Tag: healthworkersafety

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organizing a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers. Our final interview in the series is with Dr. Hasri Samion and Dr. Farina Mohd Salleh from the National Heart Institute of Malaysia (IJN).

Dr Hasri Samion, MD, M.Med, FNHAM, FAsCC  is the Chief Clinical Officer & Senior Consultant Paediatric Cardiologist, IJN. Dr Hasri’s specialities are Paediatric Cardiology, Interventional paediatric cardiology and Paediatric electrophysiology and pacing.

Dr Farina Mohd Salleh, M, M.Med is the Director of Quality and Emergency Physician & Manager, Observation & Emergency Department, IJN. Dr Farina is the Chair of Quality & Patient Safety Committee and Chair of Medication Safety Group in IJN. Prior to joining IJN in 2015, Dr Farina was an Emergency Physician at the Emergency & Trauma Department, Sungai Buloh Hospital. She is a recipient of Excellent Service Award from Ministry of Health Malaysia.

In this interview, Dr. Hasri and Dr. Farina share with us IJN’s safety culture and its roles and experience in managing patient and staff safety during this pandemic as a tertiary referral heart center. While it is important to be prepared for a crisis, being able to adapt quickly to new diseases and changing environment is just as crucial. Last but not the least, a valuable lesson learned is taking the opportunity during the lockdown period when the patient load was low to improve and redesign processes. This is an approach another hospital can emulate.

We take this opportunity to thank Dr Hasri and Dr Farina for their generous sharing.

Here is a video excerpt from the interview with Dr. Hasri and Dr. Farina

On health worker safety

Dr Hasri believes that staff safety should be within the patient safety framework and patient safety initiatives. Without healthy staff, patient safety initiatives could not be successfully implemented. Achieving health work safety is also a shared responsibility of all health workers, while management should give full support to provide a safe working environment throughout the organisation.

“Staff safety should be within the patient safety framework”

On protecting staff from safety risks, Dr Hasri’s view is that all healthcare organisations should set up an occupational safety & health (OSH) unit to look after staff safety and wellbeing. At the same time, staff at all levels of care need to be aware of the risk of infections. There are several ways to ensure staff safety during a pandemic, such as through education and training, proper and adequate PPE, screening and testing, staff engagement, effective communication and continuous support from the leadership team.

IJN’s safety culture

Safety culture is not something that can happen overnight, said Dr Farina. It is cultivated over many years, not only to reach a certain level of safety culture, but also to nurture new staff into the organisation’s culture. It is a continuous process. For IJN, the basic quality and safety structure should include local and international accreditations. That is the baseline or reference point for IJN in terms of how safety is practiced all over the world. We want to standardise safety processes and adopt best practices in IJN, said Dr Farina.

“Knowing your weaknesses, addressing them, working together on process improvement, analysing data and continuously improving. That is the safety culture in IJN”

According to Dr Farina, it is very important to have a single culture of safety – something simple and everyone understands the principles. A safety culture should trickle down from the top, with support from the management team down to every staff, whether they are clinical or non-clinical. IJN has specific goals for patient safety that include elements of staff safety as well. 

Having a healthy environment, adequate and skilled manpower, clear responsibility for care givers and effective communication, as well as creating the concept of shared patients, are essential to delivering safe and good quality care, added Dr Hasri.

Initial response to Covid-19, reopening and new norm

IJN has an infection control committee (ICC) that conducts regular surveillance of any acquired infections in the hospital. When Covid-19 cases first surfaced in Malaysia, IJN set up a task force to focus on containment and early detection processes, as well as setting up screening and testing facilities for patients. The next step was educating staff on appropriate PPE, planning for manpower needs, expanding the ICC team and ensuring new operating procedures are in place.

When IJN realised there was community spread and some patients and staff were infected and others were exposed to Covid-19, management raised the level of alert, tightened safety control, adjusted work schedules and deferred elective procedures. The volume of clinical services and patient load went down significantly during the Movement Restriction Order (MCO) period. During this lockdown period, processes were improved and adjusted to the new norm, which put IJN in good stead for the reopening as movement restrictions were gradually lifted. As the country is facing the third wave, IJN is now working on the next level of preparation to mitigate the risk of virus infection in the hospital. Dr Hasri said that as 70% Covid-19 cases are asymptomatic, staying vigilant, compliance to safety procedures and keeping good habits are the responsibility of everyone.  “We conduct regular observations and audits, share findings with the respective wards and departments so that people are aware of the issues and risks”. IJN’s current staff compliance rate is around 80% and the adherence rate is getting better.

A Covid-19 designated hospital for patients with heart conditions

In Malaysia, all Covid-19 cases are treated in designated Ministry of Health (MOH) hospitals. IJN is an exception. As the tertiary referral heart centre, IJN was asked by the ministry to be part of the Covid-19 team, as there are patients with heart conditions and are suspected of being infected by Covid-19. Symptoms such as chest pains are similar to Covid-19 symptoms. In-house Covid-19 detection PCR and Rapid Kit) are available to triage patients. “The need for treating patients with heart conditions is greater and more urgent than the risk of Covid-19 infection”, said Dr Hasri. Once the heart conditions have stabilised, the patients will be transferred to the nearby Hospital Kuala Lumpur. If the initial admission is suspected to be heart conditions, but later diagnosed to be otherwise, the patient will be transferred to a designated MOH hospital.

“The need for treating patients with heart conditions is greater and more urgent than the risk of Covid-19 infection”

Paying tributes to front liners

The Covid-19 pandemic has exposed health workers to increased workplace safety risks, including mental health and well-being. In this aspect, IJN management has been proactive in providing emotional support to staff, particularly those who respond poorly to stress and need more support. “What our management did was immediately form support groups and pre-emptively go to areas where people are at higher risk of getting infected”. The support groups, which includes senior staff members, provide counselling and address individuals with poor coping mechanism and high stress levels, Dr Farina said.

