NHEWS Hospital 2011 FullReport
MINISTRY OF HEALTH MALAYSIA
NCRC/HSU/2013.1
EDITED BY:
Sivasampu S, Arunah C
Kamilah D, Fatihah M
Goh PP, Hisham AN
NATIONAL HEALTHCARE
E S TA B L I S H M E N T &
WORKFORCE STATISTICS
HOSPITAL
2 0 1 1
N AT I O N A L H E A LT H C A R E S TAT I S T I C S I N I T I AT I V E
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
HOSPITAL
National Healthcare Establishment and Workforce Statistics (Hospital) 2011
September 2013
©Ministry of Health Malaysia
Published by:
The National Healthcare Statistics Initiative (NHSI)
National Clinical Research Centre
Ministry of Health
3rd Floor, MMA House
124, Jalan Pahang
53000 Kuala Lumpur
Malaysia
Tel.
Fax
E-mail
Website
: (603) 40439300/400
: (603) 40439500
: hsu@crc.gov.my
: http://www.crc.gov.my/nhsi/
This report is copyrighted. Reproduction and dissemination of its contents in part or in whole for research, educational or non-commercial
purposes is authorized without any prior written permission provided the source is fully acknowledged. The suggested citation is `National Clinical
Research Centre. National Healthcare Establishment & Workforce Statistics (Hospital) 2011. Kuala Lumpur 2013.’
This report is also available electronically on the website of the National Healthcare Statistics Initiative at: http://www.crc.gov.my/nhsi/
Funding:
The National Healthcare Statistics Initiative was funded by a grant from the Ministry of Health Malaysia (MRG Grant No. NMRR-09-842-4718)
Please note that there is potential for minor corrections of data in this report. Please check the online version at
http://www.crc.gov.my/nhsi/ for any amendments.
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CONTENTS
ACKNOWLEDGEMENTS
vi
ABOUT NATIONAL HEALTHCARE ESTABLISHMENT AND WORKFORCE SURVEY (NHEWS) – HOSPITAL
vii
MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM
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MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS
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SUMMARY OF STUDY PROCESS
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STUDY METHODOLOGY
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CONSORT DIAGRAM
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Consort Diagram NHEWS 2011 (Acute Curative Hospitals)
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Consort Diagram NHEWS 2011 (Maternity Services)
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Consort Diagram NHEWS 2011 (General Surgery Services)
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Consort Diagram NHEWS 2011 (Oncology Services)
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Consort Diagram NHEWS 2011 (Psychiatry Services)
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Consort Diagram NHEWS 2011 (Ophthalmology Services)
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ABBREVIATIONS
xxv
SYMBOLS
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CHAPTER 1 | OVERVIEW OF HOSPITALS AND SPECIALISTS SERVICES IN MALAYSIA
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CHAPTER 2 | ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA
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Table 2.1 Hospitals Providing Acute Curative Care
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Table 2.2 Types of Hospitals Establishment Providing Acute Curative Care
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Table 2.3 Different Types of Private Hospital’s Entrepreneurship
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Table 2.4 Inpatient beds
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Table 2.5 Operating theatre (OT), Operating Rooms (ORs) and Functioning ORs
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Table 2.6 Doctors and Patients Admission
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Table 2.7 Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Turnover Interval (TOI)
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Table 2.8 Average Length of Stay (ALOS) by Acute Hospital Type
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Table 2.9 Bed Occupancy Rate (BOR)
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Table 2.10 Turnover Interval (TOI) by Acute Hospital Type
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Table 2.11 Hospital Doctors, Staff Nurses (with and without Post Basic Training)
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Table 2.12 Community Nurses and Assistant Nurses
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Table 2.13 Assistant Medical Officers (AMO)
19
Table 2.14 Pharmacists, Physiotherapists, Occupational Therapists, and Dieticians
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Table 2.15 Medical Record Officers and Medical Social Officers
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Table 2.16 Computed Tomography (CT) Scanners and Rate of CT scan Procedures
22
Table 2.17 Magnetic Resonance Imaging (MRI) and Rate of MRI Procedures
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Table 2.18 Positron Emission Tomography (PET) and Rate of PET Procedures
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CHAPTER 3 | MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES
Table 3.1 Hospitals Providing Maternity Services
Table 3.2 Functioning Delivery Beds
Table 3.3 Dedicated OT Facilities and Functioning ORs
Table 3.4 Functional Obstetric High Dependency Unit (HDU) Beds
Table 3.5 Total Deliveries
Table 3.6 Spontaneous Vertex Deliveries (SVD)
Table 3.7 Vaginal Breech Deliveries
Table 3.8 Instrumental Deliveries using Vacuum
Table 3.9 Instrumental Deliveries using Forceps
Table 3.10 Caesarean Surgeries
Table 3.11 Lower Segment Caesarean Section (LSCS), Caesarean Hysterectomy and Hysterotomy
Table 3.12 Multiple Pregnancies Deliveries
Table 3.13 Eclampsia
Table 3.14 Post Partum Haemorrhage (PPH)
Table 3.15 Newborns Delivered & Admitted to Paediatrics, NICU & SCN
Table 3.16 Obstetrics & Gynaecology (O&G) Specialists and Medical Officers
Table 3.17 Staff Nurses and Community Nurses in O&G services
Table 3.18 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Obstetric Ward)
Table 3.19 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Labour Ward)
Table 3.20 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Obstetric HDU)
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CHAPTER 4 | SURGICAL SERVICES IN MALAYSIAN HOSPITALS
Table 4.1 Hospitals Providing General Surgery Services
Table 4.2 Total Surgeons, Operation Theatre (OT) and Theatre Scrub Nurses
Table 4.3 Dedicated Emergency/Trauma Theatres (Public Hospitals)
Table 4.4 General Surgeons and Total Elective Operating Hours (Public Hospitals)
Table 4.5 Elective Cases in General Surgery (Public Hospitals)
Table 4.6 Emergency Cases in General Surgery (Public Hospitals)
Table 4.7 Mastectomies
Table 4.8 Total, Open and Laparoscopic Inguinal Hernia Surgeries
Table 4.9 Total, Open and Laparoscopic Cholecystectomies
Table 4.10 OGDS Scopes and OGDS Cases by Surgical and Medical Specialists (Public Hospitals)
Table 4.11 OGDS Scopes and OGDS Cases (Private Hospitals)
Table 4.12 Colonoscopes and Colonoscopy Cases by Surgical and Medical Specialists (Public Hospitals)
Table 4.13 Colonoscopes and Colonoscopy Cases (Private Hospitals)
Table 4.14 ERCP Scopes and ERCP Cases by Surgical and Medical Specialists (Public Hospitals)
Table 4.15 ERCP Scopes and ERCP Cases (Private Hospitals)
Table 4.16 OGDS Scopes, Colonoscopes and ERCP Scopes
Table 4.17 Theatre Scrub Nurses
Table 4.18 General Surgeons and Anaesthesiologists
Table 4.19 Breast Surgeons, Breast and Endocrine Surgeons
Table 4.20 Vascular Surgeons, Hepatobiliary Surgeons, and Colorectal Surgeons
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CHAPTER 5 | ONCOLOGY SERVICES IN MALAYSIAN HOSPITALS
Table 5.1 Hospitals Providing Oncology Services
Table 5.2 Hospitals Providing Oncology Services (with and without Oncologist)
Table 5.3 Clean Room for Reconstitution of Cytotoxic Drugs
Table 5.4 Hospitals Providing Cytotoxic Drug Reconstitution (CDR) Services
Table 5.5 Chemotherapy Day Care Services, Chemotherapy Beds and Chairs
Table 5.6 Oncologists
Table 5.7 Oncology Trained Nurses, Radiation Therapists and Physicists
Table 5.8 Megavoltage Machines, Brachytherapy Machines and Simulators
Table 5.9 Physics Equipment and Treatment Planning System Devices
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Table 5.10 Equipment Capable of Carrying Out Intensity Modulated Radiotherapy (IMR), Image Guided Radiotherapy (IGRT) & Stereotactic Procedure
