Rose Montenegro: Excellent service and a dose of tender loving care

First of all, the new president of the Makati Medical Center is not a doctor. Secondly, she’s a woman. But it is precisely her being a non-doctor and a woman that Rosalie “Rose” Roth Montenegro uses to her advantage. A graduate of St. Theresa’s College (major in History and minor in English), where the nuns ingrained in her the passion and drive for excellence, Rose worked her way up from secretary (she could type 80 words per minute and perhaps talk just as fast) to Citiphone banking & service quality director, ABN-AMRO Savings Bank consumer banking head, and PLDT/PLDT Group senior vice president (she set up the PLDT outsourcing from the ground and competed against America; she was responsible for the business development, sales and marketing and overall operations of three 100-percent ePLDT-owned external outsourcing call centers).

Having savored the sweet taste of corporate success, Rose is no stranger either to the antiseptic smell of the hospital room. Fact is, she comes from a family of medical practitioners — her mom was a surgical nurse; her uncles and aunts, all doctors and nurses. Which makes her more medically attuned than the average consumer. Why, she can carry on a conversation about laparoscopy as if she could perform the surgery herself. But of course, MakatiMed has always been Rose’s hospital. She gave birth to all her three children there, all delivered by Dr. Constantino Manahan, who must have delivered close to 100,000 babies in his entire career that spanned 41 years. One of those kids was Rose’s firstborn, model Hans Montenegro. Her two younger children were born only 10-and-a-half months apart — to make a long story short, she was able to sweet-talk Dr. Manahan into giving her a 50-percent discount on her last childbirth.

And when Rose was offered the presidency of this 40-year-old institution, her first question was, “Do I get a free laser treatment? Does it come with the job?”

Looking at the blooming Rose, you know for sure that MakatiMed does a good — make that excellent — job.

Of course, it’s not all work and no play for Rose. She’s a tennis buff and a great fan of Swiss tennis heartthrob Roger Federer.

A woman of passion and vision, Rose Montenegro shares her heart and soul in this exclusive interview with The Philippine STAR. Excerpts:

PHILIPPINE STAR: What of your previous work experiences have come in handy in your new job as head of Makati Medical Center?

ROSE MONTENEGRO: I pioneered Citiphone banking, it’s not my original idea, it’s New York’s, but I implemented it at Citi. I was service director and Citiphone banking head. This is what’s helping me at MakatiMed because their issues are process, lack of automation, lack of policies and procedures; they’re not process-oriented … I can give you excellent service by standardizing it.

With a woman at the helm of this prestigious establishment, what changes will we see at MakatiMed?

Makati Med has always been excellent on the medical side. We’ve got some of the best medical doctors in the country. However, when they went through bad times, some of their medical equipment have been a bit dated. So now, we’re buying equipment, but we’re not buying for the sake of buying. My positioning is not the latest and the best equipment, it’s merely an enabler for the doctor to do his healing because at the end of the day, if you have a deep pocket, it’s really the doctor who treats you, it’s not the machine which is just a diagnostic tool. You may have the latest CT (computed tomography) scan, but if your radiologist is not good, he will not interpret it as well.

When I went into the billing section, they were encoding everything, double encoding — their system for in-patient was different from out-patient. Their pharmacy had a different system. And there was no single view of the patient, which is what Citibanking is. We implemented that in 1993, our slogan was “Not just banking but Citibanking.”

So, you don’t have to repeat the story of your life; at a single point of contact, we know who you are, what your previous record is. That’s what’s lacking, but MakatiMed is not the only one. My conclusion is the healthcare industry has lagged considerably in automation. Because essentially, hospitals are owned by doctors.

And then there’s the line wait concept, the waiting time, how to analyze it.

So, how did you cut down the waiting time?

They call it the triage. One of the first things we did was we did an arrival pattern study. I brought in my service quality director from Citi to help me. So we looked at arrival patterns — every hour, on the hour, how many patients, how long does it take from the door to the doctor, the turnaround time from door to doctor. We’re supposed to classify them into primary care, meaning it’s not a matter of life and death; acute, which could turn bad but not chronic; or critical or in extreme pain already; pedia or little kids.

So, what happened now with the ER is — in the first place, when I saw it, I said, “Jesus Christ, this sucks!” — we’re using zoning. The person at the triage will decide that. In the beginning, they had one or two. I said that’s not enough because that’s your bottleneck. Because I’m here waiting and writhing in pain and I see the doctors and nurses there at the back end laughing, smiling; why aren’t they helping me?

Did you do a study on the flow of patients at ER?

We did a study for 30 days — every half hour, we started analyzing who are coming in, why do they come, how many will go to acute, how many to critical. What we know now is 75 percent is only primary. Out of the 75, there’s 25 percent that doesn’t even need medicine, just a prescription for a drug. Why were we not addressing that? So now we’re setting up an express care. The first thing I told the doctors was, “You need a doctor there or, at the very least, a resident.” They said, “No, sayang naman, we’re doctors.” I said no, that’s the most important point of contact. Doctors may not think it’s an emergency, but patients will not drive all the way to Makati Med if they don’t think it’s an emergency. So I told the doctors, “You have to look at it from the patients’ point of view, not from yours.” Now, we convinced them that there should be a resident or a senior nurse. I said diagnosis starts from the minute the patient hits the door. So I told the head of ER the crucial point is your entry. I need a traffic manager who understands disease.

