

medicines related to the medical and dental services being provided by the school

clinic. These medical and dental supplies are the most widely used by the students and

school personnel since most of their concerns are medical and dental-related.

According to Mennen and Trickett (2017), the presence of medical and dental

supplies in the school clinic is a manifestation of readiness of the school to serve the

medical and dental needs of its clientele. For instance, the presence of medical

supplies allow for a maximized used of the medical facilities and services of the school

clinic. If the clinic have adequate medical supplies, it will be easy for the students and

school personnel to attend to their medical needs and health problems. Also, students

and school personnel will have immediate medication since there are medical supplies

that are abounding in the school clinic.

Meanwhile, Mennen and Trickett (2017) emphasized that the lack of medical

and dental supplies whether they are inadequate or not available can result to a lot of

problems. One of these problems is the discontinuity of care and increase in patient

time in the clinic. If these problems are properly attended to, there will be a broad

distribution of clinical problems for learning, clinical problem solving, and treatment

provided in an integrated fashion, as well as accessibility and maintenance of a patient

treatment base, have been widely described as benefits deriving from comprehensive

care programs of the school clinic.

In addition, Stephan et al. (2017) pointed out that some of the medical and

dental supplies needed in the school clinic are adhesive tape, antibiotic ointment,

antiseptic solution or towelettes, bandages, including a roll of elastic wrap and

 33

bandage strips in assorted sizes, instant cold packs, cotton balls and cotton-tipped

swabs, disposable latex or synthetic gloves, at least two pair, duct tape and gauze pads

and roller gauze in assorted sizes. There must be a first-aid manual in the school clinic.

Other supplies that are fundamental to the needs of the students and school personnel

are petroleum jelly or other lubricant, plastic bags for the disposal of contaminated

materials, safety pins in assorted sizes, scissors and tweezers, soap or instant hand

sanitizer, sterile eyewash, such as a saline solution, thermometer, triangular bandage

and turkey baster or other bulb suction device for flushing out wounds.

Likewise, the school clinic must have medical supplies like activated charcoal,

aloe vera gel, anti-diarrhea medication, over-the-counter oral antihistamine, such as

diphenhydramine (Benadryl, others), aspirin and non-aspirin pain relievers (never give

aspirin to children), calamine lotion, over-the-counter hydrocortisone cream and

personal medications that don't need refrigeration. Also, the clinic must have drugs to

treat an allergic attack, such as an auto-injector of epinephrine (EpiPen, Twinject,

others), syringe, medicine cup or spoon, emergency items, emergency phone numbers,

including contact information of the student’s family doctor and pediatrician, local

emergency services, emergency road service providers and the regional poison control

center, medical consent forms for each family member, medical history forms for each

family member, small, waterproof flashlight and extra batteries, candles and matches,

sunscreen, emergency space blanket and first-aid instruction manual.

Health Services Offered. As mentioned by Winnail et al. (2015), there are three types

of health services delivery namely: traditional core services, expanded school health

services, and comprehensive school-based health clinics. Some of the core functions of
 34

school health services include direct health care, referrals to and linkages with

community providers, and health promotion and injury and disease prevention

education. Direct care activities include screening, diagnostics, treatment, health

counseling services, medication administration, and case management of students with

special health needs.

According to Selekman (2016), the eight key areas of health related services

include health education, physical education and activity, health services, mental

health and social services, nutrition services, safe school environments, staff health

promotion, and family and community involvement. Moreover, the school must have a

comprehensive school health model which is typically the basis for the establishment

of school-based health clinics. Therefore, the clinic’s services must be an expanded

model of school health and are the result of a community's collaborative efforts to

meet the physical and mental health needs of students. One of the greatest student need

is focused on mental health issues which require for a wide range of health care

services.

As pointed out by Brener et al. (2017), school-based health clinics or school

clinics are considered to be one of the most effective strategies for delivering

comprehensive primary and preventative health services to the students in the school.

Some of the services of the school clinic must focused on preventing school-dropout

and the development of risky behaviors. School clinics must provide essential primary

care services, overcome barriers and can also act on the multiple determinants of

health, including health interventions and environmental. To strengthen the services

being provided by the school clinic, quality improvement methods to increase

 35

efficiency and improve patient care are now seen as a strategy. This can be done by

maintaining expert staff, utilizes up-to-date information technology, and draws upon

the resources of the school to train and support health care providers in employing best

practices to ensure effective and efficient health services.

California School Boards Association (2018) also highlighted that school clinic

must offer a broad array of basic primary physical and mental health services. Physical

health services include health supervision examinations, including health screening,

psychosocial histories, immunizations, and health guidance; diagnosis and treatment of

acute illnesses and injuries; acute management of chronic conditions, such as asthma,

diabetes, and epilepsy or the management of chronic conditions is usually coordinated

with the student’s medical home; treatment of common adolescent concerns, such as

acne and weight management; gynecological examinations; pregnancy testing; and

diagnosis and treatment of STDs, including HIV testing and counselling. On the other

hand, basic mental health services include mental health assessment and consultation;

individual, group and family counselling; and crisis intervention.

Likewise, Kirchofer (2016) mentioned that the school clinics must have substance

abuse services include assessment and intervention for use of illicit drugs, mainly alcohol.

There must be student referrals to the substance abuse treatment provider which originates

from the medical and mental health providers, who, during an examination, identified

substance abuse as a problem. Referrals also were made by school disciplinary staff when

a student violated the school’s substance abuse policy, which required a referral for

counselling. Hence, there must be a monitoring scheme among students to identify who
 36

among them are substance abusers or users. A drug test must be conducted periodically.

Preferably in a higher education setting. On the other hand, a staff-level health

promotion professional engages in health promotion practices that promote and

improve the health and well-being of individual students, student groups, and campus

communities. They need to have a minimum of an advanced degree in public health,

health promotion, health education, or other related discipline from an accredited

institution.

Years in the Service. As mentioned by Mulford (2013), years in service are critical

when applying for jobs especially in the health care sectors. This is to know whether

the applicant has received a considerable amount of time and effort in honing the craft

in the health care industry. The time spent for the job as health care personnel allows a

person to have professional growth since these are learning experiences that

continually help professionals to become master of their craft. The longer the years

they have stayed in the business, the higher the opportunity for them to lead a quality

professional lives that are highlighted by milestones in the discharge of their duties.

Nutbeam (2008) pointed out that the higher the years in service, the more they

become privy of the job which means that they develop the mastery of their duties and

the assumptions that everything is always under control. It is also true among health

care professionals in the HEIs who are employed in the school clinics. Since they have

aged gracefully in the conduct of their duties, they are presumed to have a vast

knowledge on the many applications of their job. This simply means that they have

developed an outstanding understanding of the needs of the students and school

personnel and how to deal with the changing medical and dental needs of the said
 37

people. Hence, the higher the years in service, the higher the opportunity to master the

work competencies expected of them by the school administration.

Likewise, Kirchofer (2016) mentioned that the school clinics must have

substance abuse services include assessment and intervention for use of illicit drugs,

mainly alcohol. There must be student referrals to the substance abuse treatment

provider which originates from the medical and mental health providers, who, during

an examination, identified substance abuse as a problem. Referrals also were made by

school disciplinary staff when a student violated the school’s substance abuse policy,

which required a referral for counselling. Hence, there must be a monitoring scheme

among students to identify who among them are substance abusers or users. A drug

test must be conducted periodically.

Furthermore, Puskar (2017) posited that the school clinic must have health

promotion services which include one-on-one patient education, as well as classroom

and community health education on a broad range of age-appropriate topics, such as

the prevention of HIV infection and acquired immunodeficiency syndrome, other

STDs, substance abuse, pregnancy, interpersonal violence, unintentional injury, and

bullying. Social services, on the other hand, should include identification of basic

needs and referrals for food, shelter, clothing, legal and employment services, and

public assistance.

Organizational Structure. As mentioned by Perrin (2017), the members of the school

clinic must be professionally prepared to face the challenges imposed by the school

clinic’s routine program and the demanding needs of the students and school personnel

both medical and dental. The organizational structure of the school clinic must be
 38

founded on skills and qualifications so that each and every member of the clinic knows

the job and has the necessary professional preparation to undertake it. Identifying the

right persons or ideal member of the school clinic is important since the school must

bring together interested parties in the school. This action is essential for planning and

assessing client’s interest and resources. It also draws on expertise from school

members in evaluating key components of the health services offered by the clinic.

Moreover, Vessey and McGowan (2016) the organizational structure of the

school clinic must consist of school health advisory councils that are tasked to oversee

the functions of all health-related services of the school including the school clinic. In

most settings, the council is composed by health and education professionals, parents,

and other community members who can mobilize community resources, represent the

diverse interests within the community, provide school personnel and families with a

sense of program ownership, and provide guidance to the school board.

Responsibilities of a coordinating council can include assessing needs and resources,

establishing program goals, developing a health care plan, coordinating school

programs with community programs and resources, providing leadership and

assistance for staff, and assuring continuous improvement through evaluation quality

assurance mechanisms.

By and large, Wolfe (2016) noted that the school clinic should be composed of

a qualified nurse who has been duly certified to pass the necessary licensure

examination for the position. The school nurse serves as the health care expert in the

school to meet student health needs with an understanding of normal growth and

development in children and youth as well as students with special needs. He also
 39

develops plans for student care based on the nursing process, which includes

assessment, interventions, and identification of outcomes and evaluation of care. He

also provides health related education to students and staff in individual and group

settings and provides consultation to other school professionals, including food service

personnel, physical education teachers, coaches, and counsellors.

Vessey and McGowan (2016) underscored that the school must also have a

school doctor or physician. The school doctor is in charge of providing medical care to

pupils in accordance with medical science and experience. This care has a holistic

approach, i.e. from the physical and the mental perspective, regardless of age or

gender and represents the health interests of pupils. The main task of the school

doctor’s activities lies in preventive medical care. The activities of a school doctor

require special medical and psycho-social knowledge, acquired by adequate training

professional development. He also aims to seek cooperation with the school governing

body and all physical and legal persons providing services in school operation in

matters which are likely to have direct or indirect effects on the state of health.

School-Related Factors

Logistic Support. As mentioned by Bly (2017), the medical and dental care or

services being provided by schools varies with budget size, regardless of many

uncontrollable factors. The rule of the thumb suggests that the more budget allocation

a school clinic has, the more funds it can use to widen its services or increase its

presence among the students and school personnel. It only goes to show that the school

clinic must have a strong logistic support from the administrative officials as well as

community stakeholders. If the clinic is widely supported and is given ample budget or
 40

funds, then it can do its mandate without worrying about the budget and hence, can

lead to realization of many of its goals and objectives.

