| 4. In which ways is the initiative creative and innovative?
The implementation of the PHDP begun with the few meetings between HPJ Pharmacy Department, HPJ IT Department, PosLaju, PosNiaga, and Legislation. The main agenda of the meeting was to discuss the mechanism of the delivery comprising of commercial rate and mode of payment, finalization of technical requirement and operations. The technical requirement inclusive of trial run of 7 deliveries as suggested by PosLaju Bangi conducted free of charge where the charges were bourne by PosLaju. PosNiaga also presented the proposed rate under Phase 2 for online and manual subscriptions as agreed by Pos Malaysia Berhad.
The operations of the PHDP were finalized on the packing on the medication prior to pick-up, HPJ is required to maintaning patient database, clients could contact Pos Malaysia Berhad Customer Service to obtain connote number for tracking shipment. Besides this, it was also agreed upon for PosLaju to call clients before delivery of the medicines and in cases where no response after 48 hours from clients for delivery, PosLaju is required to return the medicines back to HPJ.
In agreement between the stakeholders, the medicines will be couriered directly to the clients’ preferred location within 7 days from the appointment date. The maximum duration for delivery is 2 days within West Malaysia and at least 4 days for East Malaysia subjected to the terms and conditions as safety measures in maintaining the quality of the medicines. The transport and storage conditioned maintained in air conditioned temperature throughout the shipment.
The PHDP started with the initiation of the pilot project which comprises of 2 surveys which are client response survey, carried out from 3rd and 4th September 2009, which is acceptence of the new service and willingness to pay the minimal fee for the service. The survey concluded that 74.7% of clients responded to the survey accepted the new service and 60.2% willing to pay to obtain the offered service.
The pilot project was started on 13 October 2009 for the initiation of the new service. Initially the response was slow, but picked up in response soon after.
The second survey conducted in the pilot project was simple survey of targeting daily average number of clients enrolled in PHDP service. This survey was carried out from 1st March till 5 March 2010. The target number of priscription for the PHDP was justified based on the total amount of priscription screened everyday in HPJ Out-Patient Pharmacy. The target 6 patients per day was achieved after 8 months of implementation and was monitored there after.
On 24 January 2011, the “Ubat Melalui Pos” UMP system (as it is known today) was officially launced in HPJ by YB Dato’ Sri Liow Tiong Lai, the Health Minister of Malaysia.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The stakeholders are primarily consists of multidiciplinary team who were responsible for creating a self sustained service system which could cater to the target population.
Top management JKWPKL&P level
Dr Ismail Abu Taat
District Health Director, JKWPKL
Dr Nora’i Mohd Said
Director, Hospital Putrajaya(HPJ)
Dr. Salmah Bahri
Deputy District Health Director (Pharmacy) JKWPKL
Madam Halimatus Sa’diah Ahmad
Former Chief Pharmacist, Hospital Putrajaya
Madam Noraini Mohamad
Miss Salmi Abdul Razak
Miss Madeline Leong En Hui
Madam Teh Chew Charn
Miss Rubaizah Yatim
Mr Mohd Shafarudin Osman
Madam Noorazlina Hashim
Y.Bhg. Tan Sri Dato' Seri Dr. Aseh
Chairman, Pos Malaysia Berhad
Y.Bhg. Dato' Mearia Hamzah
Head of operational officer, PosNiaga
Tuan Haji Nadza Abdul
Head of operational officer PosLaju
Chief Information Officer
Rohani Abdul Wahid
Raizaini Ahmad @Harun
eBusiness & Government Agency Unit
Nor Azizan Tarja
Deputy General Manager
Mohd Effendi bin Muhammad
Deputy General Manager
Faizah binti Ismail
Head of Marketing
Noor Fazlina Noordin
Manager, Credit & Collection
Mr. Zaimy Shaari
Chief of Deputy Director, eKL Department
Miss Mazilah Mohd Amin
Assit. Chief Director, Infrastructure devolopment section, eKL Department
Miss Noor Huzaimah Husin
Assit. Chief Director, Infrastructure devolopment section, eKL Department
| 6. How was the strategy implemented and what resources were mobilized?
The resources that were utilized in the implementation and mobilization of the PHDP were that of the existing service provided through SMS TAKE & GO service. No new dispensing counters were required as the existing counters were utilized. Apart from that, pharmacists’ resources in terms of manpower, facility and technology required in mobilizing this service were also utilized from the existing SMS TAKE & GO service. The postal packaging requirement were hosted by Pos Malaysia Berhad.
Standard Operating Procedures were developed in 15 January 2010 detailing on the process of the new service from patient enrolment until the parcel is delivered to the patient were developed. Various method of client enrolment into this service is also implemented. These methods includes enrolment from the out-patient pharmacy counter, posonline (www.posonline.com.my), email (email@example.com), fax, telephone and short-messaging service (SMS) were deployed. Promotional materials were distributed during client enrolment, hospital website and the dispensing counter.
The daily operational cost were supported continouosly by HPJ administration unit.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
PHDP’s success was mainly contributed by all the stakeholders directly or indirectly.
The foundation of this innovation is a fully committed team of Hospital Putrajaya pharmacists who are the driving taskforce behind PHDP. The team underwent training to ensure that PHDP runs smoothly. The training module includes policies and standard operating procedures (SOP) of PHDP. The information is then disseminated to all pharmacy staff, thus the service well known. Furthermore, a pharmacist and other support staff such as pharmacy assistant is allocated for the purpose of ensuring the home delivery of medication to patients is uninterrupted.