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CHAPTER 6 | PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS
Table 6.1 Hospitals Providing Psychiatry Services
Table 6.2 Inpatient Dedicated Beds and Functioning Inpatient Dedicated Beds
Table 6.3 Inpatient Psychiatry Admissions, Dedicated Beds and Mean Bed Occupancy Rate
Table 6.4 Follow up Outpatient Visits, New Cases and Referrals from Wards or Emergency Department
Table 6.5 Community Psychiatric and Psychiatric Rehabilitation Services (Public Hospital)
Table 6.6 Hospital Visits with Patients below 18 Years Old and above 60 Years Old
Table 6.7 Methadone Replacement Therapy (MRT) Services & Total MRT Patients (Public Hospital)
Table 6.8 ECT Machines and Procedures
Table 6.9 Psychiatrists
Table 6.10 Clinical Psychologists
Table 6.11 Counsellors in Psychiatry Services (Full Time and Common User)
Table 6.12 Medical Social Workers in Psychiatry Services (Full Time and Common User) (Public Hospital)
Table 6.13 Nurses in Psychiatry
Table 6.14 Assistant Medical Officers in Psychiatry Service (Public Hospital)
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CHAPTER 7 | OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS
Table 7.1 Hospitals Providing Ophthalmology Services
Table 7.2 Dedicated Ophthalmology Operating Rooms (ORs) (Public Hospitals)
Table 7.3 Ophthalmology Elective Operating Hours (Public Hospitals)
Table 7.4 Cataract Surgery (Day care and Inpatient)
Table 7.5 Glaucoma Surgery (with and without Implant)
Table 7.6 Vitreoretinal Surgeries
Table 7.7 Ophthalmologists
Table 7.8 Optometrists
Table 7.9 Assistant Medical Officers (AMOs) in Ophthalmology Services (Public Hospital)
Table 7.10 Nurses in Ophthalmology Services (Public Hospital)
Table 7.11 Ophthalmology Devices
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APPENDICES
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APPENDIX 1 | LIST OF DEFINITIONS
Chapter 2 : Hospital
Chapter 3 : Obstetrics
Chapter 4 : General Surgery
Chapter 5 : Oncology
Chapter 6 : Psychiatry
Chapter 7 : Ophthalmology
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APPENDIX 2 | PARTICIPANTS FOR NHEWS (HOSPITAL) 2011
Hospital Sector: Public/ Ministry Of Health
Hospital Sector: Public/ Ministry Of Health/Psychiatric Institution
Hospital Sector: Public/ University
Hospital Sector: Public/ Jabatan Kemajuan Orang Asli
Hospital Sector: Private
Hospital Sector: Private/ Maternity Homes
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APPENDIX 3 | MALAYSIAN POPULATION, 2011
Table A3.1 Total Population by State, Malaysia 2011
Table A3.2 Total Population of Females by State, Malaysia 2011
Table A3.3 Number of Live Births by State, Malaysia 2011
Table A3.4 Total Population Under 19 Years Old by State, Malaysia 2011
Table A3.5 Total Population above 60 Years Old by State, Malaysia 2011
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APPENDIX 4 | DATA QUALITY STATEMENT
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APPENDIX 5 | SURVEY PROFILES & RESPONSE RATE
Chapter 2: Hospital Services in Malaysia
Chapter 3: Maternity Services in Malaysian Hospitals and Maternity Homes
Chapter 4: Surgical Services in Malaysian Hospitals
Chapter 5: Oncology Services in Malaysian Hospitals
Chapter 6: Psychiatric Services in Malaysian Hospitals
Chapter 7: Ophthalmology Services In Malaysian Hospitals
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APPENDIX 6 | MEDICAL SUBSPECIALTIES
Table A6.1 Anaesthesiologists, Emergency Medicine Specialists and Paediatricians
Table A6.2 Internal Medicine and Infectious Diseases Specialists
Table A6.3 Nephrologists and Endocrinologists
Table A6.4 Cardiologists and Respiratory Medicine Specialists
Table A6.5 Hepatologists and Gastroenterologists
Table A6.6 Clinical Haematologists
Table A6.7 Neurologists and Rheumatologists
Table A6.8 Geriatric Medicine Specialists
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APPENDIX 7 | OTHER SPECIALTIES IN MEDICINE
Table A7.1 Cardiothoracic and Paediatric Surgeons
Table A7.2 Plastic and Reconstructive Surgeons
Table A7.3 Neurosurgery and Urology Specialists
Table A7.4 Orthopaedic Surgeons and Sport Medicine Specialists
Table A7.5 Radiologists and Nuclear Medicine Specialists
Table A7.6 Pathologists and Forensic Pathologists
Table A7.7 Rehabilitation Medicine Specialists and Otorhinolaryngologists
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ACKNOWLEDGEMENTS
The National Healthcare Statistics Initiative team would like to thank the Director General of Health Malaysia for his continuous support towards
this survey and permission to publish the report.
Also, our sincere appreciation to the following for their participation, assistance, support and contributions:
• Deputy Director General of Health (Research and Technical Support), MOH
• Deputy Director General of Health (Medical), MOH
• Deputy Director General of Health (Public Health), MOH
• Director, National Clinical Research Centre (NCRC), National Institutes of Health (NIH)
• Director, Medical Development Division, MOH
• Director, Medical Practice Division, MOH
• Health Informatics Centre, MOH
• Private Medical Practice Control Section (National level)
• Private Medical Practice Control Unit (State level)
• The Association of Private Hospitals of Malaysia (APHM)
• All participating public, private and university hospitals which provided or allowed access to their establishment and workforce data.
• KPJ Healthcare Berhad
• Pantai Holdings Berhad
• Columbia Asia Sdn Bhd
• Malaysian Medical Council, Association of Private Hospitals of Malaysia, Obstetrical & Gynaecological Society of Malaysia, Malaysian
Psychiatric Association, Malaysian Oncological Society
• Head of Clinical Services, MOH
• Members of NHEWS (Hospital) Expert Panels
• All medical doctors and support personnel who participated in the NHEWS (Hospital)
• All those who have supported or contributed to the success of the NHEWS (Hospital) and publication of this report
Thank you.
National Healthcare Statistics Initiative (NHSI)
Ministry of Health Malaysia
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ABOUT NATIONAL HEALTHCARE ESTABLISHMENT AND WORKFORCE SURVEY (NHEWS) – HOSPITAL
BACKGROUND
The National Healthcare Establishment and Workforce Survey (NHEWS) – Hospital is an initiative to gather information on the Hospital establishment
and specialty clinical services, facilities, workforce and the medical devices available in the country. This survey covers all acute curative hospitals
and related specialty services within the public and private settings.
The rationale for this survey was to gather the relevant information that would be important for the country to develop an accurate and robust
capacity for evaluating, monitoring and implementing its healthcare policies.
OBJECTIVES
GENERAL OBJECTIVE
To document the availability and distribution of the healthcare facilities, services, workforce and devices in the country.
SPECIFIC OBJECTIVES
• To estimate the number and density of hospital or related healthcare establishments and specialty service in Malaysia by geographical area
• To establish trends in these services through continuous, consistent and reliable data collection
The NHSI data was collected based on the key user needs for local health service research. Other users should understand that the inclusion and
exclusion criteria, service and data definitions used in this report may differ from other sources. Therefore, any interpretation or comparison should
be made with caution. The Health Informatics Centre, Ministry of Health Malaysia is the official source of Health data in the country. Harmonization
of health data for the purpose of International comparisons should preferably be obtained from this official source.
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MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM
PRINCIPAL INVESTIGATOR
DATUK DR. NOOR HISHAM ABDULLAH
DR. SHEAMINI SIVASAMPU
PRINCIPAL CO-INVESTIGATORS
DR. GOH PIK PIN
DATO’ DR. NOORAINI BABA
CO-INVESTIGATORS
DR. MD KHADZIR SHEIKH AHMAD
MR. ZAMANE ABDUL RAHMAN
DR. LAILI MURNI MOKHTAR
PROJECT LIASON OFFICERS
DR. AFIDAH ALI
DR. TAHRANI PERIANA KOVINDEAR
PROJECT MANAGERS
DR. ARUNAH CHANDRAN
DR. FOO CHEE YOONG (JAN 2013 – PRESENT)
MS. FAIZAH AHMAD
SURVEY COORDINATORS
MS. KAMILAH DAHIAN
MRS. FATIHAH MAHMUD
STATISTICIAN
MS. LENA YEAP LAY LING
DATABASE DEVELOPER/ADMINISTRATOR
ALTUS SOLUTIONS SDN. BHD.
