Delivering Efficient Public Service Amidst Adversity

2nd 2018 CES Leadership Conclave
“Resilience: Steering Through Adversity, Bouncing Back Bravely”

Park Inn by Radisson, Davao City
DELIVERING EFFICIENT PUBLIC SERVICE

AMIDST ADVERSITY
05 April 2018
JULIUS A. LECCIONES, MD
EXECUTIVE DIRECTOR
PHILIPPINE CHILDREN’S MEDICAL CENTER
QUEZON AVENUE, QUEZON CITY 1100
Philippine Children’s Medical Center
 GOCC established through

PD 1631; started operations
in 1980
 Mandated to do research in
specialized pediatric
diseases, train pediatric
sub-specialists, and admit
difficult clinical cases
 200-bed premier pediatric
tertiary-care facility
 National referral center;
DOH flagship hospital for
children
Dr. Julius A. Lecciones, Delivering Efficient Public Service Amidst Adversity, 2 nd CES Leadership Conclave, Davao City, 05 April 2016
SAVING PATIENTS
Philippine Children’s Medical Center
2017
Crisis of
Unprecedented
Proportion
TOP 10 MORBIDITY
2015 2014 2013 2012
DENGUE (DF, DHF, DFS, LEUKEMIA (ALL, AML, CML, LEUKEMIA (ALL, AML, CML, DENGUE (DF, DHF, DFS,
1 DSS) BIPHE) BIPHE) DSS)
LEUKEMIA (ALL, AML, DENGUE (DF, DHF,DFS, LEUKEMIA (ALL, AML,
2 CML, BIPHE)
PNEUMONIA
DSS) CML, BIPHE)
DENGUE (DF, DHF, DFS,

3 PNEUMONIA
DSS)
PNEUMONIA PNEUMONIA
4 ACUTE GASTROENTERITIS ACUTE GASTROENTERITS ACUTE GASTROENTERITS BRONCHOPNEUMONIA
5 PREMATURITY THALASSEMIA SYSTEMIC VIRAL ILLNESS ACUTE GASTROENTERITIS
6 THALASSEMIA PREMATURITY PREMATURITY PREMATURITY
7 RHABDOMYOSARCOMA RHABDOMYOSARCOMA THALASSEMIA SYSTEMIC VIRAL ILLNESS
8 OSTEOSARCOMA GENERALIZED EPILEPSY BRONCHIAL ASTHMA BRONCHIAL ASTHMA
HIRSCHPRUNG’S
9 DISEASE
BRONCHIAL ASTHMA HIRSCHSPRUNG'S DISEASE NEPHROTIC SYNDROME
BRONCHIAL ASTHMA HIRSCHSPRUNG’S DISEASE NEPHROTIC SYNDROME GENERALIZED EPILEPSY

10
TOP TEN CAUSES OF MORTALITY
2015 2014 2013 2012
1 Leukemia (ALL, AML, CML) Leukemia (ALL, AML, CML) Leukemia (ALL, CML) Dengue Shock Syndrome
2 Pneumonia Prematurity Pneumonia Leukemia (ALL, AML)
3 Prematurity Pneumonia Congenital Anomalies Pneumonia
Acute Respiratory Distress Acute Respiratory Distress

4 Dengue Shock Syndrome Prematurity
Syndrome Syndrome
Multiple Organ Disseminated Intravascular

5 Dengue Shock Syndrome Sepsis
Dysfunction Syndrome Coagulopathy
Acute Respiratory Distress

6 Dengue Shock Syndrome Intracranial Bleed Congenital Heart Disease
Syndrome
Acute Respiratory Distress

7 Aplastic Anemia Bacterial Meningitis Septic Shock
Syndrome
8 TB Meningitis Biliary Atresia Pneumothorax Brain Herniation Syndrome
9 Congenital Anomalies Chronic Liver Disease Prematurity Congenital Heart Disease
10 Rhabdomyosarcoma Congenital Heart Disease Hepatic Encephalopathy Bronchopneumonia
Dengue is one of the leading causes of illness in the Philippines.
Dengue in the Philippines
Insufficient
prevention and
control
Need for
Dengue
Vaccine
Public
expectation to
do more
about the
disease
Food and Drug Administration
Dengue Vaccine Approval
22 December 2015: Philippines granted marketing approval to Sanofi

Pasteur tetravalent dengue vaccine, the 1st dengue vaccine registered in
Asia.
Key Efficacy Results
25-month active phase* Pooled efficacy analyses‡1
Reduction in Reduction in Reduction in

symptomatic hospitalized severe dengue †
dengue dengue
93.2%
65.6% 80.8% (95% CI: 76.1–97.9)
(95% CI: 60.7–69.9) (95% CI: 70.1–87.7)
*Data come from the 2 pivotal, phase III, large-scale efficacy trials CYD14 and CYD15, which were designed to fully assess efficacy; postdose 1; 1Full Analysis Set for Efficacy
(FASE): all subjects who received at least one injection. †severe dengue, IDMC. CI=confidence interval; DENV=dengue virus.
Dengue Public Sector Vaccination
Vaccines Access in the Philippines
AVAILABILITY
VACCINE
PRIVATE SECTOR GOVERNMENT
1. Dengue Vaccine 2016 2016