In conjunction with WPSD, IJN organised various online activities, including online games with prizes, to celebrate WPSD and pay tribute to staff and frontline workers. The first ever Patient Safety Awards were given to staff who contributed the most to patient safety. IJN management also sent out emails with pictures and messages to the swab teams, infection control, patient support, nursing and some other new teams created to manage Covid-19. Positive messages from IJN management is a way of paying tributes and showing appreciation to staff and front liners, as well as to boost staff morale.

JCI and MSQH accreditations

IJN is a JCI and Malaysian Society for Quality in Healthcare (MSQH) accredited hospital. Both accreditations are useful for safe and efficient operation of hospital, said Dr Farina. In particular, there is a chapter on global communicable diseases added into JCI’s latest edition last year. “It was as though they predicted something like this would happen. I’m quite amazed it came at a timely manner”. We had plans and drills but did not expect the pandemic to be at this magnitude, said Dr Farina.

Apart from having policies and SOP in place, Dr Farina thinks that an organisation’s ability to adapt quickly to new diseases and crisis, and to find new ways of handling the situation, is equally important. What IJN did this time was to review existing policies and develop multiple new workflows to for various scenarios. This expanded manual is useful for future references, Dr Farina said.

“Apart from policies, the adaptability of the organisation to new diseases, new requirements and new ways of handling them is just as crucial”

Lessons learned

The pandemic has highlighted the importance of being prepared for crisis, working as a team and looking out for any potential risk in healthcare. We need to continuously communicate and engage with staff and patients to understand their needs and be ready to offer options when crisis happens. That is the main takeaway for Dr Hasri.

“IJN had taken the initiatives to improve workflow and processes on patient journey during the initial strict lockdown period when patient load was low”

New process improvements were implemented during the initial lockdown and improvised quickly for both Covid and non-Covid related processes. “I think this is a good lesson learned and a good tactic. Some hospitals might have felt the shock and when hospitals reopened found themselves unprepared. We took the opportunity and made ourselves well-prepared when MCO was lifted”, said Dr Farina with a sense of pride. What motivates her team? “Patients need us. Heart diseases don’t go away because of Covid-19. IJN is the tertiary referral heart centre and patients don’t have anywhere else to go. We need safe processes in place and be ready to receive patients”, is her earnest response.

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

On private hospitals’ roles in Malaysia

In Malaysia, all Covid-19 cases are referred to government hospitals. Some private hospitals are asked to standby their ICUs and ventilators, and to support government facilities when they are overwhelmed. Fortunately, Ministry of Health (MOH) Malaysia has the situation under control so far and private hospitals have not been called upon to provide ICUs and ventilators.  Malaysia did very well in containing the virus. There was an initial panic that Malaysia might run out of ventilators. In the end there was no shortage. The role of private hospitals is mainly to provide Covid-19 screening and refer any positive cases to MOH.

“I must congratulate MOH, they are so efficient. I think they are more efficient than many western countries. That’s why our Director General Tan Sri Dr Noor Hisham is well respected”

On how Covid-19 impacts cancer patients

Before this pandemic, there was MERS, SARS and other infections, but it never came to the point where we had to be locked down. “We have to admit a lot of us in Malaysia were unprepared that Covid-19 could hit us so hard”, said Dato Dr Ibrahim. “Fortunately, many hospitals acted swiftly and were able to manage the situation. I’m glad to say that we did quite well”. A lot of credits go to MOH.

One of the key challenges Beacon Hospital faced was the Movement Control Order (MCO) which made it difficult for some cancer patients to visit the hospital for treatment. “Our patients’ concerns are not so much the fear of contracting Covid-19, but more on how to get to the hospital for treatment with so many roadblocks”.  They also don’t want the hassles of being stopped and questioned by police. “I had a lot of patients who needed hospitalisation and chemo treatment but were turned back”, said Dato Dr Ibrahim. The challenge is to find a balance between patient’s healthcare needs and restricting the public’s movement to contain the virus. The situation has improved since then.

Investing in cutting-edge technology and equipment

As a leading specialist cancer hospital in Malaysia, Beacon Hospital has always invested in cutting-edge technology on cancer treatment.  Last year, Beacon invested in Halcyon, the state-of-the-art intelligent radiotherapy machine and became the first in Southeast Asia to introduce Varian Halcyon 2.0 machine to its cancer patients.

Beacon Hospital also installed the TrueBeam radiotherapy system last year, a new generation of a linear accelerator that can deliver much faster and accurate radiation dose compared to conventional radiotherapy system. “But we are also very sensitive towards pricing”, added Dato Dr Ibrahim. Beacon Hospital wants to provide affordable healthcare, particularly on cancer treatment.

“Beacon Hospital has always invested in cutting-edge technology but also making treatments affordable”.

Digitisation and IT innovation

Beacon Hospital has also been investing in digital innovation for better outcomes, patient safety and operational efficiency.  For instance, the hospital has incorporated IT solutions into treatment machines. Patients can verify their identify before the start of a treatment to reduce errors. Doctors can monitor remotely treatment in progress to ensure that it is being given properly.

Dato Dr Ibrahim highlighted two areas where digital technology has impacted healthcare sector. The first is care delivery via telehealth. While he sees the opportunities for growth in telehealth, particularly for follow up visit and general visit, he believes that virtual consultation has its limitations. A leading oncologist in Malaysia, Dato Dr Ibrahim is of the opinion that patient-doctor contact or in-person touch will be more effective for certain types of consultations.

The second area where digital innovation is impacting healthcare is in continuing medical education (CME) through medical events and conferences.

