National Heart Institute – Tan Sri Dato’ Seri Dr. Robaayah Zambahari, Chief Executive Director – Malaysia
The National Heart Institute’s CEO portrays IJN as a national referral center for cardiovascular disease and declares: “IJN is equipped with the best in class technologies and is poised to become the market leader in Asia by offering a comprehensive range of services for cardiovascular medicine with a wide range of interventions – medical, interventional and surgical.”
How would you define IJN’s role in the context of the healthcare NKEA implemented in Malaysia in 2011?
Institut Jantung Negara IJN or National Heart Institute is a stand-alone institute for cardiovascular and cardiothoracic care, corporatized in September 1992, with the Ministry of Finance incorporated as the principal shareholder.
Institut Jantung Negara (IJN) is a leading provider of comprehensive integrated cardiovascular and thoracic care services in Malaysia. As the national referral center for cardiovascular disease, IJN sees new cases referred from all over the country as well as follow-up cases at the outpatient clinics. IJN is equipped with the best in class technologies and is poised to become the market leader in Asia by offering a comprehensive range of services for cardiovascular medicine with a wide range of interventions – medical, interventional and surgical.
We are a flagship Malaysian healthcare institute for specialized heart services and procedures. This is reflected by patients we received when in need of medical service. They see the IJN as a top quality care provider with the experience and expertise necessary to handle a variety of cases of varying complexity. In Malaysia we are a point of reference for specialized medicine.
Furthermore, IJN has taken great strides in achieving international accreditation, having been first obtained the Joint Commission International JCI accreditation in 2009 and reaccreditation in 2013. Healthcare is now a global phenomenon, and therefore quality of care needs to be at par with recognized international medical institutions
IJN is in a unique situation where we are a private entity with Government ownership, thus in a way itself a “collaboration”. As the national referral centre, we provide services to government sponsored patients (mainly), not forgetting the local private patients and international patients.
IJN being a Center of Excellence has been involved in Research activities. We have participated in multicenter trials in partnership with established organisations and institutions within the industry. One such example is the MOU with Universiti Teknologi Malaysia for the establishment of IJN UTM School of Cardiovascular Engineering, signed last year.
We are for the moment actively engaged to promote IJN to international market and specifically to countries like Indonesia, Myanmar, Vietnam and Bangladesh.
Could you give us your perspective on the positive effects of the healthcare NKEA in Malaysia?
The healthcare sector has seen robust growth over the past decade and this sector has one of the highest multipliers in the economy in Malaysia. Changing demographics, a more affluent society and more health-conscious lifestyles have led to the creation of a robust domestic industry.
While the local industry has been dominated by the public healthcare sector, over the past decade, there has been tremendous growth of private healthcare services. As such, the Government, through the healthcare NKEA, aims to further grow this sector by encouraging more private investments in areas such as manufacturing of pharmaceutical products, medical devices, clinical research, aged-care services and supporting collaborative efforts between public and private healthcare providers.
How do you manage to attract and retain the best talent inside the Institute, given the strong competition from the many private hospitals operating in Malaysia?
Being able to attract and retain talent is one of the keys to IJN’s success which has seen us established as a regional leader in cardiovascular and thoracic care.
A number of our specialists have received international awards, commendations and recognition. Many have become ‘key opinion leaders’ in their subspecialties. Many continue to be invited faculty, speakers and live case operators in local and international meetings and conferences.
There are a number of reasons why IJN has been able to attract and retain some of the best talents in the country. These include the availability and investments in the latest and state-of-the-art devices, equipment and technology. They give clinicians the confidence that the centre is serious about fulfilling our mission to be the centre of excellence in cardiovascular and thoracic care.
The attraction of professional challenge may be another reason. In IJN, while performing the regular day-to-day procedures, we also have the opportunity to perform new procedures, sometimes first in Malaysia, first in the region, first in Asia Pacific or even first-in-man. The wide variety of cases, of varying complexities, some very challenging cases, allows our clinicians to develop more professionally.
While the clinicians here are salaried, and their salary will not be able to match those in private practices, there are the ‘non-financial’ rewards. These include self-gratification of serving wide variety of cases, varying complexity of cases, in a spirit of ‘bonding’, where one can easily ask for opinion or help, with little competition among one-another, in an organization that is clinician-led.
What is the institute’s commitment to encourage clinical trials in Malaysia?
Research and development are among the ingredients of a centre of excellence. The mechanisms for research and development to progress are in place – research committee, research department with a qualified statistician as the head and with 11 clinical research assistants and 11 officers handling data management.
In the field of research, we also have established collaboration with Memorandum of Agreement and Memorandum of Understanding with universities including University Kebangsaan Malaysia, University Technology Malaysia and Baker IDI Heart and Diabetes Institute in Melbourne an independent, internationally renowned medical research facility).
