Unique role of university teaching hospitals
AUNIVERSITY teaching hospital, by definition, is an institution that provides clinical education and training to future and current doctors, nurses and other health professionals in addition to delivering medical care to patients, as well as carrying out medical research.
In Malaysia, there are five such hospitals: Universiti Malaya Medical Centre (UMMC), Hospital Canselor Tuanku Muhriz (HCTM) also known as Universiti Kebangsaan Malaysia Medical Centre, Universiti Sains Malaysia Medical Centre, International Islamic University Malaysia Medical Centre and Universiti Teknologi Mara Teaching Hospital.
UMMC director Professor Dr Tunku Kamarul Zaman Tunku Zainol Abidin said university teaching hospitals are managed and governed by their respective universities.
“So we report to the university and not to the Education Ministry. To ensure a more cohesive and direct transmission of the ministry’s vision and the spirit of collegiality, The Public University Teaching Hospital Consortium was created under the ministry.
“This effort will bring university teaching hospitals closer and they will be more organised under one banner but, more importantly, this will set a minimum standard for such hospitals in the country to ensure the care and education will be on par throughout the nation.
“University hospitals exist to provide the best training possible for the rakyat,” added Dr Tunku Kamarul Zaman.
“Other hospitals are also important to provide the setting for trainees to have a feel of the reallife situation, making practice applicable to dayto-day operations.
“However, the training should still be in an environment with complete facilities, so that trainees are taught using the most advanced tools available thus keeping up with advances in medicine.”
HCTM director Professor Datuk Dr Hanafiah Harunarashid highlighted that university teaching hospitals play a unique role in combining teaching, research and services.
“The services we provide are at the top end of the pyramid.
“As the school which produces doctors and specialists for the nation, we must keep abreast of the latest practices and cutting-edge technology.
“University teaching hospitals should also be the focus of community development, both health-and economics-centric. Quality assurance processes must also be in place, so the public is confident of the safety and quality of care,” he said.
He added that more university training hospitals mean patients have more access.
“The hospitals not only act as a hub to treat patients but are also a centre for producing competent doctors who will be able to serve other hospitals throughout the country.”
UMMC and HCTM, two of the oldest university teaching hospitals here, continue to strive to provide the most comprehensive healthcare training, research and healthcare services in the country.
While UMMC focuses on the education and training of the whole healthcare provider spectrum, one of HCTM key aims is to increase the number of specialist doctors in the nation.
When UMMC was officially opened on Aug 5, 1968, it was mainly meant to provide teaching for medical students.
Over the years, the hospital functions have evolved, from just providing education to offering research and healthcare.
“Today this hospital covers the healthcare services of an estimated area of 184sq km. We assist the Health Ministry in its role to provide healthcare to the public,” said Dr Tunku Kamarul Zaman.
However, he noted, UMMC is under the purview of the Education Ministry and, therefore, its core responsibilities are education, training and research.
“UMMC is presently the biggest healthcare training centre in the country. Healthcare training covers more than just doctors; it includes nurses, medical lab technologists, radiographers, physiotherapists, rehab specialists as well as pharmacists. As a healthcare education hub, the hospital is looking towards providing education in all specialities.”
PROGRAMMES
Education and training cover all levels of studies from diploma to postgraduate programmes. UMMC also has other programmes — a fellowship, short attachment, sub-speciality and industrial training.
“Degree and master’s programmes, which are the core business of the university, are under UM’s Faculty of Medicine. Other forms of training are run by the hospital. The diploma programmes for nurses, medical lab technologists and radiographers have been established for many decades at the hospital.
“In terms of specialist training, we have 27 medical speciality programmes and today, UMMC offers programmes other universities and institutions do not offer.
“For example, UMMC, under UM’s Medical Faculty, is the only centre in the country that offers the Oncology Masters programme, Rehab Physician Masters programme and Sports Medicine Physician Masters programme. We are the only one which produces these specialists in the country. We are still expanding, and, in the future, we will offer courses such as neurosurgery,” he said.
At any given time, there are 800 to 1,000 doctors present at the hospital for specialist training, 450 to 550 doctors in training for a medical degree (depending on intake per batch), 540 to 600 nursing students and 50 to 150 students for other courses.
“This does not include those from elsewhere doing training or are on attachment here, which can go up to 1,000 students at any one time.”