“Virtual medical conferences and continuing education may become a new norm”

Due to the pandemic, medical meetings, events and exhibitions are going virtual. Dato Dr Ibrahim said he attends 3-4 major international conferences a year. One of them is ESMO Congress in Europe (ESMO is the society of reference for oncology education and information). Like many other events, ESMO Congress too has gone virtual this year.

Beacon’s CSR Programmes

According to Dato Dr Ibrahim, Beacon Hospital is the first and only hospital in Malaysia offering Corporate Social Responsibility (CSR) programmes that provide financial assistance to patients who cannot afford cancer treatments. The hospital sets aside certain budget for the CSR fund. The fund aims to help underprivileged patients to receive cancer treatment.

“Over the last 5-7 years, we have spent around RM30m, benefitting hundreds of patients under our CSR programmes”

There are two types of treatment schemes – radiotherapy and chemotherapy. Patients who apply will be assessed for affordability and insurance coverage, and in some cases the treatment is fully funded by the CSR Fund. It is in essence charity work with a big heart.

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

In this interview, Ms. Phang speaks about Oriental’s commitment to health worker safety, a new initiative to promote a Just Culture and the need to have occupational safety and health (OSH) officers working hand in hand with infection control to ensure a safe workplace. She also shares Oriental’s experience in crisis management and the importance of emergency preparedness, not just for any pandemic but also in dealing with natural disasters.

We take this opportunity to thank Ms Phang for graciously accepting our interview request and sharing her thoughts.

Here is an excerpt from the video interview with Ms Phang

On World Patient Safety Day 2020 theme

Health worker safety is a priority for patient safety. “The theme for this year resonates with me very strongly during these tiring times as we are faced with Covid-19”, said Ms Phang. Our hospital is endeavouring to keep all our health workers safe in order for us to provide a safe environment for our patients and their families and visitors, as well as our internal clients. Given the recent uptrend in Covid-19 cases, as Malaysia sees the third wave, Oriental is giving more emphasis on ensuring health worker safety through the strict practice of safety protocols for all staff.

On patient safety, Oriental has always been focusing on the six international patient safety goals (IPSGs). However, due to the pandemic, the focus this year is mainly on infection control practices. Ms Phang shared that they recently celebrated World Patient Safety Day. Her nursing team put up a special video on IPSGs and some great posters on speaking up for safer care. The event involved clinicians, health workers, patients and their relatives and visitors. For this patient safety event, we also created our own Oriental “Safety Pledge”, said Ms Phang.

Oriental Medical’s ‘just’ culture

Oriental has started a safety culture project aimed at optimising behaviours and safety practices that will result in an improved safety culture and reinforce and support the prevention of patient harm. It is called Just Culture. “In a just culture, we encourage open reporting and participation in prevention and improvement when incidents occur”, Ms Phang explained. Her team is running a series of safety culture in services to make people aware of the importance of speaking up on safety. For instance, if staff feel that they are not being adequately provided with PPEs, they need to speak up. Human errors do occur. We should not hide errors and should be brave enough to report and address them to see how we can use errors as a way for improvement.

“Just culture also means to encourage and give recognition for speaking up, not to penalise. It is not just us leaders who should play a role; everybody should be involved”.

Setting up OSH committee to ensure a safe workplace

Having a safe workplace environment is a pre-requisite for ensuring patient and staff safety. On this, Ms Phang emphasises the need for hospitals to have OSH policies and safety officers. It is important for hospitals to set up an OSH committee to deal with safety hazards in the workplace such as chemicals, radiation and construction and renovation works on hospital facilities. Infection control looks at how to prevent the spread of infectious diseases, while a safety officer looks at the safety of the entire workplace. Both need to work hand-in-hand to create a safe working environment. Ms Phang highlights, “As leaders, we have to continuously strive to improve these two aspects of safety”.

Head-start on pandemic preparation

Due to an influenza outbreak in November and December 2019, Oriental started preparing for sufficient PPEs and closing some entry/exit doors to manage human traffic flow. When Covid-19 pandemic started in February, Oriental further enhanced the traffic flow, screening method and triaging patients, including compulsory screening of patients for OT and hospital admission. “We are also the first hospital registered and licensed to conduct screening and PCR testing”, says Ms Phang. Oriental is now a Covid-19 testing centre in Malacca, running two both PCR and antigen rapid test kits (RTK) testing. “MOH commented that we are the only private hospital to have the flow done correctly at that time”, she says.

Oriental’s experience in crisis management

Oriental is a Malaysian Society for Quality in Healthcare (MSQH) accredited hospital. Ms Phang thinks preparing for emergency and pandemic is a critical part of hospital management. “Part of the MSQH Standard – Prevention and Control of Infection Chapter – talks about pandemic preparedness as well as a disaster manual”. For Oriental, their CEO, Medical Director and safety officers were all involved in the preparation of a pandemic policy – a general policy for any type of communicable disease outbreak. “You don’t just deal with a pandemic as such, but also deal with natural disasters”. Oriental is located next to the Malacca Strait.  “This is where risk management comes in. We are located near the sea. If a tsunami or typhoon hits and causes flooding, this is what we will need to do”, said Ms Phang, referring to a crisis manual.

There was an episode of food poisoning at Oriental where several of their nursing college students were affected. With the crisis manual and risk policy, the hospital was able to quickly perform a service recovery and address the issue before public health officers arrived. The latter commented that Oriental took the right steps.

“I’m glad to say we now have a crisis manual, risk manual, pandemic policies, infection control policies and safety policies in place”

On managing health worker safety and wellbeing

In the beginning, the main challenge was to ensure there were adequate PPEs for our staff. There was a fear of our staff getting infected. It was about giving assurance to the staff, particularly the front liners, on their safety. “But after a while, we realised that mental health of our workers is another important aspect (of staff wellbeing)”, said Ms Phang.

