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PHARMACY HOME DELIVERY WITH POSLAJU (PHDP)
HOSPITAL PUTRAJAYA

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Describe in no more than 500, words the situation before the initiative began. What major problems and issues needed to be addressed? What social groups, e.g., the poor, illiterate, disabled, elderly, immigrants, women, youth, ethnic minorities, were affected and in what ways? Healthcare service in Malaysia is mainly governed by the Ministry of Health (MOH). The people are free to choose either the public or the private healthcare service. Putrajaya Hospital, a MOH health facility started its operation in 2000. It is located in the federal government administrative area of Putrajaya which is also within the Multimedia Super Corridor. Besides providing a wide range of speciality and subspeciality services, this 272 bedded hospital that utilises fully the computerised Total Hospital Information System (THIS) . As National Breast and Endocrine Centre, patients are referred from all corners of Malaysia. This poses as a significant financial and logistical problem for certain sub group of patients such as the poor, those living in rural areas without proper access to transportation, the elderly and the very ill. On average, patient’s has an appointment every 4 - 6 months whereby the doctor will provide a prescription until the next visit. Staggered supply of medicines is a common practice at HPJ to ensure safe, effective and quality supply of medication by promoting proper storage practices among patients. Findings showed that on average, 25% of patients visit the Pharmacy Counter to collect partial prescriptions every day. This becomes an inconvenience as patients have to take time off their daily schedule in order to commute to HPJ. Staggered supply of medication may generate new problem when patients are unable to obtain supplies every two months. The continuity of pharmacological treatment becomes compromised and this leads to shortcomings in achieving treatment goals. With the limited number of dispensing counters, the Client’s Charter and the Key Performance Indicator (KPI) which requires 100% of the prescriptions to be dispensed within 30 minutes are seldom achieved. Patients are also faced the problem of limited parking spaces when they come to the hospital especially during peak hours. Hence, with the restricted resources for further structural expansions, innovative services have been initiated by the hospital to ease the current situation. Among these is the Pharmacy Home Delivery by PosMalaysia (PHDP) for the supply of repeat medicines in order to avoid long waiting time, patients’ frustration looking for parking bays and at the same time fulfilling the MOH’s KPIs of providing flexible drug delivery services for patients’ convenience.

B. Strategic Approach

 2. What was the solution?
PHDP is flexible healthcare delivery service, carried out in collaboration with national courier service (Pos Malaysia Berhad). It started as a pilot project on 13th October 2009 by the Pharmacy Department of Putrajaya Hospital for delivery of partial supply of medicines to patients at the location of their choice. The idea was conceived by the current Director General of Health, YB Datuk Dr Noor Hisham Abdullah to address the shortcomings that arose with staggered medication supply. The services were offered to clients for the supply of repeat medicines after initial supply from the hospital. It is also in tandem with one of the Health Service Goals of the MOH that is “Service Closer to Home”. This innovation also involved cooperation with Malaysian Administrative Modernisation and Management Planning Unit (MAMPU) in implementating the government SMS gateway under the SMS Programme (mySMS) by using one common number i.e 15888 for all goverment agencies. The medicines will be couriered directly to the 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. The conception of PHDP was done with the objective of addressing the various drawbacks that the clients face associated with staggered medication supply. These includes patient congestion and parking constraints, inability of achieving waiting time KPI, financial and logistical obstacles, as well as issues related to patient compliance to treatment. The intention of providing PHDP may even incur additional benefit such as improving client satisfaction due to this innovative value added service. With the implementation of PHDP, patients will constantly have their medication supply anywhere and everywhere in Malaysia with minimum cost of transportation to the health facility. As Putrajaya Hospital is the National Breast and Endocrine hospital, patients living as far as East Malaysia will benefit from PHDP. For example, a journey from Kuala Lumpur to Putrajaya Hospital, a distance of 35km is estimated to cost approximately USD20 compared to USD1.50 (within West Malaysia), USD2.50 (to East Malaysia) or USD1.00 (within Putrajaya vicinity) if patients choose to use PHDP service. PHDP runs with little overlap with routine pharmacy services, it allows for more focus in servicing clients who come after their physician visits. This allows significant workload reduction during peak hours, unnecessary stress and most importantly medication errors which have become a major concern in the country. Simultaneuosly, the waiting time for the patients to obtain their medicines within 30 minutes at the Outpatient Pharmacy has improved as much as 31% (62% to 96%) since the pilot launch of PHDP in 2009. When medicines are delivered straight to their doorstep for their convenience, patients’ compliance to their medications is inevitably improved which will indirectly contribute to better treatment outcome and quality of life. Client satisfaction is reflected by the number of patients using PHDP service which grew rapidly with a total of 15 patients opting for this service within 3 months of its launching in 2009. In 2010 this number grew exponentially to 1039 patients and this number continued to grow to 3163 patients in 2011 and 4520 in 2012.
 3. How did the initiative solve the problem and improve people’s lives?
PHDP service delivers partial supply of medicines to patients at the location of their choice by the national courier, Pos Malaysia. There are various ways of using PHDP. Patients can make a pre-order at the Pharmacy counter during their initial medicines collection, telephone, email, SMS to 15888 or through the website (www.posonline.com). The use of mySMS allowed for reduction in operational cost as compared to services offered by other hospitals. It eliminates the cost of purchasing a handphone unit, SIM card and monthly billing with a telecommunication company. Data on waiting time reduction and the increase in participation has revealed that this inovation has infact been a success in meeting the objectives of its inculcation. The existence of Total Hospital Information System (THIS) facilities, partnership with MAMPU and collaboration with PosMalaysia has given the Pharmacy Department of Hospital Putrajaya an ideal opportunity to offer these innovative patient-friendly services.