According to Mennen and Trickett (2017), the greatest perceived barrier to

providing adequate health services in schools was the lack of funding and the failure

of school to recognize the need for health services. This is also the result of low

priority for school clinics. A change in the priorities of the school to blend funding

between education and health is what the school clinic needs to affect the increase in

fund among school-based health services. This is true among the SUCs since

government funding has traditionally been the main revenue source. Since most of the

SUCs are not self-sufficient, it only relies on government support and from the tuition

fees being paid by the students which a portion of it goes to the school clinic and its

services.

Likewise, Frabutt et al. (2014) pointed out that funding is also necessary for the

education, training and development of the clinic personnel which are crucial to

maintaining and enhancing their abilities in the discharge of their duties and

responsibilities. Creating and leading the changes required for modernization will

depend to a great extent on maximizing the potential of staff while increasingly

involving new and extended roles. A key aspect of this is lifelong learning for every

individual, which is at the core of clinical governance and supports the management of

risk to patients and staff. Opportunities for personal and professional development can

also play an important role in the recruitment and retention of school clinic staff.

Hence, funding is needed to fuel the continuous professional development of the

school clinic staff.

 41

Hence, Shapiro (2018) noted that funding for the school clinic is a very

essential component should the school wish to provide continuous medical and dental

services to all its students and school personnel. Likewise, funds are needed to fuel the

short and long term development plan of the school clinic so that it may keep pace

with the changing health needs and problems of its clienteles. The funds can also be

used to augment projects and programs of the health clinics that are fundamental to the

daily needs of the school personnel as well as of the students.

By and large, Nutbeam (2018) revealed that the funds of the school clinics

mostly came from the internal budget of the school or from the general appropriations

of the SUCs. Hence, the higher the general appropriations budget the more likely that

the fund allocated for the student services like school clinics could be higher. This will

also mean increase in the augmentation for the medical and dental services of the

school clinic. In the US, federal funding for school-based health centers came

primarily from the maternal and child health block grant and the Healthy

Schools/Healthy Communities program. However, as SBHCs have begun to focus on

third-party reimbursement, Medicaid has also become an important source of support.

Other funding is derived from various sources such as community-based health

centers, health care systems, foundation grants, and state and local funds.

On the other hand, Epstein (2018) commented that funds can also be resourced

externally which means that external organizations or community-based groups

whether non-government or government. These organizations have become critical

entities for sponsorship and financial support. These organizations include: hospitals,

public health departments, nonprofit health care and social service agencies.
 42

Implications for financial support vary based on the organizational sponsorship

designation. Larger and wealthier institutions are in the position to allot more finances

to centers, ensuring program sustainability independent of government financing.

Accreditation/Upgrading of Services. As mentioned by Hunter (2016), accreditation

can be the single most important approach for improving the quality of health care

structures. In an accreditation system, institutional resources are evaluated periodically

to ensure quality of services on the basis of previously accepted standards. Standards

may be minimal, defining the bottom level or base, or more detailed and demanding.

Accreditation is not an end in itself, but rather a means to improve quality. As such, it

is necessary that any institutions must be accredited and be upgraded so that the kind

of services they offer to the public is quality and highly substantial.

By and large, Goetsch et al. (2015) reported that the accreditation process and

continuous upgrading of services especially the health care programs of the school

clinic must be on top of the school’s priorities. These processes take the school to a

challenging level of development and improvement. School administrators must take

on comprehensive school reform which suggests that improvement strategies have the

best opportunity for success and sustainability when they take into account the broad

array of elements that make up the school being improved. As such, schools’

initiatives in improving itself must not only focus on school flows like dropout rate

and other related school statistical data. In a nutshell, accreditations strengthen the

fundamental leadership and steering role of national health authorities.

Meanwhile, Frabutt et al. (2015) stated that school clinic must continue to

upgrade their facilities including dental and medical services. This should be part of
 43

their plan to provide not only the best services but a holistic clinical and medical

environment for their clientele. One example of upgrading is the changing of the

medical supplies from generic to branded medicines. They should engage in

innovative and cooperative behavior beyond the requirements of the role but in the

services of organizational objectives. Thus, school clinics are encouraged to be

innovative and flexible while continually improving in the quest for excellence. The

objective is not to win, but to develop the capability of the organization to keep

improving, adapting, and satisfying dynamic student requirements.

Related Literatures

The study of Booker and Asiabaka explored the clinical services and facilities

that were used to help improve both the effectiveness and efficiency of the services

they provide the consumers and students. These studies are related to the present

undertaking since some of the school-related factors that the present study explored

were clinical services and facilities. Hence, the studies maybe used as basis in the

implementation of the Code on Sanitation of the Philippines (PD 856).

On the other hand, the objectives of the study of Faller et al. (2015) were to

determine the factors associated with the students’ utilization of the services offered in

the Loyola Schools Office of Health Services (LSHS) and their perception of needs

met. A cross-sectional study design was conducted. The setting of the study was in the

Loyola Schools of Ateneo de Manila University in Quezon City, Philippines. A total

of 352 undergraduate students from Loyola Schools excluding freshmen were

 44

surveyed using cluster sampling. The mean age of respondents is 19. Of the total

sample population, half have utilized services of the LSHS from the period June 2008

to June 2009. Most services availed corresponded to check-ups related to the Office of

Social Concern and Involvement, cases of cold and headaches. Most of the total

sample perceived their health needs to be met by the LSHS. Using bivariate analysis,

the following variables have shown a significant association with utilization of health

services: year level, attitude of LSHS staff, awareness of coordinated care services,

suggested mental health services, feedback from other students, and comfort of

disclosure of health information.

The study of Onglao et al. and Faller et al. are all related to the present study

since it both focused on the number of available medical drugs and utilization of the

health services in the health centers and schools. These studies explored the effect of

the said variables to the practices in inventory management and health services being

rendered to the clients which are also integral to the present study.

On the other hand, the Envision New Mexico (ENM) Quality Improvement

Initiative studied by Booker (2015) involved training in quality improvement concepts

and methods, identification of best practices for selected clinical services, and repeated

use of data to measure changes leading to improvement. Preliminary findings from

New Mexico suggest that quality improvement interventions can be effective, with

initial improvements over baseline reviews typically in the 20-40% range. Systematic

efforts to enhance the quality of care can help improve both the effectiveness and

efficiency of SBHCs, and provide evidence of the value of the care provided. Simple,

efficient quality improvement techniques, with the use of distance learning

 45

technologies, can help achieve the full promise of expanded school-based health care.

Quality improvement principles have been applied extensively to health care

organizations, but implementation of quality improvement methods in school-based

health centers (SBHCs) remains in a developmental stage with demonstration projects

under way in individual states and nationally. Rural areas, such as New Mexico,

benefit from the use of distance education techniques to reach providers throughout

the state.

Likewise, the study of Asiabaka (2018) described the concept, nature, types of

school facilities, need for facilities in schools and facility management problems. It

also suggested methodologies for facilities management and concluded that school

facilities give meaning to the teaching and learning process. It recommended that

school managers should carry out comprehensive assessment of the facilities to

determine areas of need. This type of assessment will assist in policy formulation as it

relates to facility management in schools. Facilities management is an integral part of

the overall management of the school. The actualization of the goals and objectives of

education require the provision, maximum utilization and appropriate management of

the facilities. Furthermore, advances in science and technology, necessitate that the

school manager should adopt modern methods of facilities management. This will

improve the quality of teaching and learning. A direct relationship exists between the

quality of school facilities provided and the quality of the products of the school. The

physical environment of a school is a major determining factor in the attainment of its

objectives.
 46

The study of Booker and Asiabaka explored the clinical services and facilities

that were used to help improve both the effectiveness and efficiency of the services

they provide the consumers and students. These studies are related to the present

undertaking since some of the school-related factors that the present study explored

were clinical services and facilities.

Meanwhile, the study of Hanganu et al. (2018) summarized current directions

in school-based dental health. School-based oral health programs give children a

chance to experience optimal oral health, but developing relevant programs that

address the need of today's children is a complex task. School-based oral health

preventive programs that are designed to help children must be relevant and offer

interventions based on current research findings. Treatment is not the answer to

solving children's oral health problems; instead, prevention is the key. Schools have

been and will continue to be an important environment for the dissemination of disease

prevention information. Because the classroom maximizes the number of children

reached simultaneously, school-based education, health promotion, and preventive

efforts are efficient. School serves as an institution that supports the adoption and

practice of behaviors deemed desirable by society. In the school, students are also

prepared to assume responsible roles as future parents and community leaders. The

year 2010 objectives help provide a focus for relevant and comprehensive school-

based oral health programs. Recommendations and proposed strategies were obtained

through personal interviews, published research, oral health conferences, personal

observation of school-based dental centers and educational institutions. The

presentation is intended to serve as guidance, based on best available information, for

 47

successful school-based dental health program development. This information is

presented with the understanding that the oral health needs of children and adolescents

are locality specific and will require flexibility in program design and implementation.

Also, the study of Kaplan et al. (2018) aimed to explore the use of physical and

mental health services for adolescents who are enrolled in managed care and have

access to a school-based health center (SBHC), compared with adolescents enrolled in

managed care without access to an SBHC. Retrospective cohort designed with age,

sex, and socioeconomic status matching to compare the use of health services for

adolescent members of Kaiser Permanente of Colorado (who had access to SBHCs)

with those with no access. The study included 342 adolescents, resulting in 3394 visits

that occurred during 3 academic years. During the study, 240 adolescents with access

to an SBHC were compared with 116 adolescents without access to an SBHC. The use

of primary and subspecialty medical, mental health, and substance abuse treatment

services; the use of after-hours care; and comprehensive preventive health supervision

visits and documentation of screening for high-risk health behaviors were also

compared. In addition, the adolescents with access were screened for high-risk

behaviors at a higher rate. School-based health centers seem to have a synergistic

effect for adolescents enrolled in managed care in providing comprehensive health

supervision and primary health and mental health care and in reducing after-hours

visits. School-based health centers are particularly successful in improving access to

and treatment for mental health problems and substance abuse.

The study of Hanganu et al. which focused on dental health programs while the

study of Kaplan et al. (2018) aimed to explore the use of physical and mental health
 48

services. These two studies are relevant to the present research since the variables like

dental health programs and health services were also explored in the present study.

