Public Hospitals In Malaysia Research Articles

Exploring the Impact of Managerial Coaching, Emotional Intelligence and Social Support on Employee Retention: The Mediating Role of Employee Resilience in Malaysian Public Healthcare

This paper explores the correlation between managerial coaching, emotional intelligence, social support, employee resilience, and retention among healthcare workers in Malaysia's public healthcare sector. Retaining healthcare staff has become a severe difficulty in the BANI (Brittle, Anxious, Non-linear, Incomprehensible) environment, worsened by the COVID-19 epidemic. The study suggests that managerial coaching, emotional intelligence, and social support are essential for developing resilience among healthcare workers. This resilience, in turn, impacts their ability to stay in their jobs. The study will employ a quantitative cross-sectional survey approach to examine the links inside specific public hospitals in Malaysia. The results are anticipated to offer a vital understanding of how public healthcare in Malaysia can strategically improve staff resilience and retention, guaranteeing the long-term viability of the healthcare workforce in a world after the pandemic. This study enhances our comprehension of the intricate processes that impact staff retention in the public healthcare industry, providing practical implications for policymakers and healthcare managers.

Fostering Nurses’ Support in the Workplace: Addressing Job Burnout Among Malaysian Medical Doctors Working in Public Hospitals

Job burnout in employees is caused by individual factors, including demographic characteristics and nurses’ support. This study analyzed the relationship between nurses’ support and job burnout among medical doctors in Malaysian public hospitals. This research was a correlational study with a cross-sectional design. The research sample was 471 employees, using the non-probability sampling method with the purposive and quota sampling techniques. Data collection used the Abbreviated Maslach Burnout Inventory (aMBI) and nurses’ support items. The data in this study were analyzed using the Statistical Package Social Science (SPSS) and Partial Least Squares Structural Equation Modelling (PLS-SEM) software. Findings suggest that 77 medical doctors who participated in the study were from Hospital Pulau Pinang, from the Emergency Department, mostly female, ranging from 24-56 years old, single, and have an MBBS education level. The study assessed the measurement model’s loading, average variance extracted (AVE), and composite reliability (CR) where the loadings were above 0.60. AVEs were greater than 0.50 and CRs were greater than 0.708. Additionally, the bootstrap BCI LL (-0.079) and UL (-0.002) for nurses’ support and job burnout were not straddled a 0 in between. Job burnout had a negative association with nurses’ support. In particular, nurses’ support towards medical doctors lowers their risk of job burnout, which has a substantial impact on medical doctors’ overall well-being. The findings indicated that medical doctors who had complete support from their nurses performed their jobs more efficiently, displayed good task performance, and experienced less job burnout.

The direct effect of institutional factors on healthcare information systems (HIS) organisational interoperability in Malaysian public hospitals.

Background: Organisational interoperability (OIoP) of the Healthcare Information System (HIS) is crucial for the success of HIS, however little is known about the impact of institutional factors. Objective: This cross-sectional study aimed to investigate the direct effect of institutional factors on OIoP for HIS in public sector hospitals in Malaysia. Methods: A conceptual OIoP framework was developed using the Personal Health Systems Interoperability and Refined eHealth European Interoperability frameworks. A self-administered questionnaire survey was used to solicit data from 300 healthcare professionals. Data were assessed through an Exploratory Factor Analysis followed by a Confirmatory Factor Analysis. Results: Structured equation modelling revealed Security and Privacy Compliance, and Stakeholder Engagement and Awareness to significantly and positively affect OIoP (R2 = 0.380). Conclusion: Healthcare organisations should prioritise clear and effective policies and regulations and enough budget and resources for the suggested framework.

Poisson-stopped sum Lévy-type processes with application to stochastic modeling of hospital arrivals

Patient arrivals at a hospital typically occur in clusters and the arrivals count data exhibits over-dispersion. To model these characteristics, the Lévy-type processes based on Poisson-stopped sum distributions are proposed as alternatives to the non-homogeneous Poisson process (NHPP), a popular model for hospital arrivals. The arrival rate for the NHPP is a deterministic function of time that does not account for arrivals in clusters while the genesis of Poisson-stopped sum distributions arises from modeling event clusters. Data on daily scheduled patient arrivals over 15-minute intervals collected from a Malaysian public hospital were used to illustrate the application of the Levy-type processes in healthcare management. It is shown that the proposed Lévy-type negative binomial and Lévy-type Thomas processes fit the data better than the NHPP. In addition, the Levy-type processes are computationally simpler and hence, it is envisaged that they will be potentially useful for implementation in staff scheduling and resource allocations.

