TREND PENINGKATAN MUTU DAN

KESELAMATAN PASIEN PADA

PELAYANAN RUMAH SAKIT DI
MALAYSIA
Assoc. Prof. Dr. M.A. Kadar Marikar
CEO Malaysian Society of Quality in Health
 CONTENT

Introduction to Malaysia
Key Patient Safety Strategies
Patient Safety Initiatives In Malaysia
Recent Achievement
The Success Factors
Challenges
 INTRODUCTION
Statistics
POPULATION (2013) 28.3 million
Life expectancy male (2010) 71.9
Life expectancy female (2010) 77
Annual population growth rate 1.3
( 2011)
Total expenditure on health 4.96%
per GDP (2009)
MOH Hospitals & Institutions 138
(2011)
Private hospital s (2011) 220
 GOVERNMENT HEALTH FACILITIES &
SERVICES

132 HOSPITAL 879 HEALTH CLINIC 106 MOTHER & CHILD CLINIC

1,864 RURAL CLINIC 87 1MALAYSIA CLINIC 1,774 DENTAL CLINIC

SPECIAL MEDICAL
6 INSTITUTIONS 6 NATIONAL INSTITUTE 16 SPECIAL INSTITUTIONS
 MOBILE FACILITIES
AMBULANCE FLYING DOCTOR SERVICE
185 7 1MALAYSIA MOBILE CLINIC 12

MOBILE DENTAL
25 MOBILE DENTAL CLINIC MOBILE DENTAL TEAM
410 136 SCHOOL TEAM

1 1MALAYSIA BOAT CLINIC 1 1MALAYSIA DENTAL CLINIC

KEY PATIENT SAFETY STRATEGIES
Promotion
& Education

Policies &
Research
Guidelines
PATIENT
SAFETY
Specific
Organisationa
Programme
l Structure
s
Monitorin
g System
 KEY PATIENT SAFETY STRATEGIES

Organisational
Policies & Guidelines
Structure
• Malaysian Society for • Healthcare standards (Hospitals,
Clinics,Chronic dialysis, Dental
Quality in Health (MSQH) Services…)
• Patient Safety Council • Malaysian Patient Safety Goals
Malaysia (at MoH) • Clinical Governance
• • Incident Reporting & RCA
Patient Safety Committee
• Safe Surgery Saves Lives
(at health facility ) • Peri-operative Mortality
• PATIENTS for Patient Notification & Review
Safety Malaysia • Independent Inquiry
• Transfusion Safety
• Clinical Practice Guidelines
Promotion & Education
• 1st National Patient Safety
Campaign 2013
• Specific patient safety areas
• Safety Culture
• Malaysian Patient Safety
Goals
• Clinical Governance
• Incident Reporting, Root
cause analysis
• Patient for Patient Safety
Malaysia in 2014
 KEY PATIENT SAFETY STRATEGIES
Specific Research/Systematic
Monitoring System
Programmes Review
• “Clean Care is Safer Care” • PRIMARY STUDIES
•Accreditation of • “Safe Surgery Saves Lives” • Medical Safety - Inpatient Care
• Medical safety – Primary care
Healthcare Facilities and • Tackling Antimicrobial Resistance • Medication Safety
• Improve accuracy of patient
Services. identification
• Blood Transfusion Safety
• Vaccine Safety
•Malaysian Patient • Transfusion Safety • Laboratory Safety
• Medication Safety • Culture – the patient perception
Safety Goal • Critical value program • Handoff Communication
•Hospital Indicator • Fall prevention • Dental Safety
• Patient Falls
• Healthcare- associated pressure
Performance for ulcer prevention • Patient Safety Culture

Accountability (HPIA) • Catheter-Related Bloodstream • SYSTEMATIC REVIEW

Infection Prevention
•Clinical Indicators • Ventilator Associated Pneumonia
• Culture
• Handoff Communication
Prevention • Medication
• Incident Reporting and Learning • Patients unvoiced needs
System
ORGANISATIONAL
STRUCTURE
PATIENT SAFETY COUNCIL
MALAYSIA

