A SingHealth staff publication
Working Hand In Hand
Teamwork and unity against H1N1
GCEO Excellence Awards 2009 Up close and personal with the nominees
Celebrating ONE year of growth with you
Exclusive birthday deals for staff inside!
Contents • Foreword by Mrs Tan-Huang Shuo Mei • Thumbs Up for Teamwork • Clean hands save lives
Introducing the SingHealth Academy
Check out the new
01-02 me+YOU • • • • • •
SingHealth institutions unite against H1N1 Stars of GCEO Excellence Awards CGH ACTION team helps elderly patients Eye on SERI’s data resources CGH goes paper-less Farewell to Mr Bernard Chen
• • • • • •
Places we hold dear on Outram Campus What our Service Excellence Committee is all about Seeking a career in healthcare CPIP workshops: Where creative ideas are born Economic evaluation of healthcare Open communication with the patient
me+SPOTLIGHT • • • •
Origins of the birthday cake At Home With…A/Prof Lee Shu Yen, SNEC Budget solutions of NHC and KKH Experts advise on how to save money and the earth • Book reviews on medical sociology
Landmark double organ transplant
SingHealth Editorial Team Tan-Huang Shuo Mei Amelia Champion Katheryn Maung Jeanie Cheah Arthur Wong Mediactive Editorial and Design Team Lyon Low Florence Long Sher Maine Wong Mediactive Pte Ltd 65 Ubi Crescent #06-07 Hola Centre Singapore 408559 T: 6846 4168 | F: 6846 4768 firstname.lastname@example.org www.mediactive.com.sg
me+SingHealth or me+SH represents who we are in SingHealth—as intertwining threads conveying synergy and complementing one another to form a beautiful fabric. me+SH links you to the action in all of SingHealth and around the healthcare industry. Do check out me+SH Online (http:// mysinghealth/Singhealth/MeSH) and me+SH Flash in your emailbox too!
me+LIVING • The Lighter Side • Living the Dream
me+SMILES • Medical milestones in history • Upcoming events
Exclusive Birthday Deals 27
Patients. At the Heart of All We Do.
All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographs or illustrations.
he Influenza A (H1N1) situation has brought about changes in the way we operate very swiftly, and at every level. In many ways, it serves as a reminder of our inter-dependence.
I am personally inspired by the strong teamwork at Outram Campus and SingHealth. Our colleagues at Outram, CGH, KKH and the polyclinics have worked tirelessly to shore up our defences, and kept us all from scrambling when Singapore confirmed our H1N1 cases. Just as we continuously refine our game plan to cope with the flu situation, this issue of me+SH has evolved to accommodate the ongoing changes around us. Before the Influenza A episode hit us, my initial message was on me+SH turning ONE, after four quarterly issues and still growing with regular contributions from colleagues across the Group. The engagement from partners outside our department adds variety and vibrance and is a sign that we are, hopefully, getting better at engaging our fellow colleagues. Then came the call to be consciously austere with the economic downturn. You might have noticed that me+SH has gone on a diet: It is much trimmer now (a conscious effort to save natural resources) yet maintains its substance. The editorial team at Group Communications has also managed to solicit advertisers who saw the potential in me+SH and committed to giving us some sponsorship (albeit small) for four issues. This issue of me+SH kicks off a section on Vibrant Campus, which zooms in on specific departments, practices or work groups in our institutions. It gives voice to the newly formed SingHealth Academy, and the Office of Research, which require a regular cluster-wide platform to share their latest newsâ€”both in print and electronicallyâ€”to engage staff cluster-wide. In this issue and upcoming ones, we keep staff updated on the many good practices that are taking place in different SingHealth institutions that can be shared, the infrastructure and facilities development that all staff should feel excited about. We invite you to share our dream to make me+SH the voice of our 15,000-strong SingHealth family. We have responded as one in the H1N1 crisis and the collective wish of Group Communications on the birthday of me+SH is to see us grow as ONE. Stay connected with me+SH.
Mrs Tan-Huang Shuo Mei Director, Group Communications & Service Quality, SingHealth Director, Communications & Service Quality, SGH
Hear Our Staff
Thanks for the good teamwork in combating H1N1.
Prof Tan Ser Kiat, GCEO, SingHealth
Mr T K Udairam, CEO, CGH
Our institutions have done well in responding to the urgency of the situation in curbing the spread of H1N1 in Singapore.
The last month has been busy for all of us as we work hard to put up our defences against the H1N1 virus. I understand that for many, especially your family members, it can be worrying too. It is for this reason, to ensure the safety of patients, visitors and staff, that we have to bear some inconvenience. Thank you for your dedication.
Thank you for your commitment and hard work —once again, you have risen to the call and we are proud of you.
On The Cover
A/Prof Lim Swee Hia, Group Director, Nursing We are very proud of the way all of you have conducted yourselves in the hard work of preparation, screening and coping with patients and their relatives. Your compassion and selfless spirit are most commendable. Stay healthy and vigilant as we tackle the growing challenge ahead of us!
This issue’s cover features the simple yet profound act of hand washing. Profound because the very act itself is not only a life-saving precaution against the H1N1 flu virus but also serves as a reminder to all of us that united we stand, together we can strengthen our defence against the virus.
n our continued fight against the H1N1 virus, the MOH has provided a checklist for us to practise good personal hygiene, be socially responsible and lead a healthy lifestyle to boost our immunity and protect against infection. • Wash your hands regularly and thoroughly with soap and water, especially before touching your eyes, nose or mouth. • Cover your nose and mouth with a tissue when coughing or sneezing. Properly dispose of the tissue in the dustbin after use. • Avoid crowded places if you feel unwell and wear a surgical mask to cover your nose and mouth. • Use a serving spoon when sharing food at meal times. • Eat a balanced diet with plenty of fruit and vegetables. • Be active. Do 30 minutes of physical activity at least five days a week. • Learn to relax. Get enough sleep and rest.
For more tips, go to www.moh.gov.sg
Behind the Scenes
Gearing up for viral war
SingHealth institutions act in unison against the threat of the H1N1 virus.
hat seemed like an exceptionally high number of flu cases in Mexico turned out to be the start of a potential pandemic. In days, the World Health Organization issued a statement that a smattering of H1N1 influenza cases in Mexico constituted a “public health emergency of international concern”. With the experience from SARS etched into our memories, we spared no effort in ensuring the safety of patients, staff and visitors. Our response to the threat was swift and sure. An SGH-Outram Campus Disease Outbreak Taskforce comprising members from SGH and national centres including representation from Duke-NUS was quickly formed on 26 April to assess the situation and put in place necessary infection control measures. The same took place at CGH, KKH and SingHealth Polyclinics.
“The Outram Campus has swiftly become a single united force against a deadly enemy— the human swine flu that has claimed many lives worldwide. We are sparing no effort to stop it from entering Singapore and our doors.” Prof Ang Chong Lye, ACEO (Clinical Services), SingHealth and CEO, SGH All staff across SingHealth institutions were operationally ready for the challenge, armed with
Beyond the frontline, our Group Procurement Office swung into action to ensure that protective supplies such as masks, drugs and vaccines were in stock. SingHealth Group Communications broadcast the latest information through the one-stop SingHealth Desktop Portal, updating staff regularly with management memos, staff bulletins, iMatter working with institutions to communicate to all staff, routine instructions, and hyperlinks to relevant sites. To ensure the seamless flow of communication, a 24-hour command centre to support activities relating to H1N1 was set up by our IT team from Integrated Health Information Systems (IHiS). It was Team SingHealth at work. As DCEO Prof Ivy Ng aptly pointed out: “Our strength against any enemy is our unity in purpose and execution.” The threat remains, especially with the first case confirmed on 27 May 2009, but we stand firm against the virus with teamwork and preparedness.