The study of Lawanson and Gede (2015) focused on the provision and

management of school facilities for the management of UBE program. School

facilities are those things that enable the teacher to carry out his/her work well and also

help the learners to learn effectively. School facilities are vital tools in the teaching

and learning process, hence the justification for their adequate provision and

management. The school facilities are divided into instructional, recreational,

residential and general-purpose types. They can be maintained through regular,

emergency or prevention and periodic maintenance. Eight stages are discussed for the

management of these facilities. However, it has been observed that these facilities are

not adequately provided for secondary schools for the implementation of this program.

The indicators are dilapidated school buildings, ill- equipped libraries and

laboratories, lack of games facilities, computers e.t.c. However, for the successful

implementation for UBE program, all these school facilities must be adequately

provided for and managed. The government should provide all necessary facilities; the

school head should ensure optimal utilization of these facilities and make sure that

they are well maintained.

Also, the study of Vandiver (2015) examined the impact of the quality of facilities

on the educational environment in high schools located in northeast Texas. The intent of

this research study was to determine the relationship between school facilities and the

school-learning environment. This study was a mixed method research that used

questionnaires and interviews to identify and appraise school facilities and learning
 49

environment. The problem was that school facilities were negatively impacting student

learning and faculty, and administrators were not properly supporting stronger facility

management. The poor condition of some schools raised serious concerns about

teacher and student safety. Educators must understand and find ways to help increase

student performance. This study used descriptive statistics to analyze the data. The

independent z-test was conducted to determine the difference in student performance

before vs. after the new facility. The results of the data analysis findings indicated that

quality and educational adequacy of educational facilities were statistically

significantly associated with student performance and teacher turnover rate showing a

statistical change also.

Interestingly, the study of Lawanson and Gede (YEAR) focused on the

provision and management of school facilities and the study of Vandiver (YEAR)

examined the impact of the quality of facilities on the educational environment which

are both related to the present study. This is so because the current research explores

the school facilities especially those that are classified under the health department.

Conceptual Framework

Figure 1 presents the conceptual framework of the study. As shown, this research

utilized Input, Process and Output method. The IV frame presents the delivery of

health care services and client care outcomes among school clinics as antecedent to

clientele satisfaction, inputs on protocol enhancement. The inputs would determine if

there were any relationships regarding the satisfaction of the clients to the different

services offered in the clinic. The process served as a tool in order to assess the
 50

effectivity of the services which will yield new protocols in order to enhance the

policies, services and operations of the school clinic

Profile of the Respondents

 Age
 Sex
 Civil Status
 Education
 Marital Status

 Degree program
for students

 Variables
 Promotive

 Preventive
 Curative

Rehabilitative
Medical equipment
Medical supplies
Health services offered
and organizational
structure
Availment of service
Nature of transaction
Response time
Quality of response
Feedback about the staff
Satisfaction to the service
 51

Data Gathering
Survey Questionnaire
Statistical Analysis

Inputs on Protocol
Enhancement
 52

Figure 1. Paradigm of the Study

Research Hypothesis

The hypotheses was tested.

 53

1. There is no significant relationship between the delivery of health care services

and structured process to the clients’ care outcomes to the level of satisfaction.

Definition of Terms

Delivery of Health Care Services service delivery is the part of a health system

where patients receive the treatment and supplies they are entitled to. All the other
 54

parts of the health system examined in this map support the delivery of healthcare

services and, as a result, corruption in these other areas will indirectly impact on the

quality of delivery. For example, unpublished harms data from clinical trials could

lead to healthcare providers basing the treatments they give on unsound medical

knowledge.

Structured Process formally defined, standardized processes that involve day-to-day

operations; exceptions rare and not well tolerated; process structure changes sowly.

Client Satisfaction is defined as a measurement that determines how happy customers

are with a company's products, services, and capabilities.

Promotive refers to the process of enabling people to increase control over, and to

improve their health. It focuses on individual behavior towards wide range of social

and environmental interventions.

Preventive is any medical service that defends against health emergencies. It includes

doctors’ visits, such as annual physicals, well woman appointments, and dental

cleanings.

Curative refers to health care practices that treat patients with the intent of curing

them, not just reducing their pain or stress. An example is chemotherapy, which seeks

to cure cancer patients

Rehabilitative refers to health care services that help individuals keep, get back, or

improve skills and functioning for daily living that have been lost or impaired because

they were sick, hurt or diabled.

 55

Medical Equipment is used for the specific purpose of diagnosis and treatment of

disease or rehabilitation following disease injury; it can be used either alone or in

combination with any accessory, consumable or other piece of medical equipment.

Medical Supplies refers to the non-durable disposable health care materials ordered or

prescribed by a physician, which is primarily and customarily used to serve a medical

purpose and includes ostomy supplies, catheters, oxygen, and diabetic supplies

Health Services Offered the furnishing of medicine, medical or surgical treatment,

nursing, hospital service, dental service, optometrical service, complementary health

services or any or all of the enumerated services or any other necessary services of like

character, whether or not contingent upon sickness

Organizational Structure is a system that outlines how certain activities are directed

in order to achieve the goals of an organization. These activities can include rules,

roles, and responsibilities. The organizational structure also determines how

information flows between levels within the company.

Client’s Availment of Services is the direct one-on-one interaction between a

consumer making a purchase and a representative of the company

Feedback of the Staff refers to the reactions to a product, a person’s performance of a

task, which is used as a basis for improvement.

Notes in Chapter II
 56

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 61

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CHAPTER III

METHODS OF RESEARCH

This chapter presents the research design used in the study. It includes the

methods and techniques used, the population and sample of the study, the research

instrument used in gathering of data, the construction and validation of instrument,

data gathering procedures, the data processing and statistical treatment employed for

analyzing the gathered data.

Methods and Techniques of the Study

The study aimed to describe the delivery of healthcare services and structured

process among school clinics as antecedent to clientele satisfaction of school clinics as

inputs on protocol enhancement. The study used a quantitative descriptive –

correlational design.

According to Polit and Beck (2012), descriptive research is the kind of research

that describes what is happening in a given situation and further, the relationships

between variables are examined. A descriptive survey typically seeks to ascertain

respondents’ perspectives or experiences on specified subject in a predetermined

structured manner. This type of research may also be referred to as non-experimental

or exploratory study. It explores the causes of particular phenomena, opens the

individual’s eyes to what is seen in a given situation because it describes what is in. In

the case of the present study, it targeted to find answers regarding delivery of health
 62

care services and client care outcomes among school clinics as antecedent to clientele

satisfaction inputs to protocol enhancemen

Population and Sample of the Study

.In order to get the appropriate sample on this research, the researcher decided

to use G*Power 3.1.9.2 software in calculating sample. Based from the calculations of

G*Power with an alpha () error of 0.05 and 0.95 power (1- err prob) at 0.15 effect

size f, the appropriate sample for this research is 107 as it identifies difference between

two dependent means. The researcher uses the random sampling based on the

availability of the possible respondents. A total of 107 including students, faculty

members and admin staff are to be considered.

 63

Research Instrument

The questionnaire is the main instrument used in gathering data from the

respondents.

There are three-sets of questionnaire to be used. One for the students, faculty

members and employees who visited and availed the services in the clinic. The

questionnaires will measure the enhanced proposed manual of operation of the school

clinic to improve their quality services and care delivered to their clientele.

The 4 point rating scale will be used to this study. The following scale was

used:
 64

Nominal Scale Description

4 - Strongly Agree
3 - Agree
2 - Disagree
1 - Strongly Disagree

Construction and Validation of Instruments

As mentioned above, the researcher employed an adopted questionnaire from

Irlandez (2018) and Pantaleon (2007), which is re-constructed using items from books,

journals, published and unpublished research papers, theses that are related in the

subject being investigated. A permit is to be asked both to the original authors of the

adopted tool but no response yet since the researcher emailed them. However, the said

tool was subjected for further reliability because of some revisions made in the

context.

To establish the reliability of the survey-questionnaire, a pre-trial survey was

conducted involving thirty or 30 respondents which are not be identified as part of the

actual study. This was done to establish its internal reliability by determining

Cronbach’s alpha with an index of .925. Determining reliability requires reliability

testing to ascertain both stability and internal consistency of the research instrument.

Internal consistency would be of paramount importance in a tool where the

measurement of an attribute such as attitude is desired.

Data Gathering Procedure

All the necessary things needed in the study were prepared appropriately.

Letter of consent for the concerned personnel were generated prior to the gatherings
 65

and has been signed by the researcher and adviser with the approval of the Graduate

School.

The researcher secured an endorsement letter from the Dean of Graduate

School of Bataan Peninsula State University to formally embark on the gathering of

data. This letter with the attached permission to conduct the study was forwarded to

the different campus of the university. Only those who had personally experienced the

services will be accommodated. A study protocol was developed to ensure attachment

on how the study was conducted.

The questionnaires were personally distributed to the respondents to ensure

100 percent retrieval of the instrument. To speed up the data collection process and to

maintain the veracity of information, identification of potential respondents was done

by retrieving and reviewing data as endorsed by the nurse on duty after obtaining

permission from each campus. The data gathered by the researcher were carefully

recorded and tallied using a tabular form which he personally prepared with the advice

of the statistician.

The completion of every retrieved questionnaire was checked to ensure

accuracy of answered data. Tallying followed after the allocation of data. The

information gathered were handed to the statistician. After the availability of the

results, data were analyzed and interpreted.

Data Processing and Statistical Treatment

The following are the statistical techniques employed to answer the specific

questions raised in the study:

 66

The delivery of health care services, clients care outcomes and level of

satisfaction were measured using frequency and mean scores while the test of

relationship is for the three dependent variables using Pearson r and Spearman rho

once normality of variances has been settled in this study

Notes in Chapter III

DF Polit and Beck CT. (2014). Essentials of research: Methods, appraisals and
utilization, 9th ed., (Philadelphia: Lippincott Williams and Wilkins

Irlandez, Janina R., (2018). Assessment of the delivery of healthcare services and level
of satisfactions among clients in Level 1 Private Hospitals in District IV,
Province of Laguna. Our Lady of Fatima University. Master of Arts in
Nursing. Graduate School. March 2018.
 67

Pantaleon, Norma R. (2007). Level of effectiveness of health care delivery system in

selected hospitals in Bataan. Master of Arts in Nursing. Unpublished Thesis.
Bataan Peninsula State University. October 2007.

