growth and expansion of medical school shows that the government wants to ..... International Journal of Automotive Technology, 2012, Volume 13(7), pp.
Available online at www.scientiaresearchlibrary.com
Scientia Research Library
ISSN 2348-0416 USA CODEN: JASRHB
Journal of Applied Science And Research, 2014, 2 (2):14-22 (http://www.scientiaresearchlibrary.com/arhcive.php)
Waste Management Practices and Organization Performance in Malaysian Healthcare Industries Mohd Hafiz Roslan[1], Nurul Fadly Habidin, Mohd Zaini Zainudin, Aqmar Nur Izzah Norazlan, Sariyati Abdul Hadji. 1
Department of Management and Leadership, Faculty of Management and Economics, Universiti Pendidikan Sultan Idris, 35900 Tanjung Malim, Perak, Malaysia
ABSTRACT The healthcare industry in Malaysia are continuously improve and on the right track, the rapid growth and expansion of medical school shows that the government wants to improve the quality of healthcare in our country. This study aim to investigate the relationship between waste management and organizational performance in the healthcare industry in Malaysia. Effective waste management can improve organizational performance (financial performance, customer performance, internal business process performance and learning Innovation and growth performance). This study also proposed structural relationship model between waste management and organizational performance, for analyze the data, Structural Equation Modeling (SEM) technic will apply. This study also suggests future research work. Keywords: wastes management; organization performance; balanced scorecard; healthcare
industries; Malaysia
INTRODUCTION According to the Department of Environment, Malaysian’s Ministry Of Natural Resources & Environment, healthcare is medical activities such as diagnosis, monitoring, treatment disease prevention or reduction defects in humans or animals and healthcare wastes means solid or liquid waste arising from healthcare. Waste management is one of the best steps in ensuring that waste is manage in a systematic and safe. Healthcare activities in medical institutions was produce waste. To achieve the goal towards systematic waste management, all countries should more focused on aspects of the healthcare waste management. According to the World Health Organization (WHO) estimates that, around 23 million people have been infected with Hepatitis B , Hepatitis C and HIV around the world as a result of the use of contaminated syringes. The prevalence of the disease is caused by the management of healthcare waste is not managed in the right way and can be spread to 14
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ people. Healthcare waste management not only have an adverse effect on the human, but environment also be polluted. Ministry of Health Malaysia is an agency responsible for organizing healthcare waste management procedures in hospitals, clinics and other medical centers in Malaysia. Some of constraints and problems to manage healthcare waste must be resolved immediately. Therefore, Ministry of Health Malaysia must serious providing better quality in healthcare, they must plan and develop a framework that systematically and effectively to manage healthcare waste with proper and carefully procedures. This framework requires a strategy and cooperation between ministries, associations of doctors, nurses associations, NGO and other stakeholders to realizing this vision. This collaboration important to establish a common guideline for every health agencies whether government or private. Thus, the purpose of this paper are to identify the waste management practices and organizational performance measures for Malaysian Healthcare Industry. This study also develop research model of waste management and organizational performance measures relationship for Malaysian Healthcare Industry. In this research, there are four categories of waste management practices that purpose: Segregation (S), Collection and Storage (CS), Treatment (T), Transport and Safe Disposal (TSD), while the four element of organizational performance: Financial Performance (FP), Customer Performance (CP), Internal Business Process Performance (IBPP), Innovation and Learning Growth Performance (ILGW). Literature Review There are few challenges and obstruction to implementing because the level of awareness among Malaysia healthcare industry is still in range low to moderate. Based on studies by Ananth et al., (2010), conducted in 12 countries in Asia, namely Cambodia, China, Japan, Lao PDR, Thailand, Vietnam, Singapore, Malaysia, Mongolia, Myanmar, Indonesia and the Philippines shows that deep knowledge of the healthcare waste management must mainly known by all healthcare staff. Low levels of knowledge about waste management among employees is one of the obstacles to reach the goals. Some of country aim to progressive waste management, but they either lack of knowledge, strategies, legislation and budgets limiting their actions. Technology was not the major problem in healthcare waste management, but management systems should be systematic and effective in order step to deal with this issue. Ananth et al., (2010) stated that observing and correcting mistakes in that task efficiently implemented necessary to improve performance and provide training skills, knowledge and proper management guide. There are many practices such as segregation, collection and storage, treatment and transport and safe disposal that can be practiced in the handling of waste management, to make more effectively and systematically. Study by Omar et al., (2012), in the district hospital Tumpat, Batu Pahat and Taiping show that savings, collection, transportation and disposal is an important element for control of biological and infectious waste. This in because, safety of workers, public and environmental sanitation is an element that should be considered in the management of health care waste. Consider on this research and development needs to be done to increase the use of more environmentally friendly technologies in the health care field.
