KUALA LUMPUR, Feb 5 – Several doctors at Queen Elizabeth Hospital (QEH) in Sabah are objecting to a Ministry of Health (MOH) mandate to rotate medical officers, particularly those from non-clinical backgrounds, to the emergency department.
The directive was issued following a new key performance indicator (KPI) – set by federal MOH – to reduce waiting times to two hours for patients to see a doctor within the emergency department’s (ED) Green Zone (non-critical cases) across government hospitals nationwide.
But dissenting medical officers at QEH, a tertiary hospital, fear potential patient harm arising from sending non-clinical doctors, especially, to treat emergency cases.
“The majority of the medical officers affected are unhappy and disagree with this. Even some doctors from emergency medicine disagree with this being implemented.
“Some doctors have left clinical work for many years, hence this will only bring more harm than good for the patients seen,” said Dr Thomas (pseudonym), who claimed to represent a group of doctors across at least four clinical departments at QEH affected by the rotation to the hospital’s emergency department.
He added: “More doctors without adequate working space defeats the purpose of us being there.” Dr Thomas spoke to CodeBlue on condition of anonymity as civil servants are prohibited from speaking publicly.
Dr Thomas questioned the need to implement a special two-hour KPI for the ED and reallocate staff resources to meet this goal.
“Not only does the ED lack enough staff, but other departments are facing the same problem as well and functioning at only 20 to 30 per cent capacity, especially those in Hospital Likas,” he remarked.
“Is it because the ED is the first thing patients see? Just to create the illusion that MOH is solving the waiting time problem, while compromising other services? In other words, gali lubang, tutup lubang (create a gap, then cover it up).”
MOH Circular Cites Rising Number Of ‘Patient Complaints And Complications’ From ‘Occasionally Very Long Waiting Times’ At ED’s Green Zone
In a January 12 circular from the office of the deputy director-general of health (medical) to all MOH hospital directors – as sighted by CodeBlue – the MOH acknowledged that the waiting times at the Green Zone in public emergency departments can “occasionally be very long”, leading to an increase in the number of “patient complaints and complications”.
Consequently, the Medical Advisory and Action Committee, in a meeting chaired by Health director-general Dr Muhammad Radzi Abu Hassan on December 28 last year, agreed to improve the waiting time for patients to see a medical officer in the Green Zone to two hours.
“The time duration is measured from the moment the patient registers until the patient is called into the consultation or treatment room,” the circular read.
One initiative suggested in that circular was to mobilise existing hospital staff from various departments – be it from other clinical departments, clinical support departments, or hospital administration – to aid the ED, alongside opening additional consultation rooms to shorten patient wait times.
MOH hospital directors and ED heads should take proactive measures to ensure Green Zone waiting times align with recommendations, in addition to the potential implementation of a “Lean Healthcare” culture, the circular noted.
JKNS: Sabah Hospitals To Rotate MOs From Various Departments, ‘Especially Non-Clinical Units’
In Sabah, state health department (JKNS) director Dr Asits Sanna stated, in a circular dated January 3, that to meet the two-hour ED KPI, MOH hospitals in the East Malaysian state were requested to identify medical officers (MOs) from various departments, “especially from non-clinical units”, eligible to implement duty rotations in the hospital’s green zone starting from the date of the circular.
Hospital directors were advised to improve the efficiency and competency of rotated ED staff through tagging or mentor-mentee programmes with emergency medicine specialists.
At QEH, following JKNS’ circular, an internal memo from QEH director Dr William Gotulis to heads of department on January 18 outlined the process for rotations to the emergency department.
The Kota Kinabalu general hospital has established a system where every two weeks, three different departments/ units will send one of their medical officers to assist in shifts at the ED, with morning shifts from 8am to 3pm and evening shifts from 3pm to 10pm.
Assigned medical officers will work alongside ED medical officers in the Green Zone for two weeks.
“Therefore, the director’s office requests each department/ unit to nominate one medical officer every three months for duty in the ED Green Zone. Implementation of this rotation will begin on March 4, 2024,” the memo stated.
Department heads are required to complete the details of their nominated medical officers by scanning the QR code provided in the memo by February 2.