CHAPTER IV

PRESENTATION, ANALYSIS, AND INTERPRETATION OF RESULTS

This chapter presents the analysis and interpretation of the findings of the

study. For an organized and complete presentation, this chapter is subdivided into six
 68

major parts in accordance with the research questions raised in Chapter I. Part I

presents the respondents’ profile. Part II describes the consciousness of the

respondents on the delivery of health services of the subject school clinics. Part III

describes the structured process considering clinic related factors. Part IV discusses the

clients’ level of satisfaction of the subject clinics’ delivery of health care services. Part

V tackles whether the delivery of healthcare services and the clients’ care outcomes

are significantly related to client satisfaction level. Lastly, Part VI discusses what

inputs can be derived from the study’s results in enhancing policies or protocols on

university healthcare services delivery.

Part I: Profile of Respondents

This part describes the profile of the study’s respondents. Table 1 next page

shows their distribution in terms of age, sex, highest educational attainment, years of

working experience, marital status, and monthly income.

Table 1
Profile of Respondents
Age f %
51 to 60 Years Old 3 2.8
41 to 50 Years Old 5 4.7
31 to 40 Years Old 12 11.2
21 to 30 Years Old 65 60.7
20 Years Old and Below 22 20.6
TOTAL 107 100.0
Sex f %
 69

Male 73 68.2
Female 34 31.8
TOTAL 107 100.0
Highest Educational Attainment f %
Master’s Degree 5 4.7
Master’s Units 2 1.9
Bachelor’s Degree 18 16.8
Others 82 76.6
TOTAL 107 100.0
Years of Experience f %
1 to 2 Years 6 5.6
4 to 6 Years 5 4.7
7 to 10 Years 3 2.8
10 Years and Above 4 3.7
No Response 89 83.2
TOTAL 107 100.0
Marital Status f %
Single 94 87.9
Married 13 12.1
TOTAL 107 100.0
Monthly Income f %
PHP30,001 to 40,000 3 2.8
PHP20,001 to 30,000 5 4.7
PHP20,00 and Below 5 4.7
No Response 94 87.9
TOTAL 107 100.0

As shown in the table, majority of the respondents are aged 21 to 30 years old

(65 or 60.7%). There are 22 or 30.6% respondents who are 20 years old and below

while 12 or 11.2% are aged 31 to 40 years. Only 8 or 7.5% of the respondents are aged

41 years and above. It can be stated that a great minority of the respondents are older

adults.
 70

Males dominated the majority of the respondents accounting to 73 or 61.3%.

Among all, 18 or 16.8% are bachelor’s degree holders while 5 or 4.7% and 2 or 1.9%

have and are pursuing their master’s degree respectively. An overwhelming majority

(81 or 76.6%) have not specified their highest educational attainment indicating that

most of them are students. In terms of working experience, only 18 of 16.8% have

indicated that they are currently employed, and among these 18, only 4 or 3.7% have

working experience of 10 years or more. Also, only 8 or 7.5% of the respondents are

earning more than 20,000 pesos a month. A huge majority of them (94 or 87.9%) are

single.

Part II: Healthcare Services Delivery of the Subject School Clinics

This part discusses the respondents’ perception of the quality of the healthcare

services delivery of the subject school clinics.

Table 2 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the quality of the healthcare services

delivery of the subject school clinics in the aspect of promotion of health.

Table 2
Promotion of Health

Verbal
Indicators x̅ σ
Equivalent
1. The school clinic has an effective information 3.50 0.5 Highly
dissemination campaign which uses variety of 0 Delivered
media that inform the public about the
 71

particular lifestyle choices and personal

behavior, the benefits of changing that
behavior and improving the quality of life.
2. The school has health appraisal and wellness
assessment programs that evaluate patients of
their risk factors that are inherent in their 0.4 Highly
3.85
lives in order to motivate them to reduce 1 Delivered
specific risk and develop positive health
habits.
3. The school clinic has lifestyle and behavior
change programs which are geared toward 0.6 Highly
3.31
enhancing the quality of life and extending 5 Delivered
the life span.
4. The school clinic has worksite wellness
0.7 Highly
programs for their employees which serve 3.62
8 Delivered
their needs in their workplace.
5. The school clinic has environmental control
programs which are being developed to 0.6 Highly
3.64
address the growing problem of 8 Delivered
environmental pollution air, land, water, etc.
0.3 Highly
Composite 3.58
1 Delivered
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Delivered
3 2.50-3.24 Delivered
2 1.75-2.49 Moderately Delivered
1 1.00-1.74 Not Delivered

As indicated, the respondents gave an over-all mean score of 3.58 (σ = 0.31),

which has a verbal equivalent of “Highly Delivered”. This means that the respondents

see that the subject school clinics are performing very well when it comes to health

promotion.

Among the indicators, the respondents gave the highest quantitative rating to

item number 2, which is about whether the subject school clinics have health appraisal

and wellness assessment programs aimed at evaluating patients of their risk factors

that are inherent in their lives in order to motivate them to reduce specific risk and
 72

develop positive health habits. Item number 3 obtained a mean score of 3.85 (σ = 0.41)

which has a verbal equivalent of “Highly Delivered”.

Oppositely, among the items, the respondents gave the lowest rating to item

number 3, which is about whether the subject school clinics have lifestyle and

behavior change programs geared toward enhancing the quality of life and extending

the life span of their clienteles. Even then, item number 3 received a mean score of

3.31 (σ = 0.65), which is still Table 2 presents the mean scores, standard deviations,

and verbal interpretations for the respondents’ perception of the quality of the

healthcare services delivery of the subject school clinics in the aspect of prevention of

illness.

Table 3
Prevention of Illness

Verbal
Indicators x̅ σ
Equivalent
1. The school clinic conducts lecture and 3.86 0.3 Highly
 73

seminars among its clients which tackles

various issues regarding illnesses and how to 7 Delivered
prevent it.
2. The school clinic has an ideal bed-capacity
0.7 Highly
and congestion of clients occupying a 3.65
8 Delivered
particular units or rooms is not observed.
3. The school clinic has an effective waste
disposal program for various medical 0.7 Highly
3.58
instruments that have been used and ready 7 Delivered
for disposal.
4. The school clinic has intended rooms for
0.6 Highly
communicable diseases where clients carrying 3.66
7 Delivered
such kind of illness are held.
5. The school clinics observes proper sanitation
0.8
and cleanliness on its environment and is 3.14 Delivered
5
aware that prevention is better than cure.
0.3 Highly
Composite 3.58
7 Delivered
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Delivered
3 2.50-3.24 Delivered
2 1.75-2.49 Moderately Delivered
1 1.00-1.74 Not Delivered

As indicated, the respondents gave an over-all mean score of 3.58 (σ = 0.37),

which has a verbal equivalent of “Highly Delivered”. This means that the respondents

see that the subject school clinics are performing excellently when it comes to illness

prevention.

Among the indicators, the respondents gave the highest quantitative rating to

item number 1, which is about whether the subject school clinics conducts lecture and

seminars among its clients tackling various issues regarding illnesses and how to

prevent them. Item number 1 obtained a mean score of 3.86 (σ = 0.37) which has a

verbal equivalent of “Highly Delivered”.

On the other hand, among the items, the respondents gave the lowest rating to

item number 5, which is about whether the subject school clinics observes proper
 74

sanitation and cleanliness on its environment and are aware that prevention is better

than cure. Item number 3 received a mean score of 3.14 (σ = 0.65), which is only good

for a verbal equivalent of “Delivered”.

Table 2 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the quality of the healthcare services

delivery of the subject school clinics in the aspect of curative aspect.

Table 4
Curative Aspect

Verbal
Indicators x̅ σ
Equivalent
1. The school clinics has an established
0.9 Highly
procedures and guidelines for ambulatory 3.58
1 Delivered
services.
 75

2. The school clinics has state of the art medical

facilities most commonly used in most 0.8 Highly
3.36
frequent cases of treatment, observation and 6 Delivered
management of cases.
3. The school clinics has enough supplies of
0.9 Highly
medicines, medical kits and paraphernalia’s 3.56
3 Delivered
which are indispensable to its operation.
4. The school clinics has an established standard
operating procedure which are conservatively 0.5
3.17 Delivered
observed in the university like basic surgery 9
and emergency units for first aid.
5. The school clinics has an established
0.7 Highly
procedures and guidelines for ambulatory 3.67
0 Delivered
services.
0.3 Highly
Composite 3.47
6 Delivered
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Delivered
3 2.50-3.24 Delivered
2 1.75-2.49 Moderately Delivered
1 1.00-1.74 Not Delivered

As can be seen, the respondents gave an over-all mean score of 3.47 (σ = 0.36),

which has a verbal equivalent of “Highly Delivered”. This means that the respondents

see that the subject school clinics are performing very good in the curative aspect of

healthcare services provision.

Among the indicators, the respondents gave the highest quantitative rating to

item number 5, which is about whether the subject school clinics have an established

procedures and guidelines for ambulatory services. Item number 5 garnered a mean

score of 3.67 (σ = 0.70) which has a verbal equivalent of “Highly Delivered”.

On the other hand, among the items, the respondents gave the lowest rating to

item number 4, which is about whether the subject school clinics have an established

standard operating procedure conservatively observed in the university such as basic

 76

surgery and emergency units for first aid. Item number 4 only received a mean score

of 3.17 (σ = 0.59), which is good for a verbal equivalent of “Delivered”.

Table 5 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the quality of the healthcare services

delivery of the subject school clinics in the aspect of restoration of health.

Table 5
Restoration of Health

Verbal
Indicators x̅ σ
Equivalent
1. The school clinic provides the clients with 0.8
3.21 Delivered
follow-up check-ups and medication. 8
2. The school clinic has a viable program for
various rehabilitative medications which are 0.8 Highly
3.46
in accordance with the principles of 9 Delivered
rehabilitation.
3. The school clinics offers and conducts Highly
0.9
qualified medical assistance for hospitalized 3.30 Delivered
2
clients.
4. The school clinic encourages community Highly
0.4
supports through feeding programs, medical 3.89 Delivered
0
and dental activities.
5. The school clinic adheres to the programs and Highly
0.6
policies in restoring health as advocated by 3.45 Delivered
5
the Department of Health. (DOH)
0.3 Highly
Composite 3.46
9 Delivered
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Delivered
3 2.50-3.24 Delivered
2 1.75-2.49 Moderately Delivered
1 1.00-1.74 Not Delivered

As can be observed, the respondents gave an over-all mean score of 3.46 (σ =

0.39), which has a verbal equivalent of “Highly Delivered”. This means that the

respondents see that the subject school clinics are performing very well when it comes

to health restoration of clients.