15
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ Table 1.The Summary of implementation for healthcare waste management practices Authors
A
B
C
Segregation
*
*
*
*
Collection and Storage
*
*
*
*
Treatment
*
*
Transport and Safe Disposal
*
*
*
D
E
*
*
*
*
(A) Ananth et al., (B) Omar et al., (C) Birpinar et al., (D) Hossain et al., (E) Al-Khatib et al. In this study, authors propose that waste management consists of segregation, collection and storage, treatment, transport and safe disposal.
MATERIAL AND METHOD Waste Management Segregation Waste generated in the hospital come from various activities performed in the hospital. Study by Omar et al., (2012), found that the amount of waste produced in hospital is depend on various factors such as number of beds, type of health services provided, the economic, social and cultural status of the patient. Various types of waste generated daily such as clinical waste, radioactive waste, chemical waste, pressurized containers and general waste requiring segregation systematically and thoroughly. According Ananth et al., (2010) the main obstacle in this separation process is the failure to segregate the waste according to the right category. Therefore, hospital staff should be more sensitive while handling healthcare waste to avoid any negligence during the segregation process of healthcare wastes. Any mistakes and negligence in the handling of waste segregation can cause infection and spread of disease. Table 2. Standard Colour Coding for Segregation Process Colour
Wastes Category
Black
General Wastes
Yellow
Clinical wastes for incineration only
Light blue
Wastes for autoclaving or equivalent treatment
Collection and Storage Healthcare waste should be collect and store prior for safe disposal process. Hospital staffs who manage the collection and storage of healthcare waste should be given training and information for 16
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ safety before they are allow to manage healthcare wastes. Based on a survey conducted by Birpinar (2009), in 192 hospitals in Istanbul, Turkey shows that 77% of the hospital use appropriate uniforms and proper equipment when handling waste collection process of healthcare in hospitals.The step was necessary to make sure healthcare waste can be managed safely and systematically. Treatment There are various types of appropriate technology in waste management. Each category of waste require different methods of treatment according to the guidelines given by the Ministry of Health. However, knowledge about waste separation categories is important to know the right method of treatment. Waste treatment technology that involves the infectious waste is often classified into burn and non-burn technologies (Ananth et al., 2010). The majority of the methods of choice around the world is through the method of treatment and disposal (Ananth et al., 2010, Jang et al., 2006). Waste recycling approach can also be applied in the method of treatment that is more environmentally friendly, for example Hospital Lam Wahh EE, Penang, Malaysia take this opportunities generate side income for their hospital. Transport and Safe Disposal Healthcare waste collect must sent to collection sites for safe disposal. Normally, at the end of each shift, the employee will collected and transported the waste to a collection point before safe disposal (Omar et al., 2012). Transportation of waste need appropriate vehicle (DOE, 2009) such as municipal truck (Askarian et al., 2004). The suitable truck need to bring waste to the disposal site safely. In addition, equipment such as trolleys, containers and all related materials, including vehicles that used to transport waste thoroughly clean and disinfect. Organizational Performance Waste management efficiency has been found to be positively related to organizational performance. In this paper, author propose that organizational performance (OP) based on financial and non-financial to achieve organizational (Habidin and Yusof, 2012). Four element of organizational performance is Financial Performance, Customer Performance, Internal Business Process Performance and Innovation and Learning Growth Performance. Table 3. The Summary of measurement for healthcare organizational performance Authors Neil and Rose, (2006) Schmitz and Platts, (2003) Robert Carton, (2004) Khaidir et al. (2013), Khaidir et al. (2014) Laske, (2001)
Measurement of organizational performance Customer Performance, Efficiency Performance, Financial Performance. supplier performance Financial performance, operational performance, and stakeholder performance Financial performance, customer performance, internal business process performance, Innovation and learning growth performance. Customer performance, Internal processes performance, Financial performance, Learning and growth performance.