“We are still encountering the problem of the public not understanding the importance of complying with safety guidelines while they are in the hospital”. Front liners are getting occasional verbal abuses and outbursts from patients and their relatives. This is one other source of stress, according to Ms Phang.

Front liner workers in a full set of PPE to triage patients can get very tiring and stressful. Staff who are exposed to Covid-19 patients have to undergo a 14-days quarantine and put in isolation, which is a stressful experience. To address staff health and mental wellbeing, Oriental provides food vouchers, rotates the teams, conducts debriefing sessions to hear the concerns of the front liners. “We also have a clinical phycologist onboard to give sessions on how to cope with stress”.

Digital transformation in healthcare

The pandemic has opened our minds on how to reach out and provide care to patients. Many hospitals are trying to go digitally savvy and adapt to the new norm, said Ms Phang. “I think telehealth is one of the new service delivery models many hospitals are exploring, and it is the way forward”.

However, she also cautioned that challenges remain, not only in terms of cost of investment but also the readiness of network infrastructure and internet connectivity in certain areas. Relevant policies and criteria should also be established for wider adoption, while concerns on data security need to be addressed to assure the public. At a recent digital health summit on accelerating digital transformation in healthcare, Ms Phang noted Dr Fazilah, the Senior Deputy Director of the Planning Division from MOH, spoke about revitalising the Malaysian economy, which has been badly impacted by Covid-19, by enhancing our digital technology and innovation. She is looking forward to some help from the government to support telehealth industry.

Reasons for optimism

“We have seen the creativity of our team with regards to innovation, the ability to move forward quickly with a purpose when faced with a situation such as this”.

The pandemic threatens our lives and causes anxieties. The paradox of it is that it has made us healthier and stronger in many ways. It has also helped to accelerate the changes in our behaviour as well as our healthcare delivery that hopefully will be a long-lasting journey, said Ms Phang with a sense of optimism.

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

In this interview, Dr Dini speaks with a wealth of knowledge on safety culture, managing safety risks and crisis management. She also shares Medistra Hospital’s support for health worker safety and wellbeing, digital initiatives and new service offerings. At the national level, Dr Dini relates the nationwide health worker safety campaign organised by MOH Indonesia and WHO South-east Asia Regional Office; and the role of accreditation agency in developing infection prevention and control training programmes.

We take this opportunity to thank Dr Dini for accepting our invitation and sharing her thoughts and the experience of Medistra Hospital.

Here is an excerpt from the video interview with Dr Dini

What follows is an edited transcript of the virtual interview between Dr Dini and Hak Yek Tan, Founder & CEO of QUASR.

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Hak: What are your thoughts on WPSD theme “Health Worker Safety: A Priority to Patient Safety”

Dr Dini: This year’s WPSD theme is a tribute to health workers around the world for their commitment in the fight against Covid-19. Many health workers especially the frontline workers, have lost their lives. We knew very little about the virus at the beginning and it was a struggle and learning process for all countries, not only in Asia but also in Europe and the US. The theme on health worker safety is very important in promoting awareness on health worker safety globally, especially during this pandemic.

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Hak: How did Medistra Hospital celebrate WPSD and support health worker safety and wellbeing?

Dr Dini: We celebrated WPSD this year by acknowledging our low infection rate on Covid-19 among our staff. From February to end-October, our staff infection was below 5%. It has been a lot of hard work to maintain our safety behaviour during this time and we are very proud to achieve that. We pay tribute to our staff by giving assurance on safety and security that they will receive the safest practice in delivering services.

We give our staff the appropriate PPEs, avoid long hour shifts by adding more staff to cover for each shift especially in the Covid-19 isolation area, give vitamins and supplements to boost immunity and provide a new open-air dining room. A zoning area to treat Covid and non-Covid patients is designed to ensure a good flow of infectious and non-infectious patients. We also develop a convenient and proper staff screening flow to check their health status upon treating or exposure to Covid-19 patients. We give security and emotional support by having regular meetings with each unit to know how we could support them better.

“Health workers are our frontline assets. They need to be safe and secure first before delivering any services. Keeping them safe and secure is definitely a requirement for me”

For me and our senior management, we are being present at all times. We did not work from home during the pandemic so that our staff know we are going through this together. I think this provides a good emotional support for our staff. I’m also sending them thank you cards for always be there for us and to stay safe and health. For this WPDS, we provided treats – a pizza day – for everyone. This is one of the things we can do to try to keep up a good spirit.

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Hak: What is your overall view on safety culture in the healthcare industry?

Dr Dini: I think hospitals in many countries are still struggling with safety culture. This is because a culture of safety is the core value and behaviour that come about when there is a collective and continuous improvement and commitment by the organisational leadership, managers and all health workers to emphasise on safety, among many competing roles and objectives.

Safety culture is a very big concept with numerous activities. To successfully implement this concept requires a huge driven power, starting from the Board to the CEO, senior management team, the physicians down to all the staff. Getting everyone onboard is definitely a continuous journey which usually takes a while for the organisation to change it culture.

“The first thing we need to build a safety culture is the awareness that it involves everyone in the organisation”

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Hak: You are a member of the National Patient Safety Committee. Was there any national campaign on health worker safety?

Dr Dini: We had a very good campaign for health worker safety nationwide together with the Ministry of Health (MOH) Indonesia and WHO South-east Asia Regional Office.  Our campaign asks health workers nationwide to speak up and raise the issue to hospital management upon any conditions that may cause harm to hospital staff. It was a big event with numerous nationwide media coverage. We are very happy with the campaign and believe that it has created awareness for everyone, especially among health workers in Indonesia.