The relationship between occupant behaviour and indoor air quality in Malaysian hospital outpatient departments: A multistage cross-sectional study

IntroductionPoor indoor air quality (IAQ) in healthcare settings may adversely impact occupants’ well-being and promote transmission of infectious respiratory disease. However, evidence on its potentially modifiable determinants, including occupant behaviour, remains scarce. This study aims to determine the relationship between occupant behaviour and IAQ in Malaysian hospital outpatient departments (OPDs). MethodsA multistage cross-sectional study of six randomly selected Malaysian public hospital OPDs was conducted. In stage one, IAQ parameters, including temperature, relative humidity (RH), air velocity (AV), carbon dioxide (CO2), total bacterial count (TBC), and total fungal count (TFC) were measured. In stage two, an observation form based on the Korsavi and Montazami tool for measuring adaptive behaviour was used to examine occupant density, activities, and operation of building envelopes and appliances. Simple correlation, partial correlation, and linear regression analyses were performed to examine the relationship between occupant behaviour and IAQ parameters. ResultsThe IAQ of selected hospital OPDs complied with established standards, except for temperature and AV. Occupant density was positively correlated with temperature and CO2. Meanwhile, occupants' activities including slow walking and brisk walking were positively correlated with temperature, AV, CO2, TBC and TFC. Conversely, occupants' opening of windows and doors were positively correlated with temperature and AV but negatively correlated with CO2, TBC and TFC. Finally, turning on fans was positively correlated with AV but negatively correlated with TBC, whereas turning on air conditioner was positively correlated with CO2. Among occupants’ behaviour, opening of windows and doors contributed the most to variation in IAQ parameters. ConclusionsThe study findings suggest that IAQ in hospital OPDs are influenced by occupant density, activities, and operation of doors, windows, and appliances. Prospective hospital IAQ guidelines should incorporate policies and measures targeting these factors to ensure occupants’ best practices in maintaining healthy hospital indoor air environments.

Prevalence and factors associated with medication administration errors in the neonatal intensive care unit: A multicentre, nationwide direct observational study.

To determine the prevalence of medication administration errors and identify factors associated with medication administration errors among neonates in the neonatal intensive care units. Prospective direct observational study. The study was conducted in the neonatal intensive care units of five public hospitals in Malaysia from April 2022 to March 2023. The preparation and administration of medications were observed using a standardized data collection form followed by chart review. After data collection, error identification was independently performed by two clinical pharmacists. Multivariable logistic regression was used to identify factors associated with medication administration errors. A total of 743 out of 1093 observed doses had at least one error, affecting 92.4% (157/170) neonates. The rate of medication administration errors was 68.0%. The top three most frequently occurring types of medication administration errors were wrong rate of administration (21.2%), wrong drug preparation (17.9%) and wrong dose (17.0%). Factors significantly associated with medication administration errors were medications administered intravenously, unavailability of a protocol, the number of prescribed medications, nursing experience, non-ventilated neonates and gestational age in weeks. Medication administration errors among neonates in the neonatal intensive care units are still common. The intravenous route of administration, absence of a protocol, younger gestational age, non-ventilated neonates, higher number of medications prescribed and increased years of nursing experience were significantly associated with medication administration errors. The findings of this study will enable the implementation of effective and sustainable interventions to target the factors identified in reducing medication administration errors among neonates in the neonatal intensive care unit. We adhered to the STROBE checklist. An expert panel consisting of healthcare professionals was involved in the identification of independent variables.

