Medical Negligence in Malaysian Hospitals: A Qualitative Thematic Analysis of Organisational and Governance Failures

Authors

  • Harminder Singh Jaila Singh Lincoln University College, Malaysia
  • Nadia Sohail Assistant Professor at Lincoln University College

DOI:

https://doi.org/10.66857/jirt.v3i2.38

Keywords:

Medical negligence, Malaysia, healthcare governance, patient safety, qualitative research, organisational risk

Abstract

This study adopts a qualitative research design using thematic analysis to examine Malaysian medico-legal court decisions. Traditionally, negligence has been examined through legal constructs such as duty of care, breach, causation, and damage (Hatta et al., 2024). However, contemporary research increasingly recognises that adverse patient outcomes arise from complex interactions within healthcare systems rather than isolated acts of misconduct (Reason, 2021).

The study employs a qualitative research design that involves the use of thematic analysis to investigate the Malaysian medico-legal court decisions to determine underlying organisational and systemic factors that contribute to medical negligence. Data analysis was done through the six-phase thematic approach by Braun and Clarke with a focus on patterns across the selected cases involving misdiagnosis, surgical error, consent issues, and post-treatment complications. This study is based on three medico-legal court cases in Malaysia and utilises Braun and Clarke's thematic analysis framework to explore the organisational and governance-related causal factors identified by these cases in relation to medical negligence.

The results show that there are four common themes: communication breakdown, documentation failure, weak governance structures, and risk factors that exist at the system level. These themes show that latent organisational conditions are the main factor in medical negligence in Malaysian hospitals, which is in line with the systems theory and the Swiss Cheese Model of accident causation.

This study contributes to the literature by offering a contextualized interpretation of medical negligence in the Malaysian healthcare institutions. It also provides practical implications in enhancing risk management structures, governance structures, and patient safety systems. These results are in line with the need to change the blame-based strategies to the system-based accountability in healthcare organizations.

Keywords: Medical negligence; Malaysia; healthcare governance; patient safety; qualitative research; organisational risk

References

[[1] Abd Samah, S. Z., & Say, K. (2022). Challenges and proposals to the Malaysian healthcare system. Journal of Health Management, 24(3), 215–228.

[2] Abosheisha, M., & Omar, I. (2025). Dimensions of medical errors: The three victims and defensive medicine. Journal of Patient Safety and Risk Management, 37(1). https://doi.org/10.1177/09246479251372341

[3] Braun, V. and Clarke, V. (2021) Thematic Analysis a Practical Guide. Sage.

[4] Chen, G. R., Luo, X., Huang, R. R., Xiong, H. Y., Ding, X. M., & Pan, S. H. (2026). The Relationship Between Barriers to Medical Error Disclosure and Patient Safety Culture: A Cross-Sectional Study. Journal of nursing management, 2026(1), e9980576. https://doi.org/10.1155/jonm/9980576

[5] Crocker H, Cromwell DA, Modha S, et al (2026), Patient-reported harm from NHS treatment or care, or the lack of access to care: A cross-sectional survey of general population prevalence, impact and responses BMJ Quality & Safety 2026;35:30-42.

[6] Dahlawi, S., Menezes, R. G., Khan, M. A., Waris, A., Saifullah, & Naseer, M. M. (2021). Medical negligence in healthcare organizations and its impact on patient safety and public health: A bibliometric study. F1000Research, 10, 174. https://doi.org/10.12688/f1000research.37448.1

[7] Hatta, M., Sumiadi, S., & Zulfan, Z. (2024). Settlement of medical negligence cases in Malaysia. In Proceedings of Malikussaleh International Conference on Law, Legal Studies and Social Science (Vol. 4, pp. 112–120).

[8] Jang, S. J., Lee, H., & Son, Y. J. (2021). Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea. International journal of environmental research and public health, 18(9), 4853. https://doi.org/10.3390/ijerph18094853

[9] Jin, X., Smith, R., & Lee, K. (2022). System-level failures in healthcare: A systems theory perspective. Journal of Healthcare Management, 67(2), 89–102.

[10] Kakemam, E., Albelbeisi, A. H., Rouzbahani, M., Gharakhani, M., Zahedi, H., & Taheri, R. (2024). Nurses' perceptions of patient safety competency: A cross-sectional study of relationships with occurrence and reporting of adverse events. PloS one, 19(1), e0297185. https://doi.org/10.1371/journal.pone.0297185

[11] Mensah, E. K. G., & Adzah, I. D. (2026, March 17). Medical negligence and patient safety: A medical-legal and human rights analysis of healthcare systems in Ghana and the United States. SSRN. https://doi.org/10.2139/ssrn.6488418

[12] Mohd Zulkefli, N. A., Yusof, M. M., & Ahmad, R. (2021). Barriers to incident reporting in Malaysian hospitals: A qualitative study. BMJ Open, 11(3), e045678. https://doi.org/10.1136/bmjopen-2020-045678

[13] Reason, J. (2021). Human error: Models and management in healthcare systems. BMJ, 320(7237), 768–770. https://doi.org/10.1136/bmj.320.7237.768

[14] Rodziewicz, T. L., Houseman, B., Vaqar, S., & Hipskind, J. E. (2024). Medical Error Reduction and Prevention. In StatPearls. StatPearls Publishing.

[15] Schulz, J. S. (2025). Resolution After Medical Injuries: Case Studies of Communication-and-Resolution-Programs Demonstrate Their Promise as an Alternative to Clinical Negligence. Laws, 14(4), 55. https://doi.org/10.3390/laws14040055

[16] Slawomirski, L., & Klazinga, N. (2022). The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level. Organisation for Economic Co-operation and Development. https://doi.org/10.1787/761f2da8-en

[17] Webb, C., Dabkowski, E., Missen, K., & Missen, A. (2025). Contributing Factors to Medication Administration Errors Among Novice Registered Nurses: An Integrative Review. Journal of clinical nursing, 34(11), 4499–4519. https://doi.org/10.1111/jocn.17721

[18] World Health Organization. (2023). Patient safety. https://www.who.int/news-room/fact-sheets/detail/patient-safety

[19] Zainal, H., Razali, H. Y., Khan, J., & Islam, M. N. (2020). Medical negligence in Malaysian practice: Legal and ethical perspectives. International Journal of Ethics, Trauma & Victimology, 6(2), 22–25.

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Published

2026-07-11

Issue

Vol. 3 No. 2 (2026): Journal of Innovative Research and Technology

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Articles

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Copyright (c) 2026 Nadia Sohail, Harminder Singh Jaila Singh

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