• Formed following directive from Malaysian Cabinet on 29th

January 2003.
• Functions:
› Advise the Honorable Health Minister on national patient safety
policies, strategies and action plans
› Enhance implementation of patient safety strategies
› Monitor and evaluate achievement of the Malaysian Patient
Safety Goals and take action at national level
› Promote and facilitate national, regional and international
collaboration in patient safety.
 MEMBERS OF
PATIENT SAFETY COUNCIL MALAYSIA Chairman
(Director General of Health Malaysia)

Private Sectors/NGOs Ministry of Higher

Appointed (8) Secretariat
Ministry of Health Education Patients for Patient
Members Ministry of Defense (Quality in Medical
(19) (3) – UMMC, Safety Malaysia
(3) Care Section, MOH)
UKMMC, HUSM
Association Malaysian Academy of Malaysian Academy
Academy of Malaysian
Association of Malaysian Academy Malaysian Academy of Malaysian of Malaysian
Private
of
Private Hospital Medical Academy of
of Malaysian
Society
Society for
Occupational &
Occupational & Pharmaceuti Family Dental
Hospital Medical Medicine for Environmental
Environmental Pharmaceuti Family Dental
Malaysia
Malaysia Association
Association Medicine Quality in
Quality in Health
Health Medicine Malaysia
Medicine Malaysia cal Society
cal Society Physician
Physician Association
Association

Currently 36 members

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PATIENT SAFETY COMMITTEE
(at facility level)
To lead patient safety
initiatives in the facility
To plan and establish ways,
work system and programme
to ensure patient safety
To ensure implementation
Malaysian Patient Safety
Goals
To monitor and assess status
of patient safety using “e-goals
patient safety”
To discuss incidents,
complaints and patient safety
issues; take appropriate actions
and assess its effectiveness
To plan and implement
promotional and educational
activities related to patient
safety
Others deem necessary
Consortium of Association of Ministry of Health
Medical Clinics Malaysia
MSQH Committee Members
 PATIENTS FOR PATIENT SAFETY
MALAYSIA
 “PATIENTS For Patient Safety Country
Workshop” conducted by MSQH &
Ministry of Health in collaboration with
WHO on 5th-6th Sept 2013.
 Following this, “PATIENTS For Patient
Safety Malaysia (PFPSM)”, voluntary
organization was established.
 PFPSM was launched by Honorary Minister
of Health on 29th April 2014
 PFPSM promotes partnership between
patients- healthcare providers -consumers in
enhancing patient safety.
 Patients engagement & empowerment to
improve patient safety
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MSQH Accreditation Standards
Malaysian Hospital
Accreditation Standards (1999)

Medical Clinic Accreditation

Programme (2012)

Chronic Dialysis Treatment

Standards (2013)

Dental Clinic Accreditation

Programme (2016)
Malaysian Hospital Accreditation Standards
First edition (1999 )

Second edition (2004)

Third edition (2008)

Fourth edition (2013)

Fifth edition (2017)

POLICIES & GUIDELINES
 Current WHO Patient Safety Goals

1. Identify patient correctly

2. Improve effective communication
3. Improve the safety of high-alert medications
4. Ensure correct-site, correct-procedure, correct-patient surgery
5. Reduce the risk of healthcare associated infections.
6. Reduce the risk of patient harm resulting from fall

PATIENT SAFETY SOLUTIONS

1. Look-Alike, Sound-Alike Medication Names
2. Patient Identification.
3. Communication During Patient Hand-Overs.
4. Performance of Correct Procedure at Correct Body Site.
5. Control of Concentrated Electrolyte Solutions
6. Assuring Medication Accuracy at Transitions in Care.
7. Avoiding Catheter and Tubing Misconnections.
8. Single Use of Injection Devices.
 POLICY -D.G HEALTH CIRCULAR NO 2/2013
-Establishment of Patient Safety Committee & Implementation of
Malaysian Patient Safety Goals

