Displaying publications 1 - 20 of 166 in total

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  1. Lum KY, Binti Indera Putera KAS, Krishnan M, Binti Libasin Z, Binti Abdullah NNR, Binti Saman Saimy IS
    PLoS One, 2023;18(11):e0294055.
    PMID: 37956122 DOI: 10.1371/journal.pone.0294055
    INTRODUCTION: In Malaysia, lean was initiated in 2012 as part of an effort to reduce waiting time at the Ministry of Health (MOH) hospitals. As of now, there are 52 public hospitals that have officially implemented lean. However, little is known whether lean is sustained within the hospitals and the critical success factors (CSFs) affecting sustainability. Therefore, this study protocol aims to fill the gap by (i) identifying the critical success factors [CSFs] for lean sustainability in the MOH, (ii) developing a validated framework to support hospitals in sustaining lean, (iii) the framework will be adapted into a checklist to measure the level of lean sustainability (iv) interviewing hospitals with the lowest and highest level of lean sustainability to further explore the barriers and boosters in sustaining lean.

    METHODS AND ANALYSIS: This study will employ a mixed-method approach and will be conducted in three phases. The first phase involves a combination of scoping review and interviews with key informants to identify the CSFs known to affect lean sustainability at the MOH hospitals and present them in a validated framework. In the second phase, the framework will be adapted into a checklist to measure the level of lean sustainability in the MOH hospitals. The findings will be used to select the hospital with the lowest and highest level of lean sustainability for an interview in the third phase.

    DISCUSSION: The lean sustainability framework will be able to provide more relevant guidance on how to increase the likelihood of lean sustainability and serve as a validated measurement tool for MOH hospitals. In addition, this study will be able to outline the differences in the contributing factors between health organizations that showed a high level of lean sustainability compared to those struggling to sustain.

    Matched MeSH terms: Hospitals, Public*
  2. Cheah WK, Choy MP, Ramananthan GRL
    Med J Malaysia, 2013;68(1):89-90.
    PMID: 23466780
    Matched MeSH terms: Hospitals, Public*
  3. Kamarulariffin Kamarudin M, Tan Jen Ai C, Lisa Zaharan N, Yahya A
    Int J Med Inform, 2022 Dec;168:104865.
    PMID: 36334465 DOI: 10.1016/j.ijmedinf.2022.104865
    BACKGROUND: A standardised mortality ratio (SMR) is the hospital observed mortality divided by its predicted mortality and has been used as an indicator to monitor hospital performance.

    OBJECTIVES: This study developed a model that predicted 30-day mortality for acute myocardial infarction (AMI) and compared the SMR among 41 Malaysian public hospitals using statistical process control charts.

    METHODS & RESULTS: Data from referral centres and specialist hospitals with cardiology services were analysed. Both referral centres and specialist hospitals had comparable mortality, except for Hospitals A and B, which the study considered outliers. Two-thirds of the remaining hospitals had an SMR of above one (SMR 1.05-1.51), but the indices were still within the expected variations.

    CONCLUSION: The SMR coupled with a funnel plot and variable life adjusted display (VLAD) can identify hospitals with potentially higher than expected mortality rates.