THUMBS UP EVERYONE
SingHealth staff have responded readily and positively in combating H1N1, and our management reciprocates. Care Packs were assembled for all 15,000 staff with the help of some 280 staff from SingHealth Corporate Office including GCEO Prof Tan Ser Kiat and DCEO Prof Ivy Ng. Items such as health supplements and hand cream to moisturise hands from regular hand washing were included in the packs. At various SingHealth institutions, cooling herbal drinks, fruits and bags of goodies were distributed to fortify staff as they bore with changes made to usual operations, inevitable inconveniences and the discomfort of donning protective gear while working for long hours.
the mindset that preparedness is key to protecting patients, visitors and ourselves.
Academic Renaissance at SingHealth
he Outram Campus has been widely By Jeanie Cheah recognised as the cradle of medical education in Singapore, and it has nurtured many a generation of doctors. Medical education began here a century ago and stayed 81 years until its move to the National University of Singapore’s Kent Ridge campus in 1986. Numerous medical students had resided in the old King Edward VII Hall hostel at Outram, which not too long ago made way for the Duke-NUS Graduate Medical School. With Duke-NUS, medical education once again returned to prominence at Outram. The present formation of the SingHealth Academy is timely in steering this exciting journey in the renaissance of medical education at Outram. The SingHealth Academy builds on our rich educational heritage to advance our goals of creating a thriving medical campus committed to excellent care, lifelong learning and innovation in clinical and translational research.
t has long been a vision of mine to create, within our SingHealth family, an academy of medical education that will not only meet all the diverse needs of the modern healthcare system, but also encourage lifelong learning, thus ensuring the future of SingHealth as a leading healthcare provider and as a healthcare educator both at a regional and global level.”
– Prof Tan Ser Kiat, GCEO, SingHealth In the ever-evolving landscape of the healthcare industry, it is necessary to empower our healthcare professionals with the best training possible. The academy serves as a formal first step towards harnessing the collective strength of our existing healthcare education efforts. This educational collaboration between SingHealth’s healthcare institutions and specialised
me+GROUP education centres galvanises resources, expertise and infrastructure to support the development of educational activities and build up intellectual capital. Through the academy, individual educational institutions can now leverage on one another’s strengths. The result is greater synergy and an overall increase in the talents and resources available for every institution. Best practices from each institution can be gleaned and shared, further strengthening the collective whole.
Learning For Life “Give a man a fish and he eats for a day. Teach a man to fish and he eats for life.” True to this saying, even the best doctor has limited capacity to do good, as he is but one person. By teaching, he increases his reach to patients exponentially. If he passes on his knowledge to just four students, he reaches four times the number of patients he would otherwise see in a week. Through teaching, he also transmits the values that the medical fraternity holds dear.
ur job is to continue to identify, recruit and retain good teachers and empower them to do their magic. The key to high medical ethics and professionalism is not crafting inspiring words but people, good people, leading the profession, setting personal examples, passing on values through daily interaction and osmosis.”
05 workshops and fellowship programmes, it provides ample opportunity for staff to better themselves. More than 3,700 nominated healthcare professionals in Singapore will benefit from the lead SingHealth Academy is taking in the training for the 2009 Excellent Service Award (EXSA). The Academy spearheaded the push to revamp the original programme to make the sessions more meaningful and interactive with role play and discussion built around healthcare scenarios. It is also taking charge of the trainthe-trainers programme for healthcare facilitators.
hat’s so exciting is that all healthcare practitioners will be continually placed on an academic path to cultivate academia and selfimprovement. We look forward to the SingHealth Academy growing the strength of medical education across SingHealth.” – A/Prof Colin Song, Group Director, Education, SingHealth
– Mr Khaw Boon Wan, Minister for Health, at the opening of the 18th SGH Scientific Meeting, 2009.
With Education as a key pillar of the SingHealth group, we are committed to nurturing generations of healthcare professionals who will improve care for patients.
Making Education A Pillar Of Strength The SingHealth Academy forms a network for the education community and creates the necessary infrastructure for education to flourish. Through its comprehensive range of activities which include seminars, conferences, simulation
It has been said that education improves lives; and at the heart of advancing medical education is the mission to serve the patient’s best interest. The addition of the SingHealth Academy ushers in a new era of development in medical excellence at SingHealth and brings us closer to realising our vision of being an academic medical centre.
Academic Institutions and Partnership at SingHealth Provides professional development courses and clinical attachments to allied health professionals.
Dedicated to enhancing skills and promoting excellence in lifelong learning among nurses.
Committed to continuing education and training of medical professionals.
Provides quality training and education on CPR, critical care, medical simulation, trauma and disaster.
Committed to continuing education and training of dental professionals.
SingHealth Alice Lee IAN
(Postgraduate Allied Health Institute)
(Life Support Training Centre)
NDCACORN (Academic Centre for Oral Healthcare at NDCS)
( Institute of Advanced Nursing)
PRIME (Primary care Medical Education) @ SHP
SGHPGMI ( Postgraduate Medical Institute)
Main provider of ophthalmic training opportunities in Singapore and the region.
SHP’s formal training arm that conducts education and training in family medicine.
A Slice Of The SingHealth Academic Pie
Singapore’s first postgraduate teaching hospital and principal training ground for specialists.
KKH Focuses on education and training in fields of neurology, neurosurgery and neuroradiology.
Preferred training centre for cardiovascular medicine in Singapore and the region.
CGH NCCS Training cancer care professionals for Singapore and the region.
Trains healthcare professionals specialising in O&G, neonatology and paediatrics.
Offers healthcare education with emphasis on general medicine, surgical practices and ‘soft skills’ training.
Strategic Partner: Duke-NUS Graduate Medical School •
Offers an innovative and rigorous post-baccalaureate medical education programme with a distinctive focus on research, aimed at building leaders and scholars in medical research, education and patient care. Collaborates with SingHealth institutions in providing hands-on clinical experience for students. SingHealth clinicians contribute actively as members of the teaching faculty and in relevant translational and clinical research.
