| 4. In which ways is the initiative creative and innovative?
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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
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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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.
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| 6. How was the strategy implemented and what resources were mobilized?
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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).
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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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.
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| 8. What were the most successful outputs and why was the initiative effective?
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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.
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| 9. What were the main obstacles encountered and how were they overcome?
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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.
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