    Matched MeSH terms: Hospitals, Public
  4. Ravindran J
    Med J Malaysia, 2008 Dec;63(5):434-5.
    PMID: 19803313 MyJurnal
    The caesarean section rate in Malaysian public hospitals has increased to 15.7% from 10.5% in the year 2000. There are inter-state variations in the rate ranging from a high of 25.4% in Melaka to 10.9% in Sabah. The West Coast states generally had a higher caesarean section rate than the East Coast states as well as East Malaysia. It would be prudent for Malaysia to implement stringent caesarean audits to ensure that rising caesarean section rates are kept in check.
    Matched MeSH terms: Hospitals, Public/statistics & numerical data*
  5. Zainal R, Mahat M
    Value Health, 2014 Nov;17(7):A790.
    PMID: 27202949 DOI: 10.1016/j.jval.2014.08.431
    Objectives: Health care services in Malaysia are widely available and accessible at a minimal cost. However, in pursuing with the health care reform, policy-makers and hospital managers need to know the unit cost for the purpose of planning and efficiency of providing the services. This study estimated the cost of out-patient services in a public hospital
    Methods:The study was conducted in a 341 bedded hospital that provide secondary level care to 24,486 in-patients and 127,389 specialist out-patients in 2010. The costs were estimated using a step-down approach where the costs were allocated to the different cost-centres. Capital costs were annualised cost of capital item with life expectancy of more than 1 year and recurrent cost were all inputs consumed within a year. Total costs were then allocated to the in-patient and out-patient services based on historical financial data with a ratio of 1: 4. This was then followed by a stepwise approach of allocating the ancillary department cost centres to the clinical department cost centres. The unit cost per patient visit was calculated based on the number of visits for each department. Base year of 2010 was used to calculate the cost and patients visits. Costs were calculated from the perspective of the hospital.
    Conclusions: The findings provide an estimate of the costs for out-patient visit. At the current minimal fee of MYR 5.00 (USD 1.5), the Ministry of Health is subsidising more than 95.0% of the health care cost for each patient. These estimates provide the policy-makers with an understanding of the cost data should they need to establish a cost basis for payment rates.
    Matched MeSH terms: Hospitals, Public
  6. Phua, K.L., Chong, J.C., Elangovan, R., Liew, Y.X., Ng, H.M., Seow, Y.W.
    MyJurnal
    Public and private hospitals in Kuala Lumpur and Selangor were evaluated in terms of their accessibility for the physically disabled. The research hypotheses for this study included the following: (1) Both types of hospitals are accessible for the physically disabled as measured by specific criteria but (2) the degree of accessibility is higher in the case of private hospitals as compared to public hospitals. A total of 23 private hospitals and 11 public hospitals in Kuala Lumpur and Selangor were invited to participate in the study. The 5 private hospitals and 5 public hospitals that agreed were evaluated for adequacy of facilities for the physically-disabled. For this purpose, 13 specific criteria were assessed and scored for each hospital. These criteria were also grouped into 5 categories, namely, parking, toilet, door and lift, corridor and ramp. Scores were compared between each hospital and then aggregated and compared for private hospitals versus public hospitals. It was found that none of the 5 private hospitals and 5 public hospitals studied satisfied 100% of the criteria evaluated. Looking at each hospital individually, the overall scores range from 32% to 92% for the criteria set. Only 4 of the 10 hospitals in our sample achieved overall scores of 80% or higher in terms of the evaluation criteria we used. With the exception of availability of ramps where public hospitals scored slightly higher ,for most of the individual criterion, private hospitals scored higher than public hospitals. Looking at each criterion across all hospitals, the scores range from 59.2% (adequacy of parking) to 85% (adequacy of corridors). The median score obtained by private hospitals and by public hospitals for all 13 criteria were analysed for any difference. The difference between private hospitals and public hospitals is not statistically significant (Mann-Whitney U = 6.5, p-value = 0.099). There is no significant difference between Kuala Lumpur/Selangor private and public hospitals in terms of accessibility for physically disabled people. However, some hospitals are more accessible for the physically disabled than other hospitals. These findings indicate that there is room for improvement.
    Matched MeSH terms: Hospitals, Public
  7. Hwong WY, Ng SW, Tong SF, Ab Rahman N, Law WC, Wong SK, et al.
    BMC Health Serv Res, 2024 Jan 05;24(1):34.
    PMID: 38183003 DOI: 10.1186/s12913-023-10397-8
    BACKGROUND: Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that influenced the provision of IVT and the variation in its rates in Malaysia.

    METHODS: A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings.

    RESULTS: Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 - 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation.

    CONCLUSIONS: In addition to the global effort to explore sustainable measures to improve patients' emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation.

