Help, I’m Being Bullied By The Ivory Tower Team — Physician

“Pleasure in the job puts perfection in the work.”

A quote from Aristotle was mentioned by the Chief Secretary to the government during his first address to the public service.

Is working in the public health service right now a pleasure or stressor? The answer depends on multiple factors; not all health care centres are the same.

The current stressors of our health care system from the perspective of operation include:

1. Demand is greater than supply;
2. Operations’ call for help is mostly left unanswered;
3. Problems are left to manifest for so long that they are now seen as a norm of everyday business (be silent and hope that the problem goes away);
4. When the problem fails to go away and leaders have no solution, they resort to an authoritarian leadership style;
5. Thus, ending with the bullying behaviour of the Ivory Tower Team located in Parcel E, Putrajaya: “If you can’t take it, then leave the service. We need resilient people who are team players.”

Yes, the Ivory Tower is a BIG BULLY and the heart of the bullying tradition in public health care.

“Structure facilitates process”: this is very true in the health care service. Currently, in urban and highly densely populated areas, the Ministry of Health (MOH) is facing a crisis of structure, logistics, and outdated processes that is unable to meet the demand for service.

Take a walk in all major specialist hospitals and governments clinics within major cities of each state and Greater Klang Valley. Start from the Klinik Kesihatan to the Emergency Department and end at the General Medical Ward.

You will see similar things for both internal and external clients:

1. Prolonged waiting time;
2. Patients on beds put at corridors not intended for clinical care area;
3. Patients lying on disaster camp beds – because physical beds are no more available;
4. Patients lying so close to one another at distance less that one foot;
5. Staff working double shifts;
6. Staff multitask, unable to focus on their core tasks;
7. Inefficient, dichotomy system and process for community clinics and hospital causing repetitive visits by one patient to these centres, “oh Doktor, saya baru keluar hospital, tapi tak baik, kena masuk hospital balik.”

Upon receiving such news, the Ivory Tower Team will usually smile and say “that is resilience in health care”. Resilience is usually used in a temporary setback or disaster situation.

Which scenario of resilience are we facing in our current working environment in government clinics and hospitals: temporary setback or disaster?

So why am I calling out this bullying attitude of the Ivory Tower?

I am forced to face a disastrous working environment, which is caused by a lack of vision, planning, execution and monitoring capability. It was bad when I was a medical officer, but worse now when I’m a specialist. Many reams of Strategic Plans have been written and many workshops of Strategic Plans have been conducted, but nothing concrete has emerged.

I am forced to face a disastrous working environment of increased demand without an increase in logistics of staffing and equipment. I always hear, “we are working on it”, but a definitive timeline is never provided.

I am forced to face a disastrous working environment with a smile to my patients, my team, and maintain composure at all times with zero defects in performance.

I am forced to face a disastrous working environment with additional job scopes of administrative, finance, and many more tasks, causing me to work beyond my hours.

I am forced to face a disastrous working environment with additional job scopes without any prospect of advancing in my grade of service once I reach service grade 56.

Thus, when a fellow doctor died by suicide from alleged bullying, I’m sad that the Ivory Tower was quick to merely respond: “We will go to the ground and investigate because we have zero tolerance to bullying culture.”

How can we be expected to be perfect when there is no pleasure in the working environment and the job? If we were a private entity, there would be a campaign to boycott our services already and no one would come and work for us.

“Structure facilitates process” and “Demands matched with capability” are basic tenets of achieving “pleasure in the job puts perfection in the work”.

It’s time for the Minister of Health to challenge his Ivory Team on their performance. We are sailing nowhere and been adrift for too long, waiting to be rescued.

We hope the Minister will focus on outcome rather than output. Waiting time is output within a particular area. The Ivory Tower is all about outcome of their system and design planning.

We suggest outcome measurements in three areas for the Ivory Tower Team:

1. Clear all patients from corridors in clinics and the Emergency Department, and ensure medical ward inpatient distancing is back to infection control acceptable range.
2. Expand and strengthen the capability of community health clinics and general practitioners (GPs) to reduce the need to refer to hospitals. Expand and strengthen specialty services to also reduce the need for referral from minor specialist hospitals to major specialist hospitals.
3. Ensure all measures above are sustainable, utilising all resources till the next general elections. We cannot be working in silos within Ministry of Health facilities only.

We are confident that measuring these parameters will steer efforts in improving the capacity and capability of our public health care system beyond current traditional approaches.

The author is a physician at a government hospital in the Klang Valley. CodeBlue is providing the author anonymity because civil servants are prohibited from writing to the press.

• This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.