The Decades-Long QA Odyssey: Celebrating the 10th National QA Convention 2019

Snapshots of the event
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The 9th QA CONVENTION
PRESENTATIONS
Oral
Poster
Market Place Poster
CONVENTION HIGHLIGHTS
: 16 Projects : 32 Projects : 42 Projects
Sungai Siput
Convention Centre,
Sungai Siput, Perak
24 - 26 October 2017
Theme: Enhancing Quality: Do More With Less
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Collaboration with Lean Centre of Excellence, UniKL
Non-competition Lean Healthcare posters located in market place for the purpose of sharing Pre-convention workshop on LEAN Healthcare Lean Champhionship awards
Tokoh QA Cemerlang award Knowledge-sharing sessions were introduced Multimedia presentation on history of QA Conventions
Second edition of Compendium of QA Projects (2007- 2017) published
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Convention Booklet Convention Booklet


Snapshots of the event
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THE WINNERS 1 Dr. Noorlia Yahaya
Pejabat Kesihatan Daerah Kulim, Kedah
Poor Control of Blood Pressure Among Diabetic Hypertensive Patients in the District of Kulim, Kedah Darul Aman
2 Dr. Brinder Nijhar
Hospital Raja Perempuan Zainab II, Kelantan Audit on the Turnaround Time in CT Scan Examinations in Patients with Improper Preparation
3 Dr. Lee Keng Chin
Klinik Pergigian Melaka Tengah, Melaka Reducing Shortfall in Quality of Dental Radiographs Taken at Klinik Pergigian Melaka Tengah
1 Dato’ Dr. Jeyaindran Tan Sri Sinnadurai Hospital Kuala Lumpur
Door-to-Needle Time for STEMI Patients in HKL, How Good Are We?
2 Dr. Yeoh Soo Fan
Pejabat Kesihatan Daerah Manjung, Perak Improving Dengue Outbreak Control in Kg Koh, Manjung District
3 Dr. Noorlia Yahaya
Pejabat Kesihatan Daerah Kulim, Kedah Towards Improving Appropriate Care of Gastational Diabetes in Kulim District
ORAL
1 Mohamad Alias
Pejabat Kesihatan Daerah Hulu Terengganu Kadar Kejadian Demam Denggi di Kalangan Penduduk Felda Hulu Terengganu
2 Dr. Yaw Sew Lian
Jabatan Kesihatan Negeri Sarawak Investigation into Outlier Status of Percentage of Repeat Fillings Done on Anterior Permanent Teeth in Sarawak
3 Dr. Hooi Lai Ngoh Hospital Pulau Pinang
An Audit on the Management of Acute Asthma in Medical Ward
2001
2003
2005
Pn Tay Shui Mui
1 Hospital Queen Elizabeth, Sarawak Commencement Time for Exchange Transfusion for Patients With Severe Neonatal Jaundice in Paediatric Department, Queen Elizabeth Hospital, Kota Kinabalu
2 Dr. Mohd Zulikifli Mohd Kasim
Hospital Sultanah Nur Zahirah, Kuala Terengganu
Reducing the Incidence of Low Apgar Score at One Minute
3 Dr. Tah Kheng Soon Hospital Melaka
Cataract Surgery in Department of Ophtalmology, Hospital Melaka
1 Cik Kala Devi Nadarajan
Hospital Sungai Petani, Kedah
High Specimen Rejection Rate in the Pathology Department of Sungai Petani Hospital
Dr. Norhayati Mohammed
2 Klinik Pergigian Rompin, Pahang Percentage of Re-Filling of Anterior Permanent Teeth Compared to Anterior Permanent Teeth Filling Exceeding the Normal Standard in the District of Rompin
3 Dr. Mohd Romzi Abd Rahman
Hospital Sultanah Nur Zahirah, Kuala Terengganu
Increasing the Optimal Rate of Portable Chest Radiographs
1 Dr. Suzaini Mat Daud
Pejabat Kesihatan Daerah Kangar, Perlis Meningkatkan Pengesanan Awal Kes Neonatal Jaundis Teruk di Daerah Kangar, Perlis
2 Dr. Noorhasmaliza Md Noor
Hospital Sultanah Bahiyah, Kedah Reduction of Methicilin Resistant Staphylococcus Aureus (MRSA) Infection in Alor Setar Hospital
3 En Mariappan Semalai
Pejabat Kesihatan Daerah Seremban Pengawalan Wabak Demam Denggi di Daerah Seremban
POSTER
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THE WINNERS (CONTD.)
1 Dr. Nor Anita Abdullah
Hospital Tengku Ampuan Afzan, Pahang Re-engineering of Low Risk Birthing Centre Pahang
2 Pn Fadilah Hassan
Hospital Sultanah Nur Zahirah, Terengganu Towards Reducing the Risk of Retained Swab after Perineal in Hospital Sultanah Nur Zahirah
Dr. Poh Eu Ping
3 Hospital Raja Permaisuri Bainun, Perak Improving the Rate of Postoperative Endophtalmitis after Ipoh Perak Cataract Surgery in the Department of Ophthalmology, Hospital Ipoh
1 Dr. Norhasni Md Zin
Hospital Tuanku Fauziah, Perlis
Iron Chelation amongst Thalassaemics: A Need for Reappraisal
2 Cik Tan Cheau Huey
Hospital Tengku Ampuan Afzan, Pahang Re-engineering the Unit of Use Drug Distribution Systems of Ward Supply to Cater Weekend Needs
En Navin Kumar Loganadan
3 Hospital Kuala Lumpur
Dispensing Repeat Medications on Appointment Basis (S.M.A.R.T) as an Alternative Dispensing Method to Reduce Patient Waiting Time at the Pharmacy Department
2009
1 Dr. Mahadevan Deva Tata
Hospital Tuanku Ja’afar, Negeri Sembilan Open Access Endoscopy Service Reduces Waiting Time in Increases Gastrointestinal Cancer Detection
2 Dr. Hjh Norasikin Mahdan
Pejabat Kesihatan Daerah Potian, Johor Menurunkan Kejadian Anaemia di Kalangan Ibu Hamil pada Usia Kandungan 36 Minggu
3 Pn Dominica Rose J.S. Daniel
Hospital Taiping, Perak
Reducing the Incidence of Ventilator Associated Pneumonia among ICU Patients
ORAL
2007
2011
1 Dr. Sazali Satari
Hospital Tuanku Fauziah, Perlis Meningkatkan Peratus Radiograf Servikal Lateral Erect yang Sempurna
2 Dr. N. Leelavathy
Klinik Kesihatan Ibu & Anak Kuala Kangsar, Perak
Mengurangkan Kadar Kejadian Neonatal Jaundice Teruk di Klinik Kesihatan Ibu & Anak
3 Dr. Rafidah Md Noor
Klinik Kesihatan Sungai Acheh, Pulau Pinang
Improving the Appropriate Management of Asthma patiemts in Klinik Kesihatan Sg Acheh Seberang Perai Selatan
1 Dr. Soon Chien Chang Hospital Melaka
Reducing the High Number of Unnecessary Intensive Care Unit Bed Booking for Elective Surgery
2 Pn Wan Noraini Wan Yussof
Hospital Kajang, Selangor
Improving Hand Hygiene Compliance among Healthcare Workers in a Government Hospital
3 Dr. Koay Beng Siang
Hospital Sungai Bakap, Pulau Pinang Improving Provision of Diabetic Care at Diabetic Clinic
1 Dr. Tan Pek Yong Hospital Pulau Pinang
Reducing Central Venous Line Related Blood Stream Infections among Paediatric Oncology
2 Dr. Hjh Arbaiah Othman
Pejabat Kesihatan Daerah Batu Pahat, Johor Increasing the Success Rate of Quit Smoking Clinic among Adolescents
Dr. Hajar Hidayah Rossdan
3 Pejabat Kesihatan Pergigian Bangsar, Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur & Putrajaya
Increasing the Retention rate of Fissure Sealant among Primary Schoolchildren
“Good conduct is when one does not require reward in exchange for a good deed” 48
- Abu Bakr As-Siddiq (RA) - The Flower
POSTER


