Exclusive: How Malaysia cut waiting times by 50%

By Charlene Chin

Interview with Dr. Nor Akma bt Yusuf, head of Malaysia’s lean healthcare initiative.

Image: Phalinn Ooi, licensed under CC BY 2.0

How did six people cut Malaysia’s hospital waiting times by 50%, and cancer treatment time from four months to one? More doctors, perhaps? Or more hospitals?

No. The Ministry of Health cut waste, re-engineering processes to make them as efficient as possible. GovInsider caught up with Dr. Nor Akma bt Yusuf of the Hospital Management Services unit to find out more.

Take what you have

Dr Nor Akma’s team first studied problems faced across hospital departments, finding common problems that could easily be addressed.

For example, the discharge process in emergency departments were inefficient, causing large numbers of patients to have to wait for a bed. “That is the issue of all our busy hospitals,” she says. Patients have to wait six to seven hours just for one bed, and “it’s so uncomfortable”.

Her team worked with hospital staff to devise simple solutions to make the management better. Hospitals without IT improvised with coloured magnets to coordinate bed allocations. Green magnets were placed on beds that were ready to be filled up; red ones to show that patients were in care; and yellow magnets indicated that patients were soon to be discharged. “All that gives you a visual” edge, she says, and it’s a “very fast” way for nurses to allocate bedding in wards.

Hospitals also set up discharge lounges for older patients who were cleared to leave, but had to wait for transport home. It could be as simple as putting up reclining chairs in a dedicated area for patients to rest, she says. The focus was on the overall objective: freeing up beds as quickly as possible so that patients could be treated.

Other solutions to tackle patient overcrowding included placing queue display panels in canteens so they can eat while waiting in turn, and setting up more registration counters to speed up administrative tasks.

What’s next?

These simple fixes made big progress for hospitals. It’s all part of the lean management technique, where all staff are consulted on how their roles can become more efficient. Hospital porters have the same say as the Chief Executive. The process is inspired by Japanese car manufacturers, who employed it to gain an edge on their Western counterparts by improving every single part of a production line.

Dr Nor Akma is now looking at building lean consultancy skills within government. “We have been quite dependant on our consultants”, and she believes there will be a time when her team has to stand on its own. To that end, the Institute of Health Systems Research - also under the Ministry of Health - has developed a unit to do the training, which she describes as a “centre of excellence”.

But her efforts will be in vain if departmental silos are not broken, she believes. Hospital processes involve “many departments which need to work together”, and waiting times of patients depend on how fast labs, pharmacies, even x-ray departments work, she says.

So her team aims to embed the lean culture among hospital staff, ensuring that there is no backsliding. They also work with national hospitals to run sharing sessions and build momentum for the initiative.

There are a total of 133 public hospitals in the country and, so far, Dr Nor Akma’s team has been to 36 of them. “We are looking at only the busy hospitals”, like state and specialist hospitals, she says. Her team has a target of 15 hospitals each year, spreading the philosophy slowly but surely on a unit by unit basis.

Dr Nor Akma and her colleagues strive to change healthcare delivery in the whole country, and it is an ambitious dream for a small team of six, but her evidence base will help convince others of the benefits.

The task could last “forever”, she laughs, because there is always inefficiency. But the potential benefits of consulting staff and focusing on results are limitless.