Running head: PRINCE COURT MEDICAL CENTRE

Prince court medical centre

Kurt Fadden
Santa Fe College
Fundamentals of Quality Management
3885
Lillian Bell
November 21, 2014
Prince court medical centre
During the outbreak of the H1N1 virus in 2009 Malaysian healthcare workers
were forced to take matters into their own hands to successfully contain and
eventually control what was being called an influenza pandemic. The situation in
Malaysia was not contained due the Ministry of Health (MOH) neglecting to issue
clear instruction on where and how to treat patients with suspected or confirmed
H1N1 infection. At the time it would seem both to an outside observer and a local
that the Malaysian government was acting irresponsibly with a sole strategy of
waiting it out and waiting for divine intervention to spare their citizens ( Siang, K., 2009).
In the meantime the Malaysian death toll was continuing to increase while
healthcare facilities were continuing to be left to fend for themselves. During this

time the staff at Prince Court Medical Centre (PCMC) moved to prepare their
institution in Kuala Lumpur for an outbreak of pandemic of Influenza. The PCMC
knew that it was critical to establish a task force to deal with the outbreak in order
to standardize treatment and share knowledge gained in the process of treating
patients. The situation in Malaysia was vastly different from that in the United
States due to the governments lack or urgency in helping Malaysian healthcare
organizations prepare for the epidemic. However, In the process of setting up and
executing an Influenza task force at PCMC they successfully created a culture of
Continuous Quality improvement within the organization that continues today.
Despite unfortunate circumstances differing form those in the United States that
forced PCMC into the situation they were able to establish a system of CQI that can
be continued if management takes the proper steps.
From the beginning of the H1N1 epidemic the United States responded in a
decisive and swift manner taking a strong mitigation approach to the issue (Huang,
2010). In the United States we were focusing on minimizing the impact by
maximizing surge capacity (Huang, 2010). Not only did the medical community in
the U.S. react quickly but they did so with the backing of the government and
sharing of information across the board to help standardize care. Obama declared
the situation a national emergency in order to deal with the rapid increase of the
infection (Obama, 2009). Obama's actions allowed Health and Human Services
Secretary Kathleen Sibelius to temporarily waive or modify certain requirements
to help health care facilities enact emergency plans to deal with the pandemic
(Obama, 2009). In the United States rather than seeking to contain the disease
officials were focusing their energy and resources on strengthening surge capacity
to treat the increasing number of cases and diminish the virus spread (Huang,

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2010). The typical American Hospital had immediate standardized admitting and
testing of H1N1 patients, as well as standardized laboratory testing. Not only was
the methodology standardized but health care organizations across all 50 states
were sharing information with each other in order to continuously improve
treatment and care of the outbreak.
However the situation in Prince Court hospital was vastly different. General
practitioners in Malaysia surrounding the centre did not know how to treat or where
to refer suspected H1N1 patients. Not only that, but urgency in the community was
low due to the low sense of urgency by the government. Where the U.S. was being
backed by the government and cooperation of information for putting the outbreak
to rest was statewide, Prince Court hospital had next to no cooperation or support.
They were left to make their own influenza task force for standardizing testing, care,
hygiene, course of action, and even ultimate resolution. Other healthcare agencies
didnt know how to handle the large influx of symptom patients and didnt have the
resources to perform timely lab tests to confirm the disease. Due to the
disorganized nature of these agencies the Prince Court hospital was left to
collaborate and collect their own information to continue to improve the system of
care for the influenza epidemic. This was differe3nt than in the U.S. were
information was being widely reported and shared for collaboration across all 50
states. The contrast in Malaysia is was that Prince court hospital was left to their
own devices to come up with an effective plan and standardization for dealing with
the H1N1 pandemic.
As highlighted above, a key issue with the influenza epidemic in Malaysia was
the lack of reaction by the ministry of health. Their initial directive was to treat
patients in dedicated government hospitals but at the same time there was a large