1 Pn Zaida Yahaya
Hospital Tengku Ampuan Afzan, Bahagian Kejururawatan, KKM
Towards Reducing the Incidence of Pressure Ulcer among Non-Ambulatory Patients
2 Dr. Ng Kuen Foong
Hospital Tuanku Ja’afar, Negeri Sembilan High Intubation Rate during Newborn Resuscitation: Recognising, Understanding and Solving the Conundrum
3 Cik Lim Siu Ann
Pusat Perubatan Universiti Malaya
Reducing the Return of Reconstituted Cytotoxic Drugs from Paediatric Oncology and Haematology Units
THE WINNERS
(CONTD.)
1 Pn Tan Sow Lian
Hospital Tengku Ampuan Afzan, Bahagian Kejururawatan, KKM
Towards Reducing the Incidence of Inappropriate Time Medication Administration
2 Dr. Nurul Hidayah Ismail
Pejabat Kesihatan Pergigian Daerah Batang Padang, Perak
Meningkatkan Peratus Murid Orang Asli dengan Kebersihan Gigi Skor Plak A bagi Sekolah Kebangsaan Pos Bersih
3 Pn Nurul Huda Yasim
Pejabat Kesihatan Daerah Kota Tinggi, Johor Menurunkan Kekerapan Terputus Bekalan Ubat di Stor Farmasi Klinik Kesihatan Daerah Kota Tinggi
1 Dr. Karniza Khalid
Hospital Tuanku Fauziah, Perlis
Pain-free Experiences in Neonates during Minor Procedures in Special Care Nursery (SCN)
2 En Mohd Azmarul A. Aziz
Hospital Rehabilitasi Cheras, Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur & Putrajaya
Improving Patient’s Compliance with Modified Consistencies Diet amongst Inpatients with Dysphagia at Hospital Rehabilitasi Cheras
3 Dr. Mohd Faizal Nizam Mohd Fozi Hospital Kemaman, Terengganu
Towards Minimizing Pain Post Elective Caesarean Section Receiving Intrathecal Analgesia in Hospital Kemaman
ORAL
2013
1 Pn Hasriah Sallah
Hospital Tuanku Fauziah, Perlis Meningkatkan Keberkesanan Hospital Outreach Programme (HOP) kepada Pesakit Terlantar
2 Cik Tan Yah Yin Hospital Pulau Pinang
Improving Percentage of Compliance Towards Therapeutic Drug Monitoring (TDM) Blood Sampling Time for Vancomycin in Penang Hospital
3 Pn L. Mageswary Lapchmanan
Hospital Selayang, Selangor
Improving Enteral Nutrition Support among Intensive Care Unit (ICU) Patients
2015
1 Dr. Nur Khalisah Liyana Abd Razak
Klinik Pergigian Kampar, Perak
Reducing Percentage of Root Canal Treatment Failure among Patients in Kampar Dental Clinic
2 En Chandrasegaran Shanmugan Hospital Pulau Pinang
Improving Serum Phosphate Level among Hemodialysis Patients in Hemodialysis Unit, Penang Hospital
3 Dr. Mohd Nazrin Jamhari
Hospital Kuala Nerang, Kedah Mempertingkatkan Kawalan Diabetes Mellitus di Kalangan Pesakit Diabetes Mellitus Jenis 2 di Hospital Kuala Nerang
2017
1 Dr. Akmal Hafizah Zamli
Hospital Sungai Buloh, Selangor
Improving Post Spinal Cord Injury Neurogenic Bladder Complication in Hospital Sungai Buloh
2 Cik Tan Peh Voon
Hospital Sultanah Aminah, Johor
Impact of a Customized Electronic Chemotheraphy Indenting System on Workflow of Cytotoxic Drug Reconstituion Unit, Hospital Sultanah Aminah, Johor
3 Dr. Noorhidayu Monyati Mohamed Noor Klinik Kesihatan Gaal, Kelantan
Low Yield of Sputum Direct Smear Acid Fast Bacillus (AFB) in Symptomatic Pulmonary Tuberculosis (PTB) Screening
POSTER
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THE LEARNED AND WISE JUDGES
O R A L
P O S TE R
Dr. Abdul Ghani bin Mohammed Din (Head)
Pengarah Perkembangan Perubatan, KKM
Dr. Hj Abdul Razak bin Haji Kechik
Pengarah Kesihatan Negeri Perak
Dr. Safurah binti Jaafar
Ketua Penolong Pengarah, Bahagian Pembangunan Kesihatan Keluarga, KKM
Dr. Yao Sik Chi (Head)
Pengarah Kesihatan Negeri Sarawak
Mr Abdollah bin Salleh
Ketua Jabatan Surgeri, Hospital Selayang, Selangor
Datin Dr. Suraya Hani binti Tun Hussein
Ketua Jabatan Dermatologi, Hospital Kuala Lumpur
O R A L
P O S TE R
Dr. Zakiah Ismail (Head)
Ketua Pusat Penyelidikan Perubatan Herba, Institut Penyelidikan Perubatan
Dr. Hasan Abd. Rahman
Timbalan Perngarah, Bahagian Kawalan Penyakit, Jabatan Kesihatan Awam, KKM
Dr. Halimah Yahya
Pakar Perunding Patologi, Ketua Jabatan Patologi, Hospital Kuala Lumpur
Dr. S. Sivalal (Head)
Timbalan Pengarah, Unit Penilaian Teknologi Kesihatan, Bahagian Perkhidmatan Perubatan, KKM
Dato’ Dr. Hj Abdul Razak bin Hj Kechik
Pengarah Kesihatan Negeri, Jabatan Kesihatan Negeri Perak
Dato’ Dr. Abd. Jamil bin Abdullah
Pengarah Perunding Bedah, Ketua Jabatan Bedah, Hospital Kuala Terengganu
O R A L
P O S TE R
Dr. Ahmad bin Mahmud (Head)
Timbalan Pengarah, Unit Penguatkuasa, Bahagian Perkhidmatan Farmasi, KKM
Dr. Lily Manoramah
Pakar Patologi, Jabatan Patologi, Hospital Kuala Lumpur
Dr. Nik Shamsidah bt Nik Ibrahim
Ketua Penolong Pengarah, Unit Kualiti dan Piawaian, Jabatan Kesihatan Awam, KKM
Dr. S. Sivalal (Head)
Pakar Perubatan Kesihatan Awam
Dr. Mary Abraham
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Penyelaras Kualiti, Kampus Kesihatan, Universiti Sains Malaysia, Kubang Kerian, Kelantan
Dr. Safurah Jaafar
Timbalan Pengarah, Unit Kesihatan Primer, Bahagian Pembangunan Kesihatan Keluarga, KKM
2005 2003 2001


THE LEARNED AND WISE JUDGES (CONTD.)
OR A L
Ketua Jabatan Pembedahan, Hospital Sultanah Nur Zahirah Kuala Terengganu
Dr. Ahmad Mahmud
Penasihat Biro Peralatan Perubatan, Bahagian Kejuruteraan, KKM
Dr. Kalsom Maskon
Timbalan Pengarah, Cawangan Kualiti Penjagaan Perubatan, Bahagian Perkembangan Perubatan, KKM
P OS T E R
Dr. Abdul Rahim Abdullah (Head)
Timbalan Pengarah Unit Telekonsultasi, Bahagian Telekesihatan, KKM
Dato’ Dr. Hj. Ahmad Razin Dato’ Hj. Ahmad Mahir
Pengarah Kesihatan Negeri, Jabatan Kesihatan Negeri Perak
Dr. Fekriah Mohd Yatim
Ketua Penolong Pengarah, Bahagian Kesihatan Pergigian, KKM
Dato’ Dr. Abdul Jamil Abdullah (Head)
OR A L
Ketua Jabatan Pembedahan, Hospital Sultanah Nur Zahirah Kuala Terengganu
Dato’ Dr. Ghazali Ismail
Ketua Jabatan Obstetrik dan Ginekologi, Hospital Sultan Ismail Johor Bahru
Assoc. Prof. Dato’ Dr. Sirajoon Noor Ghani
Pensyarah Sambilan, Jabatan Perubatan Kemasyarakatan & Pencegahan, Fakulti Perubatan Universiti Malaya
Dr. Mary Abraham
Pensyarah Kanan & Penyelaras Kualiti, Kampus Kesihatan, Universiti Sains Malaysia
P OS T E R
Dato’ Dr. Hj. Ahmad Razin Dato’ Hj. Ahmad Mahir (Head)
Pengarah Kesihatan Negeri, Jabatan Kesihatan Negeri Perak
Dato’ Dr. Halimah Yahya
Pakar Perunding Patologi (S), Jabatan Perkhidmatan Makmal, Pusat Perubatan Universiti Kebangsaan Malaysia
Mr. Wang Hwee Beng
Perunding & Penasihat Latihan
Dr. Noraini@Nun Nahar Yunus
Pakar Perunding Kanan Pergigian Pediatrik, Institut Pediatrik, Hospital Kuala Lumpur
Dato’ Dr. Abdul Jamil Abdullah (Head)
OR A L
Dato’ Dr. Abdul Jamil Abdullah (Head)
Pakar Bedah Umum, Hospital Sultanah Nur Zahirah, Kuala Terengganu
Dato’ Dr. Juita Ghazalie
Pengarah, Hospital Sultanah Bahiyah Alor Setar
Dr. Salmah Bahri
Pengarah, Bahagian Amalan & Perkembangan Farmasi
P OS T E R
Dr. Noorlia Yahaya (Head)
Timbalan Pengarah Kesihatan Negeri (KA), Jabatan Kesihatan Negeri Pulau Pinang
Dr. Naim Tan Abdullah
Pakar Anestesiologi, Hospital Putrajaya
Dr. Noraini@Nun Nahar Yunus
Pakar Perunding Kanan Pergigian Pediatrik, Institut Pediatrik, Hospital Kuala Lumpur
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2011 2009 2007