Of course, if you’re a critical case, you jump the queue. You don’t even fall in line anymore. But the problem is there are some critical things that are not easily recognizable. For example, somebody has an allergy, you’re choking inside, you could be deteriorating rapidly. That’s why we’re now increasing the number of people there and I’m coming up with the idea of dynamic line balancing.

What is dynamic line balancing?

It’s a term used in banking. If we are really full, let’s say they all arrive at the same time. Unfortunately, the theory of line management is they come in waves, not in neat little patterns. So, we now have a buzzer to the critical acute, primary, pedia to come and help us. If I’m already inundated, I have more than one person waiting, we should buzzer for help. When the line is wiped out, then you go back to your original post. We call it all hands on board.

I told the ER head that this is an excellent opportunity for our residents to be exposed to people from all walks of life, all kinds of diseases, and to think on their feet. You have to be fast. And then it hones their diagnostic skills because they see all kinds of things coming up.

What was the first thing you did when you assumed office?

One of the first things we did was collapse certain processes. We didn’t hire anybody new, we didn’t buy a lot of new equipment. What we did was we analyzed what we had. Like there are three rooms for radiology — one is digital, the other two are still analog. For some reason, they didn’t want to use the last room. We said this can’t be, we have to use all three because they’re all working. We did time-and-motion studies — what’s the average turnaround time to do a procedure. We said one of the first things we have to do is utilize all three. So now, we’re smoothening it. Because of that, right away your line wait is reduced. You’re not just waiting for the digital.

So we collapsed certain processes. Like you have a radiologist who calls you, a radiologist who positions you, a radiologist who will press. We combined all, so the one who calls you should position you already. We save that one capacity and we can use it for extended hours, doing more things. We also started using the secretaries, we understood what the secretaries and cashiers were doing, and we collapsed certain processes, which were repetitive. We were making MRI line up with the rest of the x-ray when MRI is by appointment. This was the first project we implemented and we did it with the support of the radiologists and the chair of Radiology, who was very open to it. He really liked the idea, he trained in the States, believes in customer service.

How did collapsing certain processes improve customer service?

We really wanted to improve what we were doing today. When we implemented it, after 60 days, they saw the changes and we gave them customer service handling skills, basic skills — warm, friendly, call the patient by his first name, explain what’s going to happen, manage expectations, etc. If you’re sick, you want a little compassion, a little concern.

Does that mean we’re going to see friendlier, warmer hospital staff at MakatiMed?

Oh, yes. I’m putting rewards against it. I was telling the doctors that the next step is to track them because if nobody’s keeping track of things, after a while, you go back to your old habits. And the next question is, “What’s in it for me as an employee?” So the next step is we start giving rewards, where if you do a good job, you have a job. If you go an extra mile and comply with the things we want, like attendance is crucial, timeliness, care, concern, then we’ll give little rewards, like a plaque, a pat on the back, time off, recognition. There are many ways to reward that don’t involve money. Besides, baka magmukhang pera sila, they won’t do a good job if you don’t reward them with money. I don’t have big rewards yet because as you know, Makati Med was not in great financial shape although last year was a good one for us, we earned good money. But still, we had to renovate the old building — at 40, Makati Med is quite old. We’re renovating the fourth and fifth floors, we’re moving slowly. So we’re still in an investment mode.

What are you investing in now?

One of my first investments was in technology for the x-ray. We’re investing in digital x-ray capability. It’s the latest now, most hospitals are moving towards that, it’s not cheap. So no more film, no more plate.

What new medical equipment did you have to acquire?

X-ray, a more sophisticated CT scan that can do the heart, laparoscopic surgical equipment because non-invasive surgery is the wave of the future. I have only P250 million to use and I have close to P500 million in request so I have to be very discriminating. We bought something for the laboratory, it’s called PCR — polychrome reaction. This PCR is going to be used by pulmonology, dermatology, spine, neuro (specialties), and lab so it made sense to buy it.

We’re also investing in replacing aging equipment, like our MRI; additional ultrasounds that are 4D for our delivery room.

I attended a conference and the speaker who really impressed me said that the state of the health care industry now is you have to address the needs of the aging population and the lifestyle diseases. For the aging, the bones so ortho and spine, heart, diabetes, endocrinology, geriatrics, and plastic surgery if you’re vain like us.

Plastic surgery is lucrative in this day and age. But me, if it’s my face, I will never make tipid, I won’t go to the cheapie.

But isn’t Makati Med expensive?

It’s a myth that MakatiMed is expensive, we’re not. We’re very reasonably priced. We have packages, like you pay only P30,000 for six thermage treatments, which means only P5,000 per month. Outside, it’s a lot more expensive.

In a word, how would you describe MakatiMed today?

We’re positioning ourselves as a hospital with heritage but keeping up with the times. I know I have good doctors, that’s a given. Now, I’m having so much fun with the doctors. When I first joined, everyone said the doctors are difficult, they’re suspicious because I’m not a doctor. But now, we’re having too much fun — I brought a new management team in, but my mandate to them is we’re not here to tell the doctors what to do. Because if we do that, they will hate us. It’s hard, there’s resistance because in our country, a doctor really has stature. So I said we offer our services and if they like it, success breeds its own PR.