Lessons From The Ward: The Good and The Bad of Malaysian Healthcare

Most of us have had our brush with the medical and healthcare system sometime in our lives, whether from past experience or sometime in the future.

I personally had my fare share recently – the good, the bad and the ugly, as my father was admitted and spent few months in two hospitals.

The contrast of the treatment from those two hospitals we received was like night and day, from which I derived six leadership lessons and would like to share for the benefit of not just those in the healthcare and medical field but also the healthcare organisation and system as a whole.

Trust and communication

The ability to communicate with multiple stakeholders is not only a prerequisite, but the ability to influence others, especially when it comes to high risk strategies and decisions is necessary to create an efficient environment and effective way of working.

Communication enables those in the medical team to know what to expect, and they are, as a result, calmer and better prepared to care for patient.

One of the chief surgeons operated on my dad. Although it was a high risk surgery due to the nature of the surgery combined with my dad’s critical condition, she was able to communicate confidence and influence us on the need to go ahead with the surgery while painting a conservative view of the situation to cautiously manage our expectations.

Concurring with Tim Rath and Barry Conchie’s theory based on their book, Strengths Based Leadership: Great Leaders, Teams, and Why People Follow, trust is one of the main components of communication and core foundations to build a strong team and followership.

With trust and mutual respect for each other’s role in the team, the team is more engaged and will enjoy better and more frequent communication.

Similarly, when it comes to influencing her team with the decision to go ahead with a high risk surgery, the chief surgeon commanded the followership needed, with trust and strong communication established. They do not necessarily have to fully agree with the leader on the decision made but they understood the why behind it.

Creating a safe space for risk-taking with sufficient support provided is the psychological safety needed in functional workplaces for teams to perform better and learn from mistakes.

Some of the worst outcomes come in environments where employees are afraid to share failures and take risks which leaves leaders in the dark and problems end up fester and grow.

For example, a nurse might suspect that a patient is being given a dangerously high dosage of medication — but might not call the doctor to check, because the last time she spoke up, the doctor questioned her competence.

From this example, not speaking up could have fatal consequences for the patient. Strong communication in teams allows healthcare practitioners to make better informed decisions.

By engaging with the leadership through effective communication of needs, there is active validation and real-time adaptations needed in the practice to address the changing demands of patients and healthcare environment.

As such, encouraging dialogue, sharing knowledge and experiences between multiple stakeholders not only streamlines redundant activities and reduces complexities in healthcare organisations, it also fosters better collaboration and teamwork.

Teamwork and collaboration

Medical care is one of the few sectors where lack of teamwork can actually cost lives whereby the failure to develop a strong managed care team is one of the most damaging practices when it comes to operating room efficiency.

I have personally observed this as, when my dad was wheeled into surgery last year, the surgical and anaesthesiology departments were working closely together with frequent updates on my dad’s condition while he was in ICU.

Coordination between the anaesthesiologist and the surgical team in that time is paramount to ensure patients are ready for surgery in the nick of time.

Initially, the situation seemed bleak as he was deemed not fit for surgery due to multiple organ failure where his condition would need to stabilise before any surgery could take place.

What added to the pressure was that there was a long lineup of patients who were waiting for surgery and, if he missed the cue, he would have to wait until the next turn which could be hours on end.

At the very moment his condition got better, the anaesthesiologist quickly updated the surgical team, optimising that small window of opportunity to do the necessary preparation in coordinating the patient’s care.

In this case, a seamless schedule flow from anaesthesiology to surgery is necessary to ensure a smooth transition into surgery and optimise operation time without unnecessary roadblocks and delays which could put patients’ lives at stake.

Effective teamwork encourages multiple parties to work together and facilitates integration through the interdependency among multiple stakeholders across different departments.

This is needed in the hospital setting whereby fostering a collaborative working environment with synergistic practices enables the team to achieve more as a collective team.

It has been ingrained into healthcare practitioners that no one member of the team can do it alone – not the physician, nurse, pharmacist nor physiotherapist. They must all work together as a collective team, with the patient, and for the patient.

Unified by the shared vision and values with patients’ best interests in mind, individuals are motivated to optimise team efficiency, improve healthcare practices and processes to reach the common goal.