THE LEARNED AND WISE JUDGES (CONTD.)
O R A L
P O S TE R
Dr. Muhammad Zulkifli Mohd Kassim (Head)
Pakar Perunding (Obstetrik & Ginekologi), Hospital Sultanah Nur Zahirah, Kuala Terengganu
Pn A’tia Hashim
Timbalan Pengarah Kesihatan Negeri (Farmasi), Jabatan Kesihatan Negeri Perlis
Dr. Suguna Devi Muniandy
Pakar Pergigian Ortodontik, Klinik Pergigian Seri Kembangan
Tn Hj Mohd Amran Mohd Daril
Pengarah Lean Centre of Excellence (UniKL MITEC)
The Flower
Dr. Hj Mohammad Omar (Head)
Pengarah Kesihatan Negeri, Jabatan Kesihatan Negeri Terengganu
Dr. Noorhaida Ujang
Pegawai Kesihatan Daerah, Pejabat Kesihatan Daerah Muar
Mr (Dr.) Azmi Alias
Pakar Perunding Jabatan Neurosurgeri, Hospital Kuala Lumpur
Dr. Hj Ishamuddin Mustapha
Timbalan Dekan Akademik (UniKL MITEC)
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O R AL
Pakar Bedah Umum, Hospital Sultanah Nur Zahirah, Kuala Terengganu
Dr. Noraini@Nun Nahar Yunus
Pakar Perunding Kanan Pergigian Pediatrik, Institut Pediatrik Hospital Kuala Lumpur
Dr. Mary Abraham
Penyelaras Kualiti, Universiti Sains Malaysia
P O S T E R
Dr. Salmah Bahri (Head)
Pengarah Bahagian Amalan & Perkembangan Farmasi
Dr. Noorlia Yahaya
Timbalan Pengarah Kesihatan Negeri (KA), Jabatan Kesihatan Negeri Pulau Pinang
Dr. Loh Kim Hong
Pegawai Pergigian Kanan, Pejabat Kesihatan Daerah Johor Bahru
Dato’ Dr. Abdul Jamil Abdullah (Head)
Ketua Jabatan Obstetrik & Ginekologi, Hospital Sultan Ismail, Johor Bahru
Dr. Ramli Zainal
Timbalan Pengarah, Pejabat Timbalan Pengarah Dasar & Pengurusan Farmasi, Petaling Jaya, Selangor
Dato’ Dr. Juita Ghazalie
Pengarah, Jabatan Kesihatan Negeri Perak
O R A L
P O S TE R
Dr. Muhammad Zulkifli Mohd Kassim (Head)
Pakar Perunding (Obstetrik & Ginekologi), Hospital Sultanah Nur Zahirah, Kuala Terengganu
Dr. Loh Kim Hong
Timbalan Pengarah Kesihatan (Pergigian), Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur & Putrajaya
Dr. Noorhaida Ujang
Pegawai Kesihatan Daerah, Pejabat Kesihatan Daerah Muar
Dato’ Dr. Ghazali Ismail (Head)
2017 2015 2013


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Collection of
QA ABSTRACTS
Published in the Malaysian Journal of Public Health Medicine (Supplementary Edition) and Q-Bulletin (Supplementary edition)
The abstracts of all participating projects were given the honour of being published in MJPHM Journal (Supplementary edition), commencing from the 2005 QA convention. Starting from 2019, all abstracts will be published in Q-Bulletin (Supplementary edition).
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Publication of
Q BULLETIN (SPECIAL EDITION)
Featuring each QA Convention
Following each QA convention, a special edition of the Q Bulletin was published to commemorate the particular QA convention.
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Publication of
TECHNICAL REPORT
on each QA Convention
These reports feature the “behind-the-scenes” efforts that contributed to the success of each convention.
5
5
7
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2017
DR. NORASIKIN MAHDAN
Pegawai Kesihatan Daerah Pontian Pejabat Kesihatan Daerah Pontian, Johor
DR. HJ MOHAMAD OMAR
Pengarah Kesihatan Negeri,
Jabatan Kesihatan Negeri Terengganu
DR. HJ NORDIN SALEH
Timbalan Pengarah Kesihatan Negeri (Kesihatan Awam) Jabatan Kesihatan Negeri Sarawak
MR (DR) AZMI ALIAS
Pakar Perunding Kanan, Jabatan Neurosurgeri, Hospital Kuala Lumpur
DR. MITHALI ABDULLAH @ JACQULINE SAPEN
TOKOH QA CEMERLANG
AWARD
DR. ZAHARIMAH ABDUL KADIR
Timbalan Pengarah Klinikal III Hospital Tuanku Ja’afar, Seremban
DR. FIRDAUS DATUK ABDUK GHANI
Pakar Psikiatri, Hospital Sultan Ahmad Shah, Temerloh, Pahang
DR. MONNIATY MOHAMAD
Pakar Perunding Perubatan,
Hospital Raja Perempuan Zainab II, Kota Bharu
DR. TAJUL ARIFFIN AWANG MOHD
Pengarah Makmal Kesihatan Awam, Kota Kinabalu, Sabah
DR. ABDUL NASIR MOHD ABDUL KADHER
Ketua Jabatan & Pakar Perunding Kanan, Hospital Tunku Fauziah, Kangar, Perlis
DR. SHARMINI DIANA PARAMPALAN
Pakar Perunding Kanan O&G Hospital Pulau Pinang
Pengarah Hospital,
Pengarah Hospital Yan, Kedah
“A person who feels appreciated will always do more than what is expected”
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-Unknown-
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PN L. MAGESWARY
Ketua Jabatan Dietetik & Sajian Hospital Serdang
Created in recognition of the local quality champions who possess selected characteristics including the following:
• Leadership in quality
• Technical expert in quality
• Active involvement in quality initiatives
PN MARDHIAH AMIRUDDIN
Pegawai Farmasi,
Klinik Kesihatan Peringgit, Melaka
DR. HJH NORISAH HJ MAHAT NOR
Ketua Penolong Pengarah Kanan (Kualiti) Jabatan Kesihatan Negeri Perak
EN MOHD AZMARUL A. AZIZ
Pegawai Pemulihan Perubatan (Pertuturan) Hospital Rehabilitasi Cheras


CERTIFICATE OF RECOGNITION
Selection criteria:
Number of quality projects conducted Number of quality publications produced Number of quality presentations done Number of quality projects facilitated Number of lectures delivered
Occasions of involvement as jury or panel member
The Sweet Fruits of Success
This certificate, personally signed by the Director-General of Health, is awarded to 65 active QA trainers who have demonstrated exceptional contribution and commitment towards the success of the QA programme in their respective organizations.
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“Success is not final; failure is not fatal; it is the courage to continue that counts.” -Winston S. Churchill-


KEY FACTS AND FIGURES
NUMBER OF QA PROJECTS FROM 2001-2017
2001 2003 2005 2007 2009 2011 2013 2015 2017
CLASSIFICATION OF INDICATORS EMPLOYED IN THE QA PROJECTS (2007-2017)
All measurements employed in the QA projects were grouped together based on Donabedian’s Quality Framework, “structure, process, and outcome”. (N=292).
Oral Poster
Market Place
n: 239
Process
82%
n: 292
18%
n=53
Outcome
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CLASSIFICATION OF QA PROJECTS (ICD10) (2007-2017)
Chapter Title
1
2 Endocrine, Nutritional, and Metabolic Diseases
3
6
No. of Projects
27 22
14
12 11
11 10
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Factors Influencing Health Status and Contacts with Health Services
10
12 Symptoms, Signs, and Abnormal Clinical and Laboratory Findings
Pregnancy, Childbirth, and the Puerperium
4 External Causes of Morbidity
5 Diseases of the Respiratory System
Certain Infectious and Parasitic Diseases
7 Certain Condition Originating in the Perinatal Period
8 Diseases of Digestive System
9 Diseases of Genitourinary System
7 6
4 3
3 3 3
1 1 1
Mental and Behavior disorders 11 Neoplasms
4
13 Disease of the Blood and Blood-Forming Organs and Certain Disorders Involving Immune Mechanism
14 Disease of the Eye
15 Disease of the Circulatory Systrem
18 Diseases of the Skin
19 Diseases of the Musculoskeletal System
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16
Injury of External Causes 17 Diseases of the Ear


