by Dr. Helmy Haja Mydin. First published in The News Straits Times 12 March 2014

One of the greatest responsibilities borne by governments is the facilitation of an affordable and sustainable healthcare system.

The challenges and deficiencies are unique for each country. Some governments may be guilty of insufficient investment while others (like the United States) may spend a high percentage of gross domestic product on healthcare, but persist with substandard care for its citizens.

In Malaysia, there is a commonly held but mostly inaccurate perception that public hospitals provide a substandard care compared with private institutions.

The truth is far more complex, but it is undeniable that one of the main problems faced by public hospitals is that of insufficient capacity.

I recently conversed with Datuk Dr Noor Hisham Abdullah, who is celebrating his one-year anniversary as the director-general of the Health Ministry.In a short space of time, this practising breast and endocrine surgeon has led the development of a healthcare strategy that seeks to not only strengthen the public health sector, but aims to also consolidate public and private healthcare provision in the country.

This article is a brief narrative of the first stage of this framework — the re-engineering of processes that will allow decreased congestion in public hospitals. The goals are threefold: to improve accessibility, accountability and quality. The ministry should use three main approaches to achieve these goals:

FIRSTLY, capacity can be increased by the extension of services. This is done by investing in more infrastructure and human resources, that is, building more healthcare facilities and hiring or training more medical staff.

SECONDLY, more complex intervention involves increasing efficiency in hospitals. This aims to decrease congestion and drive down costs. There are a number of methods to improve patient flow. Medical staff should actively map out patient care pathways and identify bottlenecks that need addressing.

For example, long A&E waiting times may be the result of substandard discharge planning on the wards, leading to a delay in patient movement. As a result, some hospitals have introduced discharge lounges to increase bed turnover. Others have begun to scrutinise surgical practice to identify and facilitate shorter elective admissions.

THIRDLY, a more exciting development is the role of information technology, a concept that the field of medicine has been slow to embrace not only in Malaysia, but also in most developed countries. Indeed, Malaysia has led the way in some ways. For example, we have paperless hospitals that allow electronic health records (EHR) to be reviewed easily. The difficulty lies in establishing a nationwide IT infrastructure that allows each hospital to “talk” to each other via easy access of EHR.

No country has managed to do this seamlessly and investment is slow to come as the process is very expensive — the failed IT project of the United Kingdom’s National Health Service cost about GBP12 billion (RM65 billion).

Hospitals can also buy or develop software that aid medical decisions. Facilitating doctors’ access to the latest evidence-based medicine allows for safer and faster care. A recent study by Harvard University found that the use of clinical decision support software shortened hospital stays by 370,000 days per year and lowered mortality rates as well.

At a more grassroots level, doctors and healthcare managers can facilitate the use of telemedicine. The concept has been in existence for decades, but is usually used in the private sector or in more rural areas. The ubiquitous use of smart phones also encourages the propagation of health-related apps that allow individuals to seek medical advice at their convenience.

In the US, an app called Doctor on Demand allows users to video-chat with doctors and receive medical advice in real time. Users can type in symptoms and even send photographs (for example, of a rash), after which they get paired with a nearby specialist and are advised about the need for further investigations. One can see how a similar app can be used by government clinics, especially those servicing rural areas.

Other apps help patients monitor glucose levels, blood pressure and even asthma control. Apps are cheap and convenient for patients to use, occasionally acting as a replacement for non-urgent health reviews or by recording health events. A balance will need to be struck though, as one must be careful to not be overly dependent on these devices, especially in the context of more serious illnesses.

It is not hard to see that there are many ways to improve patient flow in hospitals, and as a result, decrease congestion and improve accessibility. Changes are not easy to implement and require political and managerial will.

Once the groundwork for a stronger public sector is laid out, the focus can then shift to outcome-based performances where doctors are rewarded based on the quality of their services, an issue that I will expound on in my next article.

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Dr. Helmy Haja Mydin is a Founding Associate of IDEAS

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