    Matched MeSH terms: Hospitals, Public
  8. Manaf NH
    PMID: 15974516
    The main aim of the study is to provide an empirical analysis of quality management practice among Malaysian Ministry of Health hospital employees, ranging from medical specialists to health attendants.
    Matched MeSH terms: Hospitals, Public/standards*
  9. Saw Chien G, Chee-Khoon C, Wai VH, Ng CW
    Asia Pac J Public Health, 2015 Nov;27(8 Suppl):79S-85S.
    PMID: 26116582 DOI: 10.1177/1010539515591847
    The goal of ensuring geographic equity of health care can be achieved if the geographic distribution of health care services is according to the health needs. This study aims to examine whether acute Ministry of Health hospital beds are distributed according to population health needs in various states within Peninsular Malaysia. The health needs of each state are indicated by the crude death rate. Comparisons of the share of hospital beds to that of population with differential health needs were assessed using concentration curve and index. In most years between 1995 and 2010, the distribution of hospital beds in Peninsular Malaysia were concentrated among states with higher health needs. This is in line with the principle of vertical equity and could be one advantage of a central federal government that can allocate health care resources to prioritize states with higher health care needs.
    Matched MeSH terms: Hospitals, Public/supply & distribution*
  10. Azhar AA, Ismail MS, Ham FL
    Med J Malaysia, 2000 Jun;55(2):164-8.
    PMID: 19839143
    A total of 37,152 patients attended the Accident & Emergency (A&E) Department of Hospital Universiti Kebangsaan Malaysia (HUKM) from 1st January to 31st December 1998. Attendance during early hours (midnight to 0659 hrs.) constituted only 10.4% (3853 cases) whereas that for three other time periods of 0700-1159 hrs., 1200-1759 hrs., and 1800-2359 hrs. was 29.4% (10,927 cases), 30.8% (11,448 cases), and 29.4% (10,924 cases) respectively. Two hundred and fifty-one patients were direct admissions from other hospitals into our hospital wards and they attended the A&E department for registration purposes only. Of the remaining 36,901 that were triaged, 196 (0.5%) were resuscitation cases [Triage 1], 3648 (9.9%) were emergency cases [Triage 21, 18,935 (51.3%) were urgent cases [Triage 3], and 14,122 (38.3%) were non-urgent cases [Triage 4]. Despite fluctuations in monthly patient attendance, the proportions of patients according to time of attendance, age group, gender and triage categories remained similar throughout. As majority of patients attended during convenient hours (89.6% from 0700-2359 hrs.) and a high proportion of patients (38.3%) belonged to the non-urgent Triage category, we feel that public emergency services are possibly being abused.
    Matched MeSH terms: Hospitals, Public*
  11. Ravindran J
    Med J Malaysia, 2003 Jun;58(2):294-5.
    PMID: 14569754
    Matched MeSH terms: Hospitals, Public/statistics & numerical data*
  12. Nwagbara VC, Rasiah R, Aslam MM
    Medicine (Baltimore), 2016 Sep;95(36):e4688.
    PMID: 27603363 DOI: 10.1097/MD.0000000000004688
    Public hospitals have come under heavy scrutiny across the world owing to rising expenditures. However, much of the focus has been on cutting down costs to raise efficiency levels. Although not denying the importance of efficiency measures, this article targets a performance issue that is relevant to address the quality of services rendered in public hospitals. Thus, it is important to focus on the effectiveness of resource utilization in these hospitals. Consequently, this article seeks to examine the impact of average length of stay (ALOS) and bed turnover rates (BTR) on bed occupancy rates (BOR).