(CONTD.)
20 QA Projects on Work Processes and Services Implementation Pharmacy Projects
No. of Projects
46
Food Quality Projects Patient Care Projects Oral Health Projects Public Health Projects Training Projects Collaborative Projects
Nursing Projects Laboratory Project Other Project
TOTAL PROJECTS
8 8
3 3
3
3 2
1 1
275
“The capacity to learn is a gift; the ability to learn is a skill; the willingness to learn is a choice”. - via islamic thoughts -
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DETAILED MAPPING OF THE PROCESS INDICATORS (N=239) ACCORDING TO QUALITY DOMAINS (2007-2017)
Continuity of care 2% Patient- 3%
Centredness
Safety 12%
Coverage 12% Efficiency 16%
n: 239
1% Appropriateness 37% Effectiveness
17% Timeliness
CLASSIFICATION OF MEASUREMENTS ACCORDING TO THE TYPE OF FACILITY (N=292), WHERE THE MEASUREMENTS WERE MONITORED (2007-2017)
10%
Both
58%
Outpatient
n:292
63
32%
Inpatient
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CUMULATIVE WINNERS OF POSTER PRESENTATION BY REGION (2001-2017)
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CUMULATIVE WINNERS OF ORAL PRESENTATION BY REGION (2001-2017)


INNOVATIVE ADDITIONS OVER THE YEARS
• Collaboration with Lean Centre of Excellence, UniKL
• Non-competition Lean Healthcare posters located in
market place for the purpose of sharing
• Pre-convention workshop on LEAN Healthcare
• Lean Champhionship awards
• Tokoh QA Cemerlang award
• Knowledge-sharing sessions were introduced
• Multimedia presentation on history of QA Conventions
• Second edition of Compendium of QA projects (2007-
2017) published
• Unlimited market place posters
• Online project nomination & submission
• Barcode registration system
• Market place poster introduced
• Pre-judging session for poster presentation
• First edition of Compendium of QA projects
• Quality talks & Jury Awards Introduced
• All abstracts were included in a special MJPHM supplementary issue
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• •
The first convention
Oral and poster presentations
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Inspirational Anecdotes
CONTROL YOUR ANGER
2.0
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rce: www.moralstories.org/controlling-temper
There once was a little boy who had a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he must hammer a nail into the fence.
The first day the boy had driven 37 nails into the fence. Over the next few weeks as he learned to control his anger, the number of nails hammered daily, gradually dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence. Finally, the day came when the boy didn’t lose his temper at all. He told his father about it and the father suggested that the boy now pulls out one nail for each day that he was able to hold his temper.
The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. He said “you have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one.”
Moral: You can put a knife in a man and draw it out. It won’t matter how many times you say I’m sorry, the wound is still there. Make sure you control your temper the next time you are tempted to say something you will regret later.
Sou


“The fruits of success always grow on the tree of hard work” -Senoraroy-
The Seed
The Cycle of Quality Improvement
The Plant
The Flower
The Fruit
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How best practices from the QA projects have been translated into practice, spread and disseminated.
The Fruit


“Do not reinvent the wheel, just realign it” (Anthony J. D’Angelo)
TRANSLATING QA STUDIES INTO POLICY AND PRACTICE
A STEP FORWARD
68
The Fruit


Our previous DG reminded us that QUALITY was not new to the MOH. The convention itself began in 2001 and so far, a total of 231 projects had been presented. All of them were considered to be commendable, creative and innovative initiatives. He then focused on the idea of replicating these outstanding projects . We were urged to present and share any suitable projects at the Special DG Meeting (Mesyuarat KPK Khas). The projects would be evaluated thoroughly by the various subject matter experts and once approved, a policy would be put in place to facilitate the replication and implementation of the particular project elsewhere throughout Malaysia. This is where the Secretariat of the QA Programme is expected to take the lead in helping ensure the widespread sharing of these earmarked projects.
Adapted from Q Bulletin, July-December 2011
Surat Pekeliling Ketua Pengarah Kesihatan Bil (33/2012): Pelaksanaan Replikasi “Open Access Endoscopy” di Malaysia.
14 March 2013
Surat Pekeliling Ketua Pengarah Kesihatan Bil (5/2013): Pelaksanaan Replikasi “Quality Assurance (QA)” di Malaysia.
14 March 2013
Translating QA Studies into Policy and Practice
69
The Fruit


1
2
6
9
8
10
10 Earmarked Projects for
WIDESPREAD REPLICATION (Phase I)
Reducing Waiting Time for Endoscopy and Increasing Gastrointestinal Cancer Detection
Mahadevan D., Dharmendran R., Azrina A., Vijaya S., Kandasami P., Ramesh G., Jasiah Z., Department of Surgery, Tuanku Ja’afar Hospital, Seremban, Negeri Sembilan.
Iron Chelation Amongst Thalassaemics: A Need for Reappraisal
Shahannim I., Norhasni M.Z., Jamaluddin M., Mohammad Zamri K., Hazimah Y., Zarini J., Huzaimi N., Mohd Zamri M.H..
Tuanku Fauziah Hospital, Kangar, Perlis.
Re-engineering of Low Risk Birthing Centre (LRBC)
5
7
Reducing The High Number of Unneccessary Intensive Care Unit Bed Booking for Elective Surgery
Soon C.C., Farizawati M.A., Chew C.E., Siti Mariam A.M., Amelia A. Department of Anaesthesia and Intensive Care, Melaka Hospital, Melaka.
Improving Provision of Diabetic Care at Diabetic Clinic
4
3
Koay B.S., Tan H.Y., Lee K.F., Pang Y.S., Saw A.K., Tan S.M., Siti Zauyah Y., Nurul Zarini B.H., Maktar M.
Sungai Bakap Hospital, Penang.
Towards Reducing the Risk of Retained Swab after Perineal Repair
Mohd Zulkifli M.K., Fadhilah H., Mohd. Nasir T.A., Salmah S., Rokiah A., Hospital Sultanah Nur Zahirah, Kuala Terengganu.
Menurunkan Kejadian Anemia di Kalangan Ibu Hamil Pada Usia Kandungan 36 minggu
Norasikin M., Zaitun I., Roslenda M., Mazliza M., Rubiah L., Masriah M., Pejabat Kesihatan Pontian, Johor.
Increasing the Success Rate of Quit Smoking Clinic among Adolescents
WIDESPREAD REPLICATION (Phase II)
Phase II of this replication programme involves the nursing project entitled “Towards Reducing the Incidence of Inappropriate Time of Medication Administration” which has led to the development of National Nursing Policy for Medication Safety.
Lian T.S., Zaida Y.,Nor Azura H., Zuliwa M. Y., Noorni A., Rashidah A. B., Hartini Y., Siew Geok O., Nursing Unit, Tuanku Ampuan Afzan Hospital, Kuantan, Pahang.
70
The Flower
Nor Anita A., Ghazali I., Mohd Azam M.V., Nurhazinat V., Anna Liza R., Ganesh R., Sudesan R., Norliza I., Khatijah K., Azizah M., Rodiah A., Azizah C.D., Rahimah O., Department of Obstetric and Gynaecology, Hospital Tengku Ampuan Afzan, Kuantan.
Reducing Central Venous Line (CVL) Related Blood Stream Infections (CR-BSI) among Paediatric Oncology Patients
Yeoh S.L., Tan P.Y., Suhaila R., Azimah A., Nor Hafiza R.,
Paediatric Oncology Unit, Paediatric Department, Hospital Pulau Pinang, Penang.
Increasing Retention Rate of Fissure Sealent among Primary School Children
Hajar Hidayah R., Vijayamanohar K., Wan Aini W.Y., Nadia D.B., Umi A., Bangsar Dental Clinic, Federal Teritory of Kuala Lumpur.
Arbaiah O., Marina M.S., Zaleha J., Zainal A.R., Hariyaton R. Batu Pahat Health Clinic, Johor.


BULLETIN’S Facelift
This new look bulletin will incorporate the complete manuscript of QA projects and represents a significant
upgrade in terms of its content.
Effective Strategies in Improving Coverage of Pap Smear Screening in Pontian District
Norasikin Mahdan, Marwiyah Sood, Masriah Misdan, Rubiah Lebar, Zaitun Ibrahim, Fatimah Awab,
Pejabat Kesihatan Daerah Johor Bahru, Pejabat Kesihatan Daerah Pontian.
Improving Percentage of Appropriate Tests Conducted in Serology Lab, HSNZ
Azlina binti Yahya, Osama bin Abdul Nasir, Serology laboratory,
Hospital Sultanah Nur Zahirah, Kuala Terengganu.
Improving IUCD Usage among Reproductive Women with Diabetes Mellitus In Health Clinics of Perlis
Dr. Muhammad Ridzwan Rafi’I,
Pejabat Kesihatan Daerah Kangar, Perlis.
01 02 03
FIRST EDITION 2019
Six projects have been selected for publication in the first edition of this facelifted bulletin.
04 05 06
71 The Fruit
SUPPLEMENTARY EDITION 2019
This edition of the Q Bulletin will comprise approximately 100 abstracts of QA projects from The 10th QA Convention 2019
Medication Stockpiling: A Red Alert to Combat for Quality, Safety and Efficacy of Medication
Lee Soik Fun, Chew Wei Yee, Louise Santana Malar, Nor Azrizan Binti Hashim,
Hospital Selama, Perak.
Improving percentage of Platelet Concentrates Component Conform to the Standard Platelet Count in HSNZ
Norsuzilawati Abdullah, Noor Hamizah Mohd Hassan, Mohd Muhaimin Kambali,
Hospital Sultanah Nur Zahirah, Kuala Terengganu.
Improving Pre-Pregnancy Care (PPC) among clients with Diabetes and Hypertension at Health Clinics in Kuala Muda District, Kedah
Azira Azmi, Norazdliza Azmi, Norliza Mohd Sabri, Nur Mahfuzah Mohamed Fauzi, Che Zaiton Yahaya, Rosmiza Khazaid, Hasniza Hashim,
Kuala Muda District Health Office, Kedah, Malaysia.