2. IPV (Polio) 2002 2014
3. HPV (Cervical Cancer) 2002 2015
4. Pentavalent (Hep B, Dipht., Pert., 2003 2012
Tetanus, HiB)
5. PCV (Pneumonia) 2006 2013
6. Pneumonia vaccine for senior 1996 2012
citizens
7. Flu vaccine 2003 2012
8. Rabies (full dose) 1986 2015
9. MR-TD (measles-rubella, tetanus- 1985 (MMR) 2015
diphtheria)
SANOFI PRESS RELEASE
November 29, 2017
• Based on the 6 years of clinical data, the
new analysis evaluated long-term safety
and efficacy of Dengvaxia in people who
had been infected with dengue prior for
vaccination and those who had not.
• The analysis confirmed that Dengvaxia

provides persistent protective benefit
against dengue fever in those who had
prior infection.
• For those not previously infected by

dengue virus, however, the analysis
found that in the longer term, more
cases of severe disease could occur
following vaccination upon a subsequent
dengue infection.
Print Media
PDI, December 12, 2017
Rudy Andal (Pilipino Star Ngayon) - March 22, 2018 - 12:00am

PDI, December 15, 2017
February 20,2018
TV: “Kontrobersiya sa Dengvaxia”
Social Media
DOH Mafia
Congress and Senate Hearings
House of Representatives
When it rains, it pours!
DDHSS and HRM suffered stroke End of the year preparing to close the
books and answering COA audit
observations
Preparing for Public Revalida of PGS- Morale of the employees

ISA; ISO Recertification
Strategic Performance Management
System
Finding meaning in difficulties...
My Favorite Playlist
Ang Soundtrack ng Buhay Ko
April Boy Cueshe Kuh Orient
Sampaguita Gloria Bongga
Communicating With Media, etc...
Employees and Parents
Policemen
• Being challenged
— sometimes
severely — is part
of what activates
resilience as a
skill set
• Resilience is built
by attitudes,
behaviors and
social supports
that can be
adopted and The most resilient individuals are not the
cultivated by ones that don’t fail, but rather the ones that
anyone fail, learn and thrive because of it.
Overcoming Adversity
“The Power of the Positive”

People bounce back from adversity in two ways: they draw
upon their own internal resources, and they encounter people,
organizations and activities that provide them with the
conditions that help the emergence of their resilience.
1. Internal Locus of Control

2. External Environment Protective Factors
Performing Amidst Adversity
Internal Strength Perspective
1. Manage strong feelings and impulses

2. Cope with stress in healthy ways
3. Good problem-solving skills
4. Feel in control
5. Keep a positive mental attitude
Performing Amidst Adversity
External Protective Factors
6. Ask for help and seek resources

7. Social support and close relationships
8. Help others and find positive meaning in life
1. Manage Strong Feelings and
Impulses
People who are able to manage
strong emotions are less likely to get
Don’t Allow overwhelmed, frustrated or
Your Emotions aggressive.
to Get in the Those who are able to manage
Way feelings can still feel sadness, but

are also able to find healthy ways to
cope and heal.
Gordon Hearings
Bloopers!
Managing Emotional State
The key to having high resilience is managing our

emotional state because fundamentally, how we
are feeling dictates our physical, mental and
spiritual state.
 When we are able to feel positive emotion and display high energy,
we are in a place that allows us to work at our personal best.
 When we feel positive emotion a ‘feel good’ hormone is released and
this allows our minds to think at their best, our bodies to function
physically at their best, and for us to feel an overall sense of
fulfillment.
 This is when we are at our most resilient and the more we stay in
this space, the more resilient we become.
Coldicott H and Cook S, Training Journal, 01 June 2014
Energy and Emotions Zone
High
Energy
Anxious – High Personal Best – High

energy, negative energy, positive
emotion emotion
Negative Positive
Emotion Emotion
Break Down – Low Regeneration – Low

energy, negative energy, positive
emotion emotion
Low Coldicott H and Cook S, Training Journal,

