KUALA LUMPUR, March 1 – The government has established a new task force, led by the Chief Secretary to the Government (KSN), to reduce overcrowding in the emergency departments of public hospitals, starting with the Klang Valley.
The Special Task Force to Reform the Public Sector (STAR) chaired by KSN Mohd Zuki Ali – which was announced by Deputy Prime Minister Fadillah Yusof yesterday during Question Time in Parliament – comprises representatives from the Ministry of Health (MOH), the Ministry of Finance (MOF), the Ministry of Economy, the Public Service Department (JPA), the Prime Minister’s Department (PMD), the Malaysia Productivity Corporation (MPC), as well as the Project Acceleration and Coordination Unit (PACU) under the Malaysian Investment Development Authority (MIDA).
Bandar Kuching MP Dr Kelvin Yii said STAR has also held engagement sessions with the Malaysian Medical Association (MMA) and the Association of Private Hospitals Malaysia (APHM).
“With this, it shows urgency by the current government, because this is multi-agency and it’s led by the head of the civil service himself,” Dr Yii told CodeBlue in an exclusive interview in Parliament here yesterday.
The government backbencher said STAR’s pilot project in reducing congestion in hospital emergency departments (ED) will begin in the Klang Valley, namely Tengku Ampuan Rahimah Klang Hospital (HTAR), Selayang Hospital, Kuala Lumpur Hospital (HKL), Serdang Hospital, and Ampang Hospital.
“They’re the most congested, based on data that KKM (Ministry of Health) has,” Dr Yii said, citing internal ministry data.
“This is a pilot project. If it works, we’ll upscale it to different hospitals. Every hospital is facing the same problem.”
The DAP lawmaker said he is currently involved in a discussion on how STAR can show some deliverables within the next three to six months. “They’re looking at really immediate impact.”
“I am optimistic; in my view, this has been the most comprehensive attempt to reform and address this [ED] congestion because it comes directly from the PM, who appoints the KSN. I don’t think this has been done before.”
Dr Yii said STAR very recently discussed a February 10 circular by Health deputy director-general Dr Norhayati, as reported by CodeBlue, that revealed JPA’s instruction to MOH to halt extended hours at public health clinics (klinik kesihatan) that went beyond the days and hours permitted by a 2007 circular by the Health director-general, so as to avoid paying staff allowances.
“What we’re going to do is that we’re going to come up with a framework moving forward in terms of how to address this [ED] congestion. And every policy or pekeliling (circular) that is in the way or in between, it can be changed, because the KSN is now in charge; he has the power to change the necessary pekeliling of different government agencies.
“That’s where we want to lead forward to make sure we address this in the near future.”
Dr Yii also said MPC was brought into the task force because its specialty is on increasing productivity.
“Sometimes, we need some fresh eyes to add in to the discussion on top of MOH and everything, to how we can streamline better service delivery.”
When asked if STAR’s pilot project in the Klang Valley would utilise the seven steps to decongest EDs, as previously touted by Health Minister Dr Zaliha Mustafa, Dr Yii said: “I wouldn’t say it’s totally different, but it’s optimising some of the seven, in the sense of identifying what did not work in the seven and making it better.”
He cited, as an example, lean health care that improved effectiveness and productivity in countries like Singapore. “So I think, this task force will be tasked on how to make ‘lean’ more effective in our local culture.”
Among MOH hospitals, lean health care was first introduced at Sultan Ismail Hospital in Johor in October 2013. It is unclear how many public hospitals the lean health care system has been expanded to since.
“Just because it probably didn’t work before doesn’t mean the idea is bad,” Dr Yii replied, when CodeBlue pointed out that lean health care has been implemented before in Malaysia. “But how can we polish the idea to fit in the local and current context even better? So I think that’s one of the responsibilities of the task force.”
Dr Yii said STAR will look at the “whole holistic picture” of the public health care system, including human resources, service delivery, and optimising public-private partnership, but with an eye on reducing the overcrowding of emergency rooms.
“Covid-19 has shown how a united public-private network is kind of important. Issues of how we outsource cases to the private sector, or how we even involve doctors in the private sector to come and locum in a public health care facility. Not just doctors — the whole ecosystem — staff nurse, pharmacists.”
Prime Minister Anwar Ibrahim, who is also finance minister, said when tabling Budget 2023 in Parliament last Friday that the federal budget would include an outsourcing exercise to decant outpatients from congested MOH hospitals to university, military, and private hospitals, but did not disclose how much has been allocated for this. APHM said this would depend on private health care capacity that is currently “overstretched” too.
Anwar also announced the allocation of RM3 billion for just 1,500 new permanent and contract doctors, dentists, and pharmacists.
When CodeBlue pointed out that an overcrowded ED is the proverbial “canary in the coal mine”, Dr Yii acknowledged that full wards are a factor.
“If we cannot discharge patients on time, the turnover is not efficient, so it basically looks at that whole picture. But the main KPI is congestion in emergency by addressing the whole ecosystem.”
Multiple MPs in the current parliamentary meeting have raised concerns about overcrowded emergency rooms and public hospitals in general.
CodeBlue first reported last December that the problem of overcrowded EDs in government hospitals worsened post-Covid, such as in Raja Permaisuri Bainun Hospital (HRPB), a tertiary hospital in Ipoh, Perak, where severely ill patients were stranded in the emergency room for up to six days, amid scarce critical care beds and shortages of doctors and nurses.