COMPENDIUM OF QA PROJECTS
Following the successful development of the four QA Training Modules and the QA Workbook, this compendium builds upon the endeavours of the first edition whereby all the projects presented at the National QA Conventions were compiled to become the references/databases of QA projects for the MOH. The goals of the compendium are two-fold viz:
A collective effort towards advancing Knowledge Management and enhancing the Innovation Culture within the Ministry of Health.
To serve as a healthcare practitioner‘s armamentarium, at his/her disposal to solve quality problems.
“Tell me and I forget, teach me and I may remember, involve me and I learn”. -Benjamin Franklin-
72
The Fruit


Journal of US-China Public Administration, September 2015, Vol. 12, No. 9, 706-713 D doi: 10.17265/1548-6591/2015.09.005
A Dental Quality Effort: Sharing the Success Story∗ Zurina Abu Bakar
Section on Quality in Oral Healthcare, Oral Health Division (Ministry of Health Malaysia), Putrajaya, Malaysia
Loh Kim Hong
Oral Health Division (Kuala Lumpur State Health Department), Kuala Lumpur, Malaysia
Siti Haniza Mahmud, Samsiah Awang, Nur Ezdiani Mohamed
Institute for Health Systems Research (Ministry of Health Malaysia), Shah Alam, Malaysia
Mazlina Md Desa
Oral Health Division (Selangor State Health Department, Ministry of Health Malaysia), Shah Alam, Malaysia
Quality assurance (QA) was introduced in the oral healthcare program of the Ministry of Health Malaysia for schoolchildren to improve the quality of curative care. One aspect of care monitored was the quality of fillings done on permanent teeth by the dentists and the nurses (the operators). The indicator measured was “percentage of repeat amalgam fillings done on posterior permanent teeth”. Following 14 years of monitoring, there was substantial evidence to show that this indicator has been institutionalized among the health personnel involved in the care. Among key factors for success in institutionalizing are top management commitment as well as clear, systematic approach to quality assurance programme. All 15 states in Malaysia showed marked improvement in the achievement of the indicator from 1995 to 2009. Kedah state showed the best achievement (0.04%) and Melaka state was the least (0.64%). This indicator had created awareness among operators of their responsibility to make accurate diagnoses, correct treatment decisions and place quality restorations.
Keywords: oral health, indicator, repeat amalgam fillings
∗ The authors would like to acknowledge the Director General of Health, Malaysia, Deputy Director General of Health (Research and Technical Support) and Principal Director of Oral Health Division for the support and the permission to publish this paper. The authors also wish to extend the acknowledgements to all State Deputy Director (Oral Health) and state coordinators for their effort with in ensuring the performance is achieved.
Zurina Abu Bakar, BDS, MCD, Section on Quality in Oral Healthcare, Oral Health Division, Ministry of Health Malaysia, Malaysia; research fields: health management and oral health. E-mail: [email protected].
Loh Kim Hong, BDS, DDPH, Oral Health Division, Kuala Lumpur State Health Department, Malaysia; research fields: health management and oral health. E-mail: [email protected].
Siti Haniza Mahmud, MD, MHP, Ph.D., Institute for Health Systems Research, Ministry of Health Malaysia, Malaysia; research field: health management. E-mail: [email protected].
Samsiah Awang, BPharm, MA in Medical Science (Public Health), Institute for Health Systems Research, Ministry of Health Malaysia, Malaysia; research fields: health management and pharmaceutical. E-mail: [email protected].
Corresponding author: Nur Ezdiani Mohamed, MBBChBAO, Institute for Health Systems Research, Ministry of Health Malaysia; research field: health management. E-mail: [email protected].
Mazlina Md Desa, BDS, MCD, Oral Health Division, Selangor State Health Department, Malaysia; research fields: health management and oral health. E-mail: [email protected].
DAVID PUBLISHING
Objectives:
• • •
Wrong labelling Switching sample Incorrect patient identification
Decision to transfuse
samBploliondg & labelling
Sefnodr breloqoudest component
tranPsfrue-sion testing
Rbelloeoadsebyof Blood Bank
BDleoloivdetroytohfe ward
Troafnbsflouosidon component
Patient monitoring
•
Incorrect patient identification
Figure 2: Crucial points in blood transfusion process
Ward
Blood Bank
Ward
most crucial points in the blood transfusion process
Human
Process
System
Training
Device
Environment
Attitude
No checking mechanism
Issue related to system
Lack of knowledge
Device to help prevent BT
Workload
Wlabreolnligng
Errors Incorrect
apddrmeuvrisinosiguosn pidaetinetniftication Error
Tranesrcrroipr tion
Switching
grBoluopoidng
Iesrsruoirng
chFeacilkurbelotod aigdaeintsiftipcatioent
STRIVING TO PREVENT BLOOD TRANSFUSION ERRORS (BTE) : AN INTERVENTIONAL PILOT STUDY
Siti Haniza M1, Afifah H2, Anis Syakira J1, Emy Sarah Ng AN1, Normaizira H1 , Samsiah A1, ,Sudharshana M1, Nur Khairah B1, Suhaizanzulailla A1, Nur Ezdiani M1, Zalina M2, Faraizah A K2, Noryati A2 1Institute for Health Systems Research, Ministry of Health Malaysia
2National Blood Centre, Ministry of Health Malaysia
What are we trying to accomplish?
1
How did we do it?
Blood transfusion errors (BTE) have major and direct impact on the patient, which may lead to death or severe morbidity resulting in end organ damage and prolonged hospital stay. Serious Hazard of Transfusion (SHOT) report 2011 showed that 53.4% of the hazards reported was due to human errors in the transfusion process1. Despite numerous measures that have been taken to prevent transfusion errors, an upward trend of errors over the recent years has been observed.
Secondary Data Analysis
2
Focus Group Discussion (FGD)
In Malaysia, prevalence of BTE is monitored under National Indicator Approach (NIA) with zero error as the standard2.
 To identify crucial points in BTE
 Haemovigilance and Incident report collected between January 2012 to
explore Health care workers’
Number of cases (n)
2009 2010 2011
2012
June 2013.
A check sheet was developed based
 To
perspectives on factors contributing to BTE
Near miss Actual error
187 141 314
306 22
on work flow in blood transfusion process, existing reporting form and experts’ consensus
 Conducted among 37 participants (Doctors, Nurses & Medical Laboratory Technologist) in selected 10 public hospitals in Malaysia
14 15 27
Table 1 : Number of actual transfusion error and near miss2
3
Development of Intervention
4 Evaluation of Interventions
1. To identify crucial points in the blood transfusion process where errors could occur
2. To explore health care workers' perspective on the factors that contribute to the error in
 Automated Patient Identification Technology (APIT)  “5P” Pamphlet Developed by experts
Questionnaires were developed to assess:
 Health care workers’ acceptance
transfusion process
3. To develop interventions to prevent future blood transfusion errors 4. To evaluate the effectiveness of the interventions
Outcome Measures
and pretested in a group ohfosppaittiaelnst.s in different
on APIT Pinattrioednutcetmiopnoowfe5rmPePnatmfoplhlolewting
1. 2.
Primary outcome: Number of near misses and blood transfusion errors Secondary outcomes:
 Implemented in 2016
May-August
i. Crucial point in BTE
ii. Health care workers’ perceived contributing factors to BTE iii. Patients’ level of knowledge and perception towards BTE iv. Providers’ level of acceptance in using APIT
*Both Interventions were implemented from
Nov 2015-May 2016 5 selected wards in Hospital Pulau Pinang
Total near miss cases = 202 cases
Total Incorrect Blood Component Transfused (IBCT) cases = 18 (each case can have more than 1 error)
20% of the factors causing 80% of the problems
Registration
Technical error
Figure 3 : Findings from FGD on factors contribute to BTE
There was NO near miss or incorrect blood components transfused during the 6 months study period
34% of health care workers supported the use of APIT to prevent BTE
74% patients acquired the knowledge and empowerBedTEt.o prevent
Lesson learnt:
 Multiple factors contribute to BTE such as environment, process, system, equipment, lack of
Figure 4 : Findings on evaluation of effectiveness of the interventions
knowledge and human error
 “Blood sampling and labelling” and “Transfusion of blood component” are crucial points identified in BTE
A Way forward....
 To conduct further study on APIT & Pamphlet in other hospital setting for longer study
 BTE can be prevented via technological device and patient empowerment
 These interventions requires high levels of co-operation and commitment from all parties
duration
 To continue application of APIT & Pamphlet at other wards in Hospital Pulau Pinang Reference:
12. SNHaOtioTn(2a0l I1n1d)icSaetroioruAspHparozarcdhs, oNfaTtrioanasfluCsoiomnm, Sitteeerifnogr GQrAoPu,pMAininsutrayl oRfeHpoeratth20M11a.laSyHsOiaT Office, Manchester Blood Centre, Manchester,
involved to ensure their success and sustainability
AWcektnhoawnkletdhgeemDiernetctor General of Health, Ministry of Health Malaysia for the permission to present this poster. This study was funded by Ministry of Health, Malaysia and conducted by Institute for Health Systems Research, in collaboration with the National Blood Centre, Malaysia (NMMR 13-510-14915).
Figure 1: Pareto chart for near misses case
What have we found?
mCiasussceaonfnonteabre
sample determined heororstohpreitrianl
Widernotnigficsatmiopnle
Table 2: Distribution of error for IBCT
Poster Presented at the International Forum on Quality & Safety in Healthcare 24th-26th August 2017 . Correspondence Person Contact Details: +6013 500 0982 Email: [email protected]
Check points
eNrrooorfs
Pre: In ward 6 Blood bank 8 Post: In ward 13
No of error
Journal of US-China Public Administration, October 2015, Vol. 12, No. 10, 752-758 D doi: 10.17265/1548-6591/2015.10.002
Implementing Quality Assurance in Public Health Facilities: The Malaysian Experience
Siti Haniza Mahmud, Nur Ezdiani Mohamed
Institute for Health Systems Research (Ministry of Health Malaysia), Shah Alam, Malaysia
Azman Abu Bakar
Medical Development Division (Ministry of Health Malaysia), Putrajaya, Malaysia
The Quality Assurance Programme (QAP) in the public sector of the Ministry of Health (MOH) Malaysia had been in place for more than 25 years. It is an effort by the government to ensure that care provided is at par with the regional and the worldwide standards. The process toward attaining what was achieved today is neither an overnight nor an easy journey. Thus, this paper intends to share the implementation progress of QAP in the MOH government facilities for future benefits. To date, the MOH’s champions in quality are well-recognized and had a strong governance structure that oversees the programme. Indicators were identified according to the needs of the activities in MOH and these measurements were used to measure the quality of the healthcare services in the government facilities. Sharing of best practices is done through local quality improvement journals and reports on the quality activities and research. Among the challenges faced is the process of gathering information. After 25 years, MOH is still collecting the information manually and hopefully, a better approach can be established.
Keywords: quality assurance (QA), government facilities, implementation
The health care industry in Malaysia adopted a dichotomous approach where the Ministry of Health (MOH) Malaysia functioned as the main provider of the health care services in the country. The other providers are agencies within the public sector—Ministry of Education (teaching hospitals), Ministry of Defence (Army Hospital), and Ministry of Home Affairs along with statutory bodies and local authorities. The public sector is complemented by the private medical sector (hospitals and clinics) as well as the non-governmental organizations (Hamid et al., 1998). Till December 2013, there were 149 hospitals in the government sector in which 141 were governed by the MOH. In the same year, there were 1,039 health clinics, 1,821 village clinics (klinik desa), 212 teams of mobile clinics, 13 teams of flying doctors, 52 oral health clinics, and 27 mobile oral health clinics. Apart from that, services in the urban poor areas were also provided by 254 1Malaysia Clinics and eight 1Malaysia Mobile Clinics which cover the remote areas far from a landed health clinic such as
Siti Haniza Mahmud, MD, MHP, Ph.D., Institute for Health Systems Research, Ministry of Health Malaysia, Malaysia; research field: health management. E-mail: [email protected].
Corresponding author: Nur Ezdiani Mohamed, MBBChBAO, Institute for Health Systems Research, Ministry of Health Malaysia; research field: health management. E-mail: [email protected].
Azman Abu Bakar, MBBS (UM), MPH (UM), Ph.D., Medical Development Division, Ministry of Health Malaysia, Malaysia; research fields: health management and health policy. E-mail: [email protected].
DAVID PUBLISHING
The Fruit
QA STUDIES AT NATIONAL LEVEL
Detailed analysis of NIA performance over the years has resulted in the commissioning of specific/targeted QA studies at national level to address the problem of certain NIA indicators being categorised as shortfall in quality (SIQ). The aim is to determine the contributory factors as well as their solutions.
7
73
3
Research Highlights
Technical Reports
Posters
Journal Publications


