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NINTH MALAYSIA HEALTH PLAN
(2006-2010)            (Book 2)
 

CLINICAL DISCIPLINE:  

ORTHOPAEDICS AND TRAUMATOLOGY ,PHYSIOTHERAPY.

 

 OBJECTIVE:   To enhance the delivery of quality orthopedic and physiotherapy services

OBJECTIVES
STRATEGIES

PLAN OF ACTION

(OPERATIONALISATION)

INDICATORS/ TARGETS

REMARKS

  • Additional statements
  • Proposed method of monitoring and evaluation
Other remarks

1. To make

     accessible

      quality

     orthopaedic and

     physiotherapy

     services to all

     parts of the

     country.

1.1  Have an

Outreach

       Program-

       Coverage of

       quality

       services to all

       parts of the

       country

1.1.1 Outreach programme

        visitation by orthopaedic

         specialists and

         physiotherapist to

        designated District

        Hospitals. Have an

        effective referral

        system. To treat

        whenever possible and

    to refer when appropriate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.1  .2 Visitation by

         sub specialists to

         provide sub specialist

        care wherever needed.

 

 

 

 

1.1.3 Improved day care

         facilities

All designated hospitals should be covered.

All patients seeking Orthopaedic or physiotherapy treatment in Govt. Hospitals will be duly treated. No patient will be deprived of such services.

 

Indicator:

Measure % of hospitals covered.

 

DHC  - DHNC 

-----------------  X 100

        DHC

 Target:  100%

Frequency: 1-2 times in a month

 

SSCP – SSCNP

-----------------    X 100

      SSCP

 

Target: 100 %

Frequency : PRN

 

All Ortho Depts. must have day care services by 2008

Designated hospitals are hospitals, which can support such services. One such hospital usually covers a few Districts in a big State and a few such hospitals will cover the whole State. Depending on distance, referral made to the nearest designated hospital.

 

DHC = Designated hospitals should be covered

 

DHNC= Designated hospital not covered for any avoidable reasons.

 

 

 

SSC= Sub specialist care provided

 

SSCNP= Sub specialist care not provided despite request

 

 

 

 

 

 

 

 

2. Increase  quantity

    and improved

    quality of

    manpower by

    training for general

    and subspecialty

    care.

2.1 Improve standards

      and increase

      training of

      Orthopaedic

      specialists /

      sub specialists &

      physiotherapists.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2    Enhance Subspecialty Orthopaedic Fellowship Training in KKM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.3    Training of medical

       officers, nurses

       and paramedics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.4    Retaining

       manpower

2.1.1 Increase intake at

        local  Universities /

        Physio School

 

2.1.2 Encourage more

         Universities to set up

         Orthopaedic /

         Physiotherapy training

          programmes.

 

2.1.3 Encourage more

         Malaysians with

         recognized training

         from abroad to return

         to serve

 

2.1.4       Inculcate culture of continuing  medical  education and self improvement

 

2.1.5       More allocations to run training programmes

 

 

 

 

 

2.2.1       Increase no. of

           scholarships and full

           pay leaves.

 

 

 

 

 

 

 

 

2.2.2       Better promotion

           prospects for those

           passing

           subspecialties

           and also for trainers.

 

 

 

 

 

 

2.2.3       Credentialing and

            privileging at higher

            level for those

            passing formal

           subspecialty training.

 

 

2.3.1       Visitation to District

           Hospitals (Outreach

           Program) and train

           doctors / nurses /

           paramedics there to

           carry out basic

            orthopaedic /

            physiotherapy care.

 

 

 

 

 

 

2.3.2       To set up post basic

            Ortho training in

            Penang, Kuching

            and Trengganu

 

2.3.3       To set up a

           programme to train

           MA / nurses /

           physiotherapists in

           Ortho sub specialist

           supportive care.

 

 

 

2.4.1 Increase remuneration

          and promotion

          prospects.

 

 

2.4.2 Increase in the

          number of

         promotional posts for

         specialists &

         physiotherapists.

      

 

 

 

 

 

2.4.3 Career development

Indicator:

Measure % of increase / year

 

NT – NF

---------- X 100

    NT

 

NT= Total No. picked

         to train in all

         Universities.

 

NF= No. fail

 

Target = > 80 %

 

CME Grading

 

 

 

 

 

 

 

 

 

 

Indicator:

Measure % of scholarships & paid leaves

 

NT – NWS

-------------- X 100

    NT

 

Target = > 80 %

 

On gazettement  as sub specialist, to be promoted to next higher grade on fulfillment of all criterias.

 Trainers to be given faster promotion and incentives

 

Credentialing and privileging certification and recertification

 

 

 

Indicator:

Measure % of personnel trained at district hospitals to carry out basic ortho & physio care.