Energy 01 June 2014
2. Cope With Stress in
Healthy Ways
Be physically and mentally healthier to

have overall lower recovery needs. Use
positive and meaningful strategies to cope
better and re-establish routines more
q u i c k l y.
Physical State
Be Prepared!
3. Good Problem-Solving Skills
Respond
Thinking, planning, and problem-
solving skills contribute to feelings
D e c i s i ve l y
of independence and self - a n d Ta k e
competence. Ac c o u n t a b i l i t y
Policies and Guidelines
Dengue Fastlane
Emergency Room
In-Patients
OPD Patients
ICU Patients
4. Feel in Control
Engage in activities that help

you regain sense of control, Don’t Take
especially after the chaos of a Things
d i s a s t e r. T h i s w i l l h e l p s u p p o r t
Personally
the healing and recovery
process.
Ho’oponopono Prayer
PLEASE FORGIVE ME
I FORGIVE YOU
I FORGIVE MYSELF
I BLESS YOU
I THANK YOU
I LOVE YOU
I LET YOU GO
A Hawaiian practice of reconciliation and forgiveness. From Ensha A. Ancheta
Gordon Hearings
The authentic me!

5. Keep a Positive Mental Attitude
Be confident and hopeful about

overcoming present and future
See Yourself
difficulties. Don’t feel helpless and
powerless, or see yourself as a
as Resilient!
victim. Build a strong psychological
resilience.
You Never
Know How
Strong
You Are
Until Being
Strong
Is The Only
Choice
You Have.”
Four Strategic Themes to Increasing Resilience
Coldicott H and Cook S, Training Journal, 01 June 2014
6. Ask for Help and Seek Resources
K n o w h o w t o a s k t h e r i g h t q u e s t i o n s . Yo u
will get needed help more quickly if you
are creative in your thinking about
situations.
Resourceful people are good problem -

solvers and communicators, and have a
good social network to reach out to.
7. Social Support and Close
Relationships with Family and
Friends
Maintain strong connections with family

and friends.
Close social support can get you through

tough times, and enable you to also enjoy
relationships during everyday life.
SUPPORT SYSTEM
8. Help Others and Find Positive
Meaning in Life
P o s i t i v e e m o t i o n s l i k e g r a t i t u d e , j o y,
kindness, love and contentment can come
from helping others. Acts of generosity
can add meaning and purpose to your life
e v e n i n t h e f a c e o f t r a g e d y.

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2nd 2018 CES Leadership Conclave

“Resilience: Steering Through Adversity, Bouncing Back Bravely”

DELIVERING EFFICIENT PUBLIC SERVICE

 GOCC established through

DENGUE (DF, DHF, DFS,

4 ACUTE GASTROENTERITIS ACUTE GASTROENTERITS ACUTE GASTROENTERITS BRONCHOPNEUMONIA

5 PREMATURITY THALASSEMIA SYSTEMIC VIRAL ILLNESS ACUTE GASTROENTERITIS

6 THALASSEMIA PREMATURITY PREMATURITY PREMATURITY

7 RHABDOMYOSARCOMA RHABDOMYOSARCOMA THALASSEMIA SYSTEMIC VIRAL ILLNESS

8 OSTEOSARCOMA GENERALIZED EPILEPSY BRONCHIAL ASTHMA BRONCHIAL ASTHMA

BRONCHIAL ASTHMA HIRSCHSPRUNG’S DISEASE NEPHROTIC SYNDROME GENERALIZED EPILEPSY

2 Pneumonia Prematurity Pneumonia Leukemia (ALL, AML)

3 Prematurity Pneumonia Congenital Anomalies Pneumonia

Acute Respiratory Distress Acute Respiratory Distress

Multiple Organ Disseminated Intravascular

Acute Respiratory Distress

Acute Respiratory Distress

8 TB Meningitis Biliary Atresia Pneumothorax Brain Herniation Syndrome

9 Congenital Anomalies Chronic Liver Disease Prematurity Congenital Heart Disease

10 Rhabdomyosarcoma Congenital Heart Disease Hepatic Encephalopathy Bronchopneumonia

22 December 2015: Philippines granted marketing approval to Sanofi

Reduction in Reduction in Reduction in

1. Dengue Vaccine 2016 2016

• The analysis confirmed that Dengvaxia

• For those not previously infected by

Rudy Andal (Pilipino Star Ngayon) - March 22, 2018 - 12:00am

Preparing for Public Revalida of PGS- Morale of the employees

April Boy Cueshe Kuh Orient

Sampaguita Gloria Bongga

“The Power of the Positive”

1. Internal Locus of Control

1. Manage strong feelings and impulses

6. Ask for help and seek resources

to Get in the Those who are able to manage

Way feelings can still feel sadness, but

The key to having high resilience is managing our

Anxious – High Personal Best – High

Break Down – Low Regeneration – Low

Low Coldicott H and Cook S, Training Journal,

Be physically and mentally healthier to

Engage in activities that help

A Hawaiian practice of reconciliation and forgiveness. From Ensha A. Ancheta

The authentic me!

Be confident and hopeful about

Coldicott H and Cook S, Training Journal, 01 June 2014

Resourceful people are good problem -

Maintain strong connections with family

Close social support can get you through

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