The Star Newspaper

Monday 20th May 2013

D.G Health Circular 2/2013

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MONITORING
SYSTEM
 MALAYSIAN PATIENT SAFETY GOALS
1) *To implement Clinical Governance
2) To implement WHO’s 1st Global Patient
Safety Challenge: “Clean Care is Safer
Care”
3) To implement WHO’s 2nd Global Patient
Safety Challenge: “Safe Surgery Saves
Lives”
4) To implement WHO’s 3rd Global Patient
Safety Challenge: “Tackling Antimicrobial
Resistance”
5) To improve the accuracy of patient
identification
6) To ensure the safety of transfusions of
blood and blood products
7) *To improve medication safety
8) To improve clinical communication by
implementing a critical value program
9)* To reduce patient fall
10)To reduce the incidence of healthcare- associated
pressure ulcer
11) To reduce Catheter-Related Bloodstream
Infection (CRBSI)
12) To reduce Ventilator Associated Pneumonia
(VAP)
13) *To implement the Patient Safety Incident
Reporting and Learning System
*Applicable for clinics
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Figure 1: Number of Hospitals Surveyed vs. Total
Hospitals 2009 to 2016 (Public)
Figure 2: Number of Hospitals Surveyed vs. Total Hospitals
2009 to 2016 (Private)
 e-goals patient safety
(online notification of MPSG performance)
(http://patientsafety.moh.gov.my/)

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 MALAYSIAN PATIENT SAFETY GOALS
NOTIFICATION 2013 VIA ‘e-goals patient safety’
(1st 6 months of implementation)

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HOSPITAL PERFORMANCE INDICATORS FOR ACCOUNTABILITY

 38 indicators
 e.g.: Percentage of issues raised in the meeting with the Board of
Visitors whereby response and action had been taken (Standard ≥70%)
KPI FOR CLINICAL SERVICES

 270 indicators
 42 specialties and subspecialties
 e.g.: Percentage of Post Partum Haemorrhage (Standard ≤1%)
 Lists of Accredited Programme
Malaysian Hospital Accreditation Program is a voluntary, independent
programme conduct by Malaysian Society for Quality in Health (MSQH);
a member of the International Society for Quality in Health (ISQua)
5th Edition Malaysian Hospital Accreditation Standards
Surveyor Training Programme
 GUIDELINES
Guidelines produced by Ministry of Health Malaysia :
CLINICAL PRACTICE GUIDELINES

82 Clinical Practice Guidelines

PROMOTION & EDUCATION
1ST NATIONAL PATIENT SAFETY
CAMPAIGN

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 1ST NATIONAL PATIENT SAFETY CAMPAIGN, SEMINAR
&
LAUNCHING OF MALAYSIAN PATIENT SAFETY GOALS 24TH JUNE 2013

D.G of Health with stakeholders

Signing of Malaysian Patient Safety

Press Conference – 1st National 34
Goals Replica By D.G of Health
Patient Safety Campaign
CONFERENCES, CAMPAIGN AT FACILITY LEVEL &
EXHIBITION ON PATIENT SAFETY
MSQH-MOH Patient Safety
International Conference

Malaysian International
Healthcare Tourism Expo

Campaign & Seminar at Patient Safety Campaign in

UMMC Private Hospital
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TRAINING CONFERENCES, CAMPAIGN &
EXHIBITION
MSQH Healthcare Summit 2016
5th Edition Hospital Accreditation Standards Training
ECRI Risk Management Training
International Forum on Quality & Safety in Healthcare organized
by BMJ
ISQua 2017 in London
ISQua 2018 in Kuala Lumpur Convention Centre, KLCC, Malaysia
 MSQH Healthcare Summit 2016

Risk Management Training

Programme by ECRI
International Forum on Quality & Safety
in Healthcare organized by BMJ
ISQua 2017 in London
ISQua 2018 in Kuala Lumpur Convention Centre,
KLCC, Malaysia
 SPECIFIC
PROGRAM
FIRST GLOBAL PATIENT SAFETY CHALLENGE
“CLEAN CARE IS SAFER CARE”

The Hon.Minister of Health, affirmed

Malaysia's commitment, 15th May 2006
witnessed by Professor Didier Pittet,
leader of the Global Patient Safety
Challenge
INFECTION PREVENTION & CONTROL THROUGH
INNOVATION
15th January 2014