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MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS
HOSPITAL SERVICES
EXPERT PANEL
INSTITUTION
Datin Dr. Nor Akma Yusuf
Medical Development Division, Ministry of Health
Dato’ Dr. Hjh. Juita Ghazalie
Hospital Sultanah Bahiyah, Alor Setar
Dr. Siti Zaleha Mohd Salleh
Hospital Selayang
Dr. Laili Murni Mokhtar
Medical Development Division, Ministry of Health
Dr. Khalid Ibrahim
Hospital Sungai Buloh
Dr. Farique Rizal Abd Hamid
Hospital Sultanah Bahiyah, Alor Setar
Matron Hjh. Rosena Abdul Ghani
Nursing Division, Ministry of Health
Dr. Sheamini Sivasampu
National Clinical Research Centre, Ministry of Health
Mrs. Fatihah Mahmud
National Clinical Research Centre, Ministry of Health
MATERNITY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Ravichandran Jeganathan
Hospital Sultanah Aminah, Johor Bahru
Dato’ Dr. Ravindran Jegasothy
Hospital Kuala Lumpur
Dr. Sharmini Diana Parampalam
Hospital Seberang Jaya
Dr. Shamala Devi Karalasingam
National Clinical Research Centre, Ministry of Health
Dr. Arunah Chandran
National Clinical Research Centre, Ministry of Health
Ms. Faizah Ahmad
National Clinical Research Centre, Ministry of Health
SURGICAL SERVICES
EXPERT PANEL
INSTITUTION
Dato’ (Mr.) Abdul Jamil Abdullah
Hospital Sultanah Nur Zahirah
Mr. Andrew Gunn Kean Beng
Hospital Sultanah Aminah, Johor Bahru
Dato’ (Mr.) Wan Khamizar Wan Khazim
Hospital Sultanah Bahiyah, Alor Setar
Dato’ (Mr.) Jiffre Din
Hospital Tengku Ampuan Afzan, Kuantan
Dato’ (Mr) Mohamed Yusof Abd. Wahab
Hospital Tengku Ampuan Rahimah, Klang
Mr. Tan Wee Jin
Hospital Pulau Pinang
Mr. Nik Azim Nik Abdullah
Hospital Umum Sarawak
Mr. Yan Yang Wai
Hospital Raja Permaisuri Bainun, Ipoh
Mr. Chuah Jitt Aun
Hospital Queen Elizabeth, Kota Kinabalu
Mr. Clement Edward Thaumanavar
Hospital Tuanku Fauziah, Kangar
Mr. Nik Mohamad Shukri Nik Yahya
Hospital Raja Perempuan Zainab II, Kota Bharu
Ms. Jasiah Zakaria
Hospital Tuanku Jaafar, Seremban
Dr. Tahrani Periana Kovindear
National Clinical Research Centre, Ministry of Health
Ms. Faizah Ahmad
National Clinical Research Centre, Ministry of Health
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ONCOLOGY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Gerard Lim Chin Chye
Hospital Kuala Lumpur
Assoc. Prof. (Clinical) Dato’ Dr. Fuad Ismail
Universiti Kebangsaan Malaysia Medical Center
Dr. Nellie Cheah
Hospital Pulau Pinang
Dr. Nik Muhd. Aslan Abdullah
Universiti Kebangsaan Malaysia Medical Center
Dr. Lau Kah Liew
Hospital Kuala Lumpur
Mdm. Lim Yeok Siew
Hospital Ampang
Dr. Hafizah Zaharah Ahmad
Hospital Kuala Lumpur
Mdm. Sarah Lee Abdullah
Hospital Kuala Lumpur
Dr. Foo Chee Yoong
National Clinical Research Centre, Ministry of Health
Ms. Kamilah Dahian
National Clinical Research Centre, Ministry of Health
PSYCHIATRY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Toh Chin Lee
Hospital Selayang
Dr. Lim Chong Hum
Hospital Ampang
Dr. Khairuddin Abdul Wahab
Hospital Melaka
Dr. Azizul Awaluddin
Hospital Putrajaya
Dr. Siti Nor Aizah Ahmad
Hospital Kuala Lumpur
Dr. Chee Kok Yoon
Hospital Kuala Lumpur
Dr. Rahima Dahlan @ Mohd Shafie
Hospital Kajang
Dr. Ong Lieh Yan
Hospital Bahagia, Ulu Kinta
Mrs. Fatihah Mahmud
National Clinical Research Centre, Ministry of Health
OPHTHALMOLOGY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Elias Hussien
Hospital Selayang
Dr. Anusiah K. Selvaathurai
Hospital Melaka
Dr. Mariam Ismail
Hospital Selayang
Dr. Chandramalar T. Santhirathelagan
Hospital Sungai Buloh
Dr. Norlaila Talib
Hospital Serdang
Dr. Thayanithi K. Sandragasu
Hospital Kuala Lumpur
Dr. Arunah Chandran
National Clinical Research Centre, Ministry of Health
Ms. Kamilah Dahian
National Clinical Research Centre, Ministry of Health
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SUMMARY OF STUDY PROCESS
CRF Development and Pilot Test
Survey Population
Hospital Induction and CRF Distribution
Q
U
Data Collection and Data Entry
E
R
I
Data Cleaning, Verification and Standardisation
E
S
Data Analysis
Report / Manuscript Writing
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STUDY METHODOLOGY
Survey Population Framework Development
To determine the total hospitals and related healthcare establishment population, we first matched the records of the hospitals in the existing National
Healthcare Establishment and Workforce Survey (NHEWS) Hospital database against the independent databases of the Private Medical Practice Control
Division (private hospitals), and Medical Development Division, MOH (public hospitals). Both, the matched and unmatched records were then reviewed by
the NHEWS team. Verification was conducted by contacting each unmatched site to confirm their operational status and establishment details as of 31st
December 2011.These processes were performed for both the private and public hospital list.All verified changes were updated to our database (Figure 1).
Figure 1 Process of Determining the Total Hospitals, Maternity Homes and Psychiatry Institutions Population
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The NHEWS 2011 survey collected data from all related healthcare establishments in Malaysia that fulfilled the criteria and definition relevant to
the specific survey as shown below:
Table 1 Inclusion and Exclusion Criteria of the Respective Surveys
SURVEY
INCLUSION CRITERIA
EXCLUSION CRITERIA
Acute Curative Hospital
All general and specialized hospital providing ● Aboriginals (Orang Asli) Hospital
acute curative care
● Military hospitals
● Hospital units of institution, such as prison hospitals
● NGO hospitals
● Long term care hospitals e.g. rehabilitation and palliative care,
nursing homes, leprosy centres and psychiatric institutions
General Surgery Services
Ophthalmology Services
Maternity Services
All hospitals providing general surgical services
All hospitals providing ophthalmology services
All hospitals providing maternity services.
● Hospitals that were non-operational in 2011
Independent, stand-alone general surgery centres
Independent, stand-alone eye clinics or day surgery centre
Public health clinics that conduct deliveries
Psychiatry Services
All maternity homes
All hospitals providing psychiatry services.
Stand alone psychiatric clinics
Oncology Services
All public psychiatric institutions
All hospitals providing basic oncology services
Table 2 Definition of Specialty Services
SERVICE
DEFINITION
REMARKS
General Surgical Services Services provided by permanent/ resident ● Include general, breast & endocrine, upper gastrointestinal,
or visiting general surgeons with procedures
colorectal, vascular, hepatobilliary, trauma and thoracic
performed within the establishment
surgeries
● Exclude paediatric, plastic, urology, neurosurgery and
cardiothoracic surgeries
Ophthalmology Services
Obstetric Services
Psychiatry Services
Oncology Services
Services provided by permanent/ resident or visiting
ophthalmologist with procedures performed within
the establishment
Not specified
Services headed by a permanent/ resident
psychiatrists
Services provided by permanent/ resident and Exclude services provided by haematologists and paediatric
visiting medical or clinical oncologists, surgeons oncologists
or respiratory physicians with a special interest
in oncology, including hospitals that deliver basic
chemotherapies
Note: List of data definitions used in this survey are included in Appendix 1.
The total number of the establishments (included and excluded) in the study is summarised in Table 3.
Table 3 Summary of Total Number of Healthcare Establishment by Category
HOSPITALS BY SECTOR CATEGORY OF HEALTHCARE ESTABLISHMENT
Public
Private
Acute Curative Hospitals
TOTAL NUMBER
IN THE POPULATION
Ministry of Health
University
Aboriginals
Psychiatric Institutions
Acute Curative Hospitals (General)
Single Specialty
Maternity Homes
Note: Hospitals excluded from the study are available in Consort Diagram NHEWS Hospital 2011.
Details of hospitals that participated in NHEWS hospital survey are available in Appendix 2.
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131
3
1
4
124
11
70
NUMBER OF HOSPITALS
INCLUDED IN THE STUDY
131
3
0
4
124
11
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NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
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Survey Structure
NHEWS 2011 comprised one main and 5 sub-surveys (Figure 2). The Acute Curative Hospitals survey was the main survey that provided
the population framework. Maternity homes and psychiatric institutions were included only for the specific service surveys. General Surgical,
Ophthalmology and Oncology surveys were conducted using a specific subset of the total hospital population that provides for the specific services.
NHEWS 2011
Maternity Services
Survey
Maternity
Services Survey
(n=317)
(Hospitals)
General Surgery
Services Survey
General Surgery
Services Survey
(n=166)
(Hospitals)
Psychiatry
Services Survey
Psychiatry
Services Survey
(n=90)
(Hospitals)
Opthalmology
Services Survey
Opthalmology
Services Survey
(n=98)
(Hospitals)
Oncology
Services Survey
Acute Curative Hospitals
Survey (n=339)
Oncology
Services Survey
(n=98)
(Hospitals)
Figure 2 NHEWS (Hospital) 2011 Survey Structure
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Maternity
Services Survey
(n=26)
(Maternity Homes)
Psychiatry
Services
Survey (n=4)
(Psychiatric
Institutions)
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
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Case Report Form (CRF) Development and Pilot Testing
The CRF was developed by the NHEWS project team with input from the respective NHEWS expert panels. Separate sets of CRFs were developed
for the public and private sector because of their different practices and administrative structures.
Variables were grouped by sections based on their establishment details, facilities, activities and services, workforce and medical device. Two
different types of CRF were developed, Printed and Online. English and Malay versions of the CRF were available for the main hospital survey.
However, only the English version of CRF was used for the specialty services survey. This is to cater for the English literacy among the respondents
for the specialty services; they were most likely to be doctors or nurses and they would not have problems understanding the the CRF in English.
Definitions of services were stated at the beginning of the general surgery, ophthalmology and oncology survey forms to ensure a more accurate
and consistent response since these services are generally poorly defined.
Suitable respondents for certain specialty services were selected from the responding establishment to improve on the reliability of the data.
These included obstetrics, general surgery and psychiatry service survey. This was based on our experiences from the two previous cycles where,
general support staff had shown difficulty in understanding the survey content and providing reliable answers.
Additional feature of historical consistency references was available for respondents who submitted an online CRF upon request. This was
designed to assist in the consistency of data.
A process of verification was incorporated into the CRF: Information on the person who coordinates or completes the survey was first obtained.
This was followed by a verification of the information by the CEO or the relevant Department heads and with their signature incorporated.
Specified text boxes were provided for each question on both of the survey forms. The online forms had incorporated automated validation rules
that applied directly at time of data entry. No data could be submitted if it did not pass the validation rules. Units of certain answers (e.g. in days,
%) were also specified. Answers marked “to be auto calculated” required no input from the respondent.
Lists of the definition of terms and specialty code (for workforce list) were provided at the end of each survey form, and arranged by sections.
