Konvensyen QA/QI Ke 25 (Jubli Perak) Hospital Kuala Lumpur 6-7 November 2014,

First and foremost, I would like to thank the organising committee for inviting me to this auspicious and meaningful event, the 25th QA/QI Convention, Hospital Kuala Lumpur (HKL), with the theme “Commitment, Internalization and Realization”.
Celebrating 25 years of QA/QI in HKL is definitely reflective of years of commitment to quality. This realization is achieved because of the participation of committed individuals in the hospital. I am very glad that the organising committee has taken the effort to recognise the pioneers who have contributed in many ways towards the success of this initiative. A special word of thanks to the “Ikon Quality” individuals who will be recognised today for their contributions towards Quality in HKL. I would also like to remember those who are still serving here faithfully over the years. Your contributions are not forgotten.
As a nation working together for better health, the Ministry of Health (MOH) is to ensure a high quality health system that is customer centred, equitable, affordable, efficient, technologically appropriate, environmentally adaptable and innovative. This requires a systematic and continuous work to ensure systems are in place to deliver what is intended to be delivered.
Ladies and gentlemen, the Quality Assurance Programme (QAP) in the Ministry of Health started as early as in the year 1985 with the objective of ensuring that patient, family and the community obtain the optimum achievable benefit from the services of the MOH within the available resources. This initiative has been modelled after the Donabedian framework of Structure, Process and Outcome and the concept of ABNA, Achievable Benefit Not Achieved. The emphasis has been “local people solving local problems”. This is a Problem-Solving Approach that starts with identification of problems, prioritization of problems, problem analysis, identification of remedial actions, implementation of the remedial actions and re-evaluation thereby completing the QA cycle.
Healthcare professionals seek to provide the best for our patients and we endeavour towards providing a professional service. We establish a self check mechanism called peer review to ensure standards are kept and Clinical Practice Guidelines (CPGs) or SOPs are followed. Systems are in place to ensure healthcare professionals are continually trained and retrained, certified and privileged to perform competently. We take action to ensure all the work processes especially the clinical work processes are evidenced-based. We established a system to ensure all this is done through a systematic process, measured, evaluated and improvement instituted and reassessed.
In the MOH, many Quality Improvement initiatives run parallel to each other. Much has been done in areas of Clinical Audit, Mortality Review, Credentialing & Privileging, ISO 9001, Accreditation, Risk Management, Incident reporting and many others. I would strongly urge all clinicians not to forget the basics and that is to audit oneself. It has been said, if we do not audit ourselves, someone else will audit us. The assurance of performance must be continually sought after.
I would like to see, each professional discipline take charge and chart your way to greater heights. No one else can do that for you. It is you and you yourself together as group of like minded people that can come together to do it. Having said that, a good collaboration between healthcare professionals, allied health professionals and others is equally important. This is often the key for success and sustainability. “Teamwork, Caring and Professionalism” as envisioned in our Corporate Culture is the driving force for us to move forward together.
I would like to congratulate the HKL for the continuous publication of the Kuala Lumpur Hospital Journal of Quality Improvement for the past 17 years. Good practices should be shared and published. By publication, others will know what we are doing. Otherwise it is just a very nice thing to have for that moment. By documenting, we allow others to challenge the “good practice” for further improvements. That is Quality Assurance and Improvement.

Congratulations to HKL for the many awards won over the years. First prize for Oral presentation at the National QA Convention 2005, special Jury prize for 2007 and third prize for 2009. I am also aware that staffs of HKL has participated in many National and International Conferences and have won prizes. To mention a few, the Minimally invasive neurosurgery and navigation neuroendoscopy for cranial and skull base surgery as an effective innovation in improving surgical outcome, Robotic surgery in Urology, the HKL Experience, Minimally Invasive Spinal Surgery and many others.
I am told that HKL is the national champion for being the champion nationally in producing the most number of QA (HSA/DSA) projects in comparison with the other states in the country. This is reflective of the system that is in place to continually churn out QA projects year after year.
I would like to specially recognise the contribution of the allied health group especially the nursing team of dedicated staff that continued tirelessly towards the quality improvement. Similarly, I am told the pharmacist too has been very active group in the quality improvement activities. I am told that certain departments in HKL tend to be especially active and always winning in the Quality Improvement Awards i.e. Pharmacy, Paediatric Dental, O&G, Imaging & Diagnostic and Pathology Departments. It must be due to many champions in these departments. However, we would like other departments to also actively get involved in these initiatives and together help improve the service as HKL moves towards Premiership.
I am glad to know that HKL has started the Work Culture transformation towards Premier HKL with Service Excellence, Integrity and teamwork as the core values. As HKL Journeys towards Premier Hospital, I believe it should be a reality soon. HKL as the largest and oldest hospital in Malaysia has the structure and the process to achieve this.

