Sungai Buloh Hospital in Malaysia restructured its organizational structure and clinical services in response to the COVID-19 pandemic. The hospital shifted to a flat structure and expanded its infectious disease and critical care services. It scaled down elective surgeries and outpatient services to concentrate resources on COVID-19. Through tireless teamwork and obtaining additional resources and facilities, the hospital increased its ICU capacity and prepared over 2000 beds to handle the surge in COVID-19 cases. Good teamwork, organizational flexibility, and ensuring optimal resources were keys to the hospital's successful pandemic response.

1. KEY STRATEGIES IN THE PANDEMIC
PREPAREDNESS AS COVID-19
HOSPITAL- PERSPECTIVE FROM
HOSPITAL SUNGAI BULOH, MALAYSIA
DR KULDIP KAUR PREM SINGH
Director, Hospital Sungai Buloh

2. INTRODUCTION
• Since 25th January 2020, number of COVID-19 patients increased drastically in
Malaysia.
• Hence, the ministry declared Sungai Buloh Hospital as a COVID-19 hospital in
Klang Valley.
• 620-bedded multidisciplinary specialist hospital established in 2006. Its the main
centre for infectious disease in the country and in addition, the hospital
incorporated Pusat Kawalan Kusta Negara (PKKN) as a satellite facility.

3. INTRODUCTION(2)
• Management kept a fast pace of learning, adopting and adapting on an almost
hourly basis.
• Unprecedented level of cooperation and common purpose, the COVID-19 team
rose above self and dedicated itself to humanity’s cause of delivering the best
care to all patients.
• Changing environment, written rules in the last hour were not applicable as
new and urgent demands kept lashing endlessly.
• The success is attributed to relentless direction carried out by tireless
teamwork to build a COVID-19 emergency preparedness unprecedented in
Malaysia.

4. PRE COVID-19 SUNGAI BULOH HOSPITAL ORGANIZATION STRUCTURE

5. OBJECTIVES
The main objective of this report is to
share the organisational changes
implemented in Sungai Buloh
Hospital for preparedness in
managing COVID-19 cases in
Malaysia.

6. METHODOLOGY
Drawing from approaches for H1N1 pandemic (Sam and Abu
Bakar, 2009) and MERS-COV epidemic (Premila Devi et al.,
2014), the hospital management developed a COVID-19
pandemic preparedness strategy with the following six
perspectives.

7. STRATEGIES TOOLS
PREPARING CONSERVING SUBSTITUTING ADAPTING RE-USING
Chopra,Hick & Nacoti (2020)

8. STRATEGY 1 : TEAMWORK AND FLAT
ORGANIZATIONAL STRUCTURE
Getting good support from all departments and shifting from departmental
responses to hospital responses and eventually to Infectious Disease response.

9. STRATEGY 2: SCALING DOWN CLINICAL
SERVICES STEPWISE
Re-organization of surgical and medical services involving scaling down
electives and temporary cessation of emergency that required intensive care.

10. STRATEGY 3: DECANTING OF INPATIENT
CLINICAL SERVICES
Stabilizing in-patients and decanting of in-patient clinical services via specialist
to specialist referrals to all surrounding hospitals on standby mode.

11. STRATEGY 4: EXPANSION OF ID AND
CRITICAL CARE SERVICES
Preparation of hospital response for all critical care services to be concentrated
into accepting COVID-19 cases which involved preparation of specialist wards
and intensive care beds.

12. STRATEGY 5: SCALING DOWN SPECIALIST
OUTPATIENT CLINICAL SERVICES
Scaling down of all other out-patient services to reduce infection rate and to
mobilize resources into COVID-19 care.

13. STRATEGY 6: DIRECT CONTROL OF
RESOURCES
• Request for greater budget, human resource, equipment and facilities, bed
management and data availability.

14. RESULTS
• The hospital advisory committee restructured the pre-COVID
management into a flat hospital organizational structure
based on the needs of the COVID-19 crisis

15. COVID-19 HOSPITAL RESPONSE
ORGANIZATION

16. Number of beds during covid-19
LOCATION NO OF BEDS
MAIN BUILDING HOSPITAL
SUNGAI BULOH
560
PKKN 403
ILKKM 1200
TOTAL NO OF BEDS 2163

17. • Pre-COVID ICU 42 functioning beds
• During COVID-19, ICU beds increasing to 108 bed capacities.
• Need to ensure uninterrupted oxygen supply, the top-up was increased
from alternate day to daily supply.
• ICU facilities were revamped into makeshift green zones by blocking air
supply from the main ICU and by erecting additional walls and doors
with unilateral air flow.

18. SURGE IN COVID-19 CASES

19. CONCLUSION
Hospitals worldwide were
challenged by having shortage of
beds and reduced resources during
COVID-19 pandemic. As the first
designated COVID-19 hospital in
Malaysia, Sungai Buloh Hospital
used six key strategies to overcome
these challenges and provide
excellent healthcare services for
COVID-19 patients.

20. Recommendation
Good teamwork, flat organizational structure , ensuring
resources kept in the optimum level and continuous manpower
training are key elements for hospital preparedness for COVID-
19 pandemic.

21. THANK YOU