A Conceptual Framework on Factors Influencing Nurses’ Job Performance

The nurses' job performance can be regarded as a reflection of healthcare organizations, given that they comprise the largest group of human resource professionals who are responsible for providing high-quality care to patients. However, previous studies have emphasized that nurses in Malaysia are underperformed because of shortages in the workforce and excessive workload. Hence, understanding factors influencing the job performance of nurses will empower decision-makers to develop effective strategies aimed at enhancing nurses' performance. In Malaysia, only a few research have been performed on job performance, especially among nurses. Furthermore, limited research has delved into the specific factors influencing nurses’ job performance in Malaysia’s public hospital system. This study contributes to the existing knowledge by investigating the impact of spirituality at work and HRM practices on the nurses’ job performance in Malaysian public hospitals. This study employs a quantitative survey method using self-administered questionnaires, and the data collected will be analyzed using SPSS software Version 26. A total of 375 nurses from a population of 12, 514 nurses who worked at public hospitals in Malaysia will be selected as a sample of the study. This study offers potential benefits to authorities in Malaysian healthcare organizations by providing valuable insights for the development of compelling effective spirituality at work values and human resource management strategies aimed at enhancing the job performance of nurses.

Cost-benefit Analysis of Adopting Blockchain Technology in the Radiology Unit of a District Hospital

Background Blockchain technology has better security and immutable features, which are beneficial for healthcare data management. Decentralisation data management allows better sharing of medical images between units and departments. Objectives The objectives of this study were to determine the cost of adopting the blockchain-based system for medical images and the cost-benefit analysis for five years of adoption of this technology at a district hospital in Malaysia. Methodology Data regarding the yearly costs and workload for 2016 until 2018 were collected from a district hospital in Malaysia. The cost of blockchain implementation was obtained from a company that developed this technology. The cost-benefit analysis was done using the capital budgeting method for five years of this technology adoption. Sensitivity analysis was done to assess uncertainty conditions during this adoption. Results The total yearly cost of Radiology Unit for 2018 was MYR490,168.96. The cost for adopting blockchain technology was MYR80,000 for the software, MYR115,000 for upgrading the assets and yearly maintenance cost was MYR16,000. The total present value of net benefits for five years of technology adoption was MYR865,295.01. Sensitivity analysis shows that consumables cost-saving is the most sensitive variable. Most pessimistic situation analyses showed positive net benefits. Conclusion The adoption of blockchain technology in managing medical images offers numerous benefits to public hospitals in Malaysia. Investment in this technology can provide a good return to the organisation.

Examining the Impact of Burnout on Hospital Nurses Engaged in Shift Work: Insights From a Nationwide Cross-Sectional Study in Malaysia.

Shift workers follow nonstandard schedules that encompass overnight duty, rotational timetables, or permanent night work which can lead to misaligned core circadian physiology. Shift work has been associated with sleep deprivation, burnout, and metabolic syndrome among healthcare workers. We aimed to examine if shift nurses working in Malaysian public hospitals are more predisposed to burnout and to determine the predictors of burnout in this profession. This national-level cross-sectional study was conducted among nurses in public hospitals in Malaysia between July and November 2019 using self-administered questionnaires. Maslach Burnout Inventory-Human Service Survey was used to determine burnout. Multistage stratified sampling was used to recruit nurses from 32 hospitals. A complex sampling analysis was performed. Among the 1,491 hospital nurses, more than half (70.8%) of them followed shift work schedules. Shift nurses were mostly below 40 years old (80.9%), diploma holders (87.2%), and of lower professional grades (64.2%). The prevalence of overall burnout, as well as the domains of emotional exhaustion and depersonalization, was higher among shift nurses (27.1%) as compared to their counterparts (22.4%). Nurses who performed more than six night shifts per month were 2.6 times more predisposed to burnout. Shift work is integral to ensure round-the-clock nursing care for patients. However, nurses are increasingly faced with more shift duties due to heavy patient loads and staff shortages. Modified work schedules must be implemented to provide sufficient rest time for shift nurses to mitigate burnout. Additionally, proper human resource projection and distribution are imperative to prevent worsening burnout.

Machine learning-based risk prediction model for medication administration errors in neonatal intensive care units: A prospective direct observational study.

