Ensuring healthcare delivery system works

The NST Sunday Interview

THE SUNDAY INTERVIEW: Ensuring healthcare delivery system works
By Annie Freeda Cruez


Datuk Dr Ismail Merican, the Director-General of Health, has been making his rounds, meeting the doctors, nurses and administrators of public hospitals around the country. Putting faces to names is just the first step of his mission to make public hospitals the first, rather than last, cho ice for Malaysians, he tells ANNIE FREEDA CRUEZ

Q: We heard you have been on rounds to check what is happening in hospitals?

A: I care just not for doctors but all levels of healthcare providers in the ministry. That is why I am going round the country meeting everyone ranging from state and hospital directors to specialists, doctors, nurses, attendants, medical assistants and allied health personnel.

Why? Because I want to send the message that each one of them is important in the whole structure of the healthcare system.

I find the time to do that. Some of them had never seen the face of their director-general before. Now they have, and I'm listening to what they say. They may have particular problems and may also give good suggestions to improve the service. The important thing is to make sure they know we care.

We may not be able to offer better remuneration, but at least we can improve the working environment and career structure and provide more opportunities for them to update themselves technically.

If they want to pursue further training overseas to improve themselves, I will be the first to support them. I have gone to the Penang, Seremban and Malacca hospitals and I hope to cover all the States this year. I want to make sure I know the people I am dealing with. Some of them are names I see on documents. Now I want to meet and put a face to the names.

Q: How are you planning to bring changes?

A: I (want to) remind doctors of their role. What they can do and what they cannot do, that is what I mean by good medical practice.

I would like doctors to go back to the original concept of being doctors. I want ministry doctors to be the best they can.

Now, we are giving them more opportunities for training, providing a good working environment and better on-call allowances. In essence, we take care of our healthcare providers, so they in turn should take care of the profession and their patients and clients.

Q: You are known as the no-nonsense Director- General...

A: I have a strong sense of urgency. When instructions are given, I expect those who have been entrusted with the task to carry it out quickly and not delegate it to someone who will take a couple of weeks or months to get it done.

I place a lot of emphasis on trust and responsibility. If, for some reason, the instruction is not carried out, they must come back to me with an explanation.

When I give it to them personally, I mean business, and it also means that it is urgent and needs to be done quickly, within a week or two.

Similarly, patients must be given due attention, care, importance and a sense of dignity. It is unprofessional to make people wait and wait for decisions to be made simply because no one wants to make a decision and keep on passing the buck.

Some decisions we have made to improve the healthcare system include the implementation of the fast-track lane, reducing patients' waiting time, making sure doctors wear their white coat and name tags, rotation of doctors to various disciplines, and branding the Ministry of Health.

I assess the staff at all times. People walk into my room and I assess them as to how much they know and how much they don't know. I want to make sure they know more than me and if I know more than them in their area of expertise, I get apprehensive with the officers concerned.

The state and hospital directors must inform us of anything unusual that happens in the State or hospitals so that we can take fast remedial action. Nothing is worse than getting the news from the newspapers.

Q: What about doctors' complaints?

A: Doctors are unhappy about the working environment and slow promotions. This is my priority and hopefully in the next few months, we will be able to get more good news from the authorities regarding this.

Doctors also welcome greater opportunities to specialise and improve their knowledge and skills.

Q: What other improvements do you have in mind?

A: If they can improve the healthcare delivery system, have a sense of belonging, have a sense of urgency and are imbued with the ministry's corporate culture, I will be more than happy.

Q: At what stage is the National Health Plan?

A: It is going according to plan. Under the Ninth Malaysia Plan we are gearing towards upgrading of healthcare facilities as well as improving human capital.

I don't want to depend too much on foreign expertise. We need to start the training right now. We need to identify people, send them overseas so that they can come back and train others. Building human capital is very important.

Right now there is an imbalance regarding the type of specialist services offered in this country. We want to address this problem.

We need to identify the people and train them so that after four to five years, we will have a good group of competent and highly skilled specialists and sub-specialists to cater to the needs of our country.

Q: What about national healthcare financing?

A: I think enough has been said. The concepts and principles are very clear. The principle is, those who can afford must pay and those who cannot afford — the elderly, handicapped and the poor — will be taken care of by the Government. The concept is very simple.

We would like the public to get the same quality and scope of care or even better care from an integrated healthcare system.

Q: What about the target group?

A: It is being worked out. The Government and the ministry is very caring. We are not so heartless as to leave people in the lurch, as claimed by some NGOs or associations which keep on churning out statements and rhetoric as if they are the only ones who care about the people.

Please give us some credit. We have been toiling all these years to serve the people with high quality healthcare. Surely we are not about to abdicate our responsibility and leave sections of the population uncovered.

We always maintain that whatever we introduce is going to be better than what we have now. We are very caring and we will know what to do when the time comes.

Q: What plans (are there) to handle emerging are there and re-emerging diseases?

A: We have formed two committees. One is the National Pandemic Preparedness Plan, a special committee which will look into how we respond to a pandemic. It was set up in early May. I already had the first meeting to lay down the ground rules.

We must simulate an outbreak and see how far we are prepared. I intend to do this soon and enlist the co-operation of all stakeholders including the public and private sectors, the NGOs and the community.

We already have the SOP (standard operating procedures) and the guidelines about having these are not good enough. We need to simulate and test the system and see how prepared everyone is.

The second committee is the National Laboratory Biosafety committee which is important as well as it will make sure that all the labs in the country have the required standards to cater for the diagnosis of emerging diseases and identification of the aetiological agent.

We have in place a good surveillance system and early warning systems to detect unusual syndromes or atypical clinical presentations and take the necessary measures to contain and control as well as alert the community.