NHCQi NATIONAL HEALTH CARE QUALITY INDICATORS: A NEW PARADIGM IN MONITORING
Highlighted issues surrounding NIAs
Share findings
Agreement on framework & finding sources of indicators
inDdiactatohrusn; tinindgefxofror each indicator calculated based on their acshtaienvdeamrdent and
Sharing at international level
Directive from DG for implementation of NHCQI
KPI Patient KPK CSoaufentcyil
Outcome Based Budgeting
InHdeicalttohrs
NIA
STAGES
OFCARE: Effectiveness
Safety Patient- Costper CSoesrvtipcer, Enrollment Coverage Utiliz&ation Equity,
STAGES
OFCARE: Effectiveness Safety Patient- Costper Service, Enrollment Coverage & Equity,
STAGES OFCARE:
Effectiveness Safety Patient- Costper CSoesrvtipcer, Enrollment Coverage Utiliz&ation Equity,
Keep Healthy Cure when possible Chronic Disease/ Disability Rehab/ Palliative/ End-of-Life Care)
IND 70 IND 7672: 0.6
0IN.2D972: IND 73 IND 66
I0N.9D 63: IND 64
Keep Healthy
IND 5403,- 46 IND 542 IND 47 IND 53 IND 58
Keep Healthy Cure when possible Chronic Disease/ Disability Rehab/
IND 3236 IND 34
Service Delivery
WHorekaflothrce IND 67, 68, 69
Information Medical Products & Technologies
Finance
Leadership/ Governance
Service Delivery
Health Workforce IND 57
Medical Products & Information Technologies Health Needs of the Population
Finance
Leadership/ Governance
Information Medical Products & Technologies
Finance
Leadership/ Governance
IND 74
IND 75 IND 76
Chronic
Disease/
Disability
Rehab/
Palliative/ Palliative/
I I I N N N D D D 81 5 : 2 1 . 3 IND 13
IND 36: 0.7 IND 41: 1.02
I N D 1 1 :
I I N N D D 2 1 5 4 IND38 IND39
10th Malaysia Plan
Health Facts 2014
KPI YBMK
SOURCES OF INDICATORS
TOTAL
Index Calculation
1. Health Indicators
2. HKeyalPther,fMoramlaynsciae(IKnPdIicYaBtMorKs)of Minister of
3. KGeynePrearlforfmHaenacltehI,nMdiaclatyosrisao(KfPDIirKePcKt)or-
4. National Indicator Approach (NIA)
5. 10th Malaysia Plan (10th MP)
6. Health Facts 2014
7. Patient Safety Council
8. Outcome Based Budgeting
103 12 19 88 10 60 19 1 312
=
PeSrtfaonrmdarndce = 21.80 =210.9064
HEALTH OUTCOMES
Health Status
IND 60: 0.98
Sustainability & Financial Risk Protection Responsiveness/Experience
TUBERCULOSIS
HEALTH OUTCOMES
HealItNhD S49tatus Sustainability & Financial Risk Protection Responsiveness/Experience
DIABETES MELLITUS 17 Indicators
HEALTH OUTCOMES
HeaINlDt2h9:S1t.0a4tus Sustainability & Financial Risk Protection Responsiveness/Experience IND 24
CARDIOVASCULAR DISEASE
42 indicators
TOTAL
Siti Haniza M1, Amin Sah A2, Samsiah A1, Nur Khairah B1, Sudharshana M1, Suhaizanzulailla A1, Normaizira H1, Nur Ezdiani M1, Azman AB2, Shahnaz M3
1Institute for Health Systems Research (IHSR); 2Medical Development Division, Ministry of Health (MOH); 3Research & Technical Support Programme, Ministry of Health (MOH)
QAfrPomStuRdeyv;isgiatethder feedback on moving forward
cardiohveaaslctuhlcaarrde:isease & stroke, diabetes mellitus and tuberculosis
HEALTH SYSTEM PERFORMANCE
HEALTH SYSTEM PERFORMANCE
HEALTH SYSTEM PERFORMANCE
Health Service Quality EfficiSeynsctyemof the Access to the System
Health Service Quality EfficiSeynsctyemof the Access to the System Cost per Utilization
Health Service Quality EfficiSeynsctyemof the Access to the System
Centeredness beneficiary Efficiency IND 59
Timeliness Distribution IND 71
IND 65
Centeredness beneficiary Efficiency
Timeliness Distribution
Centeredness beneficiary Efficiency IND 40
Timeliness Distribution
HEALTH SYSTEM INPUTS
HEALTH SYSTEM INPUTS
DSelriviecrey IND 208-23
WHorekaflothrce IND 1452:-19,
HEALTH SYSTEM INPUTS
Health Needs of the Population
Health Needs of the Population
Fig 2 NHCQI Framework for Tuberculosis
Fig 3 NHCQI Framework for Diabetes Mellitus
Fig 4 NHCQI Framework for Cardiovascular Diseases
EFFECTS OF CHANGES
TAKE HOME MESSAGE This effort encourages collaboration and helps to break the silos between programmes in MOH to enhance the measurement of performance at national level.
LESSONS LEARNT
 A ‘basket’ of indicators used at national level
 Identified indicators cut across programmes and care
 Mapping shows the imbalance of current indicators which
   