 77

Among the indicators, the respondents gave the highest quantitative rating to

item number 4, which is about whether the subject school clinics encourage

community supports through feeding programs, and medical and dental activities. Item

number 4 indexed a mean score of 3.89 (σ = 0.40) which has a verbal equivalent of

“Highly Delivered”.

In contrast, among the items, the respondents gave the lowest rating to item

number 1, which is about whether the subject school clinics provide the clients with

follow-up check-ups and medication. Item number 1 received a mean score of 3.21 (σ

= 0.88), which is only good for a verbal equivalent of “Delivered”.

Part III: Clients’ Care Outcomes in the Subject School Clinics

This part discusses the respondents’ perception of the client care outcomes in

the subject school clinics.

Table 2 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the client care outcomes in the

subject school clinics in terms of availability and adequacy of facilities and equipment.

Table 6
Availability and Adequacy of Facilities and Equipment

Verbal
Indicators x̅ σ
Equivalent
1. The school clinic has a considerable number 3.68 0.6 Highly Satisfied
of medical facilities and equipment needed to 5
serve the number of clients being catered each
 78

day.
2. The school clinic has medical facilities and
equipment which are functioning normally 0.9
3.25 Highly Satisfied
and which undergo maintenance and check 0
up by competent personnel.
3. The school clinic has complied with the
requirements set by the Department of Health 0.5
3.79 Highly Satisfied
regarding the use and maintenance of medical 9
facilities and equipment.
4. The medical facilities and equipment are 0.8
3.31 Highly Satisfied
always available for use. 5
5. The school clinic provides procedural work
0.6
flow as stipulated in the manual of operations 3.45 Highly Satisfied
3
for various medical facilities and equipment.
0.4 Highly
Composite 3.50
1 Satisfied
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Satisfied
3 2.50-3.24 Satisfied
2 1.75-2.49 Moderately Satisfied
1 1.00-1.74 Not Satisfied

As can be observed, the respondents gave an over-all mean score of 3.50 (σ =

0.41), which is equivalent to a verbal interpretation of “Highly Satisfied”. This means

that the respondents are very much satisfied in the subject school clinics when it

comes to availability and adequacy of physical facilities.

Among the indicators, the respondents gave the highest quantitative rating to

item number 3, which is about whether the subject school clinics have complied with

the requirements set by the Department of Health regarding the use and maintenance

of medical facilities and equipment. Item number 3 received a mean score of 3.79 (σ =

0.59) which has a verbal equivalent of “Highly Satisfied”.

In contrast, among the items, the respondents gave the lowest rating to item

number 2, which is about whether the subject school clinics have medical facilities and

equipment that are functioning normally and are undergoing maintenance and check
 79

up by competent personnel regularly. Item number 2 received a mean score of 3.25 (σ

= 0.90), which is still good for a verbal interpretation of “Highly Satisfied”.

Table 2 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the client care outcomes in the

subject school clinics in terms of clinic environment.

Table 7
Clinic Environment

Verbal
Indicators x̅ σ
Equivalent
1. The school clinic is situated in place where it
3.52 0.69 Highly Satisfied
can be accessible to all people
2. The school clinic has proper waste disposal
3.10 0.69 Satisfied
program
3. The school clinic implements a no smoking
3.80 0.52 Highly Satisfied
policy inside its premise.
4. The employees of the university observe
cleanliness and orderliness inside and outside 3.21 0.64 Satisfied
the school clinics
5. Signage’s/directions are located in such a way
that the guidelines on ideal zoning for a 2.81 0.89 Satisfied
university setting are observed.
Highly
Composite 3.29 0.44
Satisfied
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Satisfied
3 2.50-3.24 Satisfied
2 1.75-2.49 Moderately Satisfied
1 1.00-1.74 Not Satisfied

As can be seen, the respondents gave an over-all mean score of 3.29 (σ = 0.44),

which is equivalent to a verbal interpretation of “Highly Satisfied”. This means that

the respondents are very much satisfied in the subject school clinics when it comes to

clinic environment.
 80

Among the indicators, the respondents gave the highest quantitative rating to

item number 3, which gauges whether the school clinics implement a no smoking

policy inside its premise. Item number 3 received a mean score of 3.80 (σ = 0.52)

which has a verbal equivalent of “Highly Satisfied”.

In contrast, among the items, the respondents gave the lowest rating to item

number 5, which is about whether the subject school clinics have signage/directions

that are located in such a way that the guidelines on ideal zoning for a university

setting are observed. Item number 5 only received a mean score of 2.81 (σ = 0.90),

which is only good for a verbal interpretation of “Satisfied”.

Table 8 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the client care outcomes in the

subject school clinics in terms of organizational structure.

Table 8
Organizational Structure

Verbal
Indicators x̅ Σ
Equivalent
1. Employees are polite during delivery of
0.9
procedure, housekeeping and instructional 3.34 Highly Satisfied
2
process.
 81

2. Clients expect prompt services from staff 0.9

3.30 Highly Satisfied
when the clients need them. 6
3. Nurses render cares to clients efficiently and 0.9
3.25 Highly Satisfied
therapeutically 0
4. Physicians are cheerful and accommodating 0.9
3.39 Highly Satisfied
in taking care of patients. 8
5. Staff recognize the visitors politely. 1.0
3.06 Satisfied
1
0.5 Highly
Composite 3.27
5 Satisfied
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Satisfied
3 2.50-3.24 Satisfied
2 1.75-2.49 Moderately Satisfied
1 1.00-1.74 Not Satisfied

As can be noticed, the respondents gave an over-all mean score of 3.27 (σ =

0.55), which is equivalent to a verbal interpretation of “Highly Satisfied”. This means

that the respondents are very much satisfied in the subject school clinics when it

comes to organizational structure.

Among the indicators, the respondents gave the highest quantitative rating to

item number 4, which gauges whether the school clinics have physicians who are

cheerful and accommodating in taking care of patients. Item number 4 received a mean

score of 3.39 (σ = 0.98) which has a verbal equivalent of “Highly Satisfied”.

On the other hand, among the items, the respondents gave the lowest rating to

item number 5, which is about whether the school clinic staff recognizes visitors in

polite manner. Item number 5 only received a mean score of 3.06 (σ = 1.01), which is

only good for a verbal interpretation of “Satisfied”.

Table 9 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ perception of the client care outcomes in the

subject school clinics in terms of nurse to patient ratio.

 82

Table 9
Nurse to Patient Ratio

Verbal
Indicators x̅ σ
Equivalent
1. The nurse is assigned to at least three clients 0.6
3.64 Highly Satisfied
at a time. 4
2. Clients who will avail the services should
0.5
expect prompt instructions from the medical 3.52 Highly Satisfied
9
and nursing staff.
3. Nurses can have his/her off without major 0.7
3.51 Highly Satisfied
effect on the service to the clinic. 4
4. There is one nurse reliever in the clinic to 0.5
3.77 Highly Satisfied
avoid understaffing. 8
5. There is a senior nurse who renders duty 0.4
3.75 Highly Satisfied
every day to guide and help the other nurses. 4
0.2 Highly
Composite 3.64
9 Satisfied
Scale Range Verbal Equivalent
4 3.25-4.00 Highly Satisfied
3 2.50-3.24 Satisfied
2 1.75-2.49 Moderately Satisfied
1 1.00-1.74 Not Satisfied

As can be noticed, the respondents gave an over-all mean score of 3.64 (σ =

0.29), which is equivalent to a verbal interpretation of “Highly Satisfied”. This means

that the respondents are very much satisfied in the subject school clinics when it

comes to nurse to patient ratio.

Among the indicators, the respondents gave the highest quantitative rating to

item number 4, which describes whether the school clinics have one nurse reliever to

avoid understaffing. Item number 4 received a mean score of 3.77 (σ = 0.58) which

has a verbal equivalent of “Highly Satisfied”.

On the other hand, among the items, the respondents gave the lowest rating to

item number 3, which is about whether the nurses assigned in the subject school

clinics can have his/her off without major effect on client service. Item number 3
 83

received a mean score of 3.51 (σ = 0.74), which is still good for a verbal interpretation

of “Highly Satisfied”.

Part IV: Clients’ Level of Satisfaction on the Subject School Clinics’ Delivery of

Healthcare Services

This part discusses the respondents’ level of satisfaction on th e delivery of

healthcare services using the standard feedback tool used by the subject school clinics.

Table 10 presents the mean scores, standard deviations, and verbal

interpretations for the respondents’ responses in four different aspects to wit: response

time, response quality, transaction satisfaction, and medical staff performance.

Table 10
Client’s Level of Satisfaction on Subject School Clinics’
Healthcare Services Delivery

Verbal
Aspects x̅ σ
Equivalent
1. Response Time 2.84 0.4
Immediate
4
Scale Range Verbal Equivalent
3 2.34-3.00 Immediate
2 1.67-2.33 Late
1 1.00-1.66 Overdue Time
2. Quality of Response 1.96 0.1 Clear
9
Scale Range Verbal Equivalent
2 1.51-2.00 Clear
1 1.00-1.50 Unclear
3. Satisfaction on Transaction 4.90 0.3 Excellent
6
Scale Range Verbal Equivalent
5 4.50-5.00 Excellent
4 3.50-4.49 Very Satisfactory
3 2.50-3.49 Satisfactory
2 1.50-2.49 Unsatisfied
1 1.00-1.49 Poor
4. Medical Staff Performance 5.99 0.1 Helpful
0
Scale Range Verbal Equivalent
6 5.17-6.00 Helpful
5 4.34-5.16 Courteous
 84

4 3.51-4.33 Professional
3 2.68-3.50 Polite
2 1.84-2.67 Unhelpful
1 1.00-1.83 Discourteous

As can be gleaned, the respondents gave a mean score of 2.84 (σ = 0.44) to

response time. The score has a verbal interpretation of “Immediate” indicating that the

clients are very much satisfied on the subject school clinics’ performance when it

comes to this aspect. Moreover, the respondents gave a mean score of 1.96 (σ = 0.19)

to response quality. The score has a verbal interpretation of “Clear” indicating that the

clients are very much satisfied on this aspect of the subject school clinics’

performance. Also, the respondents gave a mean score of 4.90 (σ = 0.36) to transaction

satisfaction. The score has a verbal interpretation of “Excellent” indicating that the

clients are very much satisfied also on this area of the subject school clinics’ services

delivery. Lastly, the respondents gave a mean score of 5.99 (σ = 0.10) to medical staff

performance. The score has a verbal interpretation of “Helpful” indicating that the

clients are so satisfied on this aspect of the subject school clinics’ performance.