 

NT

---- X 100

TN

 

Target > 80 %

 

 Increase to 5  by 2010 from the present 2

 

 

Full running programme by 2008

 

 

 

 

 

 

 Preferably by 2010, all state heads should hold a JUSA post.

 

State & larger hospitals > 6 specialists.

Bigger district or smaller state hospitals 3-4 specialists.

Smaller district hospitals 2 specialists.

 

Subspecialist training

(see above)

With current workload, KKM norms of  2.2 ortho specialists per 100,000 population are inadequate. It should be around 8 /100000. This however may change when the 1st batch of subspecialists completes their training in 2008-2009.

 

KKM norms;

Deficit of 286 ortho surgeons by 2008

Should be much more, > 500 at current rate.

 

 

 

 

 

 

 

 

NT= No. in training

NWS= No. without paid leave or scholarship throughout  4 years of training

 

1st batch of subspecialist coming out in 2008-2009

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NT= No. trained

 

TN = Total No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attachment  6-12 months at subspecialist care centers.

 

 

 

 

 

Brain drain is a serious setback for any planning to succeed.

 

Ensure enough specialists to cover other district hospitals on visitation.

 

 

 

 

 

 

 

 

3. To improve

     communication,

     improve doctor-

     patient relationship

     ethical concerns,

     & enhance public

     perception of

     orthopaedic 

     doctors

     & physiotherapist

3.1 To provide courses

      and a good working

      environment.

      

 

 

 

 

 

3.2 Efficient delivery of

      care

3.1.1 Provide courses to

       improve communication

      skills, body language,

      ethical considerations,

      professionalism

      and improve doctor

      patient relationship.

 

Involving relations in treatment decisions.

 

3.2.1       Improve counter

          services, reduce

           waiting   time, prompt

          delivery of care, and

          etc.

2 courses a year  

 

No. of substantiated complaints or litigations / year

 

Target :  0 %

 

 

 

KKM norms

Good communication skills, good doctor patient relationships and perceptions are paramount in healthcare delivery leading to reduced litigations and complaints. 

4. To maintain the

    delivery of high

    quality, cost 

    effective,

    orthopaedic and

    physiotherapy   

   services.

4.1 Maintain QA

      activities

 

 

 

 

 

 

4.2 Enhance research

      and  development

 

 

 

 

 

 4.3     Optimizing

       Resources

4.1.1 Continuous audit of

         care  delivered

 

4.1.2 Steps taken to reduce

          medical errors,

          mortality and

          morbidity.

 

4.2.1 Identify problematic

          areas in Ortho &

          Physiotherapy

          needing studies

 

 

 

 

 

4.3.1. Networking of

          manpower, patients &

           equipments within

           Ortho & Physio

           Depts.

 

4.3.2       Intersectoral

Cooperation

 

4.3.3       Avoid duplication of

Services – doing away with redundant services

 

4.3.4       Prioritization of care

- Trauma care takes precedence

 

4.3.5       Increase use of ICT

-         teleconsultation

-         link with other depts. & agencies

-         use of ICT in management of quality

-         keep national/ state databases and registries

-         In surgery

 

4.3.6  Ensure usage of

        appropriate health

        technology

 

 

 

4.3.7 Adequate allocation

        for implants & replace

        redundant equipments.

KKM Norms

 

 

Mortality/morbidity meetings in every Dept. at least once a month.

 

No. of studies with results needing change in policy or practice

 No of implementation of change in practice & policy

 

No of hospitals in the State with low BOR to take In chronic patients for rehabilitation

 

 

 

 

 

 

 

 

 All trauma cases to be done before 48 hrs.

 

Every department to have access to internet facilities by 2008 and all correspondence & referral preferably via e-mail.

 

Ortho KKM website by 2006/2007

 

 All new technology have to be assessed by HTA Dept. before use

 

 To increase allocation by 10 % per year

 

 

 

With corrective recommendations.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Use of consignment equipments or facilities provided by private companies to save cost of purchasing.

 

 

 

 

 

 

Computer assisted surgery – Navigation Systems. Able to do precision surgery for better outcome & reduced costs in terms of reduced hospital stay.

 

 

 

 

 

 

 

 

 

 

 

 

 

5.To expand existing

     service and

    subspecialty,

   upgrade facilities

   and create new

   service and 

   subspecialty

   services

   in designated

   Hospitals

   depending on the

   needs of the

   country

 

Menwujudkan Program Otopidik Subspecialty

(program baru)

 

To draw up new programmes for all Ortho subspecialty service.