Ladies and gentlemen,
What is next for Quality? The initiatives are many and the slogans are often mentioned. We recognised that whatever is the name given to the initiatives, the goal is the same and that is to ensure a high quality health system.
Work processes in healthcare are very complex and often outcomes cannot be guaranteed. What we have to do is to ensure that all processes run efficiently and outcomes are measured for improvement purposes. Our quality policy and strategies are available. However, we need a more focused action plan. We need to measure our success more evidently with verifiable data.
Ladies and Gentlemen,
Your theme for this year’s Convention “Commitment, Internalization and Realisation” forms the cornerstone for the next 25 years?
A model of success in any endeavour lies in ownership and empowerment. One has to feel that he or she owns the work process. Thus he or she is empowered to do the right thing. When there is ownership and empowerment, commitment is the natural outcome. This is just like a man or a woman starts his own business or his or her own clinic. He or she owns that clinic, thus is empowered to want his or her clinic to be a success and will be fully commitment to that. This commitment we are talking about comes from inside because he or she has internalise it. Thus, ideas for improvement come naturally and continually because there is a passion and motivation to do that. Realization through this commitment bears quality fruits.
This model is seen in HKL over the 25 years. I understand that one of the key successes for QA/QI in HKL is the ownership of this activity by the clinicians who have taken the leadership for this. This has been designed and built into the system over the years. QA/QI in HKL has proven as a platform for improvement and the learning has been institutionalised. It has indeed proven that people come and goes but the system remains. This strength should be further supported and strengthen. We need to continually find new younger champions so that the baton for quality is continually passed on.
In ensuring quality improvement initiatives are not slogans or good to have programmes, Hospital Directors and Heads of Department has to take active role in ensuring sufficient funds and time are made available for improvement initiatives. A mechanism of funding for such initiative should be formalised. Managers need to ensure that he or she champions to obtain funds for the purpose of improvement.
The challenges ahead are many. Healthcare personnel have to deal with emerging diseases and the ever present issues relating to appropriateness of care, over utilisation, over servicing, wastage and the list goes on. There are some newer initiatives that MOH has embarked on like the Blue Ocean Strategy and the Lean Healthcare Initiatives. To improve performance in the face of rising demand, MOH together with our partners PEMANDU and University Kuala Lumpur MITEC JB, under the Public Service Delivery Transformation Program had embarked on Lean Healthcare Initiatives which is an approach of process redesign that maps, reviews and redesign the patient journey to meet demand and ensure that care is safe, effective and efficient. Simplifying the journeys patients make through MOH hospitals can reduce errors, improve patients’ access to services, lower costs, improve patient and staff satisfaction and make better use of existing resources ( as shown from evidence in other countries that have implemented Lean Healthcare).
I can see that Lean Healthcare Initiatives is very similar what the QA/QI initiatives. Lean Healthcare is just not implementation of tools and technical methods that focuses on short events but more of a cultural change that takes time, efforts and persistence. Thus, MOH need to establish a Lean Governance and creating infrastructures such as Lean training functions, and internal consultancies to support the teams at the hospitals to drive continuous improvement. I would urge HKL is also fully embark on Lean Healthcare Initiatives as you move on another 25 years of QA/QI in HKL.
Ladies and gentlemen, I wish all of you a fruitful time in sharing the success in your QA studies and the improvement that can be instituted and replicated. I believe all of you will benefit from the programme that have been prepared.
Have an enjoyable and fruitful convention. On that note and with the great word Bismillahirahmanirrahim, I declare the Konvensyen QA/QI Ke 25 (Jubli Perak) Hospital Kuala Lumpur 6-7 November 2014, open. Thank you.

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