    Matched MeSH terms: Hospitals, Public/utilization*
  13. Salahuddin L, Ismail Z, Hashim UR, Raja Ikram RR, Ismail NH, Naim Mohayat MH
    Health Informatics J, 2019 12;25(4):1358-1372.
    PMID: 29521162 DOI: 10.1177/1460458218759698
    The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.
    Matched MeSH terms: Hospitals, Public*
  14. Yeap SS, Das Gupta E, Gun SC
    Int J Rheum Dis, 2010;13:121.
    DOI: 10.1111/j.1756-185X.2010.01502.x
    BACKGROUND: In Malaysia, patients have a choice of attending a public (fully subsidised bygovernment) hospital (PUBH) or a private (fee-paying) hospital (PRIH) for their healthcare.The aim of this study was to, firstly, provide an overview of the characteristics of MalaysianSLE patients attending rheumatology clinics, and secondly, to ascertain if there were any dif-ferences between patients attending PUBH and PRIH.
    METHODS:A standardised questionnaire was administered to all SLE patients attendingrheumatology clinics in a PRIH in Selangor state and a PUBH in Negeri Sembilan state dur-ing the months of September to December 2009.
    RESULTS:One hundred and thirty patients were included in the study. There were 55(42.3%) patients from PRIH and 75 (57.7%) from PUBH. 93.8% were female. 61.5% wereChinese, 29.2% Malay and 7.7% Indians. The majority of patients completed secondaryschooling (46.9%) with significantly less PUBH patients going onto higher education(P = 0.001). 53.8% were in fulltime employment with 37.7% housewives/unemployed.There were significantly more unemployed patients in PUBH (45.3%) versus PRIH (27.2%)(P = 0.05). 33.8% of patients were single, 60.8% married and 3.8% divorced. Average ageat SLE diagnosis was 29.8510.17 years. At diagnosis, the most common presenting symp-tom was related to the mucocutaneous system 70.8%, followed by joints 55.3%, haemato-logical 46.9% and renal 23.1%. Significantly more patients had renal involvement atdiagnosis in PUBH (33.3%) versus PRIH (9.1%) (P = 0.001). At the time of survey, therewere 12 (9.2%) patients in remission. Of those still symptomatic, 48.5% related to themucocutaneous system, 32.3% joints, 27.7% haematological, 22.3% renal, with significantlymore current renal disease in PUBH (30.7%) versus PRIH (10.9%) (P = 0.008). The mostfrequently prescribed drug was prednisolone in 83.1% of patients, followed by hydroxychlo-roquine 68.5% and azathioprine 23.1%. Only 64.8% of patients on prednisolone were onbone protective agents. More patients in PRIH were on prednisolone (90.9%) versus PUBH(77.3%) (P = 0.04), but more patients were on activated vitamin D in PUBH (72%) versusPRIH (29.1%) (P < 0.001).
    CONCLUSION:The demographics and clinical characteristics of SLE patients attending PUBHand PRIH are significantly different. This has important implications when considering edu-cational and treatment strategies
    Matched MeSH terms: Hospitals, Public
  15. Mohd Fauzi MF, Mohd Yusoff H, Mat Saruan NA, Muhamad Robat R, Abdul Manaf MR, Ghazali M
    BMJ Open, 2020 09 25;10(9):e036849.
    PMID: 32978189 DOI: 10.1136/bmjopen-2020-036849
    OBJECTIVES: This paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.