To learn more about the SingHealth Academy, visit www.singhealthacademy.com.sg
of SingHealth Empowering
What makes any organisation outstanding are its people. The GCEO Excellence Awards — SingHealth’s highest honour for staff excellence — puts the spotlight on outstanding staff who are role models in their respective fields. We have 32 inspiring nominees, who make SingHealth an institution that people remember, trust and talk about with their key contributions in patient care, education and research. me+SH gets up close with three of the nominees. By Sher Maine Wong
the cancer patient A/Prof Koo Wen Hsin, Deputy Director of NCCS Open Category: Clinical Service nominee
hen Koo Wen Hsin was much younger, he decided to become an oncologist not because someone told him to, and certainly not because he thought it would be a lucrative career. Then a part-time doctor at a hospice, where he tended to many dying cancer patients, he simply wanted the cancer patients he was helping to listen to him. Said A/Prof Koo, “At that time I saw many patients who suffered from severe side effects of chemotherapy before dying of incurable cancers. As a result, they could not carry out a lot of things they should be doing for the family, or with the family. I advised them to stop, but they would not dare to as their oncologists persisted. Since I was not an oncologist (then), it was not possible for me to convince them that chemo could potentially do more harm than good in that sort of situation. I decided to enter training to become an oncologist, in the belief that as a qualified oncologist my advice would be more acceptable.” Since then, A/Prof Koo, who joined the Department of Medical Oncology in SGH in 1993, has made his mark as an oncologist who is concerned not just with physiological treatment of disease, but also with the well-being of his patients and even their families. He believes in empowering patients to make informed choices and then supporting them in whatever they choose. A/Prof Koo is currently the Deputy Director of the National Cancer Centre Singapore (NCCS), having previously led the Department of Medical Oncology at NCCS from 2004 to 2009. “I learnt the importance of knowing what kind of patient has a disease, instead of what kind of disease a patient has,” said A/Prof Koo. Prior to this interview, for instance, he had just secured a sponsorship to pay for tuition for 23 children of cancer patients, under a NCCS assistance programme started by its director, Professor Soo Khee Chee. Said A/Prof Koo: “We have many patients with young children in school. These kids don’t do well academically because their parents are either in hospital or have passed on.” He also shared about a miraculous Christmas during which there were initially insufficient funds to buy Christmas presents for the children of cancer patients. And then an artist called him out of the blue to donate funds to the Singapore Cancer Society. “The amount? Almost exactly what we needed! This is a real story, I believe God heard me that day,” said A/Prof Koo, who chairs the society.
GCEO Excellence Awards 2009
GCEO Excellence Awards 2009
Nidu Maran Shanmugam, Advanced Practice Nurse, SGH Open Category: Clinical Service nominee
or someone who had almost stumbled into the nursing profession, nurse clinician Nidu Maran Shanmugam has certainly found the right career. Back in 1996, he decided to take up a nursing diploma at Nanyang Polytechnic because, he said, “I just wanted to try something different and the course was new.” Now, his passion for the profession is clear: Mr Nidu, an advanced practice nurse with SGH’s department of orthopaedic surgery, is an awards magnet because of his relentless drive and commitment to nursing. Mr Nidu has received 10 awards in the last 10 years, including a Singapore Excellence Service Award in 2004, a Public Service Star Service Award in 2006, and a commendation at the Canadian Orthopaedic Nursing Congress in 2007. Dr Png Hong Hock, deputy director of nursing at SGH, said of Mr Nidu: “(He) consistently drives the nursing care of patients in the hospital. He empowers his nurses by increasing their competency levels.” Notably, Mr Nidu managed to cut down the hospital stay of spine patients from five to two days, by training the nurses to teach these patients how to use ambulatory aids. He formed an orthopaedic nurses’ interest group, which meets bi-monthly to improve their skills. He continuously brushes up on his knowledge of nursing by studying: He has undergone nursing programmes in the United States and completed a Masters programme in nursing at the National University of Singapore. Mr Nidu is also an active volunteer. He provides first aid at community events, gives health talks on back care to community clubs and plays an active role in community outreach projects organised by the SGH orthopaedic department. Said Dr Png: “His skill at balancing the needs of the team with his individual responsibilities is outstanding – he manages his time with maximum efficiency.” At the end of the day, however, it all comes back to the patient. Mr Nidu gives out his mobile phone number to the patients he helps. “They can call me anytime. It’s not something I have to do, it’s just something I do out of my own initiative. I see my role as bridging communication between these patients and the surgeons.”
Juliana Lim, Assistant Manager, Outpatient Pharmacy, KKH Professional Category: Administration nominee
ome may say Juliana Lim is just a salesperson peddling products from a pharmacy. She would not be offended. Instead, the unflappable assistant manager of the outpatient pharmacy at KKH would beam brightly and tell them: “No, in my job there are plenty of opportunities for me to make a difference, and they present themselves on a daily basis.” Like the time a woman stormed into the pharmacy and started screaming expletives at the top of her voice, abusing the staff. The staff told Ms Lim that they could not take this. But Ms Lim walked up to the lady, touched her hand and said: “I’m really sorry you are having a bad day.”
The dam broke. The lady, amidst a torrent of tears, told Ms Lim that she was very stressed about her special-needs child, and that no one had treated her so nicely. Since then, Ms Lim has visited her customer at home on festive occasions and the lady makes it a point to keep popping into the pharmacy. Ms Lim leads a team of eight at the pharmacy. She has been working at KKH for 11 years and, in her words, “I’m still loving it!” On a day-to-day basis, Ms Lim said: “A large part of my role involves working alongside my colleagues to deliver the highest standards of customer service excellence. I do this by being a role model for my staff and basically, walking the talk!” Ms Lim, in all seriousness, said: “I don’t think what I do is very special, anyone could do it.” The fact is, not many pharmacy sales staff would give their slippers to a patient whose sandals were broken, or escort a customer with a sprained back looking for over-the-counter remedies to a medical clinic. Ms Lim had even gotten a wheelchair for the customer. Said Ms Lim: “I look forward to coming to work every day, I really enjoy the challenge.”
Celebrate with our nominees at the Pulse of SingHealth on 21 July 2009. Read more about them on the SingHealth Desktop Portal! http://mysinghealth/Singhealth/pulse_of_singhealth_2009/GCEOExcellenceAward2009/
GCEO Excellence Awards 2009
Formed in April 2008, the ACTION Team at CGH ensures a smooth transition from hospital to community for their elderly patients. Arthur Wong explores the team’s role as educator and planner.
n 2008, two weeks before Christmas, Hannah Tan, Care Coordinator at CGH’s Aged Care Transition (ACTION) Team and nurse by training, received an alert about a patient. Roger Tan* had been admitted and put on the Dangerously Ill List (DIL). His leg was undergoing necrosis – swelling and infested with maggots – and he had to be cleaned because he had soiled himself. Since his first admission in 2003, Roger has been in and out of the hospital due to his deteriorating condition. The 71-year-old lives with his 54-year-old, intellectually challenged wife, Mary*, in a rented oneroom HDB flat. The former airport clerk retired more than ten years ago, and now he and his wife survive on a monthly CPF payout of $297. Mary has the mental capacity of a five-year-old, and requires constant attention from Roger; but with his failing health, it has been increasingly difficult for him to be her guardian. With the patient in such dire straits, Hannah and the ACTION Team did the only thing they could. They intervened. A collaborative project between CGH and the Agency of Integrated Care (AIC) under the directive of the Ministry of Health (MOH), the goals of the ACTION Team are to improve elderly patients’ wellness and quality of life after discharge, reducing hospital re-admissions and admissions to nursing homes. The hard work and commitment of the ACTION Team have earned their poster presentation a Special Mention Award at the recent 2009 National Institute of Case Management and American Case Management Association Conference held in Boston, Massachusetts, USA, from 18-22 April. Zahara Mahmood, Head of the ACTION Team and Medical Social Worker by training, explains that their objectives are achieved through the work of care coordinators and their roles as educators and discharge planners: “Care coordinators have strong clinical skills and understand the healthcare system so that they are able to manage their patients’ complexities. They also work in partnership with the patients and their families on a range of services available in the community.” When high-risk patients like Roger are admitted to CGH, the ACTION Team assesses their needs
The CGH ACTION Team. Front row: (right to left) Dr Goh Soon Noi; Zahara Mahmood, Head of ACTION Team & Senior Medical Social Worker; Yick Lai Cheng, Admin Assistant. Second row: (right to left) Angela Tan, Senior Care Coordinator; Rosidah Adnan, Care Coordinator; Shirlyn Su, Care Coordinator; Chan Man Ee, Care Coordinator; Tan Kog Kng, Senior Care Coordinator; Qi Fenglin, Care Coordinator; Hannah Tan, Care Coordinator.