The CRFs were pilot-tested with the Person-In-Charge (PIC) of the respective services. Revisions and improvements were then made to the form
accordingly. Lists of definitions used in this survey are included in Appendix 1 of this report.
CRF Distribution
Induction of MOH hospitals was undertaken by briefing the hospital directors or representatives first.
The following documents were distributed to them and in their respective hospitals:
● Survey instruction manual
● An endorsement letter from the State Health Directors (for public hospital) or Association of Private Hospital Malaysia (APHM)
● Username and password access details for electronic CRF
● NHEWS 2010 hospital report
The induction session began with a presentation by a NHEWS hospital team member with a brief overview on the project and the aims of the
survey. This was followed by a demonstration on how to fill in the paper and electronic CRFs. Hospitals that were not represented at the induction
meeting were contacted and briefed later by phone and the survey instrument sets were delivered to them by post.
For private hospitals, the induction was done by sending a compilation of self-explanatory documents to the hospital’s highest authority e.g. CEO.
An endorsement letter by the Association of Private Hospitals Malaysia (APHM) was attached. Follow-up calls were made to each private hospital
to ensure the documents were received.
Hospital representatives were given 2 weeks to complete and submit CRFs. Non responders after this period were contacted and reminded, and
their progress monitored.
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Data Collection
Respondents had the option to choose between two modes of data submission which included:
1.
2.
Paper data submission via hardcopy Case Report Form (Printed CRF)
Electronic data submission via web application (eCRF)
The processed datasets of the list of doctors for each hospital were pre-uploaded to the online eCRFs to minimize the need for manual data
entry. These datasets were obtained from record matches on the doctor workforce from the previous year’s NHEWS survey against the databases
of Malaysian Medical Council, National Specialist Register (NSR) and Medical Development Division (MDD). The edited list was then sent to the
corresponding heads of services in the MOH or other related authorized personnel for verification.
Data Entry
Data from paper submissions were checked manually and reviewed for their completeness and logical consistency before data entry by trained
members. Data entry through eCRF was submitted directly into the NHEWS database and monitored in real-time basis. Quality of data entry
was constantly checked and maintained by several built-in features such as a compulsory data checking function, consistency checks, auto
calculations and auto default data from the previous year’s survey. Activities performed in the database were recorded by a built-in tracking
system. Historical consistency check was used for repeated variables.
Data Processing
Data cleaning was performed in parallel with data entry and based on the results of edit checks. An edit check is a checking procedure for tracing
doubtful data being entered. The editing was performed by NHEWS team members who were familiar with hospital settings. Any queries were
then attended to by contacting the data entry personnel or any authorised representative at the participant’s site to seek further clarification or
verification.
Exploratory data analysis was performed before database locking to ensure that the data was acceptable for analysis. Data duplication, range and
consistency checks were done to detect outliers and data that deviated; these procedures were undertaken with the source data providers. In cases
where the data was not verifiable with the source, cross checks were done against other sources such as the Health Information Management
System Reports, Malaysian Medical Council Doctor Database, professional societies, National Specialist Register and Registry Central Surveys.
Statistical and Estimation Procedures
NHEWS uses the census of all hospitals and related establishments from the Medical Development Division and the Private Healthcare Registration
and Enforcement Unit (CKAPS) to derive its estimates of the total facility, devices, activity and workforce of related healthcare services within the
country. As participation is voluntary, non-response was anticipated and two sources of non-response were accounted for:
Unit non-response – occured as a result of the healthcare establishment not responding to the survey.
Item non-response – occured as some respondents returned partially completed survey forms.
A survey unit will be considered as non-response if the item non-response exceeds 50% of the total questions.
Imputation techniques were used to account for item non-response and weighting for unit non-response.
Imputation: Estimating Item Non-Response
The imputation process consists of 2 stages. First, the missing values are imputed with reasonable assumptions (Logical/ Conditional Imputation).
For example, hospitals without CT scans will have zero CT imaging performed. Similarly, it is assumed that centres without operating microscopes
do not perform any cataract surgery.
The remaining missing values after logical and conditional imputation is further accessed for its suitability of other imputation techniques.
Regression imputation is used in cases where the proportion of missing values is less than 5% of the total. One fundamental assumption of
missing data imputation is that respondent and non-respondent share similar characteristics.
Weighting: Estimating Unit Non-Response
Each survey unit will be assigned a weight in order to provide a population estimate of each variable while compensating for the missing
value of unit non-response. The weight is calculated by dividing the population number to respondent number in a stratified manner based on
characteristics that are known for the whole population. These characteristic variables include state, sector, and year of establishment, type of
establishment, bed and staff strength, obtained from the above mentioned census. Each chapter of non-response weight is calculated separately
as different health services differ in terms of their non-response and overall population characteristics. This procedure also assumes similar
characteristics of both respondents and non-respondents.
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Estimates of the Total Number of the Device/ Activity/ Facility/ Workforce (T)
Where:
Ti is the number of device/ activity/ facility/ workforce available in the ith facility in the year,
Wi is the calculated weight of the ith facility
Limitation of the Estimating Procedures
NHEWS is a census survey because all in-scope Malaysian Hospitals and related healthcare establishments of study were given the survey forms.
However, because response is not mandatory, there will be a significant level of “respondent-bias” in the data. Because of this non-random
response in our survey, standard errors are not a suitable means of gauging variability.
The fundamental purpose of imputation and weighting is to adjust for bias in the responding units and produce estimates. However, these
procedures can only account for and adjust to known population characteristics. If information for a variable is not known for the whole population,
the adjustment process will not be possible.
Furthermore, as mentioned above, assumptions of the similarity of respondent and non-respondent in terms of their population characteristics
is made when imputation and weighting is used to derive estimates. Thus, if the assumption is wrong i.e. non-respondents are different from
respondents, then the estimates will have a certain degree of bias. The level of bias in the estimates will not be quantifiable without a further study
of the non-respondents.
List of Formula
Facilities, devices, activities and workforce of related healthcare establishment and services are expressed as an absolute count by state, sector
and year.
Turnover interval (TOI) is calculated as:
Where:
B is number of inpatient beds
N is number of inpatient admissions
ALOS is average length of stay
The densities of hospitals and respective healthcare services are calculated as follows:
Number of hospitals and healthcare services details/ 10,000 population =
Number of hospitals and healthcare services details/ million population =
Where:
T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the midyear population of Malaysia or the relevant geographic region where the survey was conducted.
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For maternity services:
Number of hospitals and healthcare services details/ 10,000 female population =
Where:
T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the midyear female population of Malaysia or the relevant geographic region where the survey was conducted.
Number of hospitals and specialist services details/ 100 deliveries =
Number of hospitals and specialist services details/ 1,000 deliveries =
Where:
T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the total obstetric deliveries of Malaysia or the relevant geographic region where the survey was conducted.
Details of the Malaysian population statistics for 2011 by state are available in Appendix 3.
Data-Set Finalisation and Locking
All processed data were reviewed by the project team and all members of the expert panel to ensure validity and accuracy before the finalization.
The decision to lock the data-set was made by the project team only after the finalization. No further amendments to the data-set were allowed
except for errors supported by valid evidence as determined by the project team and/or expert panel. All amendments of data-set, if any, must be
approved by the co-investigator(s).
Data Security
The NHEWS hospital data collection was authorized under the Private Healthcare Facilities and Services Act 1998. However, participation was
voluntary. Data collected in the NHEWS survey is regulated by the Personal Data Protection Act 2010 where applicable. All information collected
is held in the strictest confidence and according to legal and research ethics guidelines.
Data Quality
A full description of data quality of the data set is contained in Appendix 4.
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CONSORT DIAGRAM NHEWS 2011 (ACUTE CURATIVE HOSPITALS(a))
Total number of hospitals in Malaysia
Losses (Closed premise), n = 4
n = 353
1. Establishments ceased operations = 2
a. Multimedic Specialist & Maternity Centre
b. Hope Children Hospital – Farlim
Number of hospitals (operational)
n = 349
2. Establishment changed from Hospital
to Maternity Home =2
a. Pusat Rawatan Mahsuri
b. Klinik Wanita Nara
Excluded, n = 6
Public
Private
n = 138
n = 208
Ministry of Health
Aboriginals (JAKOA)
n = 137
n=1
University
n=3
(b)
1. Zero beds, n = 1
Excluded, n = 1
Excluded, n = 3
1.Chronic (curative) care(b), n = 1
1. Chronic (curative) care(b), n = 2
a. Hospital Tuaran
2. Chronic (curative) care(b), n = 5
a. Columbia Asia Extended
Care Hospital – Shah Alam
a. Hospital Kemajuan Orang Asli
a. Leprosy, n = 1
b. Pudu Specialists Centre
i. Rajah Charles Brooke
Memorial Hospital
2. Fertility centre = 1
a. TMC Women’s Specialist
(Kuantan) Sdn. Bhd.
b. Psychiatry, n = 4
i. Hospital Mesra Bukit Padang
ii. Hospital Bahagia Ulu Kinta
iii. Hospital Permai
iv. Hospital Sentosa
Included
Included
Included
n = 131
n = 205
n=3
Total in-scope hospitals
n = 339
(a) Acute Curative Hospital
ALOS
NCRC/HSU/2013.1
EDITED BY:
Sivasampu S, Arunah C
Kamilah D, Fatihah M
Goh PP, Hisham AN
NATIONAL HEALTHCARE
E S TA B L I S H M E N T &
WORKFORCE STATISTICS
HOSPITAL
2 0 1 1
N AT I O N A L H E A LT H C A R E S TAT I S T I C S I N I T I AT I V E
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
HOSPITAL
National Healthcare Establishment and Workforce Statistics (Hospital) 2011
September 2013
©Ministry of Health Malaysia
Published by:
The National Healthcare Statistics Initiative (NHSI)
National Clinical Research Centre
Ministry of Health
3rd Floor, MMA House
124, Jalan Pahang
53000 Kuala Lumpur
Malaysia
Tel.
