06
The Health | august-September, 2020
| Cover Story |
Doctor
of change
Running one of the largest
public hospitals in the country
can be a very stressful job, more
so during the current Covid-19
pandemic. But Professor Datuk Dr
Hanafiah Harunarashid takes it in
his stride. The Director of Hospital
Canselor Tuanku Muhriz (HCTM),
who took up the job in mid-2017,
thrives in such challenges. His
passion for the job is evident as he
talks excitedly about transforming
HCTM.
A vascular surgeon by
profession, Dr Hanafiah de-stresses
by indulging in his hobbies. For
one, he finds cooking soothing. He
also loves travelling and goes on
family holidays. He loves football
but these days he plays futsal as a
means to keep healthy and meet
friends.
Dr Hanafiah is also the
President of the Asian Surgical
Association and immediate
Past President of the College of
Surgeons Academy of Medicine
Malaysia (CSAMM), Vice President
of the Vascular Society of Malaysia
(VSM) and sits on the Executive
Council of MERCY Malaysia and
board of UKM Specialist Centre.
Though he has implemented
several notable initiatives, his job
at HCTM is far from complete. He
spoke to The Health on his plans
and challenges that lie ahead.
How would you describe your
experience since taking over as
Director in 2017?
Succession is never an easy
process as meaningful working
relationships beforehand have to
be undone with new ones rebuilt.
It was a great challenge to redraw
boundaries in light of significant
changes in the hierarchy.
With a renewed identity,
re-establishing meaningful
connections, and smart
partnerships with the existing
network of healthcare systems,
namely with the Ministry of
Health (MoH), became a priority.
Furthermore, we knew we could
not face common challenges alone.
It was an initial struggle to build
a new identity of belonging to a
much more extensive network
of teaching hospitals – forming
comparative relationships,
instead of purely competitive
engagements.
What were the main challenges
in bringing changes?
The first challenge is on the
significant restructuring of
the KL health campus. It takes
time for people to understand
and accept the changes that we
wanted to make. Secondly, it is
related to government change. We
are apolitical, and we serve the
government of the day. But when
there are changes in leadership,
Selling change
is never easy.
But, with good
leadership,
perseverance
and a strong
moral
foundation, it
can be done.
Changes
are always
tricky but not
impossible.”
there will be policy changes. We
have to adapt. Then, thirdly it is
relating to budget cuts. With the
number of patients rising, we
have to be prudent and efficient to
ensure sustainability. Fourthly, is
the challenge in maintaining high
standards of care.
How difficult is it to implement
change, especially in a system
involving more than 5,000 staff?
This is a teaching hospital, linked
to a public university with a legacy
mandate to provide essential
health services to the roughly
1.5 million population of the
surrounding area – maybe up to
five million in the case of tertiary
services.
Selling change is never easy. But,
with good leadership, perseverance
and a strong moral foundation, it
can be done. Changes are always
tricky but not impossible. The
approach must be systematic
and precise. Leaders must set
good examples. We started with a
motto: Better, Faster, Friendlier.
It may sound cliché at first,
but gradually it has become a
culture.
Changing the mindset
requires persuasion,
which is a complex
process, and that requires
careful preparation, back
and forth dialogue and a
deep understanding of how
people make decisions. The
focus must be on four crucial
areas; building credibility and
mutual trust, establishing
common ground; being
data-driven and deep
understanding
of sentiments
and elements
of a captive
audience.
Hence, the
history of
HCTM must
be taken into
account.
You are a vascular surgeon. Do
you still find time to perform
surgeries?
Yes, but not in full capacity. But
one does need to practice to keep
the skills fresh. Sometimes I
get called for difficult cases but
thankfully, nowadays it is very rare.
I would have thought the team is
very well trained and can handle
most emergencies without my
assistance.
Occasionally, I get to see some
referrals that request for a second
opinion. I do miss my regular
operating lists and student
teaching sessions. I found them
relaxing and therapeutic. There
is no better satisfaction than to
feel that you have done something
right with a patient or teach a
student some useful knowledge
and help them to become
successful.
With your busy schedule, how do
you de-stress?
I love cooking as I find it soothing.
I used to cook when I got back
from work and tried new recipes.
Nowadays, I return late, so by the
time I reach home, dinner is ready.
My wife would have done all the
cooking! So I cook on weekends
instead. That is if I don’t have
meetings!
I also love travelling. Once a
year, I will travel with my family.
Nothing exotic but we have
quality family time. The thing
about travelling is you’ll learn new
things; the culture, the people, the
food, etc. Seeing the world makes
you realise how lucky you are.
I love football. Nowadays, I play
futsal once a week. But it’s not
competitive, just to meet friends,
widen my networking and keep
myself healthy.
Can you tell us a bit about
your management style and
leadership philosophy?
I would put people first and be
courteous and professional. Make
friends, not enemies. Think big,
but always keep your feet stable
on the ground. At the same time,
be mindful of the little details but
build a trust your team can handle
them. I am always reminded
to start small and
build on my
strengths as
one does
not become
world-class
overnight. I
remember to
be humble no
matter what
post I hold. —
The Health
Need to
upstream
the healthcare
system
Managing healthcare goes beyond
just managing a disease because it is linked
to the economy, education, environment
and many other components.
Instead of focusing on handling
diseases, a greater extent is on creating
better health, and this is why public
health is becoming more vital. And
digitalising healthcare happens to be
the critical enabler for expanding precision
medicine, transforming healthcare delivery
and improving patient experience.
The Covid-19 pandemic has shown us the
way we behave, and it has proven that health
is no longer the Ministry of Health’s problem.
It is the responsibility of the whole world.
For example, looking at the causes of
death in Malaysia, more people died due to
road accidents compared to Covid-19.
The Director of Hospital Canselor
Tuanku Muhriz (HCTM), Professor Datuk Dr
Hanafiah Harunarashid said: “If we can take
a real interest in all the other things beyond
Covid-19, we can fight them (other causes of
death in Malaysia) well.”
The key to this, he said, was knowing
the causes and understanding. Are they
preventable?
“As prevention is better than cure, there
are two things that we should do; one is to
prevent, and number two is to screen,” said
Dr Hanafiah.
Preventing encompasses on knowing
the risk factors and quickly taking action to
avoid such risks. For example, to prevent the
risk of Covid-19 infection, the public is urged
to follow the new norm – wearing a mask,
avoiding confined spaces, keeping a distance
of at least one metre and maintaining good
hygiene. This is how prevention works.
Screening, on the other hand, was
mirrored to a situation.
“You may have a good lifestyle, but you
may also have diabetes because of genetic
predisposition.
“So screening means we want to catch
you very early and treat you before you get
the complications,” Dr Hanafiah explained.
Drawing attention to the importance of
preventing and screening may help to create
a better healthcare environment. And that
is what Dr Hanafiah meant by “upstreaming
the healthcare system”.
As a result, the number of people visiting
hospitals and seeking medical treatment will
be lesser. It will automatically cut down costs
for the government.
Dr Hanafiah added: “People are living
older, and the healthcare system must
provide the right facilities.
“The government can take some initiative
to provide an ecosystem or a township that
allows them to cater to the elderly lifestyle,”
he suggested.
This ecosystem may include an easyshopping
system or even having nurses to
come for a visit and to do regular check-ups.
It was proven in previous studies that a
comfortable ecosystem might help the
elderly live healthier and happier lives as it
avoids them from going into depression.
In a way, it also allows the community
to be more productive – by children not
having to take leave to look after their
parents.