and develops a discharge plan which may include services such as home care, interim care, respite care or community care management. Along with the help of community partners, the ACTION Team has been keeping a careful watch on their patients through telephone calls, home visits, or by giving support to caregivers and families. It is not uncommon to see the ACTION Team care coordinators helping to clean out the house of a patient who lives alone in a cluttered flat, packing medication into manageable portions, or even fetching the patient to the hospital for a follow-up consultation. Moreover, it is not just the complex problems that they help out with. Whipping out a large black marker, Hannah recalls an instance where she had to draw pictures of the sun and moon on plastic bags so that the patient understood when to take the medicine. “When a patient is suffering from cataract, he can’t read the small words on the normal packaging,” she elaborates. Sometimes all it takes is a simple solution; but it is the dedication and attention paid to patients that allow CGH to take geriatric transition care to a higher level. The lives of 997 patients and their family members have been changed because of the ACTION Team’s work. Among them are Roger and his wife Mary, who now enjoy a better quality of living through proper care from community and social support services. * Patients’ names have been changed to protect their identity.
Happy Birthday to me+SH. For a one year-old kid, you are very sophisticated for your age.
See Them In Action
The ACTION Team at CGH comprises six nurse clinicians and two medical social workers, aimed at helping patients make an important transition from hospital to home or in the community. me+SH takes a closer look at how they streamline and coordinate care services to optimise their patients’ outcomes.
Therma Cheung, Senior Principal Occupational Therapist, SGH
“High-risk” Inpatients Admission
ACTION Care Coordinators • Screening “high-risk” patients according to eligibility criteria • Assessment of patient’s and caregiver’s needs • Goal setting with patient and/or caregiver
Follow-up By Care Coordinators Within One Month After Discharge • Supplement care plan using Dr Eric Coleman’s “Four Pillars of Care” (Medication Management/ Reconciliation, “Red Flags”, Follow-up appointments & Patient Health Record) • Ensure that patients have necessary support services. For example: day rehabilitation services, home medical & home nursing services and social support services • Monitor patient through phone reviews and homevisitations • Optimise a patient’s self-care at home • Hand over to community partners for further monitoring
Inside the Home of A Patient
Some patients live in physical environments which are detrimental to their health conditions. The ACTION Team care coordinators have had, on many occasions, gone into patients’ homes to clear out the clutter and create a healthy living space. The photographs give an insight to what some of the patients’ homes looked like before they were cleaned up.
Bed outside the flat
Growing as ONE
The recruitment team at SEED
The Singapore Eye Research Institute (SERI) is the leading contributor of ophthalmology publications in the world, with 162 papers published from 2002 to 2008. But where do they get all the research material? Arthur Wong goes behind the scenes at the Singapore Epidemiology of Eye Disease (SEED) Centre, SERI’s population study arm, to find out.
eople tend not to talk to strangers and with the number of “magic rock” and kidnapping scams going around, it is no wonder Aidah Idris and her team face an uphill task in getting people to talk to them. It is not because they are rude or unfriendly. “Sometimes people just don’t trust you. We get stereo-typed as salesmen or cheats because it’s hard to believe that someone from the national eye centre would offer a free $300 eye check,” says Aidah. No stranger to slamming doors or raised eyebrows, Aidah joined SEED as a Recruitment Manager in 2004, and is now its Programme Manager. She tells me+SH about the significance of what her team of recruiters does.
SEED, part of SERI—the Singapore National Eye Centre’s (SNEC) research arm, plays the role of collecting and interpreting population study data for research work. It begins with the recruitment of volunteers. “This is the most crucial part of the research —even before the clinical examination—and it’s very important that you get a good team to represent the institution because it takes a certain kind of personality to go out and educate the public about the studies,” says Aidah. It all boils down to communication. SEED recently concluded the Singapore Malay Eye Study (SiMES) where more than 6,000 letters were sent out to selected Malay adults aged 40-80 years. Participation in a free eye check was sought as part of the epidemiology study. As Aidah reveals: “When they receive the letter, they usually see the offer for a free eye check and throw it away because they think it’s too good to be true.” That means the team of recruiters had to knock on more than 6,000 doors to convince people to make an appointment at SNEC.
in Malays in Singapore. There have been 45 journals published so far. The team is now working on the Singapore Indian Chinese Cohort Study (SICC), which will complete the trilogy of large-scale populationbased eye studies in the three main ethnic groups in Asia by 2011. Now, who would have thought it all began with a knock on the door?
Aidah and her team also enlisted the help of the local community services like Yayasan Mendaki and Majlis Ugama Islam Singapore (MUIS) to help spread the word and give credibility to the letters received in the mail. Road shows were held at void decks and mosques to further educate the public about the purpose of the study. SiMES had 3,280 participants – an impressive 78.8% response rate, all thanks to the perseverance of SEED recruiters. However the study does not end with the making of an appointment. After the recruitment phase, Aidah then turns her attention to the clinics, and works closely with the SERI clinic team when participants go for their examinations. “We have to treat them very well. They’re volunteers and can walk out anytime.” To ensure the comfort of all participants, the eye examination team members are not only trained to administer the series of tests, but also to handle situations of anxiety and fear. SEED’s clinical team saw 3,280 appointments, each lasting four hours. The enormous amount of information collected is passed on to the data management team for sorting and entering, and then to the data analysis team where research fellows and statisticians generate findings from the collated data. Recruiters, clinicians, data managers, research fellows and statisticians—each group has an integral role in the study but more is achieved as a collective. Said Aidah: “The study forces you to put yourself in the shoes of the people, and you have different teams coming together to achieve the objective. When you’re united, you can move mountains.” Teamwork enabled the team to provide the required population-based data on the prevalence of and risk factors for age-related eye diseases
Numbers Game An epidemiology study without numbers is like a birthday without presents. Here’s a numerological look at the SiMES. Length of study:
Number of people originally sampled:
(2004 - 2006)
Number of invitations sent out:
Number of participants for study:
Value of each eye examination:
Number of staff deployed:
Each 4-hour long exam is valued at
more than $300,
but is provided free to participants Number of journals published from SiMES:
(10 recruiters, 10 eye care professionals, 8 data managers, and 8 statistical analysts)
Amount of hard drive space used to store information:
Growing as ONE
I wish for me+SH to continue to glow and get glossier within and across SingHealth Instituions. More stories, more updates!! Best wishes for another fruitful year. Hoon Siew Jong, Senior Nurse Manager, Delivery Suite, KKH
I wish me+SH every success in its continual commitment to weave together the tapestry of lives @ SingHealth. May the threads of each issue further connect the heartstrings and minds of our people, and remind us constantly that we are one big family serving a singular mission – patients. Prof Lim Kah Leong, Senior Research Scientist and Head, Neurodegeneration Research Laboratory, NNI
Paper-less: Ironing Out The Creases
Despite initial hiccups, staff at Changi General Hospital have successfully made the first step towards a paper-less system. By Sher Maine Wong
Doctor and nurse with Bedside Mobile Workstation.
efore: When sending an order for a patient’s laboratory or blood tests, doctors and nurses would have to ensure that the handwritten forms are correctly despatched and understood. After sending in the order forms, nurses would then have to document them. After: Orders are now done by doctors, and no paperwork is required as all orders for the patients can be viewed through the computer. The new system is efficient, accurate and errors are minimised. The Computerised Physician’s Order Entry (CPOE) project at Changi General Hospital, which is part of SingHealth’s MICO (Mission to Improve Clinical Outcomes), started at the end of last year - and most of the staff have cottoned on to working with a paperless system, despite some initial hiccups. Said A/Prof Goh Siang Hiong, leader of CGH EMR Team and Senior Consultant of A&E Department: “The transition was not as smooth as we would like. It was not just the computer system. The whole process of collecting specimens, billing for tests and processing the orders for X-rays for inpatients, outpatients and ED patients had to be mapped out and thought through, and workarounds thought up, tested and verified.” “This was a very challenging process. I had to plan, learn how to implement the system hospital-wide, work with the medical champions and IT technical support teams,” said Elaine Ng, Assistant Director of Nursing.
