LETTER | No shortcut in root cause analysis of issues: MOH doctor

LETTER | Recently, many own goals were scored in media statements on two issues: the inability to get full maternity leave at public health clinics under the Hulu Langat district health office and CCTV in Sungai Buloh Hospital’s trauma resuscitation area.

Press statements are made as official statements that, instead of solving the issue, actually open up more questions on planning, policy, and leadership at the ministry level.

These also portray that the health minister is surrounded by advisers who are totally detached from ground operations.

Here are some questions one must ask about the recent issues:

Maternity leave reduction from 90 to 60 days

Why didn’t the people in charge from the facility and state mobilise staff for the situation?

State directors in Selangor are usually very experienced leaders within their field.

The minister’s answer was quite simple: “We solved the problem before the article was published.”

This is far from addressing and finding the root cause of the issue. For the operational team, the answer they would want to know is what will HQ do to improve within its premises?

CCTV in critical resuscitation area at Sungai Buloh Hospital

It’s very interesting that the Health Ministry, through the Emergency Medical and Trauma Services (EMTS), is piloting something called, “If you don’t have enough staff, use CCTV”.

Using CCTV as a countermeasure for inadequate staffing opens up more questions that are operational in nature:

1. Who will be the one monitoring the events via CCTV? Are they clinical or non-clinical personnel?

2. If clinical, how come that individual is not inside managing the patient, but can be spared outside to monitor a CCTV?

3. Really, CCTV to replace the clinical care of doctors and nurses?

If all the above is true, then please do share the guidelines on how to use it.

CCTV issues: A guide for the health minister’s press secretary

Sometimes, hard questions will trigger thinking and provide guidance for future betterment.

‘I need CCTV because I don’t have enough nurses to monitor the patient’

The Emergency Department (ED) deals with the acute resuscitation of trauma patients. Subsequently it will be taken over by the surgical team. Keeping a patient in an operating theatre environment without staff to monitor them is dangerous; CCTV will not be a safe solution.

Perhaps the team should consider stepping the patient down to acute care areas within the ED where more nurses can be pooled together.

‘I am the only trauma-trained emergency physician, I need to monitor what another specialist is doing’

All emergency physicians are trained in trauma resuscitation. For this reason, are you sure it’s in a closed loop system?

If the CCTV is in a closed loop system within the hospital, why isn’t the trained specialist in the resuscitation room directly guiding the resuscitation?

‘I need CCTV to prevent my staff stealing of patients’ property’

Walk into the ED and see how other areas are monitored with the aid of CCTV. They are never directed at patients, but placed at the entry, exit, and corridor points.

It’s never deemed professionally threatening by staff, but accepted as security measures. The feed is monitored by the security team, thus it doesn’t actually make resuscitation or the patient its main focus.

Understand the root cause of an issue

The minister needs to really understand and listen to the grouses from operations, not just fully take answers provided by desk officers regarding an issue.

The maternity leave issue was made to only need a simple solution. Yet, it needed him to do it. What happened to HQ?

The CCTV issue has been made to appear like a mistake and that it is a critical gadget for the service. If this is true, tell us that Sungai Buloh Hospital is not the only hospital with manpower shortage.

But again, why are your doctors not buying it?

At the end of the day, we need our minister to be our champion, a politician who treats us as professionals and human beings with feelings.

Not all issues are bad; issues like these, if dissected well, are good to move things forward.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.