“With increasing number of Covid-19 cases and mortality among health workers, this is a priority for MOH and for Indonesia to wake up and speak up for health worker safety”

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Hak: As an international surveyor yourself, what do you think are the roles accreditation agency can play?

Dr Dini: I think this pandemic is a good moment for us to learn new things. Accreditation agency, hospital management and healthcare professionals should work hand in hand to create impactful training programmes together. Once the awareness is already there, the accreditation agency can offer consecutive training programmes and give hospitals updated resources on infection prevention and control. This will ensure that we can learn from these good programmes on how to protect ourselves. I believe some of these have already been done nationwide by the accreditation agency.

“The need to create awareness on health worker safety starts with individuals to speak up under any circumstances of harm…this is the key to engage management to pay attention to the situation and improve”

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Hak: How does Medistra Hospital manage safety risks?

Dr Dini: We manage safety risks of this pandemic from the clinical aspect and facility aspect. From the clinical aspect, we make sure that patients are given the best treatment possible to prevent mortality and complications from comorbid factors such as diabetes, obesities, heavy-smoking patients and others. Our Covid-19 management team is part of the nationwide Covid-19 management team under MOH, comprising of the most resourceful professors and senior doctors in Indonesia. Medistra is one of the private hospitals with the lowest Covid-19 mortality rate in Indonesia.

For facility risks, we add specific zoning for Covid-19 and non Covid-19 patients throughout the hospital. We have drafting facilities, hyper-filtering systems, additional areas for gowning and drafting, conduct regular high-level disinfection for all surface areas, fogging system, temperature screening camera, touchless button for lifts, ensuring the profiling and availability of PPF or all staff.

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Hak: Is Medistra Hospital offering any new services?

Dr Dini: We have added new services like telemedicine, Covid-screening programme, isolation centres at nearby hotels (“fun-solation”) where customers can have other activities like fun games, sunbathing, ping-pong, billiards and watching movies. Medistra Hospitals is also the appointed Polymerase Chain Reaction (PCR) laboratory for the Presidential Office, embassies, MNCs and several prominent international airlines. There are many referral hospitals for Covid-19, most of them are government hospitals. Over time, Medistra has become the leading hospital for PCR testing in Jakarta and Indonesia. We have 6 to 8 types of PCR equipment with different levels of virus detection capabilities. Medistra is now the leading private hospital for PCR testing in Jakarta and Indonesia”

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Hak: Could you briefly take us through how you responded to Covid-19 pandemic?

Dr Dini: I joined Medistra in January 2020. When the pandemic hit, the first thing I did was to set up a single communication line. Establishing a clear line of communication and solid command centre from the leadership is the key in crisis management to ensure everyone receives the same information. Following that we set up zoning areas and many other facilities were set up overnight. Overall we had a smooth and effective communication across all aspect of the hospital operation.

“A clear communication line and solid command centre is the key in crisis management”

In JCI standard, there is a chapter on Prevention and Control of Infections. There is also a specific provision on disaster preparedness where hospitals are required to develop, implement and test their emergency preparedness programmes as a response to global communicable diseases. This pandemic is a very good test for all of us on emergency preparedness. It is a learning process. In the meantime, there will be more issues and additional resources and trainings that will be required.

“This pandemic is a lesson learned for everyone and prepares us on how we should be providing healthcare services in the future”

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Hak: How do you see the pandemic accelerating IT adoption and digital transformation in healthcare?

Dr Dini: Digitalisation is the game-changer as well as the opportunity for healthcare providers to gain advantage over competition. The pandemic provides the opportunity for digital transformation more than we can image. It pushes us over the boundaries of care delivery both onsite and online. Hospitals need to create an online service delivery platform to be competitive in future.

Medistra Hospital has implemented several new digital initiatives during Covid-19. We added a web-based app for Covid-19 patient monitoring connecting to our existing EMR system. Starting with screening questionnaires, to the overall monitoring of Covid-19 patient conditions online and creating dashboards for each patient.  “Medistra Hospital has implemented three digital initiatives. Namely a web-based app for Covid-19 patient monitoring, telemedicine and a breath screening app for our staff.”

The second initiative is telemedicine. In Medistra, our cases are mostly complex and chronic patients. Therefore we design our service lines to be very specific around patient needs and age sensitive-based. Our patients are mostly above 40, very loyal and choose quality over price. Patients above 60 are the most conservative to telemedicine as we know. So we offer our telemedicine services differently to be closest to the real patient feel and to provide a good customer experience.  We develop a special portable telemedicine suite-case containing digital stethoscope, portable ECGs, digital thermometer, digital blood pressure monitor, HD camera video call equipment. The suite-case is connected to our web-based data storage and EMR. All the patient information from the bar-code registration and the examination results will be automatically sent to the doctors prior to the video consultation. We deploy this portable suite case to patient’s house accompanied by our nurses. The patients will have their consultation based on real-time data just exactly as they did prior to the pandemic.

The third initiative is the implementation of breath screening application for our staff. This is in addition to the different PCR testing methods currently available.

“One of the legacies of Covid-19 is the major transformation on digitalisation in healthcare. It will outlive the pandemic. There is a lifestyle change…so I think the demand is there and people are enjoying the new normal”

On the management side, integrated telehealth comes with the capabilities of patient data gathering, AI, reporting on clinical care and enhancing workflow management. Telehealth will be a source of patient referrals in the future and offers new possibilities in care delivery.

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Hak: What are the key lessons learned?

Dr Dini: We have learned from the pandemic that hospitals need to embark on their own digitalisation plans and develop online platforms to supplement their onsite services. This is the future and there is no other options. The second lesson is that we need to make behaviour choices – wearing masks, social distancing and washing hands regularly – notwithstanding “the Covid-19 fatigue”. The third lesson is strong leadership is needed to successful manage and safely navigate a pandemic such as this.

