Blue Ocean Strategy
Risk Center (Pusat Bersalin Berisiko Low Rendah1Malaysia MAIWP-HPJ) Hospital Putrajaya.

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Healthcare service in Malaysia is 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 specialty and subspecialty services, this 341 bedded hospital that utilizes fully the computerized Total Hospital Information System (THIS) Hospital Putrajaya (HPJ) has been a favoured centre for delivery and this has caused an overload of patients wanting to deliver in HPJ. As HPJ is a computerized hospital with a total of 56 beds in the maternity/gynae ward and total of 10 delivery suites in labour room which includes observation beds. This resulted in transferring out patients to other nearby hospital such as Hospital Serdang, Hospital Kajang, Hospital Kuala Lumpur and other hospital nearby in Klang valley areas. With the existence of 4 health clinic in Putrajaya itself which are clinic Presint 3,9,11 and 18 have caused an overcrowding of patients to Hospital Putrajaya. Transferring patients out to nearby hospital for delivery has caused inconvenience and dissatisfaction among patients and this resulted in complaints letters to the hospital and other related higher authorities. This indirectly has created bad impression to the department and also hospital as a whole. Base on statistic, in 2012, a total of741 cases being transferred out to other hospital as compared in 2013 only a total of292 patients. Besides that HPJ is a first class hospital whereby the charges are higher compared to other government hospitals. This surely will allow those people who are working as government servants and medium class people to deliver at Putrajaya. This has cause a lot of dissatisfaction among public who wishes to deliver in Hospital Putrajaya. Parking places is another issue as overcrowding of patients has congested the parking area and this has cause problem not just to the public but as well as to the staffs in getting their cars parked. The implementation of “Pusat Bersalin Berisiko Rendah” (PBBR) Putrajaya has definitely solved the problem of overloading patients for delivery at HPJ and allow the low socio economic class patients to deliver at PBBR Putrajaya. The presence of PBBR has in a way solved many problems as above and it has enable public to come and deliver in PBBR without worrying about beds availability or charges. It has also indirectly resulted in reduced car park congestion. In general view, statistic of deliveries in Hospital Putrajaya shown a reduction in the total number of deliveries since the PBBR initiated In 2010 the total deliveries were 5493, in 2011 it was 5581, 2012 was 5594 and obvious reduction in 2013 after initiating PBBR was 5281. PBBR provide services to all type of groups regardless or ethnicity local or immigrants. A clinical risk criterion is the sole criteria for admission.

B. Strategic Approach

 2. What was the solution?
Ybhg Datuk Dr. Noor Hisham Bin Abdullah who is currently the Director General of Ministry of Health proposed this solution. A major problem is the overcrowding of patients wanting to deliver in Hospital Putrajaya which has caused a lot of complaints as many wishes to deliver in Hospital Putrajaya. Having PBBR Putrajaya will allow more patients especially the lower economic class patients to be delivered in Putrajaya as it is a third class charges as compared to Hospital Putrajaya which is being charged as 1st class rate. Therefore more public can come and deliver in Putrajaya as cost is no longer an issue. This has resulted in less overloading of patients in the Labour suite Hospital Putrajaya as more with fulfill criteria can be send to PBBR for delivery. It also diminishing complaints regarding not able to deliver in HPJ due to the charges and all this has increased the number of deliver in Putrajaya. Therefore more low risk cases can be delivered at PBBR and HPJ can accept more high risk cases or more problematic cases can be managed in HPJ. With the subdivision of low risk cases to PBBR, the moderate and high risk cases can be concentrated at HPJ and this can reduced the possibilities of morbidities. Therefore this will create a more systematic condition whereby the high risk will be managed in HPJ and the low risk cases being managed at PBBR. As an end results this will increase the total number of deliveries in Putrajaya. PBBR is a National Blue Ocean Strategy (NBOS) that involves multiple government agencies for the benefit to public. With NBOS, our PBBR project was able to initiate earlier than expected as the 3 agencies responsible for the PBBR took the initiative to support and to ensure that PBBR can function as early as possible without disrupting the quality and quantity of services provided.