It also took time for everyone to get used to a brand new way of doing things. “Initially, there was some resistance because of fear of the unknown. Some of the nurses were not used to the IT system and were afraid that it would delay their work processes,” Elaine added. However, help was forthcoming. The IT CPOE team set up test modules so the staff could practise and go through test-case scenarios before hitting the ground. The IT team was also on hand to help the staff 24 hours a day. The roll-out is also being done slowly. Said A/Prof Goh: “It was better to try out the implementation in one ward, then a floor, then roll out floor by floor to the entire hospital. Each ward learnt from the ward preceding it and then implemented the changes, by going slow and with daily debriefi. We were ready to stop and roll back at anytime if the system showed signs of being unable to cope.” However, the system is taking root. Said Senior Nurse Manager Ong Siew Yit: “As I go round training the nurses and helping them to trouble-shoot, we developed confidence in the system. End-users are very supportive and they adopted the system very quickly. Gradually, we can see the fruits of our labour as things are getting better each day. We have a great team that is committed and dedicated with a neversay-die attitude.” The staff are also beginning to see how the new system would allow them to spend more time on patients rather than administration. Said Senior Nurse Clinician Tan-Ho Yih Jeu: “Advantages include legible handwriting and orders. Nurses do not need to write the tests required by doctors on the manual forms, that is, the Laboratory forms. Thus, they have more time for patient’s care. It reduces the possible risk of errors made while manually transcribing the investigation orders to the forms.” Next stop for the CPOE project: KKH.
ADN Elaine Ng
A/Prof Goh Siang Hiong
Words cannot express how much we appreciate and value your leadership and guidance. We have gained much from working with you. Despite your busy schedule, you never fail to make time for anyone, regardless of rank or role; to listen and talk, to show concern and empathy….
hese sentiments shared by Ms Salbiah Dawood, Executive Secretary at SingHealth Executive Office, are echoed by many other colleagues. Assuming chairmanship at SingHealth during the outbreak of SARS in 2003, Mr Bernard Chen won over colleagues at SingHealth with his unflagging support and genuine concern. It is in a crisis that we see the true mettle of a man, and the gentle and affable Mr Chen proved to be a tower of strength in those trying times. He ensured that the Board was fully behind the
team in the battle they had to wage, and his encouragement did much to rally them together. Under his leadership, the Board and SingHealth Management forged an excellent working relationship with the Ministry of Health. This made possible the fruition of many major projects in benefiting patients and healthcare. Some examples are the Singapore Cord Blood Bank and IT projects, particularly the Electronic Medical Record system. His endorsement and direction have helped us achieve much and receive affirmation through numerous awards. A leader of integrity, Mr Chen has earned the respect of his peers in the healthcare industry. “To me, he is a perfect gentleman, a great leader, and most important of all, a true and trusted friend I can rely on,” GCEO Prof Tan Ser Kiat shares warmly. Mr Bernard Chen will be much missed at SingHealth, and we wish him the very best in his future endeavours.
Mr Bernard Chen, Chairman, SingHealth, April 2003 to April 2009 SingHealth Welcomes Mr Peter Seah “Building on the good work of Bernard and the Board, I will work closely with SingHealth’s Management in strengthening the Group to address Singaporeans’ healthcare needs and challenges. The Board will focus on good corporate and clinical governance, so that SingHealth can continue to deliver quality and costeffective care. As a Group, SingHealth must also harness and grow its talent pool, for its own needs and that of Singapore. It is now timely to review how SingHealth can further advance itself to realise the potential of its excellent tertiary care institutions like SGH and KKH as well as national specialty centres, through organising resources in patient care delivery, continuous education, and innovation in clinical research.” ~ Mr Peter Seah.
Appointed Chairman of the Board of SingHealth with effect from 15 April 2009, Mr Peter Seah plays a pivotal role in charting the broad directions for the SingHealth group as we advance in our goal of becoming a trusted healthcare leader in Singapore and the region. Mr Seah has vast experience in corporate governance and financial services as the concurrent Chairman of ST Engineering and SembCorp Industries, and the former CEO of OUB Pte Ltd. He also holds an advisory position at Temasek Holdings and serves on numerous boards including the Government of Singapore Investment Corporation, Bank of China, CapitaLand and Chartered Semiconductor Manufacturing.
M r M i st r i
NHC's current building is a former paediatric ward built with his generous donation.
Oh to be one!
r a e d ld o h Places we am Campus r t u O
Our birthday special looks at what me+SH is all about - our people, their pursuits, and the places close to our hearts. Thank you for letting us grow wih you. Here'â€™s to more beautiful pages to come.. art Patients undergoing state-of-theg. treatment are given good readin
SGH Life C entre Empowering patients to pursue a healthy lifestyle.
ygen Hyperbaricboexr cham
Houseman's Corner It won't be the same without the laughter and buzz .
Houseman Uncle He doesn't do Tarik. We asked.
ning Eye screEeC at SN unity. Giving back to the comm
Mr Lyakkathaly (A has been doing li for short) Outram Campus fobusiness in r 49 years!
Tunnels Outram Campus
nnected The entire campus is cone ork. through an underground tw
Annual Report Wall Our latest annual report making heads turn with what really matters.
View more photos on me+SHOnline (http://mysinghealth/ singhealth/mesh)! Do you have your own place that you hold dear? Take part in the me+SH contest this issue and stand to win a Golden Village Movie Pass! Turn to page 37 of the magazine for more details!
ow does one see through a patient’s eyes? By taking the journey a patient does as he navigates his way through the processes and procedures of SingHealth institutions, especially those on Outram Campus, which patients see as one entity. It was this that motivated the SingHealth Group Service Quality to organise its retreat on 30 March 2009. Staff from various departments with frontline responsibilities in each SingHealth institution were invited to share their collective wisdom and insight.
ourney JExcellence Of
It culminated in the establishment of the Service Excellence Committee (SEC) whose responsibilities include collaboration on service excellence initiatives that will strengthen SingHealth’s 5Cs quality behaviour standards. Said Tan-Huang Shuo Mei, Director, Group Communications & Service Quality and the Committee Advisor, “These initiatives are aimed at harmonising internal communication and service quality processes, and identifying opportunities to enhance the service environment so that staff can better improve patient experiences.”
Service Excellence Committee
Shaping a service mindset and catalysing a vibrant quality culture consistent with the philosophy of “Patients. At the Heart of all We Do.” are commitments upheld by all SingHealth institutions.