In conjunction with World Patient Safety Day 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

In an interview with Hak Yek Tan, Founder & CEO of QUASR, Dr. Macusi speaks about PSQua’s roles in patient safety, the impact of the Covid-19 pandemic on the healthcare industry, why education is the key in raising awareness on health worker safety, and positive mindset changes emerging from the prevailing health crisis.

We take this opportunity to thank Dr Macusi for sharing his insightful thoughts.

Here is an excerpt from the video interview with Dr Macusi

What follows are excerpts and highlights of the interview.

On World Patient Safety Day theme

Sharing his thoughts on this year’s WPSD theme “Health Worker Safety: A Priority for Patient Safety”, Dr Macusi feels that it is a timely reminder of the responsibility of healthcare facilities management to ensure resources are allocated for the necessary infrastructure, equipment and supplies and enabling processes. Viewing patient safety as a result of health worker safety is not only wise but is also very logical. In fact, we cannot ensure patient safety without establishing safety protocols for health workers’ welfare.

The phrase “primum non nocere” meaning “first, do no harm”, which always refers to patients, has taken on another perspective. It can after all, be applicable to health workers as well.

Roles of health workers

Healthcare is a high risk, high demand and high stress industry. There is a general perception that many hospitals tend to focus more on patient safety and less on staff safety.  On this, Dr Macusi’s view is that healthcare institutions tend to look at health workers as paid individuals who know the risks involved and are aware of their roles and responsibilities. On the other hand, patients are customers. It is always customers first and patient safety first. This mindset might have contributed to some neglect on staff safety. What needs to be explained is that patient safety is closely linked to staff safety.

At the same time, the mindset of most health workers is to prioritise patient welfare, to report incidents involving patients while ignoring or not prioritising their own personal safety. Dr Macusi thinks it all starts with education. Medical students are educated that ‘patients always come first’.  Importance is always given to the patients. It is ingrained in healthcare professionals’ trainings that patients come first, and patients are primary and should always be looking after. As a result, in most healthcare settings, everything is centred towards patients and their welfare, so much so that health worker safety is not very much discussed in the educational setting. To change this, Dr Macusi suggests that we should start with education.

I will propose to our Society to look into tapping the educational institutions to teach this early, so that when the students become healthcare professionals, they know that health worker safety is important and very much linked to patient safety.

Health workers also need to understand that they have an important role to play in their own safety and the safety of other staff, not just the safety of patients. Whatever happens to health workers will have an impact on their patients, be it caused by fatigue, burnout or mental stress. They should recognise it as an issue and a risk to their patients, and to provide feedback to the management about their well-being and seek help when needed.

Roles of management

Dr Macusi stresses that hospital management plays a vital role in establishing a strong safety culture. During this pandemic, transparent and effective communication between management and staff is one of the key elements in managing staff safety and wellbeing. Ensuring open communication with staff, making sure that the staff have time for breaks to rest and call their families, short meetings and huddles to discuss staff concerns and giving them assurances can be a big help to staff who are already overworked and under emotional distress.

During this pandemic, management must take additional steps to help alleviate workplace safety risks that staff are facing and are worried about. The most critical safety risks facing health workers currently are the risks of mortality and morbidity. Out of the 314,000 Covid-19 cases in the Philippines (data as of 1^st October), about 3% are health workers. The other major risks are inadequate personnel protective equipment (PPE), work overload and poor infection controls, which all contribute to emotional distress and burnout.  The emotional distress health workers are facing are rooted on the fear of being exposed to the virus and getting infected, and then spread it to family members at home. Management can help by ensuring PPE and safety measures are in place, having effective communication and constantly giving assurances.

Emergency preparedness

This pandemic has highlighted a few important reminders to the healthcare community at large. One of which is the importance of having emergency preparedness plans as well as the increasingly vital role technology plays.

During this crisis, some hospitals in the Philippines were able to respond quickly and well mainly because they have emergency response systems in place. This comes from having continual improvement of quality and safety programmes in these organisations.

This is a wake-up call for healthcare institutions that they need to be better prepared for crisis.

Dr Macusi remarks that to further advance healthcare quality and safety in the Philippines, PSQua is considering to include emergency preparedness as a new training module in the near future, so that healthcare institutions are better prepared for any eventuality, especially a pandemic or an outbreak.  

Paying tributes to health workers

In the Philippines, most of the tributes to health workers for their dedication and sacrifices are through songs. Some of the songs are specifically created during this crisis such as a Filipino song titled “Love will heal the world”. The use of social media is optimised in paying tributes to Filipino health workers who exhibited heroism. Doctors and nurses at the frontline who succumbed to the virus were given special tributes through songs in social media and TV in recognition of their contributions in combating the pandemic.

Technology and telehealth

Dr Macusi thinks that an acceleration in the adoption of IT innovations in healthcare is inevitable. Technology has empowered individuals, both patients and health workers through hand-held or portable devices. Data is collected, transmitted, processed, and used to make healthcare decisions at dizzying speed. Globally, it is estimated that 50 billion devices are already connected to the internet and many of these devices are tracking individual health data. IT innovation is already changing healthcare delivery in several ways, such as reaching people wherever they are in their health journey, identifying when people are at risk and knowing what they need before they need it, and by designing personal interventions and deploying them at a timely manner, predictively. Technology has positive impact on healthcare in terms of better performance, customer experience and better health outcomes and it will only accelerate from here.

In closing, Dr Macusi says this pandemic has placed a spotlight on health workers and fast-tracked our understanding and appreciation of health worker safety. We have gained valuable knowledge on how we can better protect and support our health workers, the importance of emergency preparedness and response plans and the critical part played by hospital management systems and continual quality improvement programmes. Above all, the lessons learned during this health crisis will go a long way in raising awareness on health worker safety as the foundation for patient safety.