 3. How did the initiative solve the problem and improve people’s lives?
The initiative is a National Blue Ocean Strategy (NBOS). It is a strategy to generate growth, profits and new demands in as contested market space such as PBBR Putrajaya. It is an approach to complete the government transformation for the benefit of public. NBOS will strengthen the collaboration of below agencies that will result in the optimum output and a better outcome. This PBBR is building interpersonal skills and this resulted in a refreshing approach to critical work. PBBR was built on teamwork of few agencies that collaborate well. These agencies each contributes and play their role well in ensuring the success of PBBR. a. Majilis Agama Islam Wilayah Persekutuan (MAIWP) contribute money for PBBR. b. Bahagian Pengurusan Hartanah (BPH) contributed an apartment block to be used as wards and the apartment hall as the birthing centre. c. Ministry of Health (MOH) provides an adequate staff which includes the Specialists, Medical officers House officers, trained staff nurses, trained midwifery nurse, attendants as well as drivers and transport.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The strategy was executed and implemented as below: a. Director General (DG) Of Ministry of Health (MOH) had a meeting with MAIWP - in order to get the grant for PBBR b. Ministry of Health meeting up with BPH in order to acquire the medical facility c. Hospital Putrajaya (HPJ) discussed with MOH Engineering team in getting the renovation done on the 16 October 2011. d. HPJ, MAIWP and BPH had a meeting in November 2011 in trying to synchronize and consents on type of services and implementation. e. Renovation started on the 21st November 2011 and completed on the 16 January 2012. f. Few HPJ internal meetings were conducted, discussed on the clinical services, work processes and installation of ICT software. g. Trial Run in January 2012. h. Service started on the 31 January 2012, whereby the 1st baby was conducted on the 31 January 2012. i. Officiate by Prime Minister on 19th April 2012

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The Stakeholder involves agencies such as listed below: a. Majlis Agama Islam Wilayah Persekutuan (MAIWP) is a government agency which is first established in 1st February 1974 under Wilayah Persekutuan Federation. It is responsible in handling the Islamic community affairs. MAIWP contributed a total of RM 9,876,000.00 to be used for paying the buildings, renovation and asset. b. Bahagian Pengurusan Hartanah (BPH) is a government institution that provides the ready built apartment not being occupied to be used as wards and low risk birthing centre. c. Ministry of Health (MOH) is a government institution and this is a healthcare institution which provides professional and supporting medical staff such as specialists, Medical officers, house officers, matrons, sisters, staff nurses and community nurses, attendants and drivers. Besides that MOH also involved in supplying engineering expertise for the renovation of PBBR.
 6. How was the strategy implemented and what resources were mobilized?
The main resources were contributed by these 3 major agencies MAIWP, BPH and KKM. Details as elaborated below: a. MAIWP main role is to contribute money to ensure the ongoing of PBBR. They supplies the monetary need to setup of the place such as labor suites, wards and others facilities need to run PBBR. b. BPH - contribute an apartment block complete with a hall to be used as labour suite. This apartment is located at Presint 8 which is about 5 minutes away from HPJ. The apartment consists of 8 floor with 6 units in each floor. Level 1 is the antenatal and postnatal wards. The second floor is meant for NICU/ SCN. The 5th floor are being used as clinics whereby main clinics are infertility, urogynae and gynaeoncology.  Infertility contains of 3 units whereby 1 unit is being used as Seminal fluid analysis counseling and preparation  Another 1 unit is used as an IUI room run by a trained staff nurses and Medical officer. Another 1 unit next to this unit is used as a counseling unit for couple before going through the IUI procedure.  Urogynae clinic for patient with Uterovaginal prolapse and urinary problems consists of 2 units. 1unit is used as a clinic with urodynamic machine placed in one of the rooms for UDS assessment.  Gynaeoncology clinic is a clinic that deals with gynae cancers. These clinics consist of 1 unit and mainly follow-up cases will be seen here. c. Ministry of Health (MOH)–This is a health care institution own by the government that provides human resources such as Specialists(Obstetricians and Gynecologists) Medical Officers, House Officers, Trained Staff Nurses, Trained Midwifery Nurses, Attendants, drivers as well as transportation(ambulance services).