5.1 To change and

      cope with

      demographic

    shift of population

    and changing

    disease patterns,

    e.g. increase in

    geriatric

    population,

     degenerative

     diseases

 

5.2 Opening of new

     Ortho and

     physiotherapy

     services in existing

     hospitals.

 

 

5.3 Upgrading of existing

     Arthroplasty

      Services & creation

      of new service

 

 

 

 

5.4 Upgrading of Spine

Services

 

 

 

 

 

 

5.5 Upgrading of General Orthopaedics and Trauma services

 

5.6  Upgrading of Pediatric Ortho services

 

 

 

5.7 Upgrading of Sports injury services

 

 

 

 

5.8 Upgrading of Ortho Oncological services

 

 

 

5.9 Upgrading of hand & upper limb services

 

 

 

 

 

 

5.10         Foot & Ankle

           Services

 

5.11         Setting up Bone

          banking services

 

5.12         Upgrading of

           Ortho OTs’

 

5.13         Upgrading of

           physiotherapy /

           rehab

           services

 

 

 

5.14         Multidisciplinary

           DM foot

           disorders clinic

 

 

5.15         Artificial limb /

           prosthetic

           Center &

           Locomotor

           Assessment

 

 

5.16         Metabolic bone

          diseases &

          Athritis Clinic

 

5.17         Rehabilitation

          wards / hospitals

          & A&E ward 

          concept

5.1.1 Identify changes and shift to plan for creating of such services – setting up of registries

 

 

 

 

 

 

 

 

 

 

 

 

P1 – Slim River, Perak

P2 – Kuala Lipis

P3 –  KIV  - Pekan/Mersing area

     

 

 

 

 

 

Existing service,

 HKL, HAS, HPP, 

 H Melaka, H Kuantan

 

New service,

 H Pandan / HSAJB

KIV- HU Sarawak (HUS)

HKB

 

 

 

Existing services,

-         HKL, HAS, HPP, H Ipoh, HKT, HUS, HTAR, H Sg Buloh

New services,

H Pandan

 KIV HKB, HQE

 

 

Continuing support of all Ortho Depts.

 

Setting up of trauma centres

 

 

Existing Services,

 HKL, HKB, H Selayang

New service

KIV  HPP, H Pandan, HAS

 HTAA Kuantan, HUS

 

Existing service,

 HKL,

New service

 H Serdang, H Pandan, KIV HPP, HUS, QEH, HKB

        

 

 

Existing service

HKB, HPP, HKL/ Putrajaya HUSarawak (Unimas)

New service

 H Pandan, QEH

 

 Existing service –                H Selayang

 

New service

 KIV -HKL, HTAA, HTAR

1 in Northern region, 1 in Southern region & 1 in East Malaysia. *

 

  • Hospitals to be identified later

 

Existing, HKL

New service at HPP

 

 

 

Laminar flows and endosuites

 

 

 

 

Increase personnel and upgrading of instruments in all physio / rehab facilities.

 

 

 

 

 

 

Setting up of a multidisciplinary DM foot clinic

 

 

 

 

Future planning depending on needs and financial situation

 

 

 

 

 

 

 

 

Future planning depending on needs and financial situation

 

 

 

 

 

Reduce use of acute beds, save costs & manpower

 

 

No. of registries to be set up on common ailments.

 

Target: 2 by 2008

 

 

 

 

 

 

 

 

 

 

1 Ortho specialist to

20,000 population

 

Surrounding radius  distance of > 100 km

 

 

At least 1 trained personnel / sub specialist in these centers.

 

1:100,000 population

 

 

 

 

 

At least 1 trained personnel / sub specialist in these centers.

 

1:100,000 population

 

 

Increase budget allocation of 10 % per year for trauma services

 

At least 1 trained personnel / sub specialist in these centers.

1:200,000 population

 

At least 1 trained personnel / sub specialist in these centers.

 

1:200,000 population

At least 1 trained personnel / sub specialist in these centers.

 

1:200,000 population

 

At least 1 trained personnel / sub specialist in these centers.

 

 

 

 

Nomination for scholarship 2006

 

 

Setting up at HPP by 2006/2007

 

 

 

In regional Hospitals by 2010

 

 

 

By 2010, to be able to offer daily physio service as compared to 1-2 times weekly as offered presently

 

 

 

 

 

In all Ortho Depts. by 2010

 

 

 

Planning to start in RM9 for RM10

 

 

 

 

 

 

 

 

Planning to start in RM9 for RM10

 

 

 

 

 

Planning to start in RM9 for RM10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P1 = phase 1

(2006-2007)

 

P2= phase 2

(2008-2009)

 

P3 = phase 3

(2009-2010)

 

To cope for the ageing population and  increase in the number of patients  requiring such subspecialities.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Hospitals to be identified later

 

Building ready by 2005

 

 

 

Prevent infections

 

 

 

 

 

 

 

 

 

 

 

 

 

According to CPG

 

 

 

 

 

 

Affordable prosthetic and orthotics for poor patients

 

Gait analysis

 

 

 

 

6  Disaster

     management

6.1 Contingency plan

        to deal with

        disasters

6.1.1 To ensure immediate

          response system in

          place

All Ortho Depts. must have a contingency plan to respond to any form of disasters.