Neonates' physiological immaturity and complex dosing requirements heighten their susceptibility to medication administration errors (MAEs), with the potential for severe harm and substantial economic impact on healthcare systems. Developing an effective risk prediction model for MAEs is crucial to reduce and prevent harm. This national-level, multicentre, prospective direct observational study was conducted in neonatal intensive care units (NICUs) of five public hospitals in Malaysia. Randomly selected nurses were directly observed during medication preparation and administration. Each observation was independently assessed for errors. Ten machine learning (ML) algorithms were applied with features derived from systematic reviews, incident reports, and expert consensus. Model performance, prioritising F1-score for MAEs, was evaluated using various measures. Feature importance was determined using the permutation-feature importance for robust comparison across ML algorithms. A total of 1093 doses were administered to 170 neonates, with mean age and birth weight of 33.43 (SD ± 5.13) weeks and 1.94 (SD ± 0.95) kg, respectively. F1-scores for the ten models ranged from 76.15% to 83.28%. Adaptive boosting (AdaBoost) emerged as the best-performing model (F1-score: 83.28%, accuracy: 77.63%, area under the receiver operating characteristic: 82.95%, precision: 84.72%, sensitivity: 81.88% and negative predictive value: 64.00%). The most influential features in AdaBoost were the intravenous route of administration, working hours, and nursing experience. This study developed and validated an ML-based model to predict the presence of MAEs among neonates in NICUs. AdaBoost was identified as the best-performing algorithm. Utilising the model's predictions, healthcare providers can potentially reduce MAE occurrence through timely interventions.

Clinical and economic impact of medication administration errors among neonates in neonatal intensive care units.

Despite efforts in improving medication safety, medication administration errors are still common, resulting in significant clinical and economic impact. Studies conducted using a valid and reliable tool to assess clinical impact are lacking, and to the best of our knowledge, studies evaluating the economic impact of medication administration errors among neonates are not yet available. Therefore, this study aimed to determine the potential clinical and economic impact of medication administration errors in neonatal intensive care units and identify the factors associated with these errors. A national level, multi centre, prospective direct observational study was conducted in the neonatal intensive care units of five Malaysian public hospitals. The nurses preparing and administering the medications were directly observed. After the data were collected, two clinical pharmacists conducted independent assessments to identify errors. An expert panel of healthcare professionals assessed each medication administration error for its potential clinical and economic outcome. A validated visual analogue scale was used to ascertain the potential clinical outcome. The mean severity index for each error was subsequently calculated. The potential economic impact of each error was determined by averaging each expert's input. Multinomial logistic regression and multiple linear regression were used to identify factors associated with the severity and cost of the errors, respectively. A total of 1,018 out of 1,288 (79.0%) errors were found to be potentially moderate in severity, while only 30 (2.3%) were found to be potentially severe. The potential economic impact was estimated at USD 27,452.10. Factors significantly associated with severe medication administration errors were the medications administered intravenously, the presence of high-alert medications, unavailability of a protocol, and younger neonates. Moreover, factors significantly associated with moderately severe errors were intravenous medication administration, younger neonates, and an increased number of medications administered. In the multiple linear regression analysis, the independent variables found to be significantly associated with cost were the intravenous route of administration and the use of high-alert medications. In conclusion, medication administration errors were judged to be mainly moderate in severity costing USD 14.04 (2.22-22.53) per error. This study revealed important insights and highlights the need to implement effective error reducing strategies to improve patient safety among neonates in the neonatal intensive care unit.

The challenges of using blockchain technology for medical data in public hospitals in Malaysia

The management and ownership of medical data will affect the future of decentralised healthcare data-sharing applications. Future research projects examining the use of blockchain technology to store medical data in governmental organisations in Malaysia will need to address governance concerns and consider how to regulate blockchain to achieve these objectives. This paper examines the present governance issues in the healthcare industry, identifies areas requiring further research, and outlines the most crucial factors for blockchain applications to function. This paper presents a systematic literature review that investigates the challenges associated with implementing blockchain applications for medical data in public hospitals in Malaysia. As a result of a systematic screening procedure, 53 primary studies were included in the final analysis, which discovered eleven significant issues individually. The analysis of eleven issues, including social, interoperability, and security concerns, presents significant challenges and solutions for blockchain applications for medical data. The systematic literature review provides insight into the current state of blockchain implementation in Malaysian public hospitals and offers helpful recommendations for addressing the identified challenges. Policymakers, hospital administrators, and blockchain technology developers can use these findings to create practices that facilitate the successful integration and implementation of blockchain applications in Malaysian public hospitals.

Nurses' perception of medication administration errors and factors associated with their reporting in the neonatal intensive care unit.