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
With the existence of PBBR there are many successful outputs: a. Number of low risk deliveries in HPJ has managed to be reduced and this will give way to the high risk cases with green, yellow and red coded to deliver in Hospital Putrajaya. b. Increased total number of deliveries as at the same time white code which is a low risk case are able to be delivered at PBBR and this contributed to an increased number of deliveries in total for Hospital Putrajaya. In 2012, the total deliveries in PBBR Hospital Putrajaya were 402 and till October 2013, the current totals are 373 deliveries. c. Reduced number of patients to the clinics as some subspecialty clinic is being managed in PBBR. d. Decongestion of the parking areas. Since low risk deliveries and some subspecialty clinics are being managed in the PBBR, more parking spaces are available. e. The existence of PBBR has reduced the number of lodger cases in the Labour Suite Hospital Putrajaya or being transferred out to other nearby hospitals. It will be more convenience to the public. f. Lower socioeconomic group can now delivered in Putrajaya as PBBR charges are 3rd class charges. This will definitely reduced the burden of hospital bills and still be able to deliver in a very comfortable and homely environment. g. Reduction in lodger cases. h. Since the implementation of PBBR, statistic has shown a reduction in number of lodger pt in the Labour Suite Hospital Putrajaya.In 2012 there were a total of 1899 cases being lodger as compared to in 2013 which were 1331 cases. This in a way has decongested lodgering in the Labour Suite. i. Open more job opportunities to public. j. Reduction in transferring out patients to nearby hospitals. k. Base on statistic, in 2012, a total of741 cases being transferred out to other hospital as compared in 2013 only a total of292 patients. This reduction reflected the success from PBBR implementation.

 8. What were the most successful outputs and why was the initiative effective?
Prior to full service progress or renovation works, human resource procument and medical assets acquired were done by coordination meetings between stakeholders and internal meetings in each stakeholders department. After service has started in PBBR medical services were monitored by the Ministry of Health through Hospital Putrajaya. Clinical Medical Services were monitored by The Head of O&G through clinical service monitoring. It will look into Medical service Key Performance Index, Mortality and Morbity review. Incidents reporting, Daily, Weekly and monthly Neonatal and Delivery census. The Maintenance service is monitored by the Director of Putrajaya Hospital through the administrative department which looks into clinical waste disposal, cleanliness and security of the compound. The Electronic Medical records are monitored by the record office and IT department of the Hospital. The hospital does 3 monthly coordination meeting of these services to ensure smooth running and trouble shoot teething problems. At the same time also plan for future expansion of the facility Overall evaluation of the implementation is done by doing customer satisfaction survey and quality assurance program under the responsibility of the Hospital Director.

