Selayang Hospital: From Glorious Days To A Sorry State Of Affairs — Dr Ghazali Ahmad

Hospital Selayang has been running on conventional manual processes for several years now, while newer hospitals in other countries have successfully implemented a Total Health Information System.

Although Hospital Kuala Lumpur (HKL) has always been the Ministry of Health’s (MOH) flagship hospital, serving as the premier national referral hospital for many years, plans for its decongestion and the strengthening of other health care facilities, including building new hospitals in the Klang Valley, were mainly confined to the drawing board until the mid 1990s, when a serious effort was initiated by the then-health director general, Dr Abu Bakar Suleiman to downsize HKL and build other new hospitals.

HKL was initially planned to be downsized to be a 1,000-bedded hospital to cater for city dwellers, while several new-generation electronic hospitals were planned to be built to serve the future health care needs of the ever increasing Greater Klang Valley population.

Hospital Sungai Buloh was planned to be the largest of the planned new hospitals with 1,300 beds (later downsized to 620 beds following the 1998 financial crisis), followed by Hospital Selayang with 960 beds, Hospital Serdang with 620 beds, and Hospital Ampang with 700 beds.

A smaller hospital was also planned for Putrajaya to serve as a district hospital for the country’s new administrative capital.

It was envisaged that when the new hospitals were completed, the Klang Valley would have more than 3,000 public hospital beds (not including university hospitals) to allow for the revamp of the busy HKL, and to cater to the ever increasing needs of tertiary and speciality health care services, which include nephrology, cardiology, hepatology, hematology, endocrinology, rheumatology, cardiothoracic and hepatobiliary surgery, neurosurgery, urology, and other niche areas, including kidney, liver, heart and lung transplants, which had to be developed further .

Additionally, to prepare for the future automation and digitisation of health care services, these new hospitals were planned to be fully electronic, incorporating the concepts of Lifetime Health Plan (LHP) and Lifetime Health Records (LHR).

The plan for seamless national electronic health records from womb to tomb in public health clinics to national tertiary hospitals, would start with the implementation of the first fully paperless tertiary hospital at Hospital Selayang, implementing a comprehensive Total Health Information System (THIS) which would encompass administration, finance, clinical services, laboratory services, imaging services , and support services, including diet and nutrition, physiotherapy, porter, transport, mortuary services and others.

A core team was set up by the MOH in 1997, tasked with getting Hospital Selayang to begin operations as the first fully electronic, paperless hospital by the end of 1999.

The MOH team, which comprised clinical specialists, radiologists, pathologists, pharmacists, senior nurses and IT officers, started their work in the Wisma Awal building, going through every conceivable work process in a tertiary hospital.

A group of IT consultants from Cerner Corporation and the Vamed Medical Consultancy Group also worked to digitise all manual work processes, regularly brainstorming with the MOH team.

As part of a fact-finding and exploratory exercise, several MOH team members visited a few hospitals in the United States to learn about the practicality and challenges of process automation.

Before the end of 1999, there was no fully paperless or fully electronic hospital anywhere in the world which fully applied the concept of THIS from admission to discharge.

The spirit of Malaysia Boleh coupled with the strong commitment, support and vision of the MOH and the government enabled Hospital Selayang to open its doors in November 1999, implementing THIS for all processes, from admission and registration to clerking and prescription writing, ordering medications, laboratory tests, imaging, scheduling, nursing entries, reports, discharges and transfers.

With its opening, Hospital Selayang soon attracted patients, not just those who were decanted from Hospital Kuala Lumpur. but also from private health care facilities in the Klang valley and beyond.

It also received visits from local dignitaries and health service managers from other countries, including Indonesia, Japan and Singapore, who wanted to witness first-hand a successful THIS implementation in a tertiary hospital.

At one point, the health minister of Singapore paid a personal visit to Hospital Selayang to receive a briefing, as Singapore planned to move in a similar direction for its public hospitals.

While the planning of other new hospitals in the Klang Valley hit a snag with the 1998 financial crisis (the plan for Hospital Sungai Buloh to replace HKL was shelved), Hospital Selayang went on to acquire more accolades in its efforts to become as the best new-generation hospital, maintaining quality and excellence in health care services, something which Malaysians erroneously and unfairly attributed to private hospitals before Hospital Selayang was opened.

The world’s first hand transplant for a baby was performed in Hospital Selayang in 2000 by pioneering hand microsurgeon Dr V Pathmanthan. A live donor kidney transplant was also performed by consultant urologist Dr Rohan Malek in the hospital in the same year, making it the second tertiary hospital after HKL to perform a kidney transplant.

The first liver transplant in a public hospital was done in Hospital Selayang in 2002 by Dr Harjit Singh, and assisted by Prof Russell Strong from Australia. The implementation of the effective On-Line Haemodiafiltration (OL-HDF) for haemodialysis therapy, and the technique of peritoneoscopic insertion of Peritoneal Dialysis (PD) catheter by non-surgeons to increase national PD uptake were also introduced in Hospital Selayang.

Many medical professionals subsequently came to learn from Hospital Selayang about the organisation and set-up of this useful and important clinical service.

Many lives were born, and many more lives were saved in Hospital Selayang at a nominal fee, thanks to the generous annual MOH budget, and thanks to the committed, caring, and selfless public health care professionals serving in Hospital Selayang.

However, unlike other venerable public hospitals, such as the United Kingdom’s St Thomas, Hammersmith, and Charing Cross. and also Singapore’s Kandang Kerbau Hospital, which continue to be well-maintained and upgraded in keeping with changing times, Hospital Selayang seems to be suffering from an unsustainable existence today.

Pictures of mouldy roofs, walls, and corridors, malfunctioning lifts, a seemingly unending occurrence of leaks and wet floors in wards and critical clinical areas, malfunctioning equipment, including those for sterilising surgical instruments, reduced operating room capacity, and the sorry state of basic facilities such as old, faded, and torn sofas in clinics and public areas, speak volumes of the state of neglect the hospital is experiencing.

Total Hospital Information System? Forget it. Hospital Selayang has been running on conventional manual processes for several years now, something that was not initially planned, while newer hospitals in other countries have successfully implemented THIS with appropriate and adequate funding from their respective governments.

Khairy Jamaluddin, the new, spirited, progressive, pragmatic, practical, and open-minded health minister, may want to pay an unannounced visit to see for himself the sorry state of Hospital Selayang.

He may be the only real hope left for the optimal resuscitation of the plummeting morale and spirit of the hospital staff and the frustrated patients of this once top-of-the-league, one-of-its-kind tertiary hospital.

Dr Ghazali Ahmad is a consultant nephrologist and served as one of the MOH team members for Hospital Selayang from 1997 to 2000. He was also the first head of the Department of Nephrology in the same hospital from 2000 to 2006.

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