Need to develop new indicators to cover broad spectrum of empty cell matrix according to the quality domains
For indicators having index less than 1: appropriate strategies needed to improve the performance
mainly focus on effectiveness of the health care performance  More emphasis should be given towards palliative and
Benchmarking with other countries’ performance measurement will add value to current indicators
Timely data for each indicator from different sources is one of the greatest challenge in implementing NHCQI.
rehabilitative care
 The index reflects performance of each indicator for the
particular diseases and at specific stages of care.
BACKGROUND
ASSESSMENT & ANALYSIS OF THE PROBLEM
The Malaysian burden of diseases is a dynamic condition which warrants a comprehensive monitoring approach encompassing a whole spectrum of care. The approach demands a tool which is sensitive in detecting the actual problem of a particular disease being monitored. The availability of a vast number of health care quality indicators but with minimal alignment among the various governance activities and national policy plans also amplifies the need for a new approach. There is a need to rejuvenate the measurement for quality improvement at national level.
Existing quality indicators are monitored in silos based on the need of individual programmes in Ministry of Health (MOH), Malaysia. There is no anchor connecting those quality indicators to reflect health outcome and health system performance at the national level. The significant impact of each indicator’s performance to the health care system is not apparent.
Study: Revisit QAP after 25 years 2009 – 2011
Consultation with program/State Liaison officers 2012 – 2013
Workshops with guidance of IHI, WHO consultants 2013 - 2014
Engagement with relevant MOH Programs May-Sep 2015 Fboacseuds on 3budrisdeansetos
engaMgeomreents with stake-
JLN Funded Consultancy & Workshop 22– 26 August 2016
Presentation to top leadership (Director-General of Health) April 2017
17 Indicators
ACKNOWLEDGEMENT:
Poster presented at
We thank the Director-General of Health, Malaysia for the permission to present this poster. This is a collaborative initiated between Institute for Health Systems Research (IHSR) and all the programs under the Ministry of Health (MOH), Malaysia
International Forum on Quality and Safety in Healthcare
Cure when possible
IND 58
1IN.0D 9:
End-of-Life Care
Fig 1 Chronology of NHCQI development STRATEGY FOR CHANGE
MEASUREMENT FOR IMPROVEMENT Data Retrieval
Performance Index
IND 46: 0.7
IND 48
IND 55 IND 56
IND 51
0.9
NIA
KPI KPK
huonldteinrgs &2d0a1t5a- 2016
End-of-Life Care
IND27
IND 29 (Indicator 29)
Prevalence of smoking in those aged > 15 years old
IND10
Kuala Lumpur Convention Centre 24 - 26 August 2017
Social / Environmental / Economic Determinants OUTPUTS
Social / Environmental / Economic Determinants
Social / Environmental / Economic Determinants
The Fruit
FINE-TUNING THE NIA WITH NHCQI
The NIA is essentially programme-based and its indicators are specific to the respective programmes’ areas of concern. Thus, to bridge the gaps such as continuity of care issues (preventive and promotive, curative, rehabilitative, and palliative), the National Healthcare Quality Indicator (NHCQI) concept was introduced. On the contrary, the NHCQI is disease or health goal-based and focuses on desired health outcomes such as the reduction of disease incidence as well as morbidity and mortality, financial risk protection and also positive patient experience.
The implementation of NHCQI helps in linking various existing indicators in different quality domains. It allow monitoring of the indicators at different stages to reflect the overall health status of the country’s population.
74
NHCQI Poster
IHI Framework


THE 10TH NATIONAL QA CONVENTION
2019
Quality-driven Healthcare:
The Heart of Universal Health Coverage
14-17 October 2019
Bukit Gambang Resort City, Pahang
7755
The 10th National QA Convention 2019


This year marks the 10th series of the convention which is jointly organised by the Institute for Health Systems Research (IHSR), the State Health Department of Pahang Darul Makmur and the Malaysian Society for Quality in Health (MSQH). Besides the QA project competition being the key agenda, this year’s convention features many exciting events including plenary sessions, a short video competition and is graced by renowned speakers who are experts in healthcare quality.
More than 100 projects are being presented at the convention, participated by more than 800 delegates representing multiple professions from the public and private health sectors.
18 39 49
Projects (Oral Category)
Projects (Poster Category)
Projects
(Market Place Category)
76
The 10th National QA Convention 2019
Convention e-Booklet


EXCITING FEATURES
of the 10th National QA Convention 2019
1 Collaboration with MSQH
3 “Tokoh QA Lagenda” Award
5
Short Video Competition
11
Q- Bulletin facelift
13
“Best Participation” Award
supplementa
r
y
e
d
O
istration for Pr
n
li
n
e
R
eg
it
io
n
esenters / C
2
10
C
12
Understudy “Trainee Jury” earmarked to become future National QA jury members
4
“Poster Pilihan Pengunjung” Award
7
Exhibition booths
9
Abstract Booklet in Q Bulletin
6
Online Registration for Presenters
8
Digital Convention Booklet (e-book)
offee Table Book
Market Place Quiz
77
The 10th National QA Convention 2019


