Intangible information technology resources

ABC Hospital also places importance on intangible-IT resources, that is, the knowledge assets, synergy and customer orientation (Bharadwaj 2000) that reside in its doctors, nurses, specialists and clinical support staff, in order to develop its IS competencies and capabilities for preventive care.

Figure 4.4 is a picture of a specialist carrying out a preventive care service while referring to HIS (identities have been hidden). According to the consultant:

Dr S #37: I have a few colleagues [doctors], who are now furthering their sub-specialisation in the liver-related disease area. They are ABC’s future important people because when they come back as experts, they will be able to share knowledge and teach others. Their expert knowledge, skills and experiences obtained from other institutions are valuable for making important decisions, especially for chronic diseases patients’ care.

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Figure 4.4: A team of specialists providing preventive care treatment to a patient using the hospital information system

Note: Identities have been hidden

Chapter 5 provides a detailed explanation with examples of how preventive care IS competencies and capabilities are developed from tangible, human and intangible-IT resources.

Preventive care awareness programs

Generally, preventive care is divided into three categories: primary, secondary and tertiary prevention (Kenkel 2000). Primary prevention reduces the occurrence of the disease, secondary prevention reduces its health consequences and tertiary prevention reduces disabilities associated with chronic illnesses (Kenkel 2000). As a national hospital with advanced medical care, specialists and HIS, ABC’s preventive care mainly focuses on secondary and tertiary prevention. Primary prevention is mostly provided at district public health clinics (Jaafar et al. 2013; Liyanatul Najwa et al. 2016).

ABC promotes awareness of preventive care by its use of banners and posters showing the major risk factors for chronic diseases on the walls of the entrances to the clinics and wards. In addition, permanent drawings related to chronic diseases are displayed on the walls and along the main elevators, as pictured in Figure 4.5. Banners and posters are also placed on the way to the hospital café, where they can be seen by patients and the public, as pictured in Figure 4.6. Further, advertisements promoting a healthy diet are shown on TV screens located at strategic locations such

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as at the central patient waiting area in the clinics, at cafés and in front of diabetes and quit-smoking clinics. They disseminate general information about daily calorie requirements to patients and the public. Facebook is also utilised to show correct techniques for medical devices that control chronic disease complications, as pictured in Figure 4.7. This effort to promote an attractive environment showing sound preventive care information helps patients and the public see the importance of preventive care.

Figure 4.5: Permanent drawings on the wall

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Figure 4.7: Videos on appropriate techniques for using medical devices

ABC is actively involved in organising awareness campaigns and forums on preventive care in conjunction with celebrating local and global events. For example, ABC annually organises campaigns and forums to support cancer survivors, awareness programs for obesity and diabetes, and celebrates nutritional month, as shown in Figure 4.8. Departments across the hospital, such as the General Surgical Department, Hepatology Department, Dietetic and Food Services Department and Pharmacy Department, collaborate with the MOH and other external agencies. The purpose of these campaigns and forums is to raise awareness about chronic diseases and to educate people on their risks and implications.

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Preventive care services

In 2016, the proportion of all deaths attributable to chronic diseases in Malaysia was 76% (Institute for Health Metrics and Evaluation 2018). Most preventive care hospitals only provide primary and secondary care with basic care facilities (Aung et al. 2013; Boo et al. 2016). However, as a national referral centre, ABC provides an extensive range of secondary and tertiary preventive care services to the nation. To do this, the hospital established specialty services for secondary and tertiary preventive care in every unit to adequately address the growing threat from chronic diseases. It was thus able to reduce patient waiting time and, more importantly, provide higher quality patient care by offering specific treatments according to its specialty services and care facilities. Challenged by the increasing burden posed by communicable and chronic diseases, ABC made preventive care part of the acute care domain, linking it to each of the major services, and provided in parallel with acute care. Its preventive care component completes a healthcare system that includes all essential aspects of healthcare delivery (Hirshon et al. 2013).

ABC provides preventive care services to patients who require medical treatment and care from a specialist. The preventive care services include secondary and tertiary prevention and supported by primary prevention service to patients.The services are delivered explicitly to people with multiple chronic diseases such as diabetes type 2, cardiovascular disease, hypertension and cancer who are at high risk of getting worse and who may be referred for hospital readmission. Such situations arise when patients seek treatment after being identified as having a chronic disease, or seek treatment when they already have late-stage complications (Farooqui et al. 2011; Leong et al. 2007). Preventive care is grouped into three categories (Kenkel 2000). Primary prevention focuses on reducing the occurrence of a disease which is before the diagnosis, secondary prevention focuses on reducing or eliminating health consequences of disease, and tertiary prevention refers to reduce disability associated with a chronic illness which is emphasised during and after the diagnosis (Kenkel 2000).