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influx of patients at private ERs. They failed to recognize that their needed to be
cooperation across private and government institutions, resulting in mass spread
confusion on the issue. Another issue highlighted in the video reporting on the
World Health Organizations (WHO) findings were that they did not educate the
public (WHO, 2009). According to a poll of the public the WHO found that even with the
mass influx of influenza cases they still did not take it seriously ( WHO, 2009). Under
normal circumstances the MOH should have not only taking the full responsibility in
promoting awareness and also in standardizing procedures for care. The MOH
should have also promoted cooperation between agencies but instead did the
opposite in the beginning. Far too much of the responsibilities needed to deal with
the epidemic were left to the devices of the institution. It is for this reason that
Prince Court hospital rose to the occasion by creating an influenza task force that
implemented the ideologies of CQI in order to address the epidemic.
During the epidemic management at Prince Court hospital successfully set up
a system to obtain continuous quality improvement. In order for them to continue
on such a path within the organization there are key steps that need to be taken.
Through their experience they formed organization center strategies such as focus
on context for work, working as a system, and promoting learning ( Sollecito, W. A., &
Johnson, J. K

,P.380). In order to continue quality improvement organizations need to

clarify organizational policies as well as values and the vision of care ( Sollecito, W. A., &
Johnson, J. K

,P.380). This is something that management a Prince Court hospital has

done and needs to continue to do, it is at the core of improving quality in healthcare
organizations. Another aspect that management must continue is the organizational
network they established throughout the epidemic. The opportunities to share
learning that led to the creation of multiple networks within the system were a key

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step in establishing an environment of CQI and need to continue to be

implemented. Such organization centered efforts can lead to positive changes in
how we organize and deliver healthcare ( Sollecito, W. A., & Johnson, J. K ,P.182)
There are also steps that Prince Court hospital must take in order to continue
to gain from its experience with working within the community during the epidemic.
Obtaining a view of the consumers of healthcare has been a key feature of CQI for
many years (Sollecito, W. A., & Johnson, J. K ,P.182). In order for the hospital to capitalize on
their involvement with the community they must continue to consider the patient as
a consumer (Sollecito, W. A., & Johnson, J. K ,P.182). While continuing to treat the patient as
a consumer they must also promote awareness of the importance of including the
community to improve patient safety as well (Nieva, V., & Sorra, J., 2014). A good way to
capitalize on this situation with the community would be to implement a safety
culture assessment (Nieva, V., & Sorra, J., 2014). For example, when mistakes are
discovered they should continue to use the community input to solve these issues
by getting to the core of the issues (Nieva, V., & Sorra, J., 2014). This would involve
recognition of the problem, gathering of information, evaluation, and a choice of the
best option moving forward (Sollecito, W. A., & Johnson, J. K ,P.183). After a situation such as
the influenza epidemic when procedure such as this were set in action is a perfect
time to continue with such endeavors.
During the H1N1 epidemic in Malaysia multiple factors contributed to the
PCMC setting up a task force as well as system of standards to address the issue.
Due to the lack of involvement of the MOH as well as cooperation between agencies
they were left to their own devices. This inherently forced them to implement
strategies that are inherent of CQI in healthcare. In order to continue this
atmosphere of improvement there are steps that management needs to continue to

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implement in the future such as organizational standards and community safety

assessment. However PCMC is on the right path to success in CQI despite the
situation that got them there was under unfortunate circumstances.

References
Huang, Yanzhong, 2010, Comparing the H1N1 Crises and Responses in the US and
China, NTS Working Paper Series No.1, Singapore: RSIS Center for Non-traditional
Security (NTS) Sudies.
Nieva, V., & Sorra, J. (2014, November 21). Safety culture assessment: A tool for improving
patient safety in healthcare organizations. Retrieved from
http://qualitysafety.bmj.com/content/12/suppl_2/ii17.full.pdf+html
Obama declares H1N1 emergency. (2009, October 26). Retrieved from
http://www.cnn.com/2009/HEALTH/10/24/h1n1.obama/index.html?iref=24hours
Siang, K. (2009, August 14). Why is A (H1N1) death rate in Malaysia four times the global case
fatality rate? [Web log post]. Retrieved November 17, 2014, from
http://blog.limkitsiang.com/2009/08/14/why-is-a-h1n1-death-rate-in-malaysia-four-times-theglobal-case-fatality-rate/
Sollecito, W. A., & Johnson, J. K. (2013). Mclaughlin and Kaluzny's continuous quality
improvement in health care. Burlington, MA: Jones & Bartlett Learning.
WHO finds Malaysians have poor knowledge of H1N1. (2009, August 29). Retrieved from
http://www.youtube.com/watch?v=j7_GFZ8msuk