BARRIERS IN INTERVENTION CHARACTERISTICS OF CLUSTER HOSPITAL (CH) IMPLEMENTATION IN MALAYSIA: AN EXPLORATORY STUDY

Authors

  • Ili Liyana Khairul Anuar Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia
  • Nik Dewi Delina Nik Mohd Kamil Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia
  • Nur Jihan Noris Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia
  • Pangie Anak Bakit Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia
  • Ng Rui Jie Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia
  • Nor Hayati Ibrahim Institute for Health Management, Ministry of Health Malaysia, Selangor, Malaysia

DOI:

https://doi.org/10.20319/lijhls.2021.71.1024

Keywords:

Implementation Research, CFIR, Hospital Mergers, Perceived Barriers, Cluster Hospitals

Abstract

To address an imbalance between congested specialist hospitals and underutilised district non-specialist hospitals, Ministry of Health Malaysia introduced Cluster Hospital (CH) in 2014. Following successful implementations from countries with similar healthcare system such as Hong Kong, and Australia, CH merges hospitals to establish an integrated network of specialist and non-specialist hospitals through shared resources, streamlined services and care coordination. A qualitative study was conducted to explore perceived barriers and boosters towards CH implementation and its sustainability among healthcare providers via semi-structured focus group discussions and in-depth interviews with purposefully selected respondents from the first six CHs. An Interview protocol was developed based on Consolidated Framework for Implementation Research (CFIR) covering five domains; intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. This paper will only highlight the perceived barriers in the intervention characteristics domain. A total of 274 participants from varying professions were interviewed. Interviews were audio-recorded, transcribed and thematic analysis was performed. In this domain, barriers to implementation were found within three constructs; complexity, design quality & packaging, and cost. Issues highlighted include intervention was designed with vague guidelines & policies, distance and travel costs within a CH, medical record safety, huge capital and operating cost involved. It was found that adaptation of evidence-based interventions needs to take into account the local context of an organisation for the implementation to be successful and produce desired outcomes. Thus, these perceived barriers raised by ground-level implementers should be considered and acted upon when strategising towards CH sustainability.

References

Ahmad, D. (2019). Enhancing Sustainability in Healthcare Delivery—A Challenge to New Malaysia. The Malaysian Journal of Medical Sciences : MJMS, 26(1), 1–4. https://doi.org/10.21315/mjms2019.26.1.1

Anderson, T., & Catchlove, B. (2012). Health and hospital reform in Australia—A local health district’s perspective. World Hospitals and Health Services: The Official Journal of the International Hospital Federation, 48(3), 21–24.

CFIR Research Team-Center for Clinical Management Research. (2021). The Consolidated Framework for Implementation Research. The Consolidated Framework for Implementation Research – Technical Assistance for Users of the CFIR framework. https://cfirguide.org/

Daivadanam, M., Ingram, M., Annerstedt, K. S., Parker, G., Bobrow, K., Dolovich, L., Gould, G., Riddell, M., Vedanthan, R., Webster, J., Absetz, P., Alvesson, H. M., Androutsos, O., Chavannes, N., Cortez, B., Devarasetty, P., Fottrell, E., Gonzalez-Salazar, F., Goudge, J., … Group, on behalf of the G. C. and C. working. (2019). The role of context in implementation research for non-communicable diseases: Answering the ‘how-to’ dilemma. PLOS ONE, 14(4), e0214454. https://doi.org/10.1371/journal.pone.0214454

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. https://doi.org/10.1186/1748-5908-4-50

Engström, A. K., Rosengren, K., & Hallberg, L. R.-M. (2002). Balancing Involvement: Employees’ experiences of merging hospitals in Sweden. Journal of Advanced Nursing, 38(1), 11–18. https://doi.org/10.1046/j.1365-2648.2002.02141.x

Fulop, N., Protopsaltis, G., King, A., Allen, P., Hutchings, A., & Normand, C. (2005). Changing organisations: A study of the context and processes of mergers of health care providers in England. Social Science & Medicine, 60(1), 119–130. https://doi.org/10.1016/j.socscimed.2004.04.017

GovHK. (2019). GovHK: Overview of the Health Care System in Hong Kong. https://www.gov.hk/en/residents/health/hosp/overview.htm

Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation Science, 7(1), 50. https://doi.org/10.1186/1748-5908-7-50

Gustafsson, C. H., & Östberg, A.-L. (2017). Experiences from the Merger of Clinics in the Swedish Public Dental Service the Employee Perspective. The Open Dentistry Journal, 11, 503–511. https://doi.org/10.2174/1874210601711010503

Hull, L., Goulding, L., Khadjesari, Z., Davis, R., Healey, A., Bakolis, I., & Sevdalis, N. (2019). Designing high-quality implementation research: Development, application, feasibility and preliminary evaluation of the implementation science research development (ImpRes) tool and guide. Implementation Science, 14(1), 80. https://doi.org/10.1186/s13012-019-0897-z

Jay Biem, H., Hadjistavropoulos, H., Morgan, D., Biem, H. B., & Pong, R. W. (2003). Breaks in continuity of care and the rural senior transferred for medical care under regionalisation. International Journal of Integrated Care, 3. https://doi.org/10.5334/ijic.85https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483941/

Kirsh, S. R., Lawrence, R. H., & Aron, D. C. (2008). Tailoring an intervention to the context and system redesign related to the intervention: A case study of implementing shared medical appointments for diabetes. Implementation Science, 3(1), 34. https://doi.org/10.1186/1748-5908-3-34

Kristensen, T., Bogetoft, P., & Pedersen, K. M. (2010). Potential gains from hospital mergers in Denmark. Health Care Management Science, 13(4), 334–345. https://doi.org/10.1007/s10729-010-9133-8

Medical Development Division. (2016). Overview of Cluster Hospital Pilot Project. In Compilation Reports of The Cluster Hospital Pilot Projects Implementation (Vol. 1). Institute for Health Management.

Medical Development Division. (2018). Hospital Cluster Initiative Handbook. Institute for Health Management.

MOH. (2019). Health Facts 2019 Booklet. MOH. https://www.moh.gov.my/moh/resources/Penerbitan/Penerbitan%20Utama/HEALTH%20FACTS/Health%20Facts%202019_Booklet.pdf

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y

Schmitt, M. (2017). Do hospital mergers reduce costs? Journal of Health Economics, 52, 74–94. https://doi.org/10.1016/j.jhealeco.2017.01.007

Sikka, V., Luke, R. D., & Ozcan, Y. A. (2009). The efficiency of hospital-based clusters: Evaluating system performance using data envelopment analysis. Health Care Management Review, 34(3), 251–261. https://doi.org/10.1097/HMR.0b013e3181a16ba7

Solstad, E., Pettersen, I. J., & Robbins, G. (2020). Hospitals as professional organizations and the perception of distances. Financial Accountability & Management, n/a(n/a). https://doi.org/10.1111/faam.12234

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Published

2021-03-15

How to Cite

Khairul Anuar, I. L., Mohd Kamil, N. D. D. N., Noris, N. J., Bakit, P. A., Jie, N. R., & Ibrahim, N. H. (2021). BARRIERS IN INTERVENTION CHARACTERISTICS OF CLUSTER HOSPITAL (CH) IMPLEMENTATION IN MALAYSIA: AN EXPLORATORY STUDY. LIFE: International Journal of Health and Life-Sciences, 7(1), 10–24. https://doi.org/10.20319/lijhls.2021.71.1024