Fax
Website
: (603) 40439300/400
: (603) 40439500
: hsu@crc.gov.my
: http://www.crc.gov.my/nhsi/
This report is copyrighted. Reproduction and dissemination of its contents in part or in whole for research, educational or non-commercial
purposes is authorized without any prior written permission provided the source is fully acknowledged. The suggested citation is `National Clinical
Research Centre. National Healthcare Establishment & Workforce Statistics (Hospital) 2011. Kuala Lumpur 2013.’
This report is also available electronically on the website of the National Healthcare Statistics Initiative at: http://www.crc.gov.my/nhsi/
Funding:
The National Healthcare Statistics Initiative was funded by a grant from the Ministry of Health Malaysia (MRG Grant No. NMRR-09-842-4718)
Please note that there is potential for minor corrections of data in this report. Please check the online version at
http://www.crc.gov.my/nhsi/ for any amendments.
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CONTENTS
ACKNOWLEDGEMENTS
vi
ABOUT NATIONAL HEALTHCARE ESTABLISHMENT AND WORKFORCE SURVEY (NHEWS) – HOSPITAL
vii
MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM
viii
MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS
ix
SUMMARY OF STUDY PROCESS
xi
STUDY METHODOLOGY
xii
CONSORT DIAGRAM
xix
Consort Diagram NHEWS 2011 (Acute Curative Hospitals)
xix
Consort Diagram NHEWS 2011 (Maternity Services)
xx
Consort Diagram NHEWS 2011 (General Surgery Services)
xxi
Consort Diagram NHEWS 2011 (Oncology Services)
xxii
Consort Diagram NHEWS 2011 (Psychiatry Services)
xxiii
Consort Diagram NHEWS 2011 (Ophthalmology Services)
xxiv
ABBREVIATIONS
xxv
SYMBOLS
xxvi
CHAPTER 1 | OVERVIEW OF HOSPITALS AND SPECIALISTS SERVICES IN MALAYSIA
1
CHAPTER 2 | ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA
5
Table 2.1 Hospitals Providing Acute Curative Care
7
Table 2.2 Types of Hospitals Establishment Providing Acute Curative Care
8
Table 2.3 Different Types of Private Hospital’s Entrepreneurship
9
Table 2.4 Inpatient beds
10
Table 2.5 Operating theatre (OT), Operating Rooms (ORs) and Functioning ORs
11
Table 2.6 Doctors and Patients Admission
12
Table 2.7 Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Turnover Interval (TOI)
13
Table 2.8 Average Length of Stay (ALOS) by Acute Hospital Type
14
Table 2.9 Bed Occupancy Rate (BOR)
15
Table 2.10 Turnover Interval (TOI) by Acute Hospital Type
16
Table 2.11 Hospital Doctors, Staff Nurses (with and without Post Basic Training)
17
Table 2.12 Community Nurses and Assistant Nurses
18
Table 2.13 Assistant Medical Officers (AMO)
19
Table 2.14 Pharmacists, Physiotherapists, Occupational Therapists, and Dieticians
20
Table 2.15 Medical Record Officers and Medical Social Officers
21
Table 2.16 Computed Tomography (CT) Scanners and Rate of CT scan Procedures
22
Table 2.17 Magnetic Resonance Imaging (MRI) and Rate of MRI Procedures
23
Table 2.18 Positron Emission Tomography (PET) and Rate of PET Procedures
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CHAPTER 3 | MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES
Table 3.1 Hospitals Providing Maternity Services
Table 3.2 Functioning Delivery Beds
Table 3.3 Dedicated OT Facilities and Functioning ORs
Table 3.4 Functional Obstetric High Dependency Unit (HDU) Beds
Table 3.5 Total Deliveries
Table 3.6 Spontaneous Vertex Deliveries (SVD)
Table 3.7 Vaginal Breech Deliveries
Table 3.8 Instrumental Deliveries using Vacuum
Table 3.9 Instrumental Deliveries using Forceps
Table 3.10 Caesarean Surgeries
Table 3.11 Lower Segment Caesarean Section (LSCS), Caesarean Hysterectomy and Hysterotomy
Table 3.12 Multiple Pregnancies Deliveries
Table 3.13 Eclampsia
Table 3.14 Post Partum Haemorrhage (PPH)
Table 3.15 Newborns Delivered & Admitted to Paediatrics, NICU & SCN
Table 3.16 Obstetrics & Gynaecology (O&G) Specialists and Medical Officers
Table 3.17 Staff Nurses and Community Nurses in O&G services
Table 3.18 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Obstetric Ward)
Table 3.19 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Labour Ward)
Table 3.20 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Obstetric HDU)
25
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29
30
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
44
45
CHAPTER 4 | SURGICAL SERVICES IN MALAYSIAN HOSPITALS
Table 4.1 Hospitals Providing General Surgery Services
Table 4.2 Total Surgeons, Operation Theatre (OT) and Theatre Scrub Nurses
Table 4.3 Dedicated Emergency/Trauma Theatres (Public Hospitals)
Table 4.4 General Surgeons and Total Elective Operating Hours (Public Hospitals)
Table 4.5 Elective Cases in General Surgery (Public Hospitals)
Table 4.6 Emergency Cases in General Surgery (Public Hospitals)
Table 4.7 Mastectomies
Table 4.8 Total, Open and Laparoscopic Inguinal Hernia Surgeries
Table 4.9 Total, Open and Laparoscopic Cholecystectomies
Table 4.10 OGDS Scopes and OGDS Cases by Surgical and Medical Specialists (Public Hospitals)
Table 4.11 OGDS Scopes and OGDS Cases (Private Hospitals)
Table 4.12 Colonoscopes and Colonoscopy Cases by Surgical and Medical Specialists (Public Hospitals)
Table 4.13 Colonoscopes and Colonoscopy Cases (Private Hospitals)
Table 4.14 ERCP Scopes and ERCP Cases by Surgical and Medical Specialists (Public Hospitals)
Table 4.15 ERCP Scopes and ERCP Cases (Private Hospitals)
Table 4.16 OGDS Scopes, Colonoscopes and ERCP Scopes
Table 4.17 Theatre Scrub Nurses
Table 4.18 General Surgeons and Anaesthesiologists
Table 4.19 Breast Surgeons, Breast and Endocrine Surgeons
Table 4.20 Vascular Surgeons, Hepatobiliary Surgeons, and Colorectal Surgeons
47
49
50
51
51
52
52
53
54
55
56
56
57
57
58
58
59
60
61
62
63
CHAPTER 5 | ONCOLOGY SERVICES IN MALAYSIAN HOSPITALS
Table 5.1 Hospitals Providing Oncology Services
Table 5.2 Hospitals Providing Oncology Services (with and without Oncologist)
Table 5.3 Clean Room for Reconstitution of Cytotoxic Drugs
Table 5.4 Hospitals Providing Cytotoxic Drug Reconstitution (CDR) Services
Table 5.5 Chemotherapy Day Care Services, Chemotherapy Beds and Chairs
Table 5.6 Oncologists
Table 5.7 Oncology Trained Nurses, Radiation Therapists and Physicists
Table 5.8 Megavoltage Machines, Brachytherapy Machines and Simulators
Table 5.9 Physics Equipment and Treatment Planning System Devices
65
67
68
69
70
71
72
73
74
75
Table 5.10 Equipment Capable of Carrying Out Intensity Modulated Radiotherapy (IMR), Image Guided Radiotherapy (IGRT) & Stereotactic Procedure
76
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CHAPTER 6 | PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS
Table 6.1 Hospitals Providing Psychiatry Services
Table 6.2 Inpatient Dedicated Beds and Functioning Inpatient Dedicated Beds
Table 6.3 Inpatient Psychiatry Admissions, Dedicated Beds and Mean Bed Occupancy Rate
Table 6.4 Follow up Outpatient Visits, New Cases and Referrals from Wards or Emergency Department
Table 6.5 Community Psychiatric and Psychiatric Rehabilitation Services (Public Hospital)
Table 6.6 Hospital Visits with Patients below 18 Years Old and above 60 Years Old
Table 6.7 Methadone Replacement Therapy (MRT) Services & Total MRT Patients (Public Hospital)
Table 6.8 ECT Machines and Procedures
Table 6.9 Psychiatrists
Table 6.10 Clinical Psychologists
Table 6.11 Counsellors in Psychiatry Services (Full Time and Common User)