C. Execution and Implementation

 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. Rank Level Name Position Civil Servant Top management JKWPKL&P level Dr Ismail Abu Taat District Health Director, JKWPKL Facilitator Dr Nora’i Mohd Said Director, Hospital Putrajaya(HPJ) Dr. Salmah Bahri Deputy District Health Director (Pharmacy) JKWPKL Team Leader Madam Halimatus Sa’diah Ahmad Former Chief Pharmacist, Hospital Putrajaya Pharmacist Madam Noraini Mohamad Miss Salmi Abdul Razak Miss Madeline Leong En Hui Madam Teh Chew Charn Pharmacist Civil Servant IT Department Miss Rubaizah Yatim Mr Mohd Shafarudin Osman Madam Noorazlina Hashim IT Personnel Private PosLaju/PosNiaga 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 Mohd.Rosdeen Hassan Chief Information Officer Rohani Abdul Wahid Manager, E-Business System Raizaini Ahmad @Harun Manager, 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 Public Institution MAMPU 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 (pharmacypost@hpj.gov.my), 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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
There are various key benefits that can be derived from this initiative. The biggest benefactors naturally are the public sector. This initiative is a time saving approach that benefits the public in a multitude of factors, such as zero waiting time as the medications were prepared beforehand and sent to the doorstep of the patient, without them leaving their home. Also, with the implementation of PHDP, patients will constantly have their medication supply anywhere and everywhere in Malaysia with minimum cost of transportation to the health facility. As Putrajaya Hospital is reference centre of excellent for the National Breast and Endocrine hospital, patients living as far as East Malaysia will find PHDP service very useful. For example, a journey from Kuala Lumpur to Putrajaya Hospital, a distance of 35km is estimated to cost approximately USD20 compared to USD1.50 (within West Malaysia), USD2.50 (to East Malaysia) or USD1.00 (within Putrajaya vicinity) if patients choose to use PHDP service. In addition, minimal fee for the PHDP service within Malaysia region that was incurred to clients proven to be cost-saving In tandem with one of the Health Service Goals, i.e. “Service Closer to Home” and 1Malaysia aspiration, i.e. “People First, Performance Now”, patients with disabilities and/or difficulties (e.g. chronic disease patients, transportation problems) can conveniently register to PHDP service through online service (www.posonline.com.my) from the comfort of their home. Medication acquisition through PHDP was made simple and stress-free compared to traditional ways, i.e. over-the-counter dispensing. Patients are guaranteed to receive their medication through PHDP service supported with fast and efficient courier service provided by POSLAJU. In the end, patients will experience an uninterrupted supply of medications, thus increasing patients’ compliance to medication regimens. Good Pharmacy Practice requires that the core of the pharmacy activity is the supply of medication that is of assured quality in alliance with Quality Use of Medicine (QUM), which incorporates the 5R’s (right drugs, right patient, right dose, right time and right route). Pharmacists play an integral role in assimilating the aspiration to bring services closer to the patient by optimizing the use of current technologies available without compromising good quality care of patients. PHDP service have successfully divert the crowd at Pharmacy counter for partially supplied medication during peak hours by as much as 2.0%, thus affecting waiting time performance indicator where 95% of patients manage to collect their medication within 30 minutes after implementing PHDP service compare with only 64% of patients before the innovation. Significant workload and unnecessary stress reduction during peak hours was recorded whilst improving productivity and quality of services. By having pharmacist involved in every facet of drug delivery prior distribution by POSLAJU, possible medication errors can be reduced to minimal. Apart from that, these services also have caused marked reduction in patient complaints and most importantly medication errors. These innovative services offer privileges and fulfil patients’ satisfaction towards provision of better health care. PHDP had received numerous positive comments from patients’ via media social, interview, survey, etc. and this service has been marked as “world class”, “convenient”, “client friendly”, “good job”, “two thumbs up”, “great idea”, etc. PHDP had been nominated for several accolades locally such as Prime Minister Innovation Award (AIPM) and National Blue Ocean Strategy (NBOS); and internationally such Asia Pacific Information and Communication Technology Alliance (APICTA) and Commonwealth Association for Public Administration (CAPAM). This project promotes healthy collaboration between the government (i.e. the hospital) and corporate bodies. It has demonstrated a win-win situation for all parties as it is a great success to introduce and develop the first integrated healthcare delivery services in Malaysia for the benefit of citizens and provides an opportunity for corporate bodies to gain economic advantage from the project.
 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