We also take this opportunity to thank Dr Jimenez for graciously accepting our interview request and sharing valuable thoughts and opinions with us. What follows is an edited transcript of the virtual interview between Dr Jimenez and Hak Yek Tan, Founder & CEO of QUASR.

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Hak: How did AHMC celebrate WPSD 2020 and what does this year’s theme mean to you?

Dr Jimenez: We celebrated WPSD 2020 by expounding on the theme “Health Worker Safety: A Priority for Patient Safety”. We highlighted the importance of promoting the safety of our healthcare workers as an integral part of patient safety initiatives, thereby creating a culture of safety that encompasses the entire organisation.

We held a webinar on 17^th September to celebrate WPSD. The webinar was officially opened by our Chief Medical Officer, followed by an inspirational message from our President & CEO. We invited two notable speakers from Joint Commission International (JCI) and our Chairman of Infection Control Committee. The event was overwhelmingly well attended by AHMC communities. I was extremely proud of it and took the opportunity to send a strong message on the importance of health worker safety. We gave awards and recognitions to our pandemic heroes and safety champs. Overall, it was a rewarding experience for all. I would say that as an organisation we have reached a level of maturity in terms of having a strong safety culture that people can identify with.

“Safe health worker is equal to safe patient is really a proven equation. Without health worker safety, there can be no patient safety.“

Hak: Do you agree that health worker safety is a prerequisite for patient safety?

Dr Jimenez: Yes, I totally agree. Safe health worker is equal to safe patient is really a proven equation. Without health worker safety, there can be no patient safety. During a pandemic, if we can’t protect our front liners, doctors and nurses by establishing safety protocols, we will soon run out of health workers to take care of our patients. If there is one thing which the pandemic has taught us, it is that we should take good care of our health workers.

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Hak: What specific initiatives has AHMC taken to establish a strong safety culture?

Dr Jimenez: We highly encourage our staff to speak up or report any safety concerns or incidents without fear of reprisal. We also encourage all staff to report near misses so that we can aggregate and analysis the data, and then take appropriate preventive actions. Another safety practice we have is Safety Leadership WalkRounds. There is nothing like having our healthcare leaders going to the frontline to speak to the staff, listen to their feedback and address their concerns. We have uncovered issues, which could have otherwise escaped our attention, during the Leadership WalkRounds. Even our President & CEO is pleased to join us.

“Strong leadership support is one of the critical components in establishing a strong safety culture.“

Hak: How did AHMC respond to Covid-19 pandemic and manage safety risks?

Dr Jimenez: We had a JCI survey in 2019 which led to the strengthening of our emergency management plan. That really helps us and makes a big difference in the way we responded to the pandemic. Having a business continuity plan in the event of not only Covid-19, but any other globally communicable diseases, would be extremely helpful. We were able to augment our care capacity by fast-tracking the training for some of our general nurses to become specialty critical care nurses without compromising on patient and staff safety. Early in the pandemic, we started using dashboards and analysing data, which are critical in guiding our management in making informed decisions on procuring additional ventilators, PPEs, drug supplies and so on.

Measures implemented to mitigate safety risks include stringent Hot/Cold area zoning, screening protocols and making sure proper segregation of Covid and non-Covid related functions. The challenges for us are in communication, information dissemination and staff training, mostly done remotely. Online learning was fast-tracked. What had previously taken several months is now being done in a week!

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Hak: Can you share with us the support and help provided to frontline workers to cope with anxiety, fatigue and burnout?

Dr Jimenez: We recently launched an awareness campaign on staff mental health and well-being as part of our overall strategy to improve staff safety and well-being. There are cases of staff working overtime and suffering from burnout, fatigue and emotional distress, not only during this pandemic but also during normal times. We provide our staff with transportation as well as boarding and accommodation at the hospital for those who do not feel safe to go back to their families. We also ensure that we have available good quality PPEs for them to use and feel safe.

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Hak: How to convince your management the benefits of investing in staff safety?

Dr Jimenez: We are advocacy of value-based healthcare, always striving to achieve better outcomes at lower costs for our patients. As we discussed earlier, health worker safety is directly linked to patient safety. An unsafe workplace is more likely to lead to the occurrence of adverse incidents, causing harm to patients and staff, disruption to operations and lost efficiency. There are various obvious and hidden costs of poor staff safety, including physical injuries, penalties, financial and reputational costs. We call these the costs of poor quality. By investing in staff safety and a safe workplace, we can reduce the costs of poor quality while ensuring desirable outcomes for patients.

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Hak: How do you see the pandemic reshaping healthcare with technology and innovation?

Dr Jimenez: We have been planning to offer telehealth services for some time. The problem then was many physicians were not keen. In May this year and amidst the pandemic, we went ahead to launch a telehealth program call the “TeleCouncil”. We see a bright future for telehealth and are considering alternative solution platforms. From the quality and safety standpoint, there is a need to establish quality and safety protocols for telehealth. One of our priorities is to use technology to reduce medication errors. The process of medication administration is very tedious involving as many as 25 steps. We believe technology can greatly minimize medication variations and errors.

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Hak: How does AHMC pay tributes to front liners for their dedication and sacrifices made in the fight against Covid-19?

Dr Jimenez: We give awards and recognitions to our pandemic heroes and patient safety champs. Recognizing what they have done in front of the community in the WPSD webinar I mentioned earlier is a gratifying way of paying tributes to them. We are proud to have several physicians and patient safety champs serving as professional role models to the rest of the community. They go out of their way to serve, to report safety issues, to collaboratively work with other departments to do their part towards a better safety culture.