IJN has been involved in numerous multinational multicenter clinical trials, many of which subsequently were published in established international medical journals and the outcomes of some of these clinical trials have impacted our clinical practice and have become guidelines in our management of patients.
Medical tourism is also on the government’s agenda with great opportunities to grow considering what Malaysia offers. What are your views on this phenomenon and does the Institute have an interest in specifically attracting international patients?
From 2009 – 2013, Malaysia has experienced a 129 percent increase in healthcare travelers. Malaysia was recently ranked as the third best place to go for quality and affordable care. Accessibility, language proficiency and cultural diversity has over the past decade made our country stand out from our regional peers. Combined with IJN’s clinical excellence in cardiovascular and thoracic care, we believe medical tourism is an opportunity for us to attract more international patients.
Playing our role in supporting the government’s initiative towards medical tourism, we have equipped our facilities and services to meet the demand and needs of foreign patients. An International Patient Centre has been set up in IJN, with the brief of facilitating the travel and logistics of international patients and accompanying family members. Here, the members of the IJN International Patient Services (IIPS) team provide assistance such as helping with flight arrangements, arranging for visas and helping with immigration clearance, coordinating the exchange of information between the specialists at IJN and the patient’s own doctor in his or her home country, and assisting with admission and discharge matters such as bill payment, insurance claims and medical leave.
What role does IJN play in raising awareness around the prevention of heart diseases in Malaysia?
The caring nature of IJN goes beyond the hospital doors. IJN is a responsible, caring organization, and strives to influence the lives of all segments of the community, and we are proud to share our knowledge and expertise with those who need it, not only those who can afford access to the best treatment.
To achieve this we venture into the community, and there are a variety of ways we raise awareness about key heart and health issues, from the ‘rural’ areas to the major corporations in Malaysia.
As an established leader in educating the community, we discuss heart disease awareness and prevention, often with health screening, at functions (like world heart day, international women’s day), at corporate organizations visits to IJN, and also when we are invited to corporate organizations’ staff days. We also regularly conduct corporate social initiatives CSI programs in various areas in the country. During these sessions, there will be health talks by health personnel on heart disease and prevention, health screening when individuals would get the following measured: height, body weight (from where we get their body mass index), blood pressure, blood sugar and cholesterol. They would then be seen by counselors who would go through the findings and advise accordingly. Where feasible, we also demonstrate Cardio Pulmonary Resuscitation (CPR) techniques.
As the founder and charismatic leader of the National Health Institute of Malaysia, what would you like to achieve in the coming years for the Institute, for cardiology worldwide and for the international reputation of Malaysia?
At the 65th World Health Assembly in May 2012, governments from 194 countries, including Malaysia, had made a commitment to reduce premature death by 25 percent by the year 2025. As the main cause of premature death worldwide is cardiovascular disease CVD, World Heart Day plays an important role as a platform to raise awareness on cardiovascular disease and encourage individuals, families, communities, and governments to take action to reduce the burden of CVD, to reduce death from CVD, and so move towards achieving the goal agreed at the World Health Assembly.
In Malaysia, heart disease is the main cause of death in Malaysian hospitals, for both men and women, accounting for approximately 25 percent of total deaths. Among women, cardiovascular disease accounted for two to two-and-half times more deaths than all cancers combined. What is more alarming is that, those afflicted are younger than our ‘Western’ counterparts. As demonstrated in the National Cardiovascular Disease Database NCVD, the average age of those admitted with heart attack was 59 years, 7 years younger than the global GRACE Registry, where the average age was 66 years. Furthermore, from the NCVD Database, we learnt that approximately 18 percent were in the 40 to 50-years age group, and approximately 31 percent were in the 50 to 60-years age group. These people are at the peak of their career and have families to support. Imagine the impact of disability and death of these young and productive people to the affected families, communities and to the country.
We have to prevent this disease. Prevention needs to be done at various levels. Firstly, primary prevention (for those not yet afflicted), with adoption of healthy lifestyle, including cessation of smoking, healthy eating, healthy activities and healthy weight. The next level is the detection and management of risk factors, with healthy lifestyle as the mainstay of treatment, and medications only if healthy lifestyle is inadequate to reach the targets. The next level is detection of disease and management of disease and its consequences. Again healthy lifestyle is the mainstay of treatment, and, if necessary, medications and intervention (coronary angioplasty or coronary artery bypass graft surgery). After these procedures and surgery, there remains the need for prevention of disease progression and hence, healthy lifestyle remains an important component of treatment.
I would like IJN to continue to grow, in provision of quality healthcare, in research and education, and contribute towards a healthier Malaysian Society. I would like for Malaysia’s reputation to grow and be known for its healthy society and the advanced level of its healthcare.
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