Medication administration is a complex process, and nurses play a central role in this process. Errors during administration are associated with severe patient harm and significant economic burden. However, the prevalence of under-reporting makes it challenging when analysing the current landscape of medication administration error (MAE) and hinders the implementation of improvements to the existing system. The aim of this study is to describe the reasons for the occurrence of MAEs and the reasons behind the under-reporting of MAEs, to determine the estimated percentage of MAE reporting and to identify factors associated with them from the nurses' perspective. This cross-sectional study was conducted using a validated self-administered questionnaire. The questionnaire contained 65 questions which were divided into three sections: (i) reasons for the occurrence of MAEs, which consisted of 29 items; (ii) reasons for not reporting MAEs, which consisted of 16 items; and (iii) percentage of MAEs actually reported, which consisted of 20 items. It was distributed to 143 nurses in the neonatal intensive care units of five public hospitals in Malaysia. Multivariable logistic regression was used to identify the factors associated with MAE reporting. The estimated percentage of MAE reporting was 30.6%. The most common reasons for MAEs were inadequate nursing staff (5.14 [SD 1.25]), followed by drugs which look alike (4.65 [SD 1.06]) and similar drug packaging (4.41 [SD 1.18]). The most common reasons for not reporting MAEs were that nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error (4.56 [SD 1.32]) and that too much emphasis is placed on MAEs as a measure of the quality of nursing care (4.31 [SD 1.23]). Factors statistically significant with MAE reporting were administration response (adjusted odds ratio [AOR] = 6.90; 95% confidence interval (CI) = 2.01-23.67; P = 0.002), reporting effort (AOR = 3.67; 95% CI = 1.68-8.01; P = 0.001), and nurses with advanced diploma (AOR = 0.29; 95% CI = 0.13-0.65; P = 0.003). Our findings show that under-reporting of MAEs is still common and less than a third of the respondents reported MAEs. Therefore, to encourage error reporting, emphasis should be placed on the benefits of reporting, adopting a non-punitive approach, and creating a blame-free culture.

Study of Energy Performance in Malaysian Public Hospital using Power Query

In 2016, the Ministry of Health (MOH), Malaysia, initiated a sustainable program that includes activities for sustainable energy management at all 145 buildings under the MOH. The focus of the sustainable energy management program is to target these buildings to reduce their annual energy consumption by 10% by 2018. The target implementation of a sustainable energy management program includes achieving 3-star EMGS certification within 5 years. By December 2022, 135 have achieved two-star certification with the requirement to achieve at least 5% energy consumption savings. By 2019, the 118 buildings that embarked on EMGS certification had achieved 22.62% energy consumption savings. District and specialist hospitals achieved 23%–24% savings in 2019. The largest energy consumption in MOH buildings is for room cooling, which is contributed by air conditioning and mechanical ventilation (ACMV) equipment. The implementation of a sustainable energy management program has contributed to energy cost savings of RM21 million per year to MOH energy bills in 2019.

Improving Employee Engagement Through HRM Practices in Public Hospitals

The objective of this study is to examine the relationship between Human Resource Management (HRM) practices and employee engagement within the context of nurses in public hospitals in Malaysia. Prior studies have investigated several factors that influence employee engagement in Malaysia. However, the present study specifically concentrates on examining the relationship between HRM practices and employee engagement. The study encompassed a sample of 330 nurses employed in public hospitals in Malaysia. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 25. The study revealed that the implementation of three specific HRM practices, namely career development, employee participation, and training and development, had a positive and significant effect on employee engagement. The findings have the potential to offer useful insights to decision-makers within healthcare organizations in Malaysia. Specifically, these insights can inform the development of effective HRM strategies aimed at enhancing employee engagement among nurses. Moreover, this study offers suggestions for future research and recommendations for the authorities to strengthen human resource policies pertaining to the healthcare sector in Malaysia.

Methods to Reduce Outstanding Medical Fees at Public Hospital in Malaysia: An Action Research Project

The aim of the study to solve problems related to revenue collection at Public Hospitals in Malaysia. Using the action research approach, two phases were adapted to review the state of metastasizing outstanding medical fees at one of the public hospitals located at west coast of Sabah and its contributing factors. The secondary data from monthly or annual financial reports, focus group discussions (N = 20), and review of government documented regulations and manuals were gathered in this study. It was revealed that the significant proportion of outstanding medical fees in the public hospital is attributed to non-citizens. The main problems faced include noncompliance with policies and procedures in the revenue collection process; lack of IT-based revenue cycle management; and poor engagement of hospital staff in revenue cycle management. Implementation of an IT-based billing system has improved communication between frontline and backend staff and hence improved revenue collection efficiency. Further collaboration with higher authorities in the implementation of a comprehensive online payment system and to increase insurance coverage for non-citizens via medical and social services are explored.