Table 6.12 Medical Social Workers in Psychiatry Services (Full Time and Common User) (Public Hospital)
Table 6.13 Nurses in Psychiatry
Table 6.14 Assistant Medical Officers in Psychiatry Service (Public Hospital)
77
80
81
82
83
84
85
86
89
88
89
90
91
92
93
CHAPTER 7 | OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS
Table 7.1 Hospitals Providing Ophthalmology Services
Table 7.2 Dedicated Ophthalmology Operating Rooms (ORs) (Public Hospitals)
Table 7.3 Ophthalmology Elective Operating Hours (Public Hospitals)
Table 7.4 Cataract Surgery (Day care and Inpatient)
Table 7.5 Glaucoma Surgery (with and without Implant)
Table 7.6 Vitreoretinal Surgeries
Table 7.7 Ophthalmologists
Table 7.8 Optometrists
Table 7.9 Assistant Medical Officers (AMOs) in Ophthalmology Services (Public Hospital)
Table 7.10 Nurses in Ophthalmology Services (Public Hospital)
Table 7.11 Ophthalmology Devices
95
97
98
98
99
100
101
102
103
104
104
105
APPENDICES
107
APPENDIX 1 | LIST OF DEFINITIONS
Chapter 2 : Hospital
Chapter 3 : Obstetrics
Chapter 4 : General Surgery
Chapter 5 : Oncology
Chapter 6 : Psychiatry
Chapter 7 : Ophthalmology
109
109
112
113
114
116
117
APPENDIX 2 | PARTICIPANTS FOR NHEWS (HOSPITAL) 2011
Hospital Sector: Public/ Ministry Of Health
Hospital Sector: Public/ Ministry Of Health/Psychiatric Institution
Hospital Sector: Public/ University
Hospital Sector: Public/ Jabatan Kemajuan Orang Asli
Hospital Sector: Private
Hospital Sector: Private/ Maternity Homes
119
119
120
121
121
122
123
APPENDIX 3 | MALAYSIAN POPULATION, 2011
Table A3.1 Total Population by State, Malaysia 2011
Table A3.2 Total Population of Females by State, Malaysia 2011
Table A3.3 Number of Live Births by State, Malaysia 2011
Table A3.4 Total Population Under 19 Years Old by State, Malaysia 2011
Table A3.5 Total Population above 60 Years Old by State, Malaysia 2011
125
125
125
126
126
127
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APPENDIX 4 | DATA QUALITY STATEMENT
129
APPENDIX 5 | SURVEY PROFILES & RESPONSE RATE
Chapter 2: Hospital Services in Malaysia
Chapter 3: Maternity Services in Malaysian Hospitals and Maternity Homes
Chapter 4: Surgical Services in Malaysian Hospitals
Chapter 5: Oncology Services in Malaysian Hospitals
Chapter 6: Psychiatric Services in Malaysian Hospitals
Chapter 7: Ophthalmology Services In Malaysian Hospitals
133
133
135
137
139
141
143
APPENDIX 6 | MEDICAL SUBSPECIALTIES
Table A6.1 Anaesthesiologists, Emergency Medicine Specialists and Paediatricians
Table A6.2 Internal Medicine and Infectious Diseases Specialists
Table A6.3 Nephrologists and Endocrinologists
Table A6.4 Cardiologists and Respiratory Medicine Specialists
Table A6.5 Hepatologists and Gastroenterologists
Table A6.6 Clinical Haematologists
Table A6.7 Neurologists and Rheumatologists
Table A6.8 Geriatric Medicine Specialists
145
145
146
147
148
149
150
151
152
APPENDIX 7 | OTHER SPECIALTIES IN MEDICINE
Table A7.1 Cardiothoracic and Paediatric Surgeons
Table A7.2 Plastic and Reconstructive Surgeons
Table A7.3 Neurosurgery and Urology Specialists
Table A7.4 Orthopaedic Surgeons and Sport Medicine Specialists
Table A7.5 Radiologists and Nuclear Medicine Specialists
Table A7.6 Pathologists and Forensic Pathologists
Table A7.7 Rehabilitation Medicine Specialists and Otorhinolaryngologists
153
153
154
155
156
157
158
159
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ACKNOWLEDGEMENTS
The National Healthcare Statistics Initiative team would like to thank the Director General of Health Malaysia for his continuous support towards
this survey and permission to publish the report.
Also, our sincere appreciation to the following for their participation, assistance, support and contributions:
• Deputy Director General of Health (Research and Technical Support), MOH
• Deputy Director General of Health (Medical), MOH
• Deputy Director General of Health (Public Health), MOH
• Director, National Clinical Research Centre (NCRC), National Institutes of Health (NIH)
• Director, Medical Development Division, MOH
• Director, Medical Practice Division, MOH
• Health Informatics Centre, MOH
• Private Medical Practice Control Section (National level)
• Private Medical Practice Control Unit (State level)
• The Association of Private Hospitals of Malaysia (APHM)
• All participating public, private and university hospitals which provided or allowed access to their establishment and workforce data.
• KPJ Healthcare Berhad
• Pantai Holdings Berhad
• Columbia Asia Sdn Bhd
• Malaysian Medical Council, Association of Private Hospitals of Malaysia, Obstetrical & Gynaecological Society of Malaysia, Malaysian
Psychiatric Association, Malaysian Oncological Society
• Head of Clinical Services, MOH
• Members of NHEWS (Hospital) Expert Panels
• All medical doctors and support personnel who participated in the NHEWS (Hospital)
• All those who have supported or contributed to the success of the NHEWS (Hospital) and publication of this report
Thank you.
National Healthcare Statistics Initiative (NHSI)
Ministry of Health Malaysia
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ABOUT NATIONAL HEALTHCARE ESTABLISHMENT AND WORKFORCE SURVEY (NHEWS) – HOSPITAL
BACKGROUND
The National Healthcare Establishment and Workforce Survey (NHEWS) – Hospital is an initiative to gather information on the Hospital establishment
and specialty clinical services, facilities, workforce and the medical devices available in the country. This survey covers all acute curative hospitals
and related specialty services within the public and private settings.
The rationale for this survey was to gather the relevant information that would be important for the country to develop an accurate and robust
capacity for evaluating, monitoring and implementing its healthcare policies.
OBJECTIVES
GENERAL OBJECTIVE
To document the availability and distribution of the healthcare facilities, services, workforce and devices in the country.
SPECIFIC OBJECTIVES
• To estimate the number and density of hospital or related healthcare establishments and specialty service in Malaysia by geographical area
• To establish trends in these services through continuous, consistent and reliable data collection
The NHSI data was collected based on the key user needs for local health service research. Other users should understand that the inclusion and
exclusion criteria, service and data definitions used in this report may differ from other sources. Therefore, any interpretation or comparison should
be made with caution. The Health Informatics Centre, Ministry of Health Malaysia is the official source of Health data in the country. Harmonization
of health data for the purpose of International comparisons should preferably be obtained from this official source.
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MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM
PRINCIPAL INVESTIGATOR
DATUK DR. NOOR HISHAM ABDULLAH
DR. SHEAMINI SIVASAMPU
PRINCIPAL CO-INVESTIGATORS
DR. GOH PIK PIN
DATO’ DR. NOORAINI BABA
CO-INVESTIGATORS
DR. MD KHADZIR SHEIKH AHMAD
MR. ZAMANE ABDUL RAHMAN
DR. LAILI MURNI MOKHTAR
PROJECT LIASON OFFICERS
DR. AFIDAH ALI
DR. TAHRANI PERIANA KOVINDEAR
PROJECT MANAGERS
DR. ARUNAH CHANDRAN
DR. FOO CHEE YOONG (JAN 2013 – PRESENT)
MS. FAIZAH AHMAD
SURVEY COORDINATORS
MS. KAMILAH DAHIAN
MRS. FATIHAH MAHMUD
STATISTICIAN
MS. LENA YEAP LAY LING
DATABASE DEVELOPER/ADMINISTRATOR
ALTUS SOLUTIONS SDN. BHD.