“Promoting patient safety is a multi-disciplinary collaborative effort.”

Hak: Can you share a lesson from the pandemic?

Dr Jimenez: If there is one other thing we learn from the pandemic, it is that promoting patient safety is a multi-disciplinary collaborative effort. The pandemic has helped all of us realise the importance of Information Technology, automation, online platforms to reach out to patients, in the provision of safe and quality care. We need to prioritise these and really focus on what we need most right now.

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Hak: From how you describe your patient safety champs, they are all front liners, no less, in this fight against the pandemic. Thank you for sharing your insightful views that provides a good guidance to other hospitals in the community.

Here is an excerpt from the video interview with Dr Jimenez

In this interview, Dr. Rosas shared the background of the current healthcare situation in Vietnam, on how the government has been and is doing an excellent job of controlling the spread of COVID19. It does seem like they have the entire situation under control and are not unduly overwhelmed at this time. 

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“WPSD was celebrated for not just a day but a week to make sure that the staff are well-educated with regards to preventing harm not only hospital-acquired infections such as covid but the most common causes of harm”.

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FV hospital considers Patient and Staff safety as a holistic program. They have a hospital-wide program called ‘gearing towards zero harm’.  In this program, they collect all the most common causes of harm in a healthcare setting. Then, they run a series of educational programs and activities to engage and educate the staff.  FV Hospital does not just focus on infectious diseases as part of this project. They consider the whole gamut of preventable medical errors to achieve holistic improvements.

Talking about the theme for this year’s WPSD, “Health worker safety a priority for patient safety” and how ‘staff safety is a precondition to Patient safety’, Dr Rosas was quick to agree.

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“Definitely. It is very closely related. Why? If your staff are not safe, how can they serve well? If your staff are getting sick, how can you serve the patients. So they are directly related”. “Safety, it starts from home.  We take care of our staffs so that they can take care of our patients.”

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Globally, many hospitals tend to focus more on Patient safety compared to health worker safety. Statistics show that the rate of occupational illness and injury in the healthcare industry is higher than that of many other sectors. So, is Health worker safety being neglected in a way? Dr Rosas thinks it is far from intentional and probably has more to do with awareness and training.

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“Most probably there is no intention for them to neglect but a lack of empowerment. You have to empower the staff, you have to engage them. If they know how to prevent or how to take care of themselves, they can take care of the patient.”

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Increasing awareness in terms of safety precautions for staff and workers is one key advise Dr Rosas has for hospitals on developing a single culture of safety.

Throughout the world, there is a lot of fatigue and burnout among medical practitioners because the system is overwhelmed. From the perspective of mental health and wellbeing, proper and effective communication with staff, especially during a pandemic like this, is essential. Agreeing to that note, Dr Rosas shares how their hospital emphasizes work-life balance. They have a program called ‘I love FV’ which is a work-life balance campaign. Here, the staff engage in various activities that are fun or engage in a hobby to relax.

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“Infact in FV, we have this program, we call it, ‘I love FV’, which is a work life balance campaign. We engage them in diff activities, not only learning, fun learning,  but also for them to engage in a hobby that will eventually make them relax and be able to focus in the work afterward.”

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Support and Guidance from the government are also vital to continuously following safety measures and protocols and ensuring an overall safe environment. On the recent COVID19 experience, Dr Rosas highlights how the government of Vietnam was quick to form a task force. They formulated protocols for preventing transmission, and actively audited all hospitals in Vietnam to ensure adherence to the internal transmission protocol.

One of the better outcomes of this pandemic is that it has accelerated Digital transformation in the healthcare industry, reshaping Healthcare with technology and innovation. FV Hospital is a digitalization pioneer. They have been using software solutions for EMR, incident reporting system, and risk management system.  Their current focus is data analytics and eventually expect to embrace even Artificially Intelligent systems.

There is no International Healthcare Safety Board!

Talking so passionately about Patient and Staff safety and envisioning an International Healthcare Safety Board, Dr Rosas and his team have been working towards adopting a National Healthcare Safety Board. What drives his passion, in specific, for Patient Safety?

Dr Rosas narrates an incident where a friend of his who was a medical director of another hospital outside Vietnam experienced an avoidable patient safety incident resulting in the death of the patient.

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“In this story, you can see the discrepancy. It was like an epiphany for me. Patient safety is not available throughout the world, especially to those who cannot avail accreditation”.

Dr Rosas says “Healthcare industry is often compared to a safety-critical industry like Aviation. Similar to Aviation, even in Healthcare, there are checklists and protocols and processes to follow. And yet, the number of preventable medical errors are still so much. So what’s the difference between Aviation and Healthcare? There’s no Healthcare Safety Board. In aviation, if you don’t follow protocols, you will be labelled as not fit to fly. But in Healthcare, you all have this freedom not to do so, and it’s a matter of life! Therefore we need to have an International Healthcare Safety Board wherein safety processes will be regulatory rather than an option for health care providers. And that’s my big dream!”

Despite all the educational materials on protocols and medication safety and so many guidelines, it is still not a priority. Patient and Staff safety, globally, is not yet the utmost priority. We need to step up, and we need to do it now. Thousands of patients across the world suffer avoidable harm or are put at risk of injury while receiving health care every single day.  Safety is for all.

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“this should be the foremost responsibility and accountability of all health care organizations – make it safe.”

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For us here at QUASR, this conversation was an immensely educating experience. Many aspects that we take for granted or assume to be the norm, are actually not so. The cost of these assumptions manifest in terms of patient and/or health worker safety. We hope you enjoyed reading about FV Hospital’s approach to healthcare safety. We believe there are many aspects of this approach that you can take forward to your organizations as well. 

Here is an excerpt from the video interview with Dr Rosas