A ‘Just Culture’ Must Be The Foundation Of Our Health Care System — Dr Musa Mohd Nordin & Prof Azizi Haji Omar

The tragic and untimely death of a colleague at Sultan Ismail Petra Hospital, Kuala Krai, has sent shockwaves through the nation’s health care fraternity.

As we mourn this profound loss, our sorrow must be channeled into a moment of deep and honest introspection for the Ministry of Health (MOH). This tragedy has, once again, torn open the curtain on chronic, systemic failures that no amount of high-level strategy can fix if we ignore the human element at our core.

We are currently inundated with announcements of new MOH tactics and strategies. The ministry, in its “all-of-government” and “all-of-society” approach, has rightly collaborated with the public and private sectors to address the complex challenges of post-modern health care.

The Reset Strategy, announced in March 2025 by the MOH, Ministry of Finance (MOF), and Bank Negara Malaysia (BNM), is a prime example of this outward focus. It is a comprehensive plan designed to tackle rising private health care costs and improve access, complete with a long list of acronyms: the base MHIT plan, DRG payment reform, strengthening EMR, and promoting Rakan KKM.

These external reformations of the private health care space are necessary. However, they risk becoming a distraction, overwhelming the festering internal issues that plague our own public health care system.

While we strategise on insurance premiums and medical inflation, our own house is on fire. The symptoms are undeniable: a high attrition rate of health care workers, severe understaffing (or is it a distribution failure due to the glaring absence of a National Health Human Resources Dashboard?), critically low morale, severe overcrowding, and a public health care service buckling under immense capacity strain.

The death in Kuala Krai is a grim testament to this reality. It is not an isolated incident but a symptom of a system where the well-being of its healers has been deprioritised.

We can talk endlessly about data, financing, and digital transformation, but these efforts are built on a crumbling foundation. A well-designed strategy will inevitably fail if it is not aligned with the cultural values of the organisation that must execute it.

This brings us to the wisdom of the management concept often attributed to Peter Drucker: “Culture eats Strategy for breakfast.”

The MOH urgently needs a cultural reset, not just a strategic one. This means moving beyond task forces and press releases to embrace a “Just Culture” in every hospital, clinic, and department. A Just Culture is not about being soft; it is about being fair and systematic. It is a culture where:

Psychological safety is paramount. Health care workers must feel safe to report errors, near misses, and — critically — bullying and harassment, without fear of retribution.

Systemic issues are investigated, not individual blame assigned. When a system is understaffed and overcrowded, it is a systemic failure, not a personal one, when a worker buckles under the pressure.

Well-being is a strategic objective. Addressing the severe understaffing and low morale is not a “human resources problem”, but the most critical strategic imperative facing the MOH today.

The Reset Strategy and other initiatives to reform the private sector are commendable, but they cannot be the entirety of the MOH’s vision.

They address the economics of health care but ignore the ecosystem that sustains it. The internal MOH issues are not “soft” problems; they are hard, structural threats to the very survival of our public health system.

It is the role of our leaders — both political and civil — to ensure that their work and ethical culture support their strategic objectives. The strategy for a modern, cost-effective health care system is meaningless if we do not have the healthy, supported, and motivated workforce to deliver it.

Let the death in Kuala Krai be the catalyst for a new kind of reform. A reform that places “Just Culture” at the center. A reform that looks inward with the same intensity we look outward.

Because a strategy might win the morning, but a strong, just, and compassionate culture is what will sustain us through the decades to come.

Both authors are paediatricians at Damansara Specialist Hospital.