This also fosters greater autonomy and encourages the adoption of leadership behaviours among staff which leads to improved patient care outcomes.

Leadership and culture

To raise levels of teamwork and nurture collaboration through inter-dependency between different healthcare practitioners, leaders need to be the first to model collaborative behaviours by adopting more inclusive leadership styles – leadership through influence, not authority, position or power.

However, many physicians are not trained to be team players but rather to use the military-style, “command and control” leadership approach during their medical training.

They are refrained from the ability to make independent decisions with every problem being perceived as the need for a solution.

Applying the traditional “command and control” environments which glorify all-knowing heroic healers challenges collaboration and creates silo mentality in healthcare.

The industry needs to shift towards a non-hierarchical style of leadership to create a collaborative work environment with team-centred leadership styles which allow individuals to work together towards organisation and patient benefit.

Unfortunately, I was on the receiving end of the detrimental effects of hierarchy and unhealthy culture in the workplace.

When my dad was transferred to one of the best specialist hospitals in the country, thinking that was for the better, we observed their rude and impolite way of treating their patients.

This could partly be attributed to the arrogance that they are the best in the country, but I could clearly see that it was because the head of department was rude to their patients and colleagues, something which breeds the same type of behaviours among those in their chain of command.

Unconsciously, the rest of the staff were behaving in the same way, thinking that that is the way the staff should function and get things done.

It also sends a message that behaving like their bosses to gain their favour and approval is what is needed to get to the top.

There was lack of care and compassion when treating their patients and handling caretakers like us, where their dignity was compromised – leaving their patients on a wet bed for hours and scolding their patients out in the open for not adhering to their advice.

As great as their technical expertise and medical knowledge were, it was the way they treated their patience which made a drastic difference in patient recovery.

Instead of a top-down approach in leadership and management, organisational success is heavily dependent on those further down, the front-line leaders. They are the ones in constant contact with the patient and the experience is formed by them.

As such, in line with Gallup’s 2nd element in Employee Engagement, ensuring that every employee has the tools, resources and support they need to do their job well is necessary.

Front-line leadership should be encouraged by empowering front-line clinicians with the given authority to make immediate judgment calls when needed during critical times and providing room for failure on new delivery ideas.

By working on their leadership skills with shared power with collective decision making, it creates a healthy environment for individuals to voice their opinions without biases that reinforce power distance.

More importantly, it also allows emerging leaders to move into leadership positions when ready.

Contextualisation and Decision-Making

The types of challenges that clinicians face when leading within the complex setting of a modern healthcare services include diverse and changing needs, increasing patient expectations, and the high cost of new inventions and treatments.

This requires clinicians to consider the needs of the wider patient population; to take decisions that not only make the best of resources but also deliver clinical quality; and implement clinically-led service improvements that are likely to succeed.

The leader’s effectiveness depends on how well the leader’s style fits the context. This speaks to how leaders need to be quick and nimble to evolve their thinking in regard to how best to work in today’s healthcare environment. Those who recognise the changes going on and adjust their leadership styles will likely be more successful.

Doctors, nurses and medical practitioners are bombarded with critical decisions in high intensity environments daily. They are required to make quick decisions with limited information given, to make the best call based on their experience and objective judgment.

Some decisions are made for the better and some for the worse. It is challenging that, in most decisions, there exists a tension in balancing the best interests of the patient with the best interests of providers — whether for economic, convenience or personal reasons.  

Based on my personal experiences, despite my dad being bed-ridden and not fit to be discharged to a normal ward, they had no choice but to go ahead due to the lack of beds in ICU.

Their choices were affected by their inability to cope with the increasing demand of patients and pressure from the top to quickly turnaround patients. As a result, the care for patients was neglected and my dad fell victim to circumstance.

The best hospital and health system leaders are critical thinkers and creative problem solvers.

But leaders in healthcare don’t run the show alone, they need to count on their team members for surgery, medical discovery or the pursuit of being successful.

In short, leaders must be more than smart — they have to be people-smart.

Emotional intelligence and empathy

Every decision made needs to be coupled with emotional intelligence and empathy especially as a healthcare practitioner.