UMMC has purpose-built facilities for training that are different from public hospitals. “These include training rooms, clinics designed to accommodate trainees, seminar rooms, audio visual teaching tools and more. We spend at least RM500 million to RM600 million on operations expenditure per year which covers education, services and research, among others.”
UMMC also provides education programmes not immediately related to medicine disciplines but linked to the industry such as healthcare financial management, engineering of healthcare facilities and human resource management in healthcare.
“This is important as the work in healthcare is very different from the other industries as it needs specific knowledge. We are developing a programme to provide education in each area. For a start, there will be at least four new courses offered next year: hospital management, hospital administration, information technology management and training for heads of departments. We plan to expand and create healthcare educator programmes for other hospitals.”
My intention is to give back to the people, and we want to teach our students, patients, nurses, doctors and specialists about this. DR TUNKU KAMARUL ZAMAN TUNKU ZAINOL ABIDIN UMMC director
RESEARCH
At UMMC, the focus is on clinical research such as interventional and diagnostic research on patients as well as other research including those that are questionnaire-based and those centred on experimental surgeries.
UMMC has ample input for such research as it has more than 1.1 million patients every year, with 4,000 to 5,000 outpatients each day and at least 20,000 visitors per day.
Research that involves non-patient related studies are handled by UM’s Faculty of Medicine as it is more equipped for such work which is mainly lab-based.
UMMC’s research centre, the Clinical Investigating Centre (CIC), is world renown and has won many awards (http://www.clinicalinvestigationcentre.com/Awards).
“In fact, based on the American multinational company IQVIA ranking for superior performance and quality in clinical research, CIC is ranked best in Malaysia, third best in the Asia Pacific and seventh best in the world.”
OUTREACH
UMMC is in the vicinity of Lembah Pantai and Taman Medan, where the problem of urban poor persists.
It intends to offer its services to the community via satellite facilities by next year, bringing the hospital to the people and thus reducing healthcare costs for residents in the area.
“For funding, we hope the local authorities,
zakat agency and the corporate sector can help support our programme. My intention is to give back to the people, and we want to teach our students, patients, nurses, doctors and specialists about this. It is important that we make it clear that healthcare is for everyone, not only those who can afford it,” said Dr Tunku Kamarul Zaman.
He explained that satellite facilities are not of the four-level healthcare model seen presently in the country, where the location serves as a preliminary site for referrals for more complex cases.
“A satellite facility is like an extension of the present hospital with full electronic record of patients made available locally. These facilities will offer specialised services including providing the same treatment as the main hospital as well as other services such as physiotherapy and diet consultation. The university also plans to expand these services to include other programmes such as social development initiatives. We hope to have three satellite facilities built in Lembah Pantai and Taman Medan each.”
PLANS
With a range of facilities in place, UMMC has yet to have a burns unit.
“Usually the care will be done in the ICU unit, but we want it to be proper and dedicated unit. We are planning a burns unit by 2021,” said Dr Tunku Kamarul Zaman.
By next year, UMMC hopes to establish a centre for big data analytics that will further enable the management to manage the hospital and provide optimum healthcare to the public.
“To serve patients better, we are working towards providing close to 100 per cent evidencebased services. For a start, we are building a big data management system that will enable the management to see every aspect of the running of the hospital and how successful we are in providing treatment. Running a large hospital like this with 1,649 beds, and with the target of zero error, there is need for a better feel and control of the operational status every day.
“Thanks to the development of our own homegrown Total Hospital Information System, I am able sit in front of a digital dashboard and I can see the number of patients being treated in a particular clinic and monitor their waiting time with 97 per cent accuracy. I can also see other aspects of the hospital performance such as waiting time at the pharmacy, cost of expenditure in real time and effectiveness of treatment.”
Under the Education Ministry initiative, he hopes all university hospitals will be electronically linked and more comprehensive population healthcare data can be collacted and analysed; thereby giving even a bigger data compilation for predictive analytics.
“We have a very clear understanding of our needs. University teaching hospitals prioritise education above everything else. Our budget has been stagnant for the past several years, despite the increase in expenditure; however, we’ve been very good at generating our own income, without raising medical service fees to the public.
“One of the ways we are able to be more sustainable is that we have established commercial areas in our premises that generate an extra RM120 million for expenditure.”