Part V: Significant Relationship of the Subject School Clinics’ Healthcare

Services and Clients’ Care Outcomes to Client Satisfaction Level

This part discusses the results of testing whether the subject school clinics’

healthcare services and clients’ care outcomes are significantly related to client

satisfaction using Pearson Product Moment of Correlation Coefficient and Linear

Regression analysis if necessary at 0.05 alpha.

Pearson Product Moment of Correlation Coefficients were computed to

investigate whether the subject school clinics’ healthcare services and clients’ care
 85

outcomes are significantly related to the clients’ satisfaction on the subject clinics’

response time. Table 11 presents the results.

Table 11
Relationship of Healthcare Services Delivery and Clients’ Care Outcomes to
Client Satisfaction of Response Time

Healthcare Services Clients’ Care

Delivery Outcomes

Pearson r -0.012 0.038

p-Value 0.904 0.700
Response Time Decision on
Accepted Accepted
Satisfaction H0
No Significant No Significant
Interpretation
Relationship Relationship
Computed using α level = 0.05

As can be seen in the table, there is no sufficient evidence that the subject

school clinics’ healthcare services delivery is significantly related to the clients’

satisfaction of the subject clinics’ response time because the p-value is greater than the

0.05 alpha (r = -0.012, p = 0.904). With this result, the null hypothesis that “healthcare

services delivery has no significant relationship to clients’ satisfaction of clinic

response time” is accepted.

Similarly, there is no sufficient evidence that the subject school clinics’

fulfillment of client care outcomes is significantly related to the clients’ satisfaction of

the subject clinics’ response time because the p-value is greater than the 0.05 alpha (r

= 0.038, p = 0.700). With this result, the null hypothesis that “fulfillment of client care

outcomes has no significant relationship to clients’ satisfaction of clinic response

time” is also accepted.

 86

Since there are no significant relationships found for both cases, regression

analysis was not performed.

Pearson Product Moment of Correlation Coefficients were computed to

investigate whether the subject school clinics’ healthcare services and clients’ care

outcomes are significantly related to the clients’ satisfaction on the subject clinics’

response quality. Table 12 presents the results.

Table 12
Relationship of Healthcare Services Delivery and Clients’ Care Outcomes to
Client Satisfaction of Response Quality

Healthcare Services Clients’ Care

Delivery Outcomes

Pearson r -0.117 0.182

p-Value 0.232 0.061
Response Quality Decision on
Accepted Accepted
Satisfaction H0
No Significant No Significant
Interpretation
Relationship Relationship
Computed using α level = 0.05

As can be seen in the table, there is no sufficient evidence that the subject

school clinics’ healthcare services delivery is significantly related to the clients’

satisfaction of the subject clinics’ response quality because the p-value is greater than

the 0.05 alpha (r = -0.117, p = 0.232). With this result, the null hypothesis that

“healthcare services delivery has no significant relationship to clients’ satisfaction of

clinic response quality” is accepted.

In the same way, there is no sufficient evidence that the subject school clinics’

fulfillment of client care outcomes is significantly related to the clients’ satisfaction of

 87

the subject clinics’ response quality because the p-value is greater than the 0.05 alpha

(r = 0.182, p = 0.061). With this result, the null hypothesis that “fulfillment of client

care outcomes has no significant relationship to clients’ satisfaction of clinic response

quality” is also accepted.

Since there are no significant relationships found for both cases, regression

analysis was not performed.

To investigate whether the subject school clinics’ healthcare services and

clients’ care outcomes are significantly related to the clients’ satisfaction on the

subject clinics’ transaction. Table 13 presents the results.

Table 13
Relationship of Healthcare Services Delivery and Clients’ Care Outcomes to
Client Satisfaction of Transaction

Healthcare Services Clients’ Care

Delivery Outcomes

Pearson r -0.125 0.070

p-Value 0.200 0.474
Transaction Decision on
Accepted Accepted
Satisfaction H0
No Significant No Significant
Interpretation
Relationship Relationship
Computed using α level = 0.05

As can be seen in the table, there is no sufficient evidence that the subject

school clinics’ healthcare services delivery is significantly related to the clients’

satisfaction of the subject clinics’ transaction because the p-value is greater than the

0.05 alpha (r = -0.125, p = 0.200). With this result, the null hypothesis that “healthcare

services delivery has no significant relationship to clients’ satisfaction of clinic

transaction” is accepted.
 88

Similarly, there is no sufficient evidence that the subject school clinics’

fulfillment of client care outcomes is significantly related to the clients’ satisfaction of

the subject clinics’ transaction because the p-value is greater than the 0.05 alpha (r =

0.070, p = 0.474). With this result, the null hypothesis that “fulfillment of client care

outcomes has no significant relationship to clients’ satisfaction of clinic transaction” is

also accepted.

Since there are no significant relationships found for both cases, regression

analysis was not performed.

Pearson Product Moment of Correlation Coefficients were computed to

investigate whether the subject school clinics’ healthcare services and clients’ care

outcomes are significantly related to the clients’ satisfaction on the subject clinics’

medical staff performance. Table 14 presents the results.

Table 14
Relationship of Healthcare Services Delivery and Clients’ Care Outcomes to
Client Satisfaction of Medical Staff Performance

Healthcare Services Clients’ Care

Delivery Outcomes

Medical Staff Pearson r -0.030 -0.106

Performance p-Value 0.396 0.176
 89

Satisfaction Decision on
Accepted Accepted
H0
No Significant No Significant
Interpretation
Relationship Relationship
Computed using α level = 0.05

As can be gleaned in the table, there is no sufficient evidence that the subject

school clinics’ healthcare services delivery is significantly related to the clients’

satisfaction of the subject clinics’ medical staff performance because the p-value is

greater than the 0.05 alpha (r = -0.030, p = 0.396). With this result, the null hypothesis

that “healthcare services delivery has no significant relationship to clients’ satisfaction

of medical staff performance” is accepted.

Likewise, there is no sufficient evidence that the subject school clinics’

fulfillment of client care outcomes is significantly related to the clients’ satisfaction of

the subject clinics’ medical staff performance because the p-value is greater than the

0.05 alpha (r = -0.106, p = 0.176). With this result, the null hypothesis that “fulfillment

of client care outcomes has no significant relationship to clients’ satisfaction of

medical staff performance” is also accepted.

Since there are no significant relationships found for both cases, regression

analysis was not performed.

Part VI: Enhancing Policies or Protocols on University Healthcare Services

Delivery based from the Study’s Results

 90

CHAPTER 5

SUMMARY, CONCLUSION AND RECOMMENDATION

This chapter presents the summary of the findings based on the gathered data

relative to the problem in Chapter I of this study. This also includes the conclusions
 91

drawn which were derived from the findings, as well as the proposed

recommendations for the usefulness of this study to its readers and other researchers.

Summary

The main problem of the study is: “Delivery of Health Care Services and

Structured Process Among School Clinics as Antecedent to Clientele Satisfaction:

Inputs on Protocol Enhancement.

Specifically, the study sought to answer the following questions:

1. How may the profile of the respondents be described in terms of;

1.1. Age;

1.2. Sex;

1.3. Civil Status

1.4. Highest Educational Attainment;

1.5. Marital Status; and

1.6 Student’s Program?

2. How the consciousness of students, teaching and non-teaching personnel be

measured in terms of delivery of health services such as:

2.1 Promotive;

2.2 Preventive;

2.3 Curative; and

 92

2.4 Rehabilitative?

3. How may the client’s care outcomes be described in terms of following clinic

related factors:

3.1 medical equipment;

3.2 medical supplies;

3.3 health services offered; and

3.4 organizational structure?

4. How may the level of client satisfaction be described in terms of:

4.1 clients’availment of service;

4.2 nature of transaction;

4.3 response time;

4.4 quality of response;

4.5 feedback about the staff;

4.6 satisfaction to the service; and

4.7 satisfaction to the outcomes?

5. Is there a significant relationship between the delivery of healthcare services,

clients care outcomes to the level of client satisfaction?

6. Based on the findings, what policy based or protocol may be enhanced?

Conclusion
 93

1. Majority of the respondents are 21 to 30 years old covering 60.7% of the total
number of respondents. Moreover, 61.3% of the total respondents are male. Majority
of the respondents are students making up 76.6% of the total number of respondents.
Only 16.8% of the respondents are currently employed and 7.5% of the total
respondents are earning 20,000 pesos per month. Lastly, 87.9% of the total number of
respondents are single.

2. The Healthcare Services Delivery of the Subject School Clinics rated “Highly
Delivered” which means that subject school clinics are performing well in terms of
health promotion, illness prevention by conducting seminars and lectures, curative
aspect of healthcare services provision and in terms of health restoration of clients.

However, based on the respondents, the subject school clinics should improve its
programs in enhancing the quality of life and extending the life span of its clienteles.
The proper sanitation and cleanliness of its environment or workplace shall also be
improved. Standard operating procedure shall also be strictly implemented specially in
basic surgery and emergency units for first aid. Lastly, follow-ups and check-ups shall
also be monitored.

3. The Client’s Care Outcomes in the Subject School Clinics rated “Highly Satisfied”
which means that the respondents are very much satisfied with the availability and
adequacy of physical facilities of school clinics, clinic environment, organizational
structure and nurse to patient ratio. Subject school clinics also complied with the
requirements of the Department of Health regarding the use and maintenance of
medical facilities and equipment.

However, the medical facilities and equipment of school clinic shall function normally
every time and must undergo maintenance and check up by a competent personnel
regularly. Clear signage and directions must also be observed. School clinic staff must
always be polite. Proper scheduling of leave shall also be observed.

4. In terms of the Level of Satisfaction on the Subject School Clinic’s Delivery of

Healthcare Services, respondents rated “Immediate” to response time, “Clear” to the
quality of response that the clinic provides, “Excellent” in terms of services delivery
 94

and helpful in terms of the subject school clinic’s performance. This only shows that
the respondents are satisfied with the health services of the subject school clinic
provides.

5. There is no significant relationship between the delivery of healthcare services,

client care outcomes to the level of client satisfaction.

Recommendations

Based on the findings and conclusions presented, the following

recommendations are suggested:

1. School clinic must create a lifestyle and behavior change programs for its clienteles
to enhance the quality of life and extend their lifespan.

2. Patient/client monitoring must be done to ensure the good health of the clienteles
and extend the services of the school clinic.