Clinical Characteristics and Outcomes of Klebsiella Pneumonia Bacteraemia in Adult

INTRODUCTION: Klebsiella pneumonia (K. pneumonia) bacteremia is one of the leading causes of hospital morbidity and mortality. Our study aimed to evaluate the clinical characteristics, risk factors and outcomes of K. pneumonia bacteremia in a Malaysian public hospital. MATERIALS AND METHODS: A retrospective cross-sectional study of adults with K. pneumonia bacteremia was conducted in a hospital in Johor, Malaysia. Demographics, medical comorbidities, source of infections and the mortality rate was reviewed and analyzed. RESULTS: A total of 185 cases of K. pneumonia bacteremia were included for analysis. The mean age for this study was 54.9 (SD 15.4), with 56.8% males and 46.5% in-hospital mortality. Extended-spectrum Beta Lactamase (ESBL) producing and Carbapenem-resistant K. pneumonia contributed to 37.3% and 1.1 % of K. pneumonia bacteremia, respectively. Among those who contracted K. pneumonia bacteremia, two most frequent sources were primary bloodstream infections (n=75, 40.5%), pneumonia (n=44, 23.8%) and urinary tract infections (n=28, 15.1%). There was statistically significant associations found between diabetes mellitus (AOR 1.46, 95% CI 1.02-2.08), cancer (AOR 2.02, 95% CI 1.33-3.05) and alcohol use disorder (AOR 7.73,95% CI 1.38-43.21 ) with K. pneumonia bacteremia. In-hospital mortality was higher in older patients by 1.03 odds (p=0.003). CONCLUSION: Diabetes mellitus, cancer, and alcohol use disorder were independent risk factors associated with K. pneumonia bacteremia. Patients with advanced age had a higher mortality rate.

A Longitudinal Evaluation of the Preferences of Patients With Advanced Cancer for Quality of Life and Survival in Malaysia: A Discrete Choice Experiment

ObjectivesThis study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time. MethodsA discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay. ResultsOne hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in “severe” health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents’ preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost. ConclusionsAs QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.

Hlasové chování sester: empirická studie v malajsijských veřejných nemocnicích

Hlasové chování sester: empirická studie v malajsijských veřejných nemocnicích

Mapping Levels of Palliative Care Service Development in Malaysian Public Hospitals Using the WHO Public Health Model of Palliative Care.

This national audit involving Ministry of Health (MOH) Hospitals aimed to map out the levels of development of palliative care services and essential palliative medication availability in Malaysia. An online survey coupled with manual follow up was conducted throughout all MOH hospitals in Malaysia. Data collected described elements of the palliative care service(PCS) based on the WHO public health model. Data was computed using a novel matrix to determine three key indices which were the 1) palliative care development score (PCDS), 2)essential medications availability score (EMAS) and 3) opioid availability score (OAS). These scores then allowed mapping of PCS according to scores of 1-4 (1=least developed, 4=most developed). Out of all 140 MOH hospitals 88.6% (124) completed the PCDS survey, 120(85.7%) for the EMAS survey and 140 (100%) for the OAS survey. A total of 32(25.8%) hospitals had formal PCS with 8(25%) having resident palliative physicians (RPP), 8(25%) visiting palliative physicians(VPP) and 16(50%) no palliative physician (NPP). Out of these services, 17 (53%) had dedicated palliative care beds. In the PCDS survey, hospitals with PCS had significantly higher mean PCDS of 2.59 compared to 1.02 for non-PCS hospitals (P<0.001). The EMAS survey showed 109(90.8%) hospitals had EMAS of four and the OAS survey showed that 135(96.4%) hospitals had oral morphine available. This study shows that palliative care service development in MOH hospitals is still very limited however, majority of MOH hospitals in Malaysia have all the essential medications and oral morphine available.