Networking of

 patients & all

 resources between

  hospitals

To prevent and

     reduce disease

     burden

1  To implement

      preventive

      measures to

      reduce burden of

      orthopaedic related

      diseases and

      trauma.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Reduce disease

    burden by early

    operation and

    intervention

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 3. Reduce burden of

    disease by

    screening

1.1  Have public awareness and education programmes on Ortho related diseases

 

 

1.2  Program to reduce incidence of falls in elderly patients

 

 

 

1.3  Program to prevent osteoporosis and improve bone density

 

 

 

1.4  Program to reduce obesity

 

 

 

1.5  Back care program

 

 

 

1.6  To develop and improve community physiotherapy and strengthen wellness and back to work programme.

 

 

1.7  Education to reduce motor vehicle accidents and work related accidents

 

 

 

 

 

 

1.8  DM foot prevention

According to CPG

 

1.9  Aggressive approach to

      combat nosocomial

       infections in wards.

 

 

 

 

2.1 All compound fractures

      must be operated upon

      urgently

 

 

 

 

 

2.1       Some ortho condition

needs to be treated

        sufficiently early to

        reduce morbidity

 

 

 

 

2.2       Use of Computer

        assisted surgery /

        robotics

 

 

 

 

 

 

2.3       To ambulate elderly

         patients after   

         operation or from bed

         rest as early as

         possible

 

 

3.1.1 Scoliosis screening in

         schools

 

 

 

 

3.1.2 DM foot screening &

         prevention

 

 

 

 

3.1.3 Screening of elderly

         patients on discharge,

      to see whether they

      have family support &

      whether they can

      come for follow up

Two programs a year

 

 

 

 To commence as soon as possible

 

 

 

 

To commence as soon as possible

 

 

 

Ongoing at physio Depts., ensure continuity

 

Ongoing at physio Depts., ensure continuity

 

All hospitals with Ortho & Physio Depts. must carry out this programme by 2008

 

 All hospitals with Ortho & Physio Depts. must  educate patients on their follow up as well as to the public via forums and exhibitions.

 

All depts. to have a program by 2010

 

All Depts. To have a committee to oversee nosocomial infection prevention.

 

Before 8 hours

 

All hospitals must have a daily Trauma OT  0f 8 hours by 2008

 

 

To have increase Ortho OT time in all hospitals by another 60 % by 2010

 

 

 

 To obtain Navigation systems by 2006 in selected centers.

HKL, HPP, HAS

 

 

 

 All physio depts. to have a plan to ambulate by 3rd POD unless contraindicated

 

 

Ongoing program, may be shelved if not cost effective

 

 

 

All hospitals must have a multidisciplinary DM foot screening program by 2010

 

All depts. to have such facilities by 2010

Collaborate with Bhg. Sumber to have forums and exhibitions

 

R&D to determine factors causing falls in the elderly and measures to prevent it

 

Exercise and body balancing programmes

 

 

Reduce stress on joints & reduce backache

 

Reduce backache and early back to work

 

Community physio – training of nurses at heath centers to carry out simple basic physiotherapy.

 

 

 

Collaborate with Road Safety Council and SOCSO

 

 

 

 

 

 

Multidisciplinary

approach

 

 To commence immediatedly

 

 

 

 

 

Delayed treatment results in

complications needing prolonged treatment & costs.

 

 

 

Statistics shows marked increase of Ortho operated cases as compared to nearest discipline by approx. 80 %

 

 

Reduced hospital stay and save costs

 

Precision Surgery

 

Faster recovery

 

 

 

To start immediately

 

Prevent morbidity

 

 

 

 

 

 

 

 

 

 

According to CPG

 

 

 

 

 

To “catch” neglected elderly patients not able to fend for themselves.

 

Collaborate with Social Welfare

Committee :

1. Dr Se To Boon Chong,HPP                                                                                  

2. Dato Dr Suresh Chopra, HAS                                                                                 

3. Dr Anwar Hau, HKB                                                                                              

 4. Dr Neela, KKM  

5. Pn. Asiah, Physio, HKL      

 

Prepared by: Dr Se To Boon Chong

                      with help from Bahagian

                     Perkembangan, KKM.

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