Typically, patients who seek treatment at ABC are elderly. Most have at least two major co-morbid chronic illnesses, such as coronary heart disease, chronic obstructive pulmonary disease, chronic kidney disease or diabetes. ABC receives most referrals

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for eligible patients directly from other district hospitals, health clinics and private medical centres.

Since ABC opened its services to the public, its preventive care service, especially in providing specialised care to chronic disease patients for secondary and tertiary preventive care has been highly successful. For instance, as a renowned national tertiary referral centre for one of the cancers, ABC receives about 150 patients with the cancer every year with an overall survival rate of more than 70%. Moreover, with its many specialties, ABC is a training hospital for one of the public universities in Malaysia, providing teaching facilities for a particular chronic disease aspect for Year 4 and 5 medical students. The university established a chronic disease unit at ABC, and has received full accreditation to become a training centre. A clinic for that chronic disease is also held at ABC Hospital on selected days.

Dr Z #19: ABC has many sub-specialities that most of the other hospitals do not have. For an example of sub-speciality, our ophthalmology unit has a diabetic retinopathy area. Other departments also have their own sub-specialities. To this date, we are proud to say that ABC is receiving many medical students; nursing students and even doctors are coming here for practical or furthering their studies and sub-specialities, and the reason is because of the experts and the sub-specialities that ABC has.

Other than becoming a training hospital, ABC also plays an important role as a referral centre to another district hospital (known as a sister hospital) nearby. ABC’s specialist and medical officer visit the sister hospital to share their specialty skills and knowledge, offering consultation and treatment to the sister hospital’s patients. ABC also provides training to the healthcare practitioners at the district hospitals. Thus, ABC’s specialty services play a crucial role in providing preventive care services and training, sharing expertise and treating patients for specific medical needs on chronic disease categories such as diabetes, heart disease, cancer and respiratory problems.

To ensure its preventive care is successful, ABC focuses on three components – administrative efficiency, quality of care and health promotion. First, administrative efficiency is evidenced by the way ABC healthcare practitioners manage how the services are delivered to patients (Krist et al. 2013). For example, a patient suffering from chronic diseases is admitted to the ward, scheduled for blood tests and scans,

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and prepared for counselling. A patient report is prepared, treatment is organised, and medication prepared and administered. As Nurse K explained:

Nurse K #38: Patients with smoking habits usually have cardiovascular problems. I have received many cases like this. When a patient is referred to this unit, the first thing is to organise the treatment procedures that the patient will need to go through. By doing this, the patient will understand the reason for getting the treatment. For example, I will explain that the patient will need to go through carbon monoxide test to determine their smoking status and what the level means. This is because if the patient knows his carbon monoxide level, the patient may be prone to quit smoking. And if the patient is a light smoker, it is more likely that he may want to stop straight away.

Second, quality of care refers to “whether individuals can access the health structures and processes of care, which they need and whether the care received is effective” (Campbell, Roland & Buetow 2000, p. 1614). At ABC, a structured patient care process is provided and the patient will go through several appropriate care scenarios in each process to ensure they receive the best care from healthcare practitioners. For example, a patient will be advised on treatment plans and alternatives, treated by a health professional team, taken care of and monitored closely by trained nurses, and will receive education and counselling from the dietician and pharmacist. In certain cases, they will also receive guidance and support from a physiotherapist to improve the physical aspects of their condition. The following is one example of how the consultant explains the doctors’ efforts towards patients that may lead to quality of care:

Dr St #39: A doctor is a role model to another practitioners. As a doctor, it is how you treat, communicate and educate a patient until you can clear the patient’s doubt on their health issues. I always stress to my doctors how they should deliver news on the patient’s disease, advise the patient on the treatment alternatives and the implications from the treatment. I can see that if my patient can understand clearly what is happening to them, they will be open to accept the doctor’s suggestion on the treatment plans and finally follow all the treatment suggested.

Third, health promotion in ABC includes holding awareness campaigns for the public, conducting patient education and counselling to raise awareness, providing education on chronic disease risks, and providing care management. Gullotta and Bloom (2003) refer to health promotion as a range of activities with the purpose of improving the health of individuals, groups and communities through general activities like health

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education, health communication and social activities. Section 4.3 discussed some of these examples, and Section 4.6 highlights more examples.

Preventive care patient processes

To achieve the above-mentioned three main components of preventive care (administrative efficiency, quality of care and health promotion), ABC integrates its tangible, human and intangible-IT resources within its preventive care patient processes. This combination of IS resources helps to develop the IS competencies of the healthcare practitioners. These competencies consist of relevant skills sets and IS capabilities that are used during patient care processes to deliver preventive care. These crucial elements are portrayed by the healthcare practitioners and applied during the day-to-day operations and procedures in preventive care patient processes. The healthcare practitioners involved during the preventive care patient processes are from many disciplines, including doctors, nurses, dieticians, pharmacists, physiotherapists and health-education officers. Figure 4.9 depicts ABC’s six preventive care patient processes.

Figure 4.9: Preventive care patient processes at ABC Hospital