    DESIGN: Cross-sectional.

    SETTING: Seven core clinical disciplines from seven tertiary public hospitals in Malaysia.

    PARTICIPANTS: Study was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).

    RESULTS: The mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=-0.704 and r=-0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=-3.316, 95% CI=-4.516 to -2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.

    CONCLUSIONS: Work-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

    Matched MeSH terms: Hospitals, Public
  16. A Rahim AI, Ibrahim MI, Musa KI, Chua SL, Yaacob NM
    PMID: 34574835 DOI: 10.3390/ijerph18189912
    Social media is emerging as a new avenue for hospitals and patients to solicit input on the quality of care. However, social media data is unstructured and enormous in volume. Moreover, no empirical research on the use of social media data and perceived hospital quality of care based on patient online reviews has been performed in Malaysia. The purpose of this study was to investigate the determinants of positive sentiment expressed in hospital Facebook reviews in Malaysia, as well as the association between hospital accreditation and sentiments expressed in Facebook reviews. From 2017 to 2019, we retrieved comments from 48 official public hospitals' Facebook pages. We used machine learning to build a sentiment analyzer and service quality (SERVQUAL) classifier that automatically classifies the sentiment and SERVQUAL dimensions. We utilized logistic regression analysis to determine our goals. We evaluated a total of 1852 reviews and our machine learning sentiment analyzer detected 72.1% of positive reviews and 27.9% of negative reviews. We classified 240 reviews as tangible, 1257 reviews as trustworthy, 125 reviews as responsive, 356 reviews as assurance, and 1174 reviews as empathy using our machine learning SERVQUAL classifier. After adjusting for hospital characteristics, all SERVQUAL dimensions except Tangible were associated with positive sentiment. However, no significant relationship between hospital accreditation and online sentiment was discovered. Facebook reviews powered by machine learning algorithms provide valuable, real-time data that may be missed by traditional hospital quality assessments. Additionally, online patient reviews offer a hitherto untapped indication of quality that may benefit all healthcare stakeholders. Our results confirm prior studies and support the use of Facebook reviews as an adjunct method for assessing the quality of hospital services in Malaysia.
    Matched MeSH terms: Hospitals, Public
  17. Al Mutair A, Layqah L, Alhassan B, Alkhalifah S, Almossabeh M, AlSaleh T, et al.
    Sci Rep, 2022 Dec 12;12(1):21487.
    PMID: 36509906 DOI: 10.1038/s41598-022-26042-z
    The economic impact of the COVID-19 pandemic on global health systems is a major concern. To plan and allocate resources to treat COVID-19 patients and provide insights into the financial sustainability of healthcare systems in fighting the future pandemic, measuring the costs to treat COVID-19 patients is deemed necessary. As such, we conducted a retrospective, real-world observational study to measure the direct medical cost of treating COVID-19 patients at a tertiary care hospital in Saudi Arabia. The analysis was conducted using primary data and a mixed methodology of micro and macro-costing. Between July 2020 and July 2021, 287 patients with confirmed COVID-19 were admitted and their data were analyzed. COVID-19 infection was confirmed by RT-PCR or serologic tests in all the included patients. There were 60 cases of mild to moderate disease, 148 cases of severe disease, and 79 critically ill patients. The cost per case for mild to moderate disease, severe disease, and critically ill was 2003 USD, 14,545 USD, and 20,188 USD, respectively. There was a statistically significant difference in the cost between patients with comorbidities and patients without comorbidities (P-value 0.008). Across patients with and without comorbidities, there was a significant difference in the cost of the bed, laboratory work, treatment medications, and non-pharmaceutical equipment. The cost of treating COVID-19 patients is considered a burden for many countries. More studies from different private and governmental hospitals are needed to compare different study findings for better preparation for the current COVID-19 as well as future pandemics.
    Matched MeSH terms: Hospitals, Public
  18. Lim AH, Ab Rahman N, Nasarudin SNS, Velvanathan T, Fong MCC, Mohamad Yahaya AH, et al.
    BMC Public Health, 2024 Jan 03;24(1):79.
    PMID: 38172715 DOI: 10.1186/s12889-023-17579-3
    BACKGROUND: There are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018-2021.

    METHODS: This study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors.

    RESULTS: The overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and 'Not Recommended' antibiotics increased slightly over the years.

    CONCLUSION: Antibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.

    Matched MeSH terms: Hospitals, Public
  19. Ching CY
    IHRIM, 1995 Feb;36(1):3-5.
    PMID: 10142965
    Matched MeSH terms: Hospitals, Public/manpower; Hospitals, Public/organization & administration
  20. Nwagbara VC, Rasiah R
    Global Health, 2015;11:44.
    PMID: 26582159 DOI: 10.1186/s12992-015-0131-y
    Against the backdrop of systemic inefficiency in the public health care system and the theoretical claims that markets result in performance and efficiency improvement, developing countries' governments have been rapidly commercializing health care delivery. This paper seeks to determine whether commercialization through an expansion in private hospitals has led to performance improvements in public hospitals.
    Matched MeSH terms: Hospitals, Public/economics; Hospitals, Public/standards*
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