The Hospital Putrajaya top management never failed to provide support for the project to take-off. They offered working space under the roof of Hospital Putrajaya exclusively for PHDP. This working space is utilized for drug preparing, packaging, storing and collection. A dedicated parking area is allocated for Pos Malaysia van for collection to ensure no delay in patients receiving their medications month to month.
As one of the hospital in Malaysia which implement THIS, this innovation will require an advancement in technology, both hardware and software. In order to achieve this, a good support was obtained from the hospital top management and other collaborating parties which include Malaysian Administrative Modernisation and Management Planning Unit (MAMPU) and Pos Malaysia. The necessities required in setting up this programme such as printers, computers, and technical support was provided. As communication between healthcare providers and patients are crucial in the delivery of any healthcare service, MAMPU has effectively worked together with Hospital Putrajaya to offer broadcasting services (mySMS). This broadcasting service has facilitated pharmacists-patient relationship where pharmacists will inform patients when their medication is sent out. Patients have the option to arrange their delivery time through mySMS.
Government and non-government collaboration was a success in PHDP. Pos Malaysia was thoroughly involved by providing various requirements needed. Right from preparing until receiving, they provided the material for packaging, labelling as well as free pick up service. Promotion is done by Hospital Putrajaya to try to attract customers to join in by providing pamphlets and promoting PHPD to patients during dispensing.Other than that, Pos Malaysia also actively promotes PHDP hand in hand with Hospital Putrajaya to future customers. This promotional campaign is advertised through internet and television. Cooperation of Pos Malaysia and Hospital Putrajaya was translated in their directly involvement in producing television advertisements together.
| 8. What were the most successful outputs and why was the initiative effective?
Several mechanism and indicator has been developed to guarantee the project being monitored and evaluated.
One of the monitoring parameter is Key Performance Indicator (KPI). The KPI is sent out to the Malaysia Pharmaceutical Division on a monthly basis. The KPI documents the number of parcel sent out to patients in East Malaysia and West Malaysia. This number reflects the amount of participants involved in PHDP. When the service was first implemented in 2009, the amounts of participants were 15, which then increased dramatically to 1039 participants in 2010. The number increased consistently in 2011 and 2012, with 3163 and 4520 participants respectively.
After the implementation of this innovation, a positive outcome was observed, especially the group of patients who have staggered supply of medication. Therefore, a par was set as to ensure that 20% of patients with staggered supply of medication use Value Added Services provided by Hospital Putrajaya which includes PHDP. This parameter will help to sustain this innovation and measure the magnitude of achievement.
Other than KPI, PHDP is also monitored through Pharmacy Management Statistics which is also done monthly. This statistics captures the number of new patients who take part in PHDP, as well as patients who have used this service more than once. Besides that, statistics for the number of parcels returned to Hospital Putrajaya are also captured. This information provides the means for Hospital Putrajaya to investigate the pitfalls of Pharmacy Home Delivery by Poslaju. Thus, the effectiveness of PHDP can be evaluated from time to time.
As a continuous surveillance of PHDP, integrated meeting with all stakeholders are held to safeguard the sustainability of the innovation. This meeting is a platform to discuss issues pertaining to PHDP, as well as to improve the service at national level.
A Patient Satisfaction Survey was conducted in 2010 to evaluated patient’s satisfaction towards the innovation. Patients were given a courtesy call to ask whether they are satisfied with the service, and 100% of patients were pleased with the service. Patients were also inquired is they are interested to continue to use the service in the future, and 93% were interested. This fuelled the innovation to transform into a service that appeals to a large audience.
| 9. What were the main obstacles encountered and how were they overcome?
No advancement comes without any obstacles. At the beginning of the implementation of PHDP, only 60% of patients were willing to pay for the service. Patient perception towards PHDP was successfully changed in the coming years through promotions and precise explanation by Hospital Putrajaya Pharmacists.
As the number of participants rises, there is a need for additional manpower and working space to cater for the increasing amount of requests for PHDP. With this limitation, Hospital Putrajaya had taken strategies to maximize manpower and working space. This is done by staff rotations and deployment during peak hours. The working space is maximized by installing cabinets to increase storage space for medications.
Financial constraint was also an obstacle in managing PHDP. The start-up cost was minimal; nevertheless the operational cost is quite substantial. The cost includes packaging material, broadcasting cost and other hidden costs. This obstacle was minimized with the collaboration between Hospital Putrajaya and Pos Malaysia, whereas the broadcasting cost has been minimized to USD $0.03 per SMS. This cost being supported under the hospital operational budget.
There is also a setback in delivery of medication, where some parcels are unable to be delivered to the addressee. As a remedial action, a PHDP hotline was introduced to accommodate any related enquiries. The broadcasting service is utilized as a means to notify patients when they can expect their parcels to arrive. Lost parcel is traceable through the Pos Malaysia website, and should any problems arise, they could be easily contacted trough their hotline for assistance.
As the innovation sets sail, a comprehensive patient database is required to facilitate in the delivery of the correct medication to the correct patient. This database includes patient information (ie: ID, contact information), prescription date, duration and expected time for delivery. To achieve this, technical support was provided by the management of Hospital Putrajaya.