 9. What were the main obstacles encountered and how were they overcome?
As any centers, PBBR also has its own obstacles that are either in the process of improving or still in planning to overcome. The obstacles are as listed below; i) Number of deliveries.  Earlier the number of deliveries has been low as cases need to be screening by the Labour Suite HPJ before sending to PBBR.  However, health side clinics have been briefed regarding the criteria required to send patients to PBBR and as a results of these actions, more low risk patients came walk in to PBBR and this has caused an increased in the number of deliveries in PBBR. ii) Wards limitation.  Wards limitation has now becoming a problem as more patients occupying PBBR. As at the moment only 1st floor is being used as wards and this give rise to a total of 16 beds which are not enough. Therefore a plan of expanding the wards to 2nd and possible 3rd floor is currently in discussion.  By expanding the wards, more public will be able to deliver at this centre. iii) Staffing.  With the increasing number of deliveries, more staff is required and this is being identified and attended to. Adequate staff is important in ensuring optimal care to the public. During the early initiation of PBBR, 252 staff were acquired however only 30% intake of staff during the implementation. iv) Hospital compliance.  Despite having the whole apartment block assigned for PBBR, only the ground, 1st and 2nd floors are established and approved for usage. This is because of limited budget for further implementation.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The benefits of PBBR are as listed below: i) More low risk deliveries in PBBR.  With the existence of PBBR, more low risk deliveries will be conducted there and this will directly increases the number of deliveries in Putrajaya as a whole.  This will reduced the overload of deliveries in the Labour Suite of HPJ. ii) More high risk deliveries in HPJ.  Labour Suite in HPJ will be able to concentrate on attending the high risk cases as these cases are associates with more morbidity. iii) Enable lower social economic population delivering in HPJ.  HPJ is a 1st class hospital whereby the charges are higher compared to other government hospitals.Therefore only those who are affordable or government servants are able to deliver in HPJ.  However, with the existence of PBBR with 3rd class charges, public especially the lower socioeconomic group will be able to deliver in Putrajaya and this will benefit the public as a whole. iv) Expansion of other services such as subspeciality clinic at PBBR.  Despite the low birthing centre, with a strategic locations and infrastructural, PBBR can be expandable and providing other subspeciality clinics to the public. v) More training to the staff as more deliveries obtained.  More deliveries will enable the junior doctors and nurses to practice their skills and this indirectly will improve their clinical assessment and management. Therefore the public will be receiving services from well trained and professional staffs. vi) Expansion of women health services to the public.  With the above steps, PBBR will not only managing low risk deliveries, it will also able to give other services in improving women health to the public. vii) PBBR gives a home environment to public with low risk to deliver. It is a very warm environment, with comfort feeling, safe and very important attended by well trained medical personnel.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
PBBR is a good example for other hospitals. Despite it short term of life, it has shown to give a lot of benefit to the public that’s not just confined to Putrajaya but also to the Klang Valley areas. As a National Blue Ocean Strategy programme that received supports from Majlis Agama Islam Wilayah Persekutuan, Bahagian Pengurusan Hartanah and Kementerian Kesihatan Malaysia, PBBR will be able to sustain in the future time and this can be transferrable to other centers. PBBR can be taken as an example or a pilot study in initiating other centers to have a NBOS program similar or more expandable as the aim is to give an optimum healthcare to the public without burdening them about the cost. Great benefits will be obtained by the public and this will not just improve the healthcare in Malaysia generally, it will also bring up the women health care to the eyes of the world.

 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)
PBBR is a National Blue Ocean Strategy that involves collaborations of MAIWP, BPH and MOH is indeed a beneficial programme that not only gives a lot of benefit to the public especially to the lower socioeconomic status group, it also helps in improving the health care especially women health care in our country. This programme can be expandable to the highest point in order to give the optimum benefits to all.It can be a good example to other states to initiate the same programme as we believed one of our aim is to give the best and optimum medical care to the public as what has been said by our Prime Minister Datuk Seri Mohd Najib Tun Abd Razak that public are to be taken as 1st priority in ensuring transformation towards good. Involvement of other department such as anesthesiology, pediatric and others are very beneficial in ensure not just optimum care but also good outcome by the end of the clinical treatment. In the future, PBBR is not just constrain to low birthing centre but the services should be expandable to moderate risk group as well as providing other women health care such as subspecialty clinics as this can improve the overall women health status in our country.

Contact Information

Institution Name:   Risk Center (Pusat Bersalin Berisiko Low Rendah1Malaysia MAIWP-HPJ) Hospital Putrajaya.
Institution Type:   Government Agency  
Title:   DATUK DR  
Telephone/ Fax:   +603-88832545
Institution's / Project's Website:  
Postal Code:   62502
State/Province:   PUTRAJAYA

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