3. A regular seminar or trainings must be conducted to improve the subject school

clinic services as well as its customer relations/services.

4. School clinics should continue their existing policy with regards to healthcare

services since it shows a highly delivered results.

5. Improvement on sanitation protocols should be implemented. Healthcare providers

may perhaps put some additional instruction or information to the other areas of

university as well as in their clinics regarding the effects of poor sanitation in their

area aside from giving health care instruction.

7. In case of unappearance of clients previously having their check-up on their

expected date, a follow-up care mechanism must be implemented (e.g. teacher-clinic

collaboration, home follow-up, etc.) in order to provide a total patient care.

 95

8. Perhaps some existing delivery of care may be reviewed and revised by health care

providers in the clinic in order to provide a more satisfying experience to their

clientele.

9. For the future researchers, they may conduct the same study to other context such as

colleges either a city-subsidized or a private institution to compare the result as this

study obtains. A Qualitative or mixed-method approaches perhaps can be also

conducted to identify the problems on delivery based on the experienced of clienteles

and healthcare providers.

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Appendix A

Study Protocol

Master of Arts in Nursing

Thesis Writing
Study: “Delivery of Health Care Services and Structured Process among School
Clinics as Antecedent to Clientele Satisfaction: Inputs on Protocol Enhancement”
Researcher: Billy Ray A. Marcelo, RN
Institution: Bataan Peninsula State University – Graduate School

Prior to proposal, a protocol was developed. It is described below.

A. Objectives
1. To provide profile among the effectiveness of the delivery of health
care services and structured process among school clinics.
2. To assess the delivery of health care services and clientele
satisfaction among school clinics.
3. To determine the significant differences in the delivery of health
care services and clientele satisfaction for protocol enhancements.
4. To further assess the relationship between the delivery of health
care services and clientele satisfaction in school clinics.
5. To outline implications to School Nursing.

B. Purposes
1. To help the researcher focus on the research question
2. To gather data and determine perspective using the adopted
validated tool.
3. To determine perspective of selected participants.

C. Unit of analysis based on the statistical findings using the adopted tool.

D. Methodology – Quantitative – Descriptive design – Correlational

E. Population Sample –Simple Random Sampling

Using this technique allows the study to assess the delivery of health care
services and structured process among school clinics and get the
satisfaction for protocol enhancements. The study will collect survey data
at all clinics in Bataan Peninsula State University.
 103

F. Sources of Evidence
F.1 Structured interviews using the adopted tool
F.2 Internal documentation (policies – manuals and clinical pathway
guidelines)
F.3.Secondary data sources (published articles, researches and books)
F.4 Adopted survey tools
F.5. Inputs on protocol enhancement.

G. Data Collection and Analysis

Holistic analysis draws conclusions based on the text as a whole using the
statistical findings.

Sincerely yours,

Researcher

Appendix B
 104

Letter to Conduct Data Gathering

March 25, 2019

GREGORIO J. RODIS,PhD
University President
Bataan Peninsula State University
City of Balanga, Bataan

Sir:

Greetings!

The undersigned would like to seek your endorsement for a preliminary and actual
data gathering in the perusal of his thesis study entitled, “DELIVERY OF HEALTH
CARE SERVICES AND CLIENT CARE OUTCOMES AMONG SCHOOL CLINICS
AS ANTECEDENT TO CLIENTELE SATISFACTION: INPUTS ON PROTOCOL
ENHANCEMENT”. The study is conducted as part of an academic requirement of the
Master of Arts in Nursing major in Administration and Supervision in Bataan
Peninsula State University, Graduate School, Philippines. Likewise, the study
determines the relationship of delivery of healthcare services, client care outcomes and
satisfaction among teaching, non-teaching personnel and students. Inputs will enhance
protocol and policies relevant to the operations of school clinics. The undersigned
would like to seek the total numbers of students, teaching and non-teaching personnel
in the Bataan Peninsula State University.

Rest assured that all data collected will be treated private and confidential. Data
gathered shall be used solely for research purposes.

Your assistance to this research endeavor will benefit the aforementioned. Hoping for
your favorable response. Thank you very much and may continue to live the research
excellence in our profession. Godbless.

Member, Panel of Experts

Sincerely yours,

BILLY RAY A. MARCELO,RN

Student, MAN Program

Endorsed by:

RONNELL D. DELA ROSA,PhD,DNM,FRIN

Thesis Adviser/Dean, Graduate School
 105

Appendix C

Letter to Adopt Research Study

May 25, 2019

For: Ms. Norma R. Pantaleon

College of Nursing and Midwifery
Bataan Peninsula State University

Dear Mam,

Greetings with peace and gratitude!

In pursuit of my research study entitled, “Delivery of Healthcare Services and the

Level of Clients’ Care Outcomes among School Clinics as Antecedent to Clientele
Satisfaction: Inputs on Policy Enhancement. The researcher would like to seek your
consensual approval to use the Research Instrument of your thesis entitled, Delivery of
Healthcare Services and Patient’s Satisfaction in Selected Hospitals in Region III. The
tool could serve as a guide in attending the need in the assessment matters on delivery
of health services and level satisfaction among clients. Likewise, some modifications
will be executed and you will be informed respectively.

Moreover, the researcher would like to ask also for a certification that the use of the
tool has been approved by the original author. The certificate will be used for the
distribution of actual survey among respondents in selected hospitals. The study is
conducted a part of an academic requirement of the Master of Arts in Nursing
Program, Graduate School. Herewith is the research protocol.

Your assistance to this research endeavor will benefit the aforementioned. Hoping for
your favorable response. Thank you very much and may continue to live the nursing
excellence in our profession. God bless

Sincerely yours,

Mr. Billy Ray A. Marcelo, RN

Graduate Student

Endorsed by:

Ronnell D. Dela Rosa, PhD

Adviser, Thesis Writing
Dean, Graduate School

Appendix D
 106

Informed Consent for Study Respondents (Actual Study)

Date:_________

Code:________

I understand that I am being asked to participate in a research study entitled,

“Assessment in the Delivery of Health Services and Level of Satisfaction Among
Clients: Basis for Improvement”. This research study aims to assess the delivery of
health care services among private hospitals and its relation to the level of client’s
satisfaction as basis for the improved services. This consent is intended for
participants of this study.

If I agree to participate in the study, I will be interviewed through the adapted tool
using the participants’ prefer language/dialect to be used as such English/Tagalog for
approximately 60-120 minutes. The interview will take place after duty hours or at
their most convenient time and upon the approval of university president of the
institution.

No identifying personal data will be included and when the data are documented,
however, the researcher will use numerical coding to monitor the number of
respondents. I understand that I would not receive any amount of money or form of
payment for participating in the study. There are no risks associated with this study.

I realize that I may not participate in the study if I am younger than 18 years of age or
I cannot speak English/Tagalog. I agree with the approval of my immediate
supervisor.

I also realize that my participation in the study is entirely voluntary, and I may
withdraw from the study at any time I wish. If I decide to discontinue my participation
in this study, I will continue to be treated in the usual and customary fashion.

I understand that all study data will be kept confidential. However, this information
may be used in nursing publications or presentation. I understand if I sustain injuries
from my participation in this research study, I will not be automatically compensated
by the researcher.

If I need to I can contact Billy Ray A. Marcelo for any questions or doubt, student,
Bataan Peninsula State University, Graduate School, Master of Arts in Nursing
Program any time during the study. (Contact No. 09174687864) or email at
billyrayamarcelo@gmail.com
 107

The study has been explained to me, I have read and understand this consent form, all
my question have been answered and I agree to participate, I understand that I will be
given a copy of this signed consent form.

________________________
____________
Signature of the Participant DATE

_________________________
____________
Printed Name & Signature of Witness DATE

_________________________ _____________
Mr. Billy Ray A. Marcelo, RN DATE
(Researcher)
 108

Appendix E

Research Instrument
(Assessment for Delivery Healthcare Services)

Study Title: Delivery of Healthcare Services and the Level of Clients’ Care Outcomes
Among Schools Clinics as Antecedent to Clientele Satisfaction: Inputs on Policy
Enhancement

Researcher: Billy Ray A. Marcelo, RN

Part I. Respondent’s Profile (Employees and Students)

Instructions: Please put a check in the blank that corresponds to your answer.

1. Age _____ 60 years old above

_____ 51 to 60 years old
_____ 41 to 50 years old
_____ 31 to 40 years old
_____ 21 to 30 years old
2. Sex
_____ Male
_____ Female

3. Highest Educational Attainment for Employees

_____ Doctorate Degree Holder

_____ Doctorate Degree with earned units
_____ Master’s Degree Holder
_____ Master’s Degree with earned units
_____ Bachelor’s Degree
_____ Others (Pls. specify:__________________)

For Students: Please include the Course/Program:

____________

4. Marital Status
_____ Single
_____ Married
_____ Divorced/Separated
_____ Widowed/Widower

5. Length of Experience for Employees

_____ 1 to 3 years
_____ 4 to 6 years
_____ 7 to 10 years
 109

_____ 10 years and above

Year Level for Students: __________

6. Monthly Income for Employees:

_____Php 40,001.00 above

_____Php 30, 001.00 to 40,000.00
_____Php 20,001.00 to 30,000.00
_____Php 20,000.00 below

Part II. This evaluation is to appraise the delivery of healthcare services among
selected school clinics. Please rank in degree of healthcare services accordingly in the
basis of your current knowledge and most objective assessment by checking the
appropriate score in the box denoting the extent by which the health care is being
delivered. The following scales will be used.
4 – highly delivered
3 – delivered
2 – moderately delivered
1 – not delivered

4 3 2 1
1. Promotion of Health
1.1 The school clinic has an
effective information
dissemination campaign which
uses variety of media that inform
the public about the particular
lifestyle choices and personal
behavior, the benefits of
changing that behavior and
improving the quality of life.
1.2 The school has health
appraisal and wellness
assessment programs that
evaluate patients of their risk
factors that are inherent in their
lives in order to motivate them to
reduce specific risk and develop
positive health habits.
1.3 The school clinic has
lifestyle and behavior change
programs which are geared
toward enhancing the quality of
life and extending the life span.
 110