Isabel Yong (Chairperson)
Deputy Director, Group Service Quality Deputy Director, Service Quality
Chang Sook Mei
Assistant Director, Corporate Affairs
Director, Specialty and Ambulatory Services
Deputy Director, Quality Service Management
Manager, Clinical Affairs
Assistant Director, Operations
Hong Wee Tin
Manager, Operations & Quality Management Department
Senior Manager, SingHealth Polyclinics
Director, Quality Service
Babara Maria Seet
Manager, Group Service Quality
Executive, Group Service Quality
Service With A
Dr Lim See Lim, Senior Consultant, Cardiothoracic Surgery
I was afraid about my procedure but Dr Lim came to me with a big broad smile, putting me at ease. He was forthright, honest and took the time to explain in detail my medical condition and the surgery’s benefits...” – Mr John Thomas, in an email, July 2008.
n 27 March 2009, three staff received the National Heart Centre’s (NHC) Service Quality Gold award – the centre’s most prestigious service award given annually to doctors, nurses or staff. Congratulations to the awardees! We share some of their accolades.
Sister Rosalind Sim,
Mr Chua Eng Ann,
Senior Nurse Manager
Patient Services Officer
An exemplary administrator and outstanding leader. Her staff showed excellent nursing care and responded promptly to our needs.”
My mother was warded twice at NHC… Mr Chua, from Ward 44, made it a point to introduce himself and offer assistance and services that made life a breeze for the patient and family…”
– Ms Dolly Lee, on a service quality award nomination form, February 2008.
– Ms Jacqueline Tan, on a service quality award nomination form, May 2008.
When healthcare institutions click and work together like matching pieces of a jigsaw puzzle, miracles can happen... and it did, when SGH and NHC teamed up for Asia’s first-ever heart and liver transplant.
By Sher Maine Wong
The multi-disciplinary team behind the historic operation
“As we celebrate the satisfaction of achieving a landmark clinical milestone, this doubleorgan transplant anchors our belief that when we go beyond institutional boundaries and work seamlessly, we can cocreate clinical outcomes that will radically transform the lives of our patients, and achieve professional satisfaction too.” GCEO Prof Tan Ser Kiat
During the transplant, co-ordinating between the heart and liver transplant teams for both donor and recipient proved to be a major challange. Timing the recovery and transportation of the individual organs was crucial in ensuring their viability. In the 12-hour operation, the NHC team, led by Dr C. Sivathasan, Dr Lim Chong Hee and Dr Lim Yeong Phang, first completed the heart transplant in three and a half hours. Then the SGH liver transplant team, led by Dr Tan Yu Meng, Dr Cheow Peng Chung and Dr Alexander Chung, completed the liver transplant in five hours. The anaesthesiology team was led by A/Prof Hwang Nian Chih and Dr Lai Fook Onn. In all, from both medical institutions, a team of 30 to 40 surgeons, physicians, anaesthetists, nurses, other allied healthcare workers including medical social workers, transplant coordinators, pharmacists and rehabilitation therapists were involved.
At the point when this magazine is going to print, the teams are glad to report that Mr Lau is recovering well from the double-organ transplant.
Landmark Double Transplant in Asia
f Mr Lau Chin Kwee had only needed a new heart or a new liver, the transplant operation—though complex—would have been conducted without fuss. As it turned out, Mr Lau required both organs and the two clinical teams involved—the SGH Liver Transplant Service led by A/Prof Tan Chee Kiat and the NHC Heart Transplant Team—leapt to the rescue in a concerted bid to save his life. Mr Lau had a rare genetic condition known as Familial Amyloid Polyneuropathy, whereby his liver produced abnormal proteins which affected the nerves and could impair the other organs in his body. It was found that his heart had been damaged by the abnormal proteins deposits in the heart tissues, a condition known as infiltrative cardiomyopathy (amyloidosis), hence the need for a double-transplant. SGH and NHC’s successful efforts in mid-April resulted in Asia’s first ever heart and liver transplant. The co-ordination was tremendous: Before the surgery, the teams from the two institutions held meetings to discuss potential problems, technical challenges and the detailed steps of the operating procedures so that the heart transplant, followed by the liver transplant, would take place smoothly.
in seeking healthcare professionals Despite the economic downturn, the healthcare sector remains robust. SingHealth is working to attract more healthcare professionals into the ranks and clarify misconceptions about these professions. By Sher Maine Wong
ada bte Ahmad Khalid, 19, former Meridien Junior College student, is exactly the kind of candidate the joint committee chaired by SingHealth hopes to reach out to. Now studying physiotherapy at Nanyang Polytechnic, Nada knew early on what the course entailed after attending a sports injury management workshop as a 15-year-old school athlete. A career talk she attended last year on available scholarships by staff from SingHealth and the Health Ministry cemented her decision. “Even without the scholarship I still would have gone into physiotherapy because I knew how useful it was to learn skills like how to prevent and recover from sports,” she said. The national joint publicity committee, led by SingHealth and
comprising MOH, NHG and Alexandra Health, is working to spread the word on what a career in healthcare is really like. To reach more youths, this year’s campaign includes a “new media” component. Through a dedicated website, audiences can live a day in the life of allied health professionals and nurses by accessing video clips and blogs. “It was a challenge harnessing the evolving new media platform, but we gained a lot from the experience. New media channels we communicated our message through—blogging, seeding and web advertising—allow for greater creativity and interactivity. These tools have a longer life span than conventional advertising,” said Janice Ong, Assistant Manager, SingHealth Group Communications, and a key member of the committee.
The website features real healthcare professionals, which means staff doubled up as models and actors. Said Muhd Illyaas, Diagnostic Radiographer, SGH: “I hadn’t realised how challenging it was to memorise lines. Each time I forgot my lines, I had to do a re-take, but it was good fun. We started at 7am and it took half a day to complete filming on seven professions.” The committee went beyond the usual print advertisements and career talks to bring across the message of “Everyday People, Extraordinary Lives”. Two commissioned television interstitials gave our healthcare professionals the chance to communicate what motivates them in their jobs and a shot at stardom. The clips were aired on MediaCorp Channels 5 and 8 in March this year.
Joyce Lim, Advanced Practice Nurse Intern and Diabetes Nurse Educator, KKH, who was three months pregnant at the time of filming, talked about her participation.
With Singapore’s ageing population placing more demands on the healthcare service, Health Minister Khaw Boon Wan announced last year that an additional 4,500 doctors, nurses, pharmacists and allied health
professionals would be recruited over the next two years, with the number rising to 6,200 by 2012. To attract more ‘A’ level students and mid-career candidates into healthcare, at least 250 local and overseas scholarships for various allied health disciplines will be offered for fresh ‘A’ level students. SingHealth has also been actively conducting career talks and working with the Workforce Development Agency to help people interested in a mid-career switch gain places for professional retraining. The committee is focused on changing the image of nursing as a career and raising the profile of allied health professionals including physiotherapists, medical social workers, radiographers, speech therapists, dietitians and podiatrists. Said Nell Van Den Ende, Manager, Planning and Healthcare Professional
Highlights of the joint committee’s work: •
Produced a newspaper supplement in TODAY in February 2009 featuring 10 healthcare professionals titled “Healthcare: A hot list of cool careers” in collaboration with MediaCorp Press
Ran a series of television advertisements on MediaCorp Channels 5 and 8 in March this year
Launched http://www.healthcareers.sg, an interactive website featuring healthcare careers and a very interesting nurses’ blog
Depicted healthcare professions through a wallpaper design contest
Started Facebook Allied Health group for anyone who wants to chat and find out more about the professions
Groups, SingHealth, and a joint committee member: “The committee’s work has allowed us to develop partnerships with tertiary institutions to increase the understanding of the wide variety of healthcare careers and challenge some of the misconceptions about working in the field.” The efforts have been well received. Tan-Huang Shuo Mei, Director of Group Communications & Service Quality, SingHealth, and Chair of the Joint Committee, commented on the impact of collaborating and pulling resources together, “Working with other healthcare clusters has led to cross-sharing. There is a wealth of talent to tap on and staff can easily serve as influential ambassadors for their own professions. The challenge lies in attracting people who truly believe in caring for the sick, relieving pain and saving lives.”
