Patterns and Challenges of Outpatient Services in Level I Government Hospital in Dinalupihan, Bataan: Basis for Operational Improvement Plan
DOI:
https://doi.org/10.5281/zenodo.21851847Keywords:
outpatient services, government hospital, service utilization, operational challenges, mixed-methods research, healthcare quality, patient flow, strategic improvement plan, referral system, DinalupihanAbstract
This study evaluated outpatient service utilization patterns and operational challenges in a Level I government hospital in Dinalupihan, Bataan, as basis for a Strategic Improvement Plan. A sequential explanatory mixed-method design, anchored in pragmatism, Donabedian’s Quality of Care Model, and Systems Theory, was used. The quantitative phase retrospectively analyzed hospital records from January to December 2025, while the qualitative phase explored the experiences of healthcare workers and patients through interviews and phenomenological analysis using Colaizzi’s method. Quantitative findings showed 33,838 outpatient consultations, with adult services comprising the largest share (34.3%), followed by pediatric (24.4%) and prenatal services (16.0%). Injury of unspecified body region was the most frequent case type (31.1%), while October recorded the highest monthly patient volume (11.1%). Female patients had significantly higher monthly consultation volumes than males (p < .001). Qualitative findings revealed operational challenges, particularly insufficient doctors, high patient volume, prolonged waiting times, OPD-to-ER overflow, inadequate diagnostic equipment such as ultrasound, uncomfortable waiting areas, and patients leaving without being seen. Financial barriers, out-of-pocket expenses, inefficient referral mechanisms, RHU bypassing, and limited technology infrastructure contributed to fragmented service delivery. Despite these challenges, patients continued to use the hospital because consultations were free, PhilHealth coverage reduced financial burden, staff were approachable, and the facility was accessible. The findings indicate a structural capacity-demand mismatch and systemic coordination gaps. The proposed improvement plan prioritizes workforce optimization, infrastructure and equipment upgrades, digital and appointment-system integration, patient support, and strengthened RHU referral networks to improve efficiency, accessibility, continuity, and quality of outpatient care.
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Barasa, V., & Virhia, J. (2022). Using intersectionality to identify gendered barriers to health-seeking for febrile illness in agro-pastoralist settings in Tanzania. Frontiers in Global Women's Health, 2, Article 746402. https://doi.org/10.3389/fgwh.2021.746402
Barbadillo, A. F. P., et al. (2024). Turnaround time of consults in primary care system in rural Philippines: A descriptive retrospective cohort study. Acta Medica Philippina. https://doi.org/10.5454/actamedicaphilippina
Berg, K. M., et al. (2023). 2023 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: Summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation, 148(24), e187–e280. https://doi.org/10.1161/CIR.0000000000001179
Biya, M., Gezahagn, M., Birhanu, B., Yitbarek, K., Gertachew, N., & Beyene, W. (2022). Waiting time and its associated factors in patients presenting to outpatients departments at public hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Services Research, 22, Article 107. https://doi.org/10.1186/s12913-022-07502-8
Butalid, R. M., Butalid, J. V. M., Nacion, A. D. S., Escasiñas, M. A. F. T., Coyoca, G. S. E., Seno, R. T., & Tabil, V. G. (2024). Barriers to healthcare access among visually impaired in Iligan City, Philippines: A qualitative study. The Malaysian Journal of Nursing, 16(2), 209–219. https://doi.org/10.31674/mjn.2024.v16i02.025
Caguimbal, M. S. B. (2017). A system study on the General Outpatient Department [Unpublished manuscript or institutional paper]. De La Salle University Institutional Repository.
Cenizal, C. I. (2019). Triage and registration time in the outpatient services of government tertiary hospital: A time-motion study. Philippine Health Research Registry / NUHRA.
Chen, H., Gao, Q., Yeoh, B. S., & Liu, Y. (2022). Irregular migrant workers and health: A qualitative study of health status and access to healthcare of the Filipino domestic workers in Mainland China. Healthcare, 10(7), Article 1204. https://doi.org/10.3390/healthcare10071204
Cohen, L., Manion, L., & Morrison, K. (2018). Research methods in education (8th ed.). Routledge.
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). SAGE Publications.
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE Publications.
Dans, L. F., et al. (2024). Baseline surveys of three primary care sites in the Philippines. Philippine Council for Health Research and Development.
Department of Health. (2020). Implementing rules and regulations of Republic Act No. 11223: Universal Health Care Act. https://doh.gov.ph
Department of Science and Technology – Philippine Council for Health Research and Development. (2017). National ethical guidelines for health and health-related research.
Divinagracia, S. S., & Guevarra, J. G. (2024). Patient satisfaction of outpatient department services in a Level 1 private hospital in Western Visayas, Philippines. Philippine Social Science Journal, 7(4), 44–52. https://doi.org/10.52006/main.v7i4.931
Donabedian, A. (1988). The quality of care: How can it be assessed? Journal of the American Medical Association, 260(12), 1743–1748. https://doi.org/10.1001/jama.1988.03410120089033
Donabedian, A. (2003). An introduction to quality assurance in healthcare. Oxford University Press.