1.4The school clinic has

worksite wellness programs for
their employees which serve
their needs in their workplace.
1.5 The school clinic has
environmental control programs
which are being developed to
address the growing problem of
environmental pollution air,
land, water, etc.
2. Prevention of Illness
2.1 The school clinic conducts
lectures and seminars among its
clients which tackles various
issues regarding illnesses and
how to prevent it.
2.2 The school clinic has an
ideal bed-capacity and
congestion of clients occupying
a particular units or rooms is not
observed.
2.3 The school clinic has an
effective waste disposal program
for various medical instruments
that have been used and ready
for disposal.
2.4 The school clinic has
intended rooms for
communicable diseases where
clients carrying such kind of
illness are held.
2.5 The school clinics observes
proper sanitation and cleanliness
on its environment and is aware
that prevention is better than
cure.
3. Curative Aspect
3.1 The school clinics has an
established procedures and
guidelines for ambulatory
services.
3.2 The school clinics has state
of the art medical facilities most
commonly used in most frequent
cases of treatment, observation
and management of cases.
 111

3.3 The school clinics has

enough supplies of medicines,
medical kits and paraphernalia’s
which are indispensable to its
operation.
3.4 The school clinics has an
established standard operating
procedure which are
conservatively observed in the
university like basic surgery and
emergency units for first aid.
3.5 The school clinic has a
competent medical doctors,
nurses and other support
personnel whose qualification
are far beyond the minimum
standard.
4. Restoration of Health
4.1 The school clinic provides
the clients with follow-up check-
ups and medication.
4.2 The school clinic has a
viable program for various
rehabilitative medications which
are in accordance with the
principles of rehabilitation.
4.3 The school clinics offers and
conducts qualified medical
assistance for hospitalized
clients.
4.4 The school clinic encourages
community supports through
feeding programs, medical and
dental activities.
4.5 The school clinic adheres to
the programs and policies in
restoring health as advocated by
the Department of Health.
(DOH)
 112

Questionnaire C
(Assessment of the Clients’ Care Outcomes)

Study Title: Delivery of Healthcare Services and the Level of Clients’ Care Outcomes
Among Schools Clinics as Antecedent to Clientele Satisfaction: Inputs on Policy
Enhancement

Researcher: Billy Ray A. Marcelo, RN

Part I. Respondent’s Profile (Employees and Students)

Instructions: Please put a check in the blank that corresponds to your answer.

1. Age _____ 60 years old above

_____ 51 to 60 years old
_____ 41 to 50 years old
_____ 31 to 40 years old
_____ 21 to 30 years old
2. Sex
_____ Male
_____ Female

3. Highest Educational Attainment for employees.

_____ Doctorate Degree Holder

_____ Doctorate Degree with earned units
_____ Master’s Degree Holder
_____ Master’s Degree with earned units
_____ Bachelor’s Degree
_____ Others (Pls. specify:__________________)

Course/Program for Students: ___________

4. Marital Status
_____ Single
_____ Married
_____ Divorced/Separated
_____ Widowed/Widower

Part II. This evaluation is to appraise the level of clients’ satisfaction among school
clinics in the university setting. Please rank in degree of satisfaction accordingly in
the basis of your current knowledge and most objective assessment by checking the
appropriate score in the box denoting the extent by which the client is had
demonstrated degree of satisfaction. The following scales will be used:
 113

4 – highly satisfied
3 – satisfied
2 – moderately satisfied
1 – not satisfied

4 3 2 1
1. Availability and Adequacy
of Facilities and Equipment.
1.1 The school clinic has a
considerable number of medical
facilities and equipment needed
to serve the number of clients
being catered each day.
1.2 The school clinic has
medical facilities and equipment
which are functioning normally
and which undergo maintenance
and check up by competent
personnel.
1.3 The school clinic has
complied to the requirements set
by the Department of Health
regarding the use and
maintenance of medical facilities
and equipment.
1.4 The medical facilities and
equipment are always available
for use.
1.5 The school clinic provides
procedural work flow as
stipulated in the manual of
operations for various medical
facilities and equipment.
2. Clinic Environment
2.1 The school clinic is situated
in place where it can be
accessible to all people
2.2 The school clinic has proper
waste disposal program
2.3 The school clinic implements
a no smoking policy inside its
premise.
2.4 The employees of the
 114

university observe cleanliness

and orderliness inside and
outside the school clinics
2.5 Signage’s/directions are
located in such a way that the
guidelines on ideal zoning for a
university setting are observed.
3. Organizational Structure
(Personnel)
3.1 Employees are polite during
delivery of procedure,
housekeeping and instructional
process.
3.2 Clients expect prompt
services from staff when the
clients need them.
3.3. Nurses render cares to
clients efficiently and
therapeutically
3.4 Physicians are cheerful and
accommodating in taking care of
patients.
3.5 Staff recognize the visitors
politely.
4. Nurse to Patient Ratio
4.1 The nurse is assigned to at
least three clients at a time.
4.2 Clients who will avail the
services should expect prompt
instructions from the medical
and nursing staff.
4.3 Nurses can have his/her off
without major effect on the
service to the clinic.
4.4 There is one nurse reliever in
the clinic to avoid understaffing.
4.5 There is a senior nurse who
renders duty every day to guide
and help the other nurses.
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Appendix F

Orani Campus
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 117

Main Campus
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119
120
121
 122

Balanga Campus
123
124
125
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BILLY RAY A. MARCELO, RN, MAN

573 Eskina St. Lalawigan, Samal, Bataan 2113
CP: +63917-4687864/+63921-8665218
Email: billyar7@yahoo.com
Skype ID: billyar7rn

PERSONAL INFORMATION

Age : 34
Date of Birth : October 02, 1985
Civil Status : Single
Sex : Male
Citizenship : Filipino
Place of birth : Orani, Bataan

EDUCATIONAL BACKGROUND

Master of Arts in Nursing

Major in Administration and Supervision
Bataan Peninsula State University
November 2016 – June 2019
Graduate

Bachelor of Science in Nursing

Bataan Peninsula State University
June 2002 – March 200
 127

LICENSURE

Philippine Nurse Licensure Examination 2006

PRC License no. 0410247
PRC Board Rating 75
Date first issued: November 24, 2006
Valid until October 2021

Saudi Commission for Health Specialties

License no. 13-k-n-0028559
Date Issued: June 2013
Valid until June 2016

Department of Nursing
Ministry of Health and Prevention
United Arab Emirates
Registration no. 015845
Issue date: March 03, 2019
Valid until: March 03, 2023

PROFESSIONAL EXPERIENCE

Total years of Experience: 12.4 years

Present Work:

Head Nurse
Bataan Peninsula State University
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Main Campus
Health Services Unit
August 08, 2016 – Present

Lecturer
College of Nursing and Midwifery
Bataan Peninsula State University
August 2019 – Present

DETAILED JOB DESCRIPTION

 Provide healthcare to students and staff

 Perform health screenings
 Serve as liaisons between school personnel, family, and community healthcare
providers to ensure a healthy school environment
 Developing plans for student care based on assessment, interventions, and
identification of outcomes, and the evaluation of care
 Monitoring immunizations, managing communicable diseases, and assessing
the school environment as to prevent injury and ensure safety
 Overseeing infection control measures
 Maintains and provide update to all medical records and administer all routine
tests and examinations for patients
 Supervise efficient working of staff to develop clinical services
 Conduct and checks the facilities and participates in periodic performance,
improvement and plans
 Organizes and schedule all meetings and maintain efficient schedule for all
nursing activities

CASES HANDLED IN THE HOSPITAL

- Motor Vehicular Accident/Road Traffic Accident/Unresponsive patients

- Gunshot/lacerated and penetrating wounds and blunt injuries
- Head injuries with multiple trauma
- Chest pain/Angina and Myocardial Infarction and other underlying disorders
- Cerebrovascular accidents and other neurological problems
- Stroke and hypertension
- Abdominal pain
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- Sickle Cell disease

- Minor trauma and fractures with application of casting and splints
- Fever such as symptoms related to SIRS
- Diabetes/Hyperglycemia/Hypoglycemia
- COPD/Bronchial asthma
- Anaphylaxis and other related allergies
- Seizures
- Burns

SPECIAL EQUIPMENT/MACHINES OPERATED

- Electrocardiogram machine
- VS 3 Monitors/Cardiac Monitors
- Defibrillator/Manual and AED
- Otoscope/Opthalmoscope
- Suction Apparatus/Machines
- Wall mounted oxygen with flow meter
- Allaris Infusion pumps
- Weighing Scale
- Glucometer
- Jaundice Meter
- Accuvein
- Nebulizer
- Pulse Oxymeter
- Thermoscan

EMPLOYMENT BACKGROUND

Head Nurse Primary Care Plus Inc.

(June 2016-August 2016) Quezon City

Accident and Emergency Nurse Security Forces Hospital

Clinical Resource Nurse Dammam, KSA (JCI and CBAHI Accredited)
(October 2012-December 2015)

Staff Nurse (ER and MS) Bataan General Hospital

(January 2007-October 2012) Balanga City, Bataan
 130

Instructor Bataan Peninsula State University

(June 2007-October 2011) College of Nursing and Midwifery
Balanga Campus

CREDENTIALS AND CERTIFICATIONS

1. Community-School Relations: Building Responsiveness and Volunteerism

Experience on Drug Abuse Prevention and Education
August 28-30, 2019
Cebu City, Philippines

2. Disaster Risk Reduction and Management Planning Workshop

Incident Command System Executive Training Course
August 5-6, 2019
Subic Bay, Philippines

3. Principles and Application of Kinesiology Taping

November 5-7, 2018
Manila, Philippines

4. Training Course on Auditing Quality Management System

July 17-21, 2017
BPSU, Philippines

5. Wound Management Course

June 13-14, 2015
Security Forces Hospital, KSA

6. Emergency Triage Course

February 26, 2015
Security Forces Hospital, KSA
 131

7. Preceptorship Course
June 15-16, 2014
Security Forces Hospital, KSA

8. Basic Life Support/ Advance Cardiac Life Support

American Heart Association
Valid 2021
St. Luke’s Medical Center, Philippines

9. IV Therapy Preceptorship Course

Valid till October 2015
Balanga City, Philippines

REFERENCES

Evelyn R. Rubia, RN, PhD

Chief Nurse
Bataan General Hospital
Contact No. +63917-8013756

Ma. Lorella Mitra, RN

Charge Nurse
Security Forces Hospital
Dammam, KSA
Contact No. +966538552125
Email mmitra@sfhd.med.sa
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Dr. Ramoncito B. Tria

Cardiologist
Philippine Heart Center
Contact No. +63917-8665971

I hereby certify that the statement, data, information and documents stated and
attached herein are the factual truth to the best of my knowledge.

Billy Ray A. Marcelo, RN, MAN