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MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS
HOSPITAL SERVICES
EXPERT PANEL
INSTITUTION
Datin Dr. Nor Akma Yusuf
Medical Development Division, Ministry of Health
Dato’ Dr. Hjh. Juita Ghazalie
Hospital Sultanah Bahiyah, Alor Setar
Dr. Siti Zaleha Mohd Salleh
Hospital Selayang
Dr. Laili Murni Mokhtar
Medical Development Division, Ministry of Health
Dr. Khalid Ibrahim
Hospital Sungai Buloh
Dr. Farique Rizal Abd Hamid
Hospital Sultanah Bahiyah, Alor Setar
Matron Hjh. Rosena Abdul Ghani
Nursing Division, Ministry of Health
Dr. Sheamini Sivasampu
National Clinical Research Centre, Ministry of Health
Mrs. Fatihah Mahmud
National Clinical Research Centre, Ministry of Health
MATERNITY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Ravichandran Jeganathan
Hospital Sultanah Aminah, Johor Bahru
Dato’ Dr. Ravindran Jegasothy
Hospital Kuala Lumpur
Dr. Sharmini Diana Parampalam
Hospital Seberang Jaya
Dr. Shamala Devi Karalasingam
National Clinical Research Centre, Ministry of Health
Dr. Arunah Chandran
National Clinical Research Centre, Ministry of Health
Ms. Faizah Ahmad
National Clinical Research Centre, Ministry of Health
SURGICAL SERVICES
EXPERT PANEL
INSTITUTION
Dato’ (Mr.) Abdul Jamil Abdullah
Hospital Sultanah Nur Zahirah
Mr. Andrew Gunn Kean Beng
Hospital Sultanah Aminah, Johor Bahru
Dato’ (Mr.) Wan Khamizar Wan Khazim
Hospital Sultanah Bahiyah, Alor Setar
Dato’ (Mr.) Jiffre Din
Hospital Tengku Ampuan Afzan, Kuantan
Dato’ (Mr) Mohamed Yusof Abd. Wahab
Hospital Tengku Ampuan Rahimah, Klang
Mr. Tan Wee Jin
Hospital Pulau Pinang
Mr. Nik Azim Nik Abdullah
Hospital Umum Sarawak
Mr. Yan Yang Wai
Hospital Raja Permaisuri Bainun, Ipoh
Mr. Chuah Jitt Aun
Hospital Queen Elizabeth, Kota Kinabalu
Mr. Clement Edward Thaumanavar
Hospital Tuanku Fauziah, Kangar
Mr. Nik Mohamad Shukri Nik Yahya
Hospital Raja Perempuan Zainab II, Kota Bharu
Ms. Jasiah Zakaria
Hospital Tuanku Jaafar, Seremban
Dr. Tahrani Periana Kovindear
National Clinical Research Centre, Ministry of Health
Ms. Faizah Ahmad
National Clinical Research Centre, Ministry of Health
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NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
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ONCOLOGY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Gerard Lim Chin Chye
Hospital Kuala Lumpur
Assoc. Prof. (Clinical) Dato’ Dr. Fuad Ismail
Universiti Kebangsaan Malaysia Medical Center
Dr. Nellie Cheah
Hospital Pulau Pinang
Dr. Nik Muhd. Aslan Abdullah
Universiti Kebangsaan Malaysia Medical Center
Dr. Lau Kah Liew
Hospital Kuala Lumpur
Mdm. Lim Yeok Siew
Hospital Ampang
Dr. Hafizah Zaharah Ahmad
Hospital Kuala Lumpur
Mdm. Sarah Lee Abdullah
Hospital Kuala Lumpur
Dr. Foo Chee Yoong
National Clinical Research Centre, Ministry of Health
Ms. Kamilah Dahian
National Clinical Research Centre, Ministry of Health
PSYCHIATRY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Toh Chin Lee
Hospital Selayang
Dr. Lim Chong Hum
Hospital Ampang
Dr. Khairuddin Abdul Wahab
Hospital Melaka
Dr. Azizul Awaluddin
Hospital Putrajaya
Dr. Siti Nor Aizah Ahmad
Hospital Kuala Lumpur
Dr. Chee Kok Yoon
Hospital Kuala Lumpur
Dr. Rahima Dahlan @ Mohd Shafie
Hospital Kajang
Dr. Ong Lieh Yan
Hospital Bahagia, Ulu Kinta
Mrs. Fatihah Mahmud
National Clinical Research Centre, Ministry of Health
OPHTHALMOLOGY SERVICES
EXPERT PANEL
INSTITUTION
Dr. Elias Hussien
Hospital Selayang
Dr. Anusiah K. Selvaathurai
Hospital Melaka
Dr. Mariam Ismail
Hospital Selayang
Dr. Chandramalar T. Santhirathelagan
Hospital Sungai Buloh
Dr. Norlaila Talib
Hospital Serdang
Dr. Thayanithi K. Sandragasu
Hospital Kuala Lumpur
Dr. Arunah Chandran
National Clinical Research Centre, Ministry of Health
Ms. Kamilah Dahian
National Clinical Research Centre, Ministry of Health
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NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
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SUMMARY OF STUDY PROCESS
CRF Development and Pilot Test
Survey Population
Hospital Induction and CRF Distribution
Q
U
Data Collection and Data Entry
E
R
I
Data Cleaning, Verification and Standardisation
E
S
Data Analysis
Report / Manuscript Writing
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STUDY METHODOLOGY
Survey Population Framework Development
To determine the total hospitals and related healthcare establishment population, we first matched the records of the hospitals in the existing National
Healthcare Establishment and Workforce Survey (NHEWS) Hospital database against the independent databases of the Private Medical Practice Control
Division (private hospitals), and Medical Development Division, MOH (public hospitals). Both, the matched and unmatched records were then reviewed by
the NHEWS team. Verification was conducted by contacting each unmatched site to confirm their operational status and establishment details as of 31st
December 2011.These processes were performed for both the private and public hospital list.All verified changes were updated to our database (Figure 1).
Figure 1 Process of Determining the Total Hospitals, Maternity Homes and Psychiatry Institutions Population
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The NHEWS 2011 survey collected data from all related healthcare establishments in Malaysia that fulfilled the criteria and definition relevant to
the specific survey as shown below:
Table 1 Inclusion and Exclusion Criteria of the Respective Surveys
SURVEY
INCLUSION CRITERIA
EXCLUSION CRITERIA
Acute Curative Hospital
All general and specialized hospital providing ● Aboriginals (Orang Asli) Hospital
acute curative care
● Military hospitals
● Hospital units of institution, such as prison hospitals
● NGO hospitals
● Long term care hospitals e.g. rehabilitation and palliative care,
nursing homes, leprosy centres and psychiatric institutions
General Surgery Services
Ophthalmology Services
Maternity Services
All hospitals providing general surgical services
All hospitals providing ophthalmology services
All hospitals providing maternity services.
● Hospitals that were non-operational in 2011
Independent, stand-alone general surgery centres
Independent, stand-alone eye clinics or day surgery centre
Public health clinics that conduct deliveries
Psychiatry Services
All maternity homes
All hospitals providing psychiatry services.
Stand alone psychiatric clinics
Oncology Services
All public psychiatric institutions
All hospitals providing basic oncology services
Table 2 Definition of Specialty Services
SERVICE
DEFINITION
REMARKS
General Surgical Services Services provided by permanent/ resident ● Include general, breast & endocrine, upper gastrointestinal,
or visiting general surgeons with procedures
colorectal, vascular, hepatobilliary, trauma and thoracic
performed within the establishment
surgeries
● Exclude paediatric, plastic, urology, neurosurgery and
cardiothoracic surgeries
Ophthalmology Services
Obstetric Services
Psychiatry Services
Oncology Services
Services provided by permanent/ resident or visiting
ophthalmologist with procedures performed within
the establishment
Not specified
Services headed by a permanent/ resident
psychiatrists
Services provided by permanent/ resident and Exclude services provided by haematologists and paediatric
visiting medical or clinical oncologists, surgeons oncologists
or respiratory physicians with a special interest
in oncology, including hospitals that deliver basic
chemotherapies
Note: List of data definitions used in this survey are included in Appendix 1.
The total number of the establishments (included and excluded) in the study is summarised in Table 3.
Table 3 Summary of Total Number of Healthcare Establishment by Category
HOSPITALS BY SECTOR CATEGORY OF HEALTHCARE ESTABLISHMENT
Public
Private
Acute Curative Hospitals
TOTAL NUMBER
IN THE POPULATION
Ministry of Health
University
Aboriginals
Psychiatric Institutions
Acute Curative Hospitals (General)
Single Specialty
Maternity Homes
Note: Hospitals excluded from the study are available in Consort Diagram NHEWS Hospital 2011.
Details of hospitals that participated in NHEWS hospital survey are available in Appendix 2.
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131
3
1
4
124
11
70
NUMBER OF HOSPITALS
INCLUDED IN THE STUDY
131
3
0
4
124
11
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NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
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Survey Structure
NHEWS 2011 comprised one main and 5 sub-surveys (Figure 2). The Acute Curative Hospitals survey was the main survey that provided
the population framework. Maternity homes and psychiatric institutions were included only for the specific service surveys. General Surgical,
Ophthalmology and Oncology surveys were conducted using a specific subset of the total hospital population that provides for the specific services.
NHEWS 2011
Maternity Services
Survey
Maternity
Services Survey
(n=317)
(Hospitals)
General Surgery
Services Survey
General Surgery
Services Survey
(n=166)
(Hospitals)
Psychiatry
Services Survey
Psychiatry
Services Survey
(n=90)
(Hospitals)
Opthalmology
Services Survey
Opthalmology
Services Survey
(n=98)
(Hospitals)
Oncology
Services Survey
Acute Curative Hospitals
Survey (n=339)
Oncology
Services Survey
(n=98)
(Hospitals)
Figure 2 NHEWS (Hospital) 2011 Survey Structure
xiv
Maternity
Services Survey
(n=26)
(Maternity Homes)
Psychiatry
Services
Survey (n=4)
(Psychiatric
Institutions)
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011
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Case Report Form (CRF) Development and Pilot Testing
The CRF was developed by the NHEWS project team with input from the respective NHEWS expert panels. Separate sets of CRFs were developed
for the public and private sector because of their different practices and administrative structures.
Variables were grouped by sections based on their establishment details, facilities, activities and services, workforce and medical device. Two
different types of CRF were developed, Printed and Online. English and Malay versions of the CRF were available for the main hospital survey.
However, only the English version of CRF was used for the specialty services survey. This is to cater for the English literacy among the respondents
for the specialty services; they were most likely to be doctors or nurses and they would not have problems understanding the the CRF in English.
Definitions of services were stated at the beginning of the general surgery, ophthalmology and oncology survey forms to ensure a more accurate
and consistent response since these services are generally poorly defined.
Suitable respondents for certain specialty services were selected from the responding establishment to improve on the reliability of the data.
These included obstetrics, general surgery and psychiatry service survey. This was based on our experiences from the two previous cycles where,
general support staff had shown difficulty in understanding the survey content and providing reliable answers.
Additional feature of historical consistency references was available for respondents who submitted an online CRF upon request. This was
designed to assist in the consistency of data.
A process of verification was incorporated into the CRF: Information on the person who coordinates or completes the survey was first obtained.
This was followed by a verification of the information by the CEO or the relevant Department heads and with their signature incorporated.
Specified text boxes were provided for each question on both of the survey forms. The online forms had incorporated automated validation rules
that applied directly at time of data entry. No data could be submitted if it did not pass the validation rules. Units of certain answers (e.g. in days,
%) were also specified. Answers marked “to be auto calculated” required no input from the respondent.