THE JUDGES
of the 10th National QA Convention 2019
ORAL CATEGORY
Official Jury
Dato’ Dr. Abd Jamil Abdullah (Head)
Pakar Bedah Umum
Hospital Sultanah Nur Zahirah
Dr. Izzamin Idris
Pegawai Kesihatan Daerah
Pejabat Kesihatan Daerah Kota Bharu
Dr. Suguna Devi Muniandy
Pakar Pergigian Ortodontik Klinik Pergigian Seri Kembangan
Trainee Jury
Dr. Raja Zarina Raja Shahardin
Pakar Perunding Pergigian Pediatrik Hospital Kuala Lumpur
Dr. Cheah Wee Kooi
Pakar Perubatan & Geriatrik Hospital Taiping
Pn Farizan Abdul Ghafar
Pegawai Farmasi Hospital Serdang
POSTER CATEGORY
Official Jury
Mr (Dr) Azmi Alias (Head)
Pakar Perunding Jabatan Neurosurgeri Hospital Kuala Lumpur
Dr. Noorhaida Ujang
Pegawai Kesihatan Daerah Pejabat Kesihatan Daerah Muar
Pn A’tia Hashim
Pengarah Lembaga Farmasi Malaysia Kementerian Kesihatan Malaysia
Trainee Jury
Dr. Habibah Yacob
Timbalan Pengarah
Cawangan Epidemiologi dan Sistem Penyelidikan Kesihatan Pergigian
Dr. Noorul Emilin Abdul Khalid
Pegawai Perubatan
Pejabat Kesihatan Daerah Sik
Dr. Zahar Azuar Zakaria
Pakar Perunding Obstetrik dan Ginekologi Hospital Kemaman
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2019
PN FARIZAN ABDUL GHAFFAR
Pegawai Farmasi Klinikal, Hospital Serdang, Selangor
DR. ZAINAL ABIDIN OTHMAN
Ketua Jabatan Anaestesiologi, Hospital Melaka
DR. ROSLAN JOHARI
Pengarah,
Hospital Rehabilitasi Cheras
DR. NORDIN MOHAMED
Ketua Penolong Pengarah Kanan, Jabatan Kesihatan Negeri Perlis
DR. KHAMIZA ZANOL ABIDIN
Pakar Periodontik,
Klinik Pergigian Gunung Rapat, Perak
The QA Icon
TOKOH QA CEMERLANG AWARD
DR. LEE MING LEE
Pakar Perunding Pediatrik Nephrologi, Hospital Tuanku Ja’afar, Seremban
PN NOOR MARIATI OTHMAN
Pegawai Farmasi, Hospital Jengka, Pahang
DR. WAN ZAHANIM WAN YUSOFF
Pakar Perunding Obstetrik & Ginekologi, Hospital Raja Perempuan Zainab II, Kota Bharu
PN FAJARATUNUR A. SANI
Pegawai Farmasi,
Pejabat Kesihatan Daerah Johor Bahru, Johor
DR. MOHD ZULKIFLI MOHD KASIM
Pakar Perunding Obstetrik & Ginekologi, Hospital Sultanah Nur Zahirah Terengganu
DR. NGIAN HIE UNG
Pengarah,
Hospital Sibu, Sarawak
DR. RAJA ZARINA RAJA SHAHARDIN
Pakar Pergigian Pediatrik, Hospital Kuala Lumpur
DR. NORIZAN AHMAD
Ketua Penolong Pengarah Kanan, Jabatan Kesihatan Negeri Kedah
PN ATISHA ABDUL HANIF
Pegawai Farmasi, Hospital Pulau Pinang
“Yesterday I was clever, so I wanted to change the world, Today I am wise, so I am changing myself ” -Rumi-
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Dato’ Dr. Abd. Jamil Abdullah, is a Consultant Surgeon at Hospital Sultanah Nurzahirah, Kuala Terengganu. He is certainly an extraordinary medical doctor and a renowned QA champion in Malaysia as well as internationally.
Born in Pahang on 7th December 1956, he obtained his basic medical degree from the University of Alexandria, Egypt and then went on to obtain his postgraduate surgical qualifications in Edinburgh, UK. He is also an avid sportsman. He was once an examiner for the Masters in Surgery course, twice MMA chairman for the Terengganu branch and also a national treasurer for SCHOMOS.
His QA journey began way back in the early 1990’s when he was appointed to replace his colleague as the hospital’s Clinical QA Coordinator for Patient Care Services, which he accepted rather reluctantly. From then on, one thing led to another and he became more interested in QA. As the QA coordinator, he had to attend the National QA workshop conducted by the Health Systems Research Division, part of the training of which involved undertaking a QA research project.
In 1993, he was given the opportunity to learn more about QA through visits to several US hospitals. Then, in 1996, he undertook a one-month study tour in Melbourne and Sydney, Australia. Well-equipped with the fundamental knowledge and tools of QA, he further honed his skills by implementing various QA activities both locally and nationally. He has been accorded recognition as a QA expert when he was appointed as a National QA Convention judge for more than a decade. He has also greatly contributed to the field of Patient Safety and Hospital Accreditation programmes.
Significantly, he has simplified the teaching of QA in such a way that even the most inexperienced practitioner of QA could grasp its fundamentals. To this end, he co-authored the seminal QA publication entitled “QA Workbook; Problem Solving Approach”, which has become the main reference text used in QA training. He is a treasure trove of QA knowledge and is ever willing to impart or share his knowledge with anyone interested in QA. His aim is to promote and strengthen the QA movement in Malaysia through knowledge sharing. Dato’s memorable teaching methods include
“Bangau oh Bangau” approach in understanding cause and effect analysis in QA.
He is a much sought after QA resource person whose dream is to train as many people as possible in the field of QA. To him, most importantly, quality improvement activities should be undertaken to improve services as well as
health outcomes for the raison d’etre of the healthcare system i.e. our patients.
Thus, Dato’ Dr. Abd.Jamil Abdullah is certainly deserving of the QA Lagenda Award 2019.
TOKOH QA LAGENDA AWARD
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PEARLS OF WISDOM
Emanating from the Lips of our QA Champions
12
QAP and QA convention have created a platform for awareness of quality
As a platform for learning and improving through research approach
An effective and efficient method to resolve quality issues with added value and to reduce waste
As a platform of learning from and sharing with other industries
As an appreciation, effective rewards and incentive mechanism
Create quality culture among staff to think of a better and efficient way of solving quality problems
Provide centralised electronic database of QA projects
Suggestions for the betterment of QA convention in the future
Project-related issue:
• Improvements suggested should be data-driven • Finding ways to sustain gains made for
long-term improvement
• Ensuring continuous monitoring of the QA
project
• Expand the topics and coverage of quality
projects presented
Presentation related issue:
• Need for better use of current
technology during presentation
Content/agenda of the convention:
• Diversifying the speaker pool to include experts
from both health and non-health sector
Allocation of specific budget for QAP project implementation and upscale as well as for organising QA convention
More effort needed to translate good quality project into policy and practice
Sincere views of the Malaysian QAP including the QA conventions
81
What Do some Quality Champions say?


3 Suggestions for the betterment of QAP in Malaysia as a whole
Need for better understanding of the root cause of quality problems
Solution and strategies for change must be workable and practical
Enhanced engagement with private sector Need for integration of all quality initiatives Strengtening the quality structure at all levels
The need to develop coherent implementation and Enhance leadership commitment
monitoring plan e.g.
• Include QA implementation as part of
organisational performance target
Strengthening QA training programme:
• Conduct continuous training activities at all levels
to develop a pool of QA champion
• Apply new ways of training with IT
• Provide opportunity for international training
• Continue organising QA convention
• Be the international/regional champion in quality
Continuous review of prevailing indicator and standard
Positive quality culture – no blame culture Innovation and technology in quality
Our heartfelt appreciation to the following QA champions for their invaluable words of wisdom:
Dato’ Dr. Ahmad Razin Ahmad Mahir, Dato’ Dr. Azman Abu Bakar, Dr. Mohammad Omar, Dato’ Dr. Abd. Jamil Abdullah, Dato’ Dr. Ghazali Ismail, Datin Dr. Siti Haniza Mahmud, Dr. Noorhaida Ujang, and Dr. Raja Zarina Raja Shahardin.
82
What Do some Quality Champions say?


Utilise more innovative approaches and techniques to further
enhance the dissemination of QA study findings.
Promote the application of findings and recommendations of
QA studies for decision making.
Undertake continuous mass capacity building for QA
Develop and promulgate
innovative training materials as well as
introduce up-to-date or cutting edge quality tools
for the conduct of QA projects
Develop and implement
aggressive mechanisms
to promote the replication
and upscaling of commendable QA
projects.
Open up opportunities for
international training in QA
Establish digitalised database for
QA projects
Promote and facilitate
the publication of QA projects within the local and international arena.
To enhance
reward system for
QA including giving due recognition to promising
QA practitioners.
To uplift
the international
standing of our national QA convention by inviting
world renowned speakers and opening the convention to
regional and international participants (ASEAN/
WPRO countries).
Establish smart partnerships with like- minded organisations in
order to promote systemic quality culture within the
Malaysian healthcare systems.
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Nurturing Passion and Commitment - The way forward to further excellence:
CRAFTING THE FUTURE
To nurture future leaders and champions for quality
Capacity building Dissemination Other


Inspirational Anecdotes 3.0
By: David Bolick
When Japan’s Sanyo Shinkansen “bullet train” first came into service, residents along the train line complained about the disturbing noise level. Almost half of the line was made up of a tunnel section, and the train would produce a tunnel boom on exiting due to the sudden change in air resistance.
The engineers pondered about the problem until one of them remembered having read about a bird with a unique design feature-THE KINGFISHER.
To catch its prey, the kingfisher dives from the air, which has low resistance, into high-resistance water and it only creates the smallest splash upon entry.
The engineer surmised that this was due to the shape of the kingfsher’s beak being perfectly suited to deal with such changes in resistance.
He and his colleagues conducted simulations by shooting various shapes into a pipe and measuring the pressure waves on exit. The data showed that the ideal shape for the nose of the bullet train was almost identical to a kingfisher’s beak - Thus, PROBLEM SOLVED!
The engineers probably would have had a much more difficult time finding the solution if they had relied solely on their training and experience as mechanical engineers.
The solution was only found when one of them LOOKED ELSEWHERE.
84 84
Source: www.activated.org
THE KINGFISHER EFFECT


Acknowledgement
Our sincere appreciation to all those who had given their views and provided ideas towards the realisation of this book
The Decades-long QA Odyssey
Celebrating the 10th National QA Convention 2019
85


Centre for Healthcare Quality Research (CHQR) as the Editorial Members
Standing from left: Ms Anis Faiqa, Dr. Divya Nair, Mrs Norhafizah, Mr Mohd Syafiq, Dr. Nur Wahida Mrs Normaizira, and Dr. Siti Fazira Edzua.
Sitting from left: Mrs Noor Hasidah, Dr. Izzatur Rahmi, Dr. Samsiah, and Mrs Nur Khairah.
EDITORIAL TEAM
Dr. Paa Mohamed Nazir Abdul Rahman as the associate editor
The chief editor, Dr. Samsiah Awang and Dr. Paa Mohamed Nazir Abdul Rahman as the associate editor






INSTITUTE FOR HEALTH SYSTEMS RESEARCH MINISTRY OF HEALTH MALAYSIA
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