17
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ Financial Performance According to Shazali et al., (2013), and Ali et al.,(2013), operational efficiency can reduce costs while improving customer satisfaction and outcome. Carton (2004) state that, the financial performance is essential in the process of measuring the effectiveness of an organization. Financial performance was a measure of a company's financial status (Revere, 2007). In addition McPhail et al., (2008) conclude that organization strategy, implementation, and execution are contributing to achieve financial targets.
Customer Performance Customers are the most important asset of a business, (Zumstein, 2007). In healthcare industry, customers are concern with the level of service offered. Hospital administration should organize customer right awareness campaigns, increase efficiency and reduce waiting times and provide a full explanation of medicine and ensure a clean environment in the hospital (Joseph, 2012) and support by McPhail et al., (2008) states that organization must provide quality goods and services for customer service satisfaction. Besides that, observations from the top of the organization on internal business process lead to satisfied customer expectations (Achterbergh et al., 2003). Consider on this, the relationship between customer and hospital staff influence the customer performance. Customers have right to express their dissatisfaction if the service dissatisfactory. Staff must show good behavior, being a good listener and able to give a clear explanation to the satisfaction of the patient. This is essential in providing the best service to customers. Internal Business Process Performance Internal business processes is important in establish the company's operations or the service is applicable to items offer meet the needs of users. Top management play an important role to identify the operational management process that can bring benefits to the organization strategy (Habidin, 2012, Habidin et al., 2012, Habidin et al., 2013). In addition, Kaplan and Norton, (1996) show that internal business processes can be focus in several factors such as brand management, leadership, product quality and customer experience. Internal business process use to achieve shareholder and customer satisfaction through the adoption of innovation in business (McPhail et al., 2008). Innovation and Learning Growth Performance Learning and growth issues focus on ability of employees, quality of information systems and the effects of organisational alignment to achieve organization goals (McPhail et al., 2008). An organization should have the ability to identifying the expectations of customers, through expectations, the organization consider what they must to do and take actions needed to improve the efficiency with innovation for customer satisfaction (Kaplan and Norton, 1996).
Research Hypotheses The waste management practices framework developed in this study proposes that waste management has a direct impact on organization performance. According to theory of quality management, the improvement initiatives have a significant positive correlation with performance 18
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ (Hamid, 2011). Therefore, based on literature review and the research framework, the following hypotheses of the study have been developed: H1: There is a positive and direct significant relationship between waste management implementation and operational performance in Malaysian healthcare industry. Research Methodology In this study, sampling method by using structured questionnaire. The population of this study comprised in Malaysian Healthcare Industry. Questionnaires will distribute to manager in Malaysia Healthcare Industry. To analyze the data, two statistical techniques were adopted. Exploratory factor analysis, reliability analysis and confirmatory factor analysis to test for construct validity, reliability, and measurements loading were performed Structural Equation Modeling (SEM) techniques were utilized to perform the required statistical analysis of the data from the survey. Having analyzed the measurement model, the structural model was then tested and confirmed. The Statistical Package for the Social Sciences (SPSS) version 17 was used to analyze the preliminary data and provide descriptive analyses about thesis sample such as means, standard deviations, and frequencies. SEM using AMOS 6.0 will use to test the measurement model. A Proposed Research Model