Lists of the definition of terms and specialty code (for workforce list) were provided at the end of each survey form, and arranged by sections.
The CRFs were pilot-tested with the Person-In-Charge (PIC) of the respective services. Revisions and improvements were then made to the form
accordingly. Lists of definitions used in this survey are included in Appendix 1 of this report.
CRF Distribution
Induction of MOH hospitals was undertaken by briefing the hospital directors or representatives first.
The following documents were distributed to them and in their respective hospitals:
● Survey instruction manual
● An endorsement letter from the State Health Directors (for public hospital) or Association of Private Hospital Malaysia (APHM)
● Username and password access details for electronic CRF
● NHEWS 2010 hospital report
The induction session began with a presentation by a NHEWS hospital team member with a brief overview on the project and the aims of the
survey. This was followed by a demonstration on how to fill in the paper and electronic CRFs. Hospitals that were not represented at the induction
meeting were contacted and briefed later by phone and the survey instrument sets were delivered to them by post.
For private hospitals, the induction was done by sending a compilation of self-explanatory documents to the hospital’s highest authority e.g. CEO.
An endorsement letter by the Association of Private Hospitals Malaysia (APHM) was attached. Follow-up calls were made to each private hospital
to ensure the documents were received.
Hospital representatives were given 2 weeks to complete and submit CRFs. Non responders after this period were contacted and reminded, and
their progress monitored.
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Data Collection
Respondents had the option to choose between two modes of data submission which included:
1.
2.
Paper data submission via hardcopy Case Report Form (Printed CRF)
Electronic data submission via web application (eCRF)
The processed datasets of the list of doctors for each hospital were pre-uploaded to the online eCRFs to minimize the need for manual data
entry. These datasets were obtained from record matches on the doctor workforce from the previous year’s NHEWS survey against the databases
of Malaysian Medical Council, National Specialist Register (NSR) and Medical Development Division (MDD). The edited list was then sent to the
corresponding heads of services in the MOH or other related authorized personnel for verification.
Data Entry
Data from paper submissions were checked manually and reviewed for their completeness and logical consistency before data entry by trained
members. Data entry through eCRF was submitted directly into the NHEWS database and monitored in real-time basis. Quality of data entry
was constantly checked and maintained by several built-in features such as a compulsory data checking function, consistency checks, auto
calculations and auto default data from the previous year’s survey. Activities performed in the database were recorded by a built-in tracking
system. Historical consistency check was used for repeated variables.
Data Processing
Data cleaning was performed in parallel with data entry and based on the results of edit checks. An edit check is a checking procedure for tracing
doubtful data being entered. The editing was performed by NHEWS team members who were familiar with hospital settings. Any queries were
then attended to by contacting the data entry personnel or any authorised representative at the participant’s site to seek further clarification or
verification.
Exploratory data analysis was performed before database locking to ensure that the data was acceptable for analysis. Data duplication, range and
consistency checks were done to detect outliers and data that deviated; these procedures were undertaken with the source data providers. In cases
where the data was not verifiable with the source, cross checks were done against other sources such as the Health Information Management
System Reports, Malaysian Medical Council Doctor Database, professional societies, National Specialist Register and Registry Central Surveys.
Statistical and Estimation Procedures
NHEWS uses the census of all hospitals and related establishments from the Medical Development Division and the Private Healthcare Registration
and Enforcement Unit (CKAPS) to derive its estimates of the total facility, devices, activity and workforce of related healthcare services within the
country. As participation is voluntary, non-response was anticipated and two sources of non-response were accounted for:
Unit non-response – occured as a result of the healthcare establishment not responding to the survey.
Item non-response – occured as some respondents returned partially completed survey forms.
A survey unit will be considered as non-response if the item non-response exceeds 50% of the total questions.
Imputation techniques were used to account for item non-response and weighting for unit non-response.
Imputation: Estimating Item Non-Response
The imputation process consists of 2 stages. First, the missing values are imputed with reasonable assumptions (Logical/ Conditional Imputation).
For example, hospitals without CT scans will have zero CT imaging performed. Similarly, it is assumed that centres without operating microscopes
do not perform any cataract surgery.
The remaining missing values after logical and conditional imputation is further accessed for its suitability of other imputation techniques.
Regression imputation is used in cases where the proportion of missing values is less than 5% of the total. One fundamental assumption of
missing data imputation is that respondent and non-respondent share similar characteristics.
Weighting: Estimating Unit Non-Response
Each survey unit will be assigned a weight in order to provide a population estimate of each variable while compensating for the missing
value of unit non-response. The weight is calculated by dividing the population number to respondent number in a stratified manner based on
characteristics that are known for the whole population. These characteristic variables include state, sector, and year of establishment, type of
establishment, bed and staff strength, obtained from the above mentioned census. Each chapter of non-response weight is calculated separately
as different health services differ in terms of their non-response and overall population characteristics. This procedure also assumes similar
characteristics of both respondents and non-respondents.
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Estimates of the Total Number of the Device/ Activity/ Facility/ Workforce (T)
Where:
Ti is the number of device/ activity/ facility/ workforce available in the ith facility in the year,
Wi is the calculated weight of the ith facility
Limitation of the Estimating Procedures
NHEWS is a census survey because all in-scope Malaysian Hospitals and related healthcare establishments of study were given the survey forms.
However, because response is not mandatory, there will be a significant level of “respondent-bias” in the data. Because of this non-random
response in our survey, standard errors are not a suitable means of gauging variability.
The fundamental purpose of imputation and weighting is to adjust for bias in the responding units and produce estimates. However, these
procedures can only account for and adjust to known population characteristics. If information for a variable is not known for the whole population,
the adjustment process will not be possible.
Furthermore, as mentioned above, assumptions of the similarity of respondent and non-respondent in terms of their population characteristics
is made when imputation and weighting is used to derive estimates. Thus, if the assumption is wrong i.e. non-respondents are different from
respondents, then the estimates will have a certain degree of bias. The level of bias in the estimates will not be quantifiable without a further study
of the non-respondents.
List of Formula
Facilities, devices, activities and workforce of related healthcare establishment and services are expressed as an absolute count by state, sector
and year.
Turnover interval (TOI) is calculated as:
Where:
B is number of inpatient beds
N is number of inpatient admissions
ALOS is average length of stay
The densities of hospitals and respective healthcare services are calculated as follows:
Number of hospitals and healthcare services details/ 10,000 population =
Number of hospitals and healthcare services details/ million population =
Where:
T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the midyear population of Malaysia or the relevant geographic region where the survey was conducted.
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For maternity services:
Number of hospitals and healthcare services details/ 10,000 female population =
Where:
T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the midyear female population of Malaysia or the relevant geographic region where the survey was conducted.
Number of hospitals and specialist services details/ 100 deliveries =
Number of hospitals and specialist services details/ 1,000 deliveries =
Where:
T is an estimate of the total quantity of the variable available in the country in the year under consideration.
P is the total obstetric deliveries of Malaysia or the relevant geographic region where the survey was conducted.
Details of the Malaysian population statistics for 2011 by state are available in Appendix 3.
Data-Set Finalisation and Locking
All processed data were reviewed by the project team and all members of the expert panel to ensure validity and accuracy before the finalization.
The decision to lock the data-set was made by the project team only after the finalization. No further amendments to the data-set were allowed
except for errors supported by valid evidence as determined by the project team and/or expert panel. All amendments of data-set, if any, must be
approved by the co-investigator(s).
Data Security
The NHEWS hospital data collection was authorized under the Private Healthcare Facilities and Services Act 1998. However, participation was
voluntary. Data collected in the NHEWS survey is regulated by the Personal Data Protection Act 2010 where applicable. All information collected
is held in the strictest confidence and according to legal and research ethics guidelines.
Data Quality
A full description of data quality of the data set is contained in Appendix 4.
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CONSORT DIAGRAM NHEWS 2011 (ACUTE CURATIVE HOSPITALS(a))
Total number of hospitals in Malaysia
Losses (Closed premise), n = 4
n = 353
1. Establishments ceased operations = 2
a. Multimedic Specialist & Maternity Centre
b. Hope Children Hospital – Farlim
Number of hospitals (operational)
n = 349
2. Establishment changed from Hospital
to Maternity Home =2
a. Pusat Rawatan Mahsuri
b. Klinik Wanita Nara
Excluded, n = 6
Public
Private
n = 138
n = 208
Ministry of Health
Aboriginals (JAKOA)
n = 137
n=1
University
n=3
(b)
1. Zero beds, n = 1
Excluded, n = 1
Excluded, n = 3
1.Chronic (curative) care(b), n = 1
1. Chronic (curative) care(b), n = 2
a. Hospital Tuaran
2. Chronic (curative) care(b), n = 5
a. Columbia Asia Extended
Care Hospital – Shah Alam
a. Hospital Kemajuan Orang Asli
a. Leprosy, n = 1
b. Pudu Specialists Centre
i. Rajah Charles Brooke
Memorial Hospital
2. Fertility centre = 1
a. TMC Women’s Specialist
(Kuantan) Sdn. Bhd.
b. Psychiatry, n = 4
i. Hospital Mesra Bukit Padang
ii. Hospital Bahagia Ulu Kinta
iii. Hospital Permai
iv. Hospital Sentosa
Included
Included
Included
n = 131
n = 205
n=3
Total in-scope hospitals
n = 339
(a) Acute Curative Hospital
ALOS