Jalo, R. I., Bamgboye, E. A., Salawu, M. M., Akinyemi, J. O., Uja, U., Ogah, O. S., & Ajayi, I. O. (2025). Gender disparities in hypertension prevalence, awareness and healthcare seeking behaviour among young adults in Nigeria. BMC Cardiovascular Disorders, 25(1), Article 151. https://doi.org/10.1186/s12872-025-04532-x
Jones, R. P. (2025). Capacity planning (capital, staff and costs) of inpatient maternity services: Pitfalls for the unwary. International Journal of Environmental Research and Public Health, 22(1), Article 87. https://doi.org/10.3390/ijerph22010087
Kast, F. E., & Rosenzweig, J. E. (1972). General systems theory: Applications for organization and management. Academy of Management Journal, 15(4), 447–465. https://doi.org/10.5465/255141
Kumar, A., & Gupta, P. (2020). Assessment of patient flow and waiting time in outpatient departments in tertiary care hospitals in India. Journal of Health Management, 22(3), 321–330. https://doi.org/10.1177/0972063420941553
Laza, A. I. B., Bulotano, K. E. E., Fontanilla, M. A. E., Hernandez, H. T. A., De Guzman, J. N. D., & Pacifico, E. G. (2026). An exploratory study on maternal healthcare barriers in Barangay Kaingin 1, using the Integrated Patient-Centered Healthcare Services Framework (IPCHSF) and the National Safe Motherhood Program (NSMP). DLSU Senior High School Research Congress Conference Proceedings, 5(10), 2.
Lincoln, Y. S., Lynham, S. A., & Guba, E. G. (2011). Paradigmatic controversies, contradictions, and emerging confluences, revisited. In N. K. Denzin & Y. S. Lincoln (Eds.), The SAGE handbook of qualitative research (4th ed., pp. 97–128). SAGE Publications.
Mendoza, R. J., & Dizon, M. C. (2022). Operational efficiency and patient satisfaction in outpatient departments of government hospitals in Central Luzon. Asian Journal of Public Health, 14(1), 23–25.
Morgan, D. L. (2014). Pragmatism as a paradigm for social research. Qualitative Inquiry, 20(8), 1045–1053. https://doi.org/10.1177/1077800413513733
Morrow, R., Rodriguez, A., & King, N. (2015). Colaizzi’s descriptive phenomenological method. The Psychologist, 28(8), 643–644.
Mwanswila, M. J., et al. (2024). Outcome evaluation of technical strategies on reduction of outpatient waiting time: A QI intervention. BMC Health Services Research, 24, Article 11231. https://doi.org/10.1186/s12913-024-11231-5
Onyejesi, C. D., Alsabri, M., Del Castillo Miranda, J. C., Aziz, M. M., Ram, M. D., Abady, E. M., & Abdelbar, S. M. (2025). Pediatric emergency disaster preparedness: A narrative review of global disparities, challenges, and policy solutions. International Journal of Emergency Medicine, 18(1), Article 91. https://doi.org/10.1186/s12245-025-00789-2
Owusu, A. A., Boakye, K., Boateng, D., Osei-Mensah, C., & Agyei-Baffour, P. (2024). Patient satisfaction with quality of care at outpatient departments in selected health facilities in Kumasi, Ghana. BMC Health Services Research, 24, Article 1027. https://doi.org/10.1186/s12913-024-11399-w
Pajaron, M. C., & Vasquez, G. N. A. (2023). Weather, lockdown, and the pandemic: Evidence from the Philippines. Philippine Journal of Science, 152(S1), 119–131.
Pavia, R. D. P. (2024). Patient perspectives. EClinicalMedicine, 74, Article 102720. https://doi.org/10.1016/j.eclinm.2024.102720
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Republic Act No. 10173. (2012). Data Privacy Act of 2012. Official Gazette of the Republic of the Philippines. https://www.officialgazette.gov.ph/2012/08/15/republic-act-no-10173/
Reyes, A. T., Serafica, R., Kawi, J., Fudolig, M., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2023). Using the socioecological model to explore barriers to health care provision in underserved communities in the Philippines: Qualitative study. Asian/Pacific Island Nursing Journal, 7(1), Article e45669. https://doi.org/10.2196/45669
Serafica, R., Reyes, A. T., Cacciata, M. C., Kawi, J., Leyva, E. W. A., Sy, F. S., & Evangelista, L. S. (2025). Bridging the gap: Reducing health inequities in access to preventive health care services in rural communities in the Philippines. Journal of Transcultural Nursing, 36(1), 24–33. https://doi.org/10.1177/10436596241285091
Smith, J., Tan, L., & Parker, R. (2020). Managing outpatient efficiency through digital transformation: Lessons from Singapore and the UK. The International Journal of Health Planning and Management, 35(6), 1420–1432. https://doi.org/10.1002/hpm.3067
Utino, L., Birhanu, B., Getachew, N., & Ereso, B. M. (2023). Perceived quality of medical services at outpatient department of public hospital in Dawro Zone, Southern Ethiopia. BMC Health Services Research, 23, Article 209. https://doi.org/10.1186/s12913-023-09178-0
Von Bertalanffy, L. (1968). General system theory: Foundations, development, applications. George Braziller.
World Health Organization. (2021). Primary health care on the road to universal health coverage: 2021 monitoring report. WHO Press.
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