No Extra Compensation For Working Weekends During Rotation To Emergency Department
Dr Thomas highlighted a lack of transparency in the selection process, noting that some medical officers are exempted from rotation. “Those that don’t ‘favour’ the boss may be ‘placed’ there permanently just because he or she got the ugly side of their bosses.”
He also highlighted the absence of compensation or claims for working weekends during the rotation. “Not only is our salary small, but our on-call pay is also minimal. We are then pressured to do this without any additional incentives,” he added.
The QEH memo outlines a Green Zone rotation schedule, with the psychiatry, surgery, and pathology departments slated for rotation from March 4 to March 17, followed by the occupational safety and health (OSH) unit, blood bank, and dermatology department from March 18 to March 31.
Other departments and units listed in the rotation schedule include neurosurgery, respiratory, anaesthesiology, urology, forensic, otorhinolaryngology, clinical research centre (CRC), sports medicine, radiology, ophthalmology, plastic surgery, palliative, rehabilitation, orthopaedic, wound care, and medical.
Dr Thomas described the rotation as “disrupting primary work” and questioned if other departments were considered less important. “Other departments, especially in Sabah hospitals, are also lacking doctors, with many quitting as they don’t see the light at the end of the tunnel in the current situation,” he said.
“Looking at a single variable doesn’t reflect the whole crap situation MOH is facing at all. Were there any studies done prior to implementing this?” Dr Thomas questioned.
“This is purely just a knee-jerk reflex from them to temporarily solve this issue. Everyone wants to expand this, expand that, and no one has enough human resources. We may eventually have to hire the public to help take blood samples.”
Dr. Thomas suggested five solutions to better address the situation:
- Mobilise emergency department staff in three major hospitals in Kota Kinabalu
- Offer a RM60 per hour incentive for doctors rotating to the emergency department
- Conduct a study before implementing this
- Divert light cases like cough and URTI to nearby health clinics
- Increase the ED waiting time KPI slightly to ease the burden of Green zone cases
MOH Encourages All MOs, Regardless Of Usual Roles, To ‘Share The Responsibility Of Patient Care’
MOH Putrajaya said its new two-hour waiting time KPI at the Green Zone of government hospital EDs nationwide was designed to complement its recent initiatives, like the extended-hour service at public health clinics and the Madani Medical Scheme at private general practitioner (GP) clinics.
“This initiative not only breaks down silos but also presents a golden opportunity to strengthen interdisciplinary partnerships within public health facilities,” the MOH said in a statement to CodeBlue, without attribution to the health minister or a specific MOH official.
“Failure to make bold changes to departmental culture at this juncture could compromise the efficiency of the health system and the delivery of optimal patient care.”
The MOH also considered the two-hour waiting time target for patients to see a doctor at the ED’s Green Zone to be “realistic and practical”, pointing out that many hospitals had previously achieved it even before the KPI was set last month.
However, major hospitals with high patient burdens have waiting times beyond two hours, leading to patient complaints.
“In consensus with top MOH management and senior medical practitioners, there is an acknowledgment of the need to mobilise manpower beyond reliance on EDs alone.”
The MOH explained that increasing workforce allocation to the Green Zone would enable the existing ED workforce to focus on semi-critical and critical cases in the Yellow and Red Zones.
“This initiative, combined with a recently improved triaging system, is considered a critical step in reducing mismanagement and facilitating faster admissions or transfers to other cluster hospitals.”
In response to concerns about potential patient harm from the rotation of non-clinical MOs to the emergency department, the MOH pointed out that the Green Zone mainly deals with mild and non-critical cases requiring “basic expertise”.
“In fact, this approach is viewed as a workforce optimisation strategy, distributing the responsibility of patient care more equitably among health practitioners. It encourages all MOs, regardless of their usual roles, to contribute to this initiative and share the responsibility of patient care.”
The MOH said it planned to further decongest major hospitals by decentralising certain services and specialties to secondary hospitals and public health clinics.
“Major hospitals will focus on complex cases requiring specialised care, while clinic-based, elective, and supportive services will be mainly handled at secondary hospitals and KKs (klinik kesihatan).
“The extension of hospital clusters to include KKs and the placement of resident internal medicine and ED physicians at secondary hospitals are also part of this comprehensive plan to enhance health care quality and access.”