“I really enjoy my work and I think it’s a good campaign to profile the nursing and allied health careers. It’s hard work, but I believe that if you have the passion to do the best for your patients, every day is not a working day. We work hard and play hard!”
Clinical Outcomes To ensure that patients get the best care possible, clinical leaders and managers through CPIP are putting their heads together to see how they can improve on healthcare services.
By Sher Maine Wong
f we just take a step back from the hustle and bustle of the daily grind, and ask ourselves – Is there anything in my sphere of work I can improve on? – there would be many answers. Particularly in healthcare, for clinical leaders and managers who work with patients; sometimes, there is a gap between best practice and reality. Fortunately, there is a platform where clinical leaders and managers can ask these questions and work on the answers: the Clinical Practice Improvement Programme (CPIP). A training programme focused on quality improvement methodology and its application to enhance patient care; it has a major project component which requires participants to identify an “issue” in their work area and find its root causes. CPIP takes participants on a journey to investigate the issue and find ways to resolve it. It guides participants in achieving their goals methodically, through small scale testing for the interventions developed. Examples of clinical outcomes derived through the course of CPIP projects include: 1 SHP: Ensuring that all patients in SHPBedok with abnormal laboratory results have an action plan documented in the casenotes and those requiring recall, be contacted within 4 working days from the point of triage. This reduces the risk of patient harm as a result of delayed follow-up care. 2 KKH: Optimising the care of children with head injury by eliminating skull X-rays which were inferred from studies as unnecessary.
3 SGH: Increasing same day admissions for elective surgery at SGH Urology Centre from 16% to 70% in 6 months. Implementing same day admissions at operating theatres is a cost-saving initiative beneficial to both patients and the organisation.
“As the largest healthcare group committed to providing trusted leadership in medicine, we must always give top priority to ensuring the best clinical outcome for our patients.” ~ GCEO Prof Tan Ser Kiat Q – Quality Matters, a SingHealth publication (2007) The issues are varied, but the key lesson in CPIP is one of quality. Quality is not a message that is merely dished out to participants, but it is very much a part of the delivery of CPIP itself. It is no wonder that each batch of participants graduate with positive feedback. “Initially I thought CPIP would be just another typical course where I sit, listen and absorb, and then continue with life at work. But I was wrong. The project really really enhanced my understanding of what I learnt in the course and tested my application of the tools.” “All the topics are relevant and make me understand improvement, safety, evidencebased medicine and QI.”
What: Where: The Team: Findings:
A closer look at two CPIP projects… Improving the functional status of patients with low back pain CGH Ye Liuzhen (Leader), Choi Yik Ming, Goh Ming Rong, Tan Hai Yang The project team found that in some cases, the condition of patients with low back pain was not improving as quickly as desired. They found, through interviews, that the problem was due to several factors, including inaccurate diagnostic assessment of patients leading to ineffective management, and insufficient patient education.
Their recommendations included increasing the consultation time for staff working in the physiotherapy outpatient spine clinic and allocating time for seniors to do clinical teaching. With the interventions, patients’ functional outcomes have improved.
What: Where: The Team:
Use of mechanical anti-DVT device in the neurosurgical patients SGH Dr Darren Koh (Leader), Chia Lay Kiang, Ng Hui Jun , John Thomas, Wee Choo Neo The mechanical anti-DVT device can help to prevent deep-vein thrombosis (DVT) in neurosurgery patients – a condition where a blood clot forms in the vein. Neurosurgery is associated with risks for DVT and DVT can be fatal.
As many as 364 cases of DVT were seen in neurosurgical patients in 2006.
The project team found out that the device was not always used due to various reasons such as insufficient devices, time constraints to set up the equipment or the absence of protocol to guide the staff on the right way to use the device.
To encourage the use of the machine for all neurosurgeries, the project team suggested stationing a machine in the neurosurgical operating theatre, training the health attendants to prepare the machine and drafting a protocol. These measures were put in place in 2007, and have led to the usage of the antiDVT device in almost all neurosurgical cases in the operating theatre.
Anti-DVT machine (with tubings and cuffs)
Growing as ONE
Happy Birthday me+SH! It has been a joy to watch you grow and you have definitely shown yourself to be an important part of the SHS family news. You help us appreciate the person behind the job. Dr Celia Tan, Deputy Director, Allied Health Division, SGH
The Magazine has developed to be more personable, and is a great communicative tool. I’m so happy that I was on the cover of the first issue, I do wonder how the rest of the group (in the picture) are doing now. Rachel Woon, Hospital Play Therapist, KKH
Dr Darren Koh applying a cuff to a patient
Whither Economics In Healthcare? Good healthcare practice, management and policy are anchored on the drive towards clinical excellence and quality patient care. While these are noble aims, no society has the means to provide all the medical care that people desire. And so, policy-makers, administrators and clinicians are confronted with having to make decisions—a tough call at times. This is why economic analysis is increasingly being integrated in healthcare decision-making processes around the world. In Australia and Canada, guidelines have been proposed for the pharmaceutical industry on the preparation of economic analyses to be included in submissions to the government committee deciding on the reimbursement of pharmaceuticals. A new drug has to demonstrate that it gives good value for money before it is listed in the national or provincial formularies. Economics @ Work How then does economics contribute to decisions in healthcare? Here is a hypothetical illustration: A new drug called Easybreathe has just been approved by the FDA (the Food and Drug Administration). Two months later, EasyBreathe is granted approval by Singapore’s Health Promotion Board for commercial sale in Singapore. This steroidal drug is touted to help prevent asthmatic attacks. Pop a chewy tablet once a day and voila, no more inhalers needed. Will doctors then recommend EasyBreathe to their patients? Naturally, doctors will be concerned with questions such as: What are the side effects? Is it effective? How does it compare with the Ventolin inhaler? Does EasyBreathe prolong life, or the health of a patient? Is it addictive? Which patients is it effective for? Is it dangerous for pregnant women, or patients with high blood pressure? Are there long-term implications of taking EasyBreathe? What have the clinical
101 By Rachel Tan, Policy Analyst, Policy & Research.
trials on this drug shown? What is the appropriate dosage to prescribe? Economic analyses add a resource dimension to the list of considerations. How does EasyBreathe compare with the other available drugs and devices in terms of cost and benefits to health? Will patients require fewer follow-up consultations with doctors if they switch to EasyBreathe? Is it worthwhile for a patient to spend $500 a month more for EasyBreathe than for him to continue with his existing inhaler? If the Government were to spend $1 million to subsidise EasyBreathe, are we satisfied that the Government should channel the money to Easybreathe rather than some other way?
In a nutshell, economic evaluations are an exercise in weighing the value of an intervention, comparing it with the next best alternative use of resources. The concept of opportunity costs is central in economics. Each time we choose to use resources to meet one need, we give up the opportunity to use the resources to meet some other need.
