The Role of Clinicians in

Quality Transformation
Dato Abd Jamil Abdullah
Head of Surgical Services
Ministry of Health

Consultant Surgeon, HSNZ, Kuala Terengganu


Traditional roles
Traditionally
Doctors
Nurses
Allied Health

PATIENT CARE
Administrators
Finance
Engineers

ORGANISATIONAL
CARE
Clinician participation
CEOs in highest-performing organisations
engage clinicians in dialogue and in joint
problem-solving efforts
Enhancing Engagement in Clinical Leadership, Acdemy of
Royal Medical Colleges and NHS Institute, 2007
Clinician power
Hospitals with greatest clinician
participation in management scored 50%
higher on drivers of performance than
hospitals with low levels of clinical
leadership
Pedro J Castro et al, A Healthier health care systemfor
the United Kingdom Mckinseyquarterly.com, Feb 2008
Clinicians & Quality
Quality not in Medical School syllabus
Clinicians not formally taught leadership &
transformation skills
Doing better and process management
usually self-taught
Gold standard Double blind controlled
trials & evidence-based medicine

My QA journey in
KKM
QA Workshops - 1991
QA WORKSHOP FOR MEDICAL
SUPERINTENDENTS &
COORDINATORS Port Dickson

25.02.91- 02.03.91 7 days
06.05.91- 08.05.91 5 days

NIA, H.S.A, Problem-Solving Approach

Achievable
Benefit
Not
Achieved
(ABNA)
Avedis Donabedien
Problem
Prioritisation
Quality
Assurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification of
Remedial
Actions
Implementation of
Remedial Actions
Re-evaluation of
the Problem
Problem
identification
Problem solving
approach cycle
QA Study Tour, USA
18.10.93 - 08.12.93 2 months
New York, Baltimore, Kansas City,
Chicago, Salt Lake City, Los Angeles
Different QA approaches
No part time QA clinicians
Good non-clinical support
QA Cycle, Incident reporting, process
control
1
st
National QA Conference

Kuala Lumpur

13.12.94 - 15.12.94
Awareness of Quality Assurance
Qa Management &
Methodology Course
27.11.95 - 30.11.95, Kuala Lumpur
Exposure to other methodologies
Benchmarking, risk management
Report cards

Other Quality Initiatives
POMR
Credentialling
TQM
ISO
Accreditation



Quality Related Exposures
QA
Courses/Workshops
QA Conferences
QA Conventions
ISQua Conferences
Travelling Fellow

ISO
Safe Surgery
TQM
Accreditation
Infection Control
Strategic Planning
5S
TGP
P5VS
Other Courses
MANAGEMENT FOR CLINICIANS,
18.03.96 - 22.03.96, Genting

MANAGEMENT FOR CLINICIANS ,
16.10.96 - 17.10.96 , Air Keroh
KKM & Manchester University

HEALTH TECHNOLOGY ASSESSMENT,
25.03.96 - 26.03.96



CLINICAL PRACTICE GUIDELINES WORKSHOP
08.12.96 - 10.12.96
K.Lumpur

STRATEGIC MANAGEMENT by INTAN Kijal

CREDENTIALLING WORKSHOP, Kuala Lumpur
KKM, Academy of Medicine Malaysia



MSQH Accreditation
QA Convention
KONVESYEN QA, Kuala Terengganu
28.08.00 29.08.00
Every 2 years
2013 in Kota Bharu.
A result of many echo workshops
Showcase of QA efforts

Patient Safety
THE WHITE BOARD

Intra-op Communications
Check-In
Intermittent report
`Shout it Out
Pre Closure
disclosure

Can we
start
now?
Intra op. communication
Shout out
One pack in !
Stable,
B/P 100/60
Intermittent
communication
Photo Credit : SSSL, H Ipoh
Hows he doing?
One pack
IN
Pre-Closure Disclosure
Closing now
Preparation of
Final swab
count
Closing sutures
Prepare reversal
Plan for the next
case
Communication with Relatives
Informing of progress
Showing of specimen
The operating surgeon should do
pre- & post operative visits.

drnoraishah@moh.gov.
my 14March2011
30
Launching of
MOH Save Surgery Saves Lives Initiative
in Langkawi , 15
th
Nov 2009
Officiated by Director of
Medical Development Division, MOH
Y.Bhg. Dato Dr Azmi Shapie
THE MALAYSIAN THEMESafer Surgery
Through Better Communication
Safe Surgery Workshops
Involved all category
of OT staff
Clinician driven
Can only minimise
errors
PROBLEMS
Surgical Error
Prevention
Capt. Stephen W. Harden
Better Teamwork. Better Systems. Better Care.
Thoughts + Actions +
Habits + Character =
Culture

The Formula for Changing Culture
Thoughts with training
Actions with system tools
Habits with leadership actions
Character
Culture
Getting clinicians on
board
Why Clinicians need to be in
Process owners
Role models
Natural leaders
Knowledgeable

Advantages
People of Influence
When they know & understand quality
Understand standards
Support quality initiatives
Lead & give input
Innovate and change for the better
Why few clinicians involved
Not sure if time is well spent
Assumption that a long learning period is
required
More interested in scientific, clinical-related
improvements
No incentives employment, promotion,
financial
Lack of opportunities for training in-
house, abroad
What will interest clinicians?
Work related quality
They give the input
Support to collect and analyse data
Platform to share
Incentives to go on
SURGICAL OUTCOME AUDIT
REPORT
Standard: 3% 16%
Problems with Audit:
Reporting, reliability of data collection
CLINICAL AUDIT
YEAR TOTAL CASES
COMPLICATION
RATE
EL EM EL EM
2010 804 1110 3.50% 5.10%
2011 827 913 2.50% 7.30%
2012 597 1013 7.70%) 5.40%
Reasons for failed surgery

TOTAL FAILED 2010 2011
20129
TOTAL SURGERY 4753 5267 3458
Dr. C, Normal Vs Abnormal Finding, Apr-Jul 05
0
10
20
30
40
50
60
Apr May Jun Jul
Month
C
a
s
e
s
TOTAL OGDS OGDS AB-OGDS AB-SIGM

What role
Leader
Role model
Teacher
Enforcer
Champions
Whistleblower

Levels of Clinical
Leadership
Institutional Leader
CEO, DG
Clinician & Leader for organisation
Little patient contact
Able to communicate vision
Skilled in strategic thinking, succession
planning, political-savvy,
Strong negotiation skills and influence

Service leader
Head of Specialties and services
Advocate of own service
Well connected to centres of excellence
Innovative
People and service development skills
Champion of evidence-based medicine
Frontline leader
Outstanding clinicians
Passionate about work, respected by
collegues
Can see opportunities for improvement
Understands quality improvement
techniques & tools
Team worker
To transform
Clinicians cannot just do ONLY clinical
work day-in & day-out
Grab any opportunity to learn extra skills
Fit into whatever comfortable level of
leadership role
Understand and involved with
Management Systems
Clinicians must be willing to be
part of the organisations tink
tank
Involve in non-clinical training
Getting to quality
- aware
- educate
- practice
- internalise
- incentives
Conclusion
Clinicians MUST be involved with Quality
Initiatives
Exposure & training essential
Champions will emerge to keep the flag
flying
Incentives sustain the momentum


Quality is a
journey ,
not a destination
Thank you