Prof. Diedier Pittiet

Director, Infection Control Program, WHO Datuk Dr. Noor Hisham
Collaborating Centre on Patient Safety Abdullah
-Delivering lecture “Infection Control: From Director General of Health
43
Rubbing to Dancing Around The World” -Delivering keynote address
 HAND HYGIENE COMPLIANCE VS
HEALTH CARE ASSOCIATED INFECTION
National Average of HHCR,
2008 - 2012
90 82.8
80
70
Percentage 56.6
60
50
40
30
20
10
0
National Average of HCAI, 2008 - 2012
3.5
3.15
3
2.5
Percentage

2
1.54
1.5
1
0.5
0 44
SECOND GLOBAL PATIENT SAFETY
CHALLENGE
“SAFE SURGERY
THEM E SAVES LIVES” MINISTRY OF HEALTH MALAYSIA
PERIOPERATIVE CHECKLIST
“ S A F E R S U R G E RY
THROUGH BETTER
C O M M U N I C AT I O N ”

Launching of Safety
Surgery Saves Lives
2009 45
IMPROVE PATIENT
IDENTIFICATION

46
MEDICATION SAFETY

“tall man lettering” concept

for sound alike medication.

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INCIDENT REPORTING-LEARNING SYSTEM & ROOT CAUSE ANALYSIS
RCA workshop for state health
department, hospitals & health
clinics:
State Directors & officers
Hospital Directors
Doctors
Paramedics
have been conducted since 2005.
According to zone, states
facilities.
3-2 days workshop
30-50 people, 6-10 per group
Content of Workshop:
Concept of Incident Reporting &
Learning System
Flow of reporting
Concept of RCA
How to do RCA
Examples of case presentation
and Group discussion on how to conduct
RCA based on scenarios
Group presentation
ACTIVITIES ON RCA
 ACTIVITIES ON IR & RCA
Latest Training on Incident Reporting & Learning System and
RCA was conducted in MSQH, The National Cancer Institute
Malaysia and Kuala Lumpur State Health Dept.
LESSONS LEARNT FROM INCIDENT
Why Patient Safety Incident Happen?
Lack of /unclear
“Refuse” to
“communicatio
n” use check list

“Assume” “Multi”
tasking
“OK”
culture Culture
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 RECENT ACHIEVEMENTS OF 2017

Quality & patient safety now included in 11 th Malaysia Plan (2016-2020)

Patient Safety Council of Malaysia (13 th January 2014) agreed to implement WHO Multi-
professional Patient Safety Curriculum Guide in:
Medical, Pharmacy, Dental, Allied Health and Nursing undergraduate programs
Housemanship training

Chairperson of PATIENTS For Patient Safety Malaysia is now a member of Patient Safety Council of
Malaysia (patient representative) and MSQH Committee member.

Malaysian Patient Safety Goals notification (June- Dec 2013) received for the first time

Developments of Healthcare standards and Refinements and Upgrading of existing standards.

PFPS Malaysia activities (Pilot project with 13 public & private hospitals in 2016)
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 SUCCESS FACTORS
Commitment of top leaders

Smart partnership and Good collaboration between Public, Private and

Profesional bodies.

Proactive and dedicated champions at national and facility level.

Internalization and institutionalization of patient safety mindset and

safety culture.

Top-down and bottom-up feedback system between policy makers,

implementers, providers and patients and families.

Integration of patient safety in Malaysian Healthcare Accreditation

Standards for facilities and services.
 CHALLENGES

Increase
workload

Staff
factors

Limited
resources

Patient &
family factors
 ACKNOWLEDGEMENT

WORLD HEALTH ORGANISATION Geneva and WPRO

MINISTRY OF HEALTH MALAYSIA
MALAYSIAN SOCIETY FOR QUALITY IN HEALTH
PATIENTS FOR PATIENT SAFETY MALAYSIA

Thank you

www.msqh.com.my
kadar@msqh.com.my
“Always remember to be safety conscious and above all do no harm”
…

Terima Kaseh

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