More formally, an economic evaluation is a comparative analysis of alternative courses of action in terms of both their costs and consequences. It is a valuation in allocative efficiency, without political and other considerations. Akin to a firm’s production process, healthcare interventions are “inputs” and the outcomes of the interventions are the “outputs”. An efficient allocation of resources is achieved when the value of what is being produced by using available resources in one particular way is greater than the value of what is being produced by alternative uses of the same resources. With controlled clinical trials, the scientific aspects of medical interventions, such as a drug or a procedure, tend to be fairly well researched. These studies are widely published; data on clinical outcomes and treatment efficacies are readily available. There are also well-established treatment pathways and protocols for many diseases and conditions. The economic dimension, is however, often very local. While
a basis for decision-making and encourages the objective allocation and use of health technologies and interventions. Multi-disciplinary Approach Economic evaluation is a multidisciplinary activity requiring a synthesis of information from various sources. Economists and decision analysts are the overall project coordinatorsâ€”they plan the project structure, design the methods, and guide and test the assumptions, simulations and inferences. The contributions from clinicians are critical: Clinicians provide advice on the quality of evidence on the
Economists & Decision Analysts
effectiveness of the interventions being evaluated, and perspectives on the local clinical practices and constraints are especially pertinent. Administrators and finance personnel can provide data on the costs of interventions. The SingHealth Centre for Health Services Research (CHSR) is building up capabilities in the discipline of healthcare economics. In addition to medical professionals, the team also comprises a healthcare economist, a statistician and a decision analyst. The team welcomes opportunities to collaborate with clinical departments to take on economics-related projects, be it in the evaluation of drugs, devices, technologies or process enhancements.
Data on costs of intervention
Quality of evidence
Guide & test assumptions, simulations & inferences
we can glean instructive insights on the principles and methodologies of economic evaluations conducted elsewhere, such as in the UK or the US, the prices and cost structures used for the analysis are not directly applicable nor are they representative of the local situation. The cost of wages, prices of food and supplies differ from one locality to another. In the midst of scarce resources and competing demands, economic evaluations are helpful in decisionmaking, especially when comparisons have to be made across departments or programmes. Economic evaluations ensure that an adequate range of alternatives and good evidence of effectiveness are considered. This offers
Honesty… Still The Best Policy When things go wrong, or if there’s a temptation to sweep a problem under the carpet, recall the old axiom “honesty is the best policy”. me+SH delves into the value of communication, one of SingHealth’s 5Cs.
onest communication is the foundation of trust. The following incident illustrates clearly a lesson in trust we can all learn from:
Mr John Lee was admitted to the hospital for a medical problem related to fluid retention. He was discharged three days later. Soon after his discharge, a senior doctor called Mr Lee’s family and explained that there was a mix-up in the medicine prescribed. Mr Lee and his family met the doctor at the hospital and he explained in detail what happened. The doctor assured Mr Lee that he would be fine and apologised sincerely for the mistake. He informed Mr Lee there would be a full investigation into the incident and procedures would be put in place to prevent a recurrence. Although shocked by the admission, the doctor’s integrity and the institution he represented reassured Mr Lee and his son, who subsequently wrote to the hospital in praise of the doctor’s honesty. He was most impressed that the senior doctor had assumed the responsibility of explaining and apologising for an error made by a junior doctor under his charge. The hospital’s transparency and readiness to accept accountability had averted a potential lawsuit. The investigation unveiled that the patient had received medicine meant for another patient. It was a human error, albeit one that could be eliminated.
At the operational level, the lesson learnt is that one can never be too careful. When issuing prescriptions, at least two identifiers like name, identification number or date of birth should be used in verifying that the prescription is given to the correct patient. From a broader perspective, the lesson is one of building trust. The doctor-patient relationship is a unique one, where a patient entrusts his health to a total stranger. Honesty in communication is crucial in building trust, and in Mr Lee’s case, retaining trust. It is a case in point that honesty is indeed the best policy. The next patient may not be as understanding as Mr Lee and his family. A more educated public with greater awareness of healthcare issues ups the ante for the medical profession. However, these should only spur the profession in leveling up and not hinder its practice of open communication with the patient.
E.A.T.* explores the origins of the humble birthday cake.
he custom of having a cake on your birthday is based on the ancient Greek tradition of offering moon-shaped honey cakes or bread to the Moon Goddess, Selene (Luna in Roman). The Greeks would place lit candles on these cakes to make them glow like the moon. They believed the smoke would carry their wishes to their Gods above. In the Middle Ages, German cakes made of sweetened bread dough commemorating the birth of Jesus gradually became popular in German birthday celebrations of young children. A large candle placed in the centre of the cake symbolised the “light of life”. Candles were used to mark the passage of time with lines and numbers, to render them as timekeepers while they burned slowly. Today, lit candles maintain their status atop birthday cakes with multiple candles corresponding to the age of the celebrant. A silent wish is made before blowing out all the birthday candles in one breath; if successful, it signifies that the wish will come true. The Romans and Egyptians used honey to sweeten their breads, which were leavened with yeast and enhanced with dried fruits and nuts. In early Europe, cake making was seen as a progression of bread making—with the words for bread and cake used interchangeably—the difference being in taste; cakes were sweet while bread was not. By the 15th and 19th centuries, cake making had become more ornate. To improve taste, baking powder and whipped egg whites replaced yeast in leavening cakes. Elaborate icing decorations were made from refined icing sugar, egg whites, flavourings and colours. Cake creations reached their zenith in Victorian times. By then, the birthday cake had become a sweet or dessert traditionally served first to a person on his/her birthday. Today, cakes are used to commemorate some of our most important celebrations.
Exclusive Birthday Offers! Centre Ps 20% discount for purchases above S$60. Le Bon Marche 10% discount for food, wine and retail purchases. *Terms and conditions apply. Refer to http://mysinghealth/ singhealth/mesh/index for information.
me+SH Turns 1!
Of all the means which wisdom acquires to ensure happiness throughout the whole of life, by far the most important is friendship.” ~ Epicurus (341-270 BCE)
“Here’s to many more years of me+SH! May each year add a feather to the expansive wing of time and another chapter to the chronicles of SingHealth. Happy birthday me+SH!”
~ SingHealth Epicurean Arts Team
*E.A.T. is a special interest group supported by Office of Student Affairs, SingHealth Academy. Find out more about our events by emailing email@example.com or adding us on Facebook
ers is the house of a young mother. Guests who sit on the tastefully chosen burgundy sofa set face a set of glass doors liberally pasted with Thomas and Friends decals, those who stop to admire the artwork by local artists have toys liberally strewn at their feet, and at any point of the conversation their hostess stops to attend to two little boys. Said hostess is Adjunct Associate Professor Lee Shu Yen, 36: ophthalmologist by day, mother by night and weekends. Despite a busy daily schedule which starts at 7am and ends when she rushes home for dinner with the boys, A/Prof Lee is clearly the doting and very involved mother to threeyear-old Kai Jie, and 15-month-old Min Jie. Before the interview starts, she tells you: “Kai’s favourite trains (from
At Home With…
Lee Shu Yen Always in her element at work, ophthalmologist Lee Shu Yen displays the same passion and dedication at home as a young mother of two sons. She shares with me+SH the joys of motherhood and family ties. By Sher Maine Wong
It makes for some great family moments. Like when her mother administered her general anaesthesia while she was giving birth—“Mum said general anaesthesia was faster than epidural!” Essentially, being a doctor was something she did not even think about. “It was a natural process since I grew up in that kind of environment,” says A/Prof Lee. During her secondary school days at Singapore Chinese Girls’ School, she would hop over to her grandfather’s and father’s clinic at Mount Elizabeth Hospital after school to