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
identification

Problem
Prioritisation
Re-evaluation of
the Problem

Quality
Assurance
Cycle

Implementation of
Remedial Actions

Problem solving
approach cycle

Problem
Analysis

Quality
Assurance
Study

Identification of
Remedial
Actions

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

1st 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
Can we
start
now?

Check-In
Intermittent

`Shout
Pre

report

it Out

Closure
disclosure

Intra op. communication

Hows he doing?

One pack in !

One pack
IN

Stable,
B/P 100/60

Intermittent

communication

Shout
Photo Credit : SSSL, H Ipoh

out

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.

THE MALAYSIAN THEMESafer Surgery

Through Better Communication

Launching of
MOH Save Surgery Saves Lives Initiative
in Langkawi , 15th Nov 2009
Officiated by Director of
Medical Development Division, MOH
Y.Bhg. Dato Dr Azmi
Shapie
drnoraishah@moh.gov.
30

my 14March2011

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 inhouse, 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

YEAR
2010
2011
2012

COMPLICATION
TOTAL CASES
RATE
EM
EL
EL
EM
804
5.10%
Standard:1110
3% 16%3.50%
913 2.50%
827
7.30%
1013 7.70%)
597
5.40%

Problems with Audit:

Reporting, reliability of data collection

CLINICAL AUDIT

Reasons for failed surgery

TOTAL FAILED
TOTAL SURGERY

2010
4753

2011
5267

20129
3458

Dr. C, Normal Vs Abnormal Finding, Apr-Jul 05

60
50

Cases

40
30
20
10
0

Apr

May

Jun

Jul

Month
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