Emotional intelligence consists of a set of personal and social competencies.

Personal competence consists of self-awareness, confidence, self-regulation, conscientiousness, and motivation.

Social competence consists of empathy and social skills such as communication and conflict management.

Emotional intelligence is also key as a clinician in motivating, communicating and managing conflict. This not only relates to handling difficult patients but having a positive impact on staff and in organisations.

What I admired in the doctors that I dealt with in the General Hospital was their ability to separate their emotions and be objective in conveying difficult news and in decision-making, while being able to empathise and show compassion when needed.

I appreciate one of the senior doctors in the emergency department who, when my dad was in the emergency ward, gave us updates on my dad’s condition.

That gave us the assurance that we needed throughout the night although he did not need to.

Empathy is a large part of emotional intelligence. Demonstrating care is especially important and useful in healthcare as it impacts patient outcomes.

Unfortunately, exhibiting empathy and compassion is sometimes deemed as a nice-to-have instead of a pre-requisite.

It may be considered as the soft-side in leadership, but Florence Nightingale acknowledged the importance of empathy and its centrality to quality patient care. She realised the need for a positive environment in after-patient care and established the first patient library is creating to help patients recuperate and have something to look forward to.

This sets her apart in becoming an effective leader whereby she harnessed her emotional and social intelligence to create a connection culture.

It is the same with managing a team and influencing others in the organisation. There is much more value on a leader who is open to listening to others and can handle team relationships well.

I remember specifically one houseman who although was not assigned to my dad case, would still come visit my dad in the ICU after his long shifts and make an effort to check on my dad.

I could see his deep passion to want see patients better and he was deeply grieved when my dad’s condition got worse.

Contrastingly, in a different situation when my dad was in the normal ward of the specialist hospital, we requested to be transferred to the private ward.

The medical team not only rejected our proposition but made unpleasant comments in front of other patients.

“That is the state of the current situation right now due to the healthcare system and this is what you have to deal with the limited resources here in Malaysia. If you are not happy, you can either complain or deal with it,” they would say.

And when my dad’s situation got worse, they would jeer with comments like: “Look at him in such a bad condition, yet still insisting on being transferred to a private ward.”

I understand the stress that they have to deal with on a daily basis, but having such a negative attitude is bad for the well-being of the patients.

Attitude and Commitment

Part of the right attitude that medical practitioners should have is to be responsible – having the care of their patients as top priority; passion – serving the needs of the patients and putting that above their own; and contrarian toughness – to see opportunities where others see barriers.

I was amazed by the dedication of the medical team at the General Hospital during the night when my dad was first admitted.

They would work for 24-hour shifts with minimal sleep and rest breaks, taking case after case and back-to-back surgeries, and were still able to complete my dad’s surgery successfully.

Their capability and competency was top-notch with their ability to endure through those physically, mentally and emotionally challenging conditions and yet, able to remain calm under duress particularly impressive.

This could be attributed to their years of training with the tenacity and perseverance to overcome challenging situations built and ingrained in them, but I nevertheless admire their passion and dedication to their profession.

Similarly, Nightingale saw her profession as more than just a job, but as a mission and calling. She chose a path of relentless commitment in caring for others and endured arduous working conditions which would be considered intolerable in today’s world.

Yet she never complained of “burnout” and, through devotion to her calling, she changed the world of healthcare forever.

Nightingale’s legacy has reminded us that caring for the sick is a mission, not just a business; that being a healthcare professional is a calling, not just a job.

The first duty of healthcare leadership is inspiring this commitment.

We might not be able to immediately change the state of our healthcare today, but we can start right now by promoting a culture of ownership towards a better medical and healthcare system with the leadership lessons shared above.

As Nightingale said: “We should never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often the mustard-seed germinates and roots itself.”

All great things start from humble beginnings. Step out, take the journey and stay committed on being the change. Our breakthrough will come one day.

Amanda Chua would like to acknowledge the medical staff and team at General Hospital who played a part in for their remarkable display of compassion and teamwork in saving her dad. The success of his surgery and significant improvements in his recovery is a true reflection of their dedication to patients and communities. Email her at amanda.chua@leaderonomics.com