PHDP have been applauded by the public with a steady increase in the total number of patients using these services while their inputs and recommendations have been sourced through various customer satisfaction surveys. The support from public is the pillar that has enabled PHDP to grow from strength to strength. They have embraced this initiative and recognised it as a viable alternative to the routine experience of collecting medicines from the pharmacy. The support from the government sector, particularly from the state and ministry levels, has been vital in maintaining the sustainability of PHDP. Various government agencies such as MAMPU, under the patronage of the Prime Minister Department have contributed pivotal collaborations to expand the services of PHDP. One such collaboration is the usage of MySMS under MyGoverment Mobile Services with the official number for all government services, i.e. 15888. PHDP also forged strong links with corporate bodies such as POS Malaysia and DAPAT. POS Malaysia via POSLAJU is a national courier service with extensive coverage all over Malaysia while DAPAT have been the service provider for various government mobile and internet services. PHDP has managed to generate income for these corporate agencies while trying to emulate their strong work ethics and business know how. Promotional activities are carried out continuously via various channel of media advertisement, e.g. websites, bulletin, brochures, and social media that would involve government and private agencies such as MOH websites, MAMPU, POS Malaysia and other hospitals. In sustaining the PHDP service, minimal dedicated staff required to manage the PHDP service (i.e. a pharmacist and an assistant). Therefore, this service can be implemented to other healthcare facilities in Malaysia with minimum human resource involved. The optimisation of information technology in Hospital Putrajaya has also portrayed development of integration services with other government agencies and non-government agencies such as MAMPU and POS Malaysia. The PHDP service is easily implemented in other healthcare institution with electronic prescription and/or Total Hospital Information System (THIS). Information conveyed via electronic system that can be accessed by other institutions, providing fast and accurate information at finger tips. Alternatively, institutions without electronic system can rely on MySMS service provided by MAMPU as a kick-start for PHDP implementation.
 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Pharmacy Home Delivery with PosLaju (PHDP) is one of the creative innovations introduced by Putrajaya Hospital which had successfully improved frontline services in health facilities of Malaysia. The service helped to achieve our Ministry of Health (MOH) National Key Performance Index (KPI) in reducing patients’ waiting time to obtain medicines at the pharmacy counters. It is an innovation in healthcare created to deliver good quality care by reaching out all patients regardless of location and age. With PHDP, all patients in Putrajaya Hospital is assured to receive continuous supply on medication where medication are delivered directly to their doorstep regardless any region in Malaysia. The collaboration between Putrajaya Hospital and other agencies, especially with MAMPU and Pos Malaysia Berhad (PMB) have indeed demonstrated a win-win situation for all parties as it is a great success to introduce and develop the first integrated healthcare delivery services in Malaysia for the benefit of the population and provides an opportunity for corporate bodies to gain economic advantage from the project. The initiative indirectly improves team work and create a condusive working environment for the pharmacy staffs. Crowds of patients with partial prescription for continuity of medication were shifted by opting PHDP service. Therefore, this project enhances the excellent services and good image of Putrajaya Hospital with lesser waiting time on medication supply and reduction of dispensing errors as medication are prepared at least 1 week before delivered by post to all patients in need. Patients’ responses towards PHDP service are positive and encouraging. In addition, support and commitment from higher authorities in MOH have shown great success of the service with further expansions in other health facilities in Malaysia which in turn will benefit all walks of life. With the success of the pilot project of PHDP in Putrajaya Hospital and the flexibility of this innitiave, PHDP is easily adapted and adopted to all MOH healthcare facilities. With the success of the pilot project of PHDP in Hospital Putrajaya, Ministry of Health (MOH) have expanded this services nationwide under the name of “Ubat Melalui Pos 1Malaysia” (UMP 1Malaysia), which served Malaysian citizens proper pharmaceutical care and continuous healthcare service. Official launching of UMP 1Malaysia was officiated on 24th January 2011. In conclusion, the development of PHDP have shown significant improvement in productivity, creativity and innovation with great efficiency in providing better healthcare delivery system with world class services to patients.

Contact Information

Institution Name:   HOSPITAL PUTRAJAYA
Institution Type:   Government Agency  
Contact Person:   NORA'I MOHD SAID
Title:   DR  
Telephone/ Fax:   03-83124356 / 03-88880137
Institution's / Project's Website:  
E-mail:   ppnorai@hpj.gov.my  
Address:   HOSPITAL PUTRAJAYA, ADMINISTRATIVE CENTER OF FEDERAL GOVERNMENT OF MALAYSIA, PRECINCT 7
Postal Code:   62250
City:   PUTRAJAYA
State/Province:   FEDERAL TERRITORY OF PUTRAJAYA
Country:  

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