We started work on the healthcare transformation two years ago in Malaysia. This is part of the Public Service Delivery Transformation (PSDT) programme and its intent is to “do more with less” – using the same amount of resources to deliver more than before.


Oxford Economics in their modelling of ten countries predicted that by 2025 there would be a wide gap in public service delivery funding from the government due to the increasing expectations of the citizens. We reckon Malaysia would need an additional funding of USD12 billion to deliver the services to its citizens by 2025.


The question then, where do we get the funding?


Or are we resigned to cutting services to the public?


One option is to improve our current service delivery. To do this, we need to make the delivery processes effective and efficient. Effective means delivering more value to the citizens, whereas efficient means we do more with less. One of the ministries that have embarked on the PSDT programme is the Malaysian Ministry of Health (MOH).


We started with the Oncology Department at the tertiary hospital, Hospital Sultan Ismail (HSI). The concern was that those suffering head and neck cancer had to wait an average of four months to get radiation therapy treatment. The treatment would take another 35 continuous days. The long waiting time means a delay in receiving treatment that could result in poorer outcomes for patients.


Our culture loves the idea of revolutionary and immediate change. However, turnaround efforts often fail because radical change sets off our brain’s fear response and shut down our powers to think clearly and creatively. Our path of change in the healthcare began with small steps of process improvement. These small steps tend to bypass our mental alarm system, hence allowing our creative and intellectual processes to flow without obstruction. The philosophy as someone said is “the road to success is always under construction”.


We did the improvement in two phases. Phase 1 is reducing the waiting time from 120 days to 60 days, whereas Phase 2 is reducing it further to 30 days to be in sync with the world standard. We accomplished both Phase 1 and Phase 2 within four months using the LEAN Thinking.

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LEAN thinking changes our focus of managing the Oncology Department from optimising separate components of healthcare to simplifying the flow of services throughout the entire patient experience.


We began by mapping the process using the “Value Stream Mapping” tool. It is a representation of the current the flow of patients and services through the Oncology Department. This enables us to see the delays and constraints in the process. Mapping the current flow is the first step in working towards the desired improvement of 30 days’ waiting time.

What we did was not rocket science but very effective.

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