*Note: S=Segregation, CS= Collection and Storage, T= Treatment, TSD= Transport and Safe Disposal, WM= Waste Management, OP= Organizational Performance, FP= Financial Performance, CP= Customer Performance, IBPP= Internal Business Process Performance, ILGP= Innovation and Learning Growth Performance
Figure 1 Model of the study
CONCLUSIONS Waste management is closely linked to organizational performance. Previous studies have shown that the importance of waste management in the healthcare industries. Waste management practices that systematically and efficiently able to improve organizational performance, especially in the healthcare industry. Based on proposed model and a previous study, research hypotheses are being 19
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ developed. Next step is to develop a questionnaire to gather information on the study. Hopefully in future research will bring more benefits not only in academics but also in the healthcare industry. Acknowledgement The researchers would like to acknowledge the Ministry of Higher Education (MOHE) for the financial funding of this research thought Exploratory Research Grant Scheme (ERGS), Research Management Centre (RMC), UPSI for Research University Grant (RUG)
REFERENCES [1]. A P Ananth, V Prashanthini, C Visvanathan; Healthcare waste management in asia, Journal of Waste Management, 2010, Volume 30, pp. 154-161. [2]. A Woolridge, A Morrissey, P S Phillips; The development of strategic and tactical tools, using systems analysis, for waste management in large complex organisations: a case study in UK healthcare waste, Journal of Resources Conservation & Recycling, 2005, pp. 115-137. [3]. B Robert Carton; Measuring organization performance: an exploratory study, 2004 [4]. D Komilis, A Fouki, D Papadopoulos; Hazardous medical waste generation rates of different categories of health-care facilities, Journal of Waste Management, 2012, Volume 32, pp. 14341441. [5]. D Omar, SN Nazli, S Karuppan; Clinical waste management in district hospitals of Tumpat, Batu Pahat and Taiping,Journal Social and Behavioral Sciences, 2012, Volume 68, pp. 134-145. [6]. D Zumstein; Customer performance measurement, 2007.Department of Environment (DOE), Ministry Of Natural Resources & Environment;Guidelines on the handling and management of clinical wastes in Malaysia, (2009). [7]. I A Al-Khatib, C Sato; Solid health care waste management status at health care centers in the west bank – palestinian territory, Journal of Waste Management, 2009, Volume 29, pp. 2398-2403. [8]. J Achterbergh, R Beeres, D Vriens; Does the balanced scorecard support organizational viability, 2003, Volume 32, pp. 1387-1404. [9]. J Schmitz, KW Platts; Roles of supplier performance measurement indication from a study in the automotive; Journal of Management Decision, 2003, Volume. 41, pp. 710-720. [10]. L Revere, K Black, and D Love; An empirical investigation into healthcare performance indicators and the implications for developing a balanced scorecard. Mora-Monge CA, Proceedings of the 38th south west decision science institute, DSI, San Diego, 2007, 505-514. [11]. M Askarian, M Vakil, G Kabir; Hospital waste management status in university hospitals of fars provenance, Iran, Environmental Health Research, 2004, 14(4), 295–305. [12]. M E Birpinar, M S Bilgili, T Erdogan; Medical waste management in turkey: a case study of Istanbul, Journal of Waste Management, 2009, Volume. 29, pp. 445-448. [13]. M S Hossain, A Santhanam, N A N Norulaini, A K M Omar; Clinical solid waste management practices and its impact on human health and environment, 2011, Volume 31, pp. 754-766. [14]. N A Khaidir, N F Habidin, N A Shazali, N Ali, and N H Jamaluddin; Investigation of Six Sigma Practices and Process Innovation for Malaysian Healthcare Industry, International Journal of Innovation and Applied Studies, 2014, Volume 5 (2), pp. 131-138. [15]. N A Khaidir, N F Habidin, N Ali, N A Shazali, and N H Jamaluddin; Six Sigma Practices and Organizational Performance in Malaysian Healthcare Industry, IOSR Journal of Business and Management, 2013, Volume 6 (5), pp. 29-37.
20
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ [16]. N A Shazali, N F Habidin, N Ali, N A Khaidir and N H Jamaluddin; Lean Healthcare Practice and Healthcare Performance in Malaysian Healthcare Industry, International Journal Scientific and Research Publications, 2013, Volume 3 (1), pp. 1-5. [17]. N Ali, N F Habidin, N H Jamaluddin, N A Khaidir, and N A Shazali; Customer Relationship Management and Organizational Performance in Malaysian Healthcare Industry, International Journal of Advancements in Research and Technology, 2013, Volume 2 (1), pp. 1-5. [18]. N F Habidin, A F M Zubir, J Conding, N A S L Jaya, and S Hashim; Sustainable Manufacturing Practices, Sustaining Lean Improvement and Sustainable Performance in Malaysian Automotive Industry, World Review of Entrepreneurship, Management and Sustainable Development, 2013, Volume. 9(4), pp. 444-459. [19]. N F Habidin, and S M Yusof, (2012); Relationship between lean six sigma, environmental Management System, and Organizational Performance in Malaysian Automotive Industry, International Journal of Automotive Technology, 2012, Volume 13(7), pp. 1119-1125. [20]. N F Habidin, C M Z C Omar, H Kamis, N A Latip, and N Ibrahim; Comfirmatory Factor Analysis of Lean Healthcare Practices in Malaysian Healthcare Industry, Journal of Contemporary Issues and Thought,2012, Volume 2, pp. 17-29. [21]. N F Habidin; Structural Analysis and Tool of Lean Six Sigma, Strategic Control Systems and Organizational Performance, Engineering Doctorate (Engineering Business Management) Thesis, Razak School and Advance Technology, (Universiti Teknologi Malaysia, 2012) [22]. NA Shazali, NF Habidin, N Ali, NA Khaidir, NH Jamaludin; Healthcare practice and healthcare performance in Malaysian healthcare industry”, Journal of Scientific and Research Publications, 2013, Volume 3. [24].NF Habidin, and SM Yusof; A proposed strategic balanced scorecard model: Strategic control system and organizational performance in malaysian automotive industry, Journal of Business and Management,2012, Volume 1, pp. 39-44. [25]. O Laske; A learning-and-growth metric for strategy-focused organizations, 2001 [26]. OK Joseph; Healthcare delivery and customer satisfaction in Ghana. A case study of the Koforidua Regional Hospital, Institite Of Distance Learning (Kwame Nkrumah University of Science and Technology, 2012) [27]. R A Hamid; Factor influencing the success of lean services implementation: Conceptual Framework, International Conference on Business and Economic Research Proceeding, 2011. [28]. R Kaplan, D Norton; Linking the balanced scorecard to strategy. California Management Review, Volume 39, pp. 53-79 [29]. R McPhail, Carmel Herington, Christopher Guilding; Human resource managers perceptions of the applications and merit of the balanced scorecard in hotels, International Journal of Hospitality Management, 2008, Volume 27, pp. 623-631. [30]. R Mohee; Medical wastes characterization in healthcare institutions in Mauritius, 2005, Volume 25, pp. 575-581. [31]. S Neill, GM Rose; The Effect of Strategic Complexity on Marketing Strategy and Organizational Performance, Journal of Business Research, 2006, Volume 59, pp. 1-10. [32]. S –s Chung, C W H Lo; Evaluating sustainability in waste management: the case of construction and demolition, chemical and clinical wastes in Hong kong, Journal of Resources Conservation & Recycling, 2003, Volume 37, pp. 119-145. [33]. V E Manga, O T Forton, L A Mofor, R Woodard; Health care waste management in Cameroon: a case study from the southwestern region, Journal of Resources, Conservation and Recycling, 2011, Volume 57, pp. 108-116. [34]. World Health Organization, 2008. Healthcare Waste and its Safe Management. http://www.healthcarewaste.org (Accessed 2 January 2014). 21
Mohd Hafiz Roslan et al J. of Appl. Sci. And Research, 2014,2(2):14:22 ______________________________________________________________________________ [35]. Y W Cheng, K –C Li, F C Sung; Medical waste generation in selected clinical facilities in Taiwan, Journal of Waste Management, 2010, pp. 1690-1695. [36]. YC Jang, C Lee, OS Yoon, H Kim; Medical waste management in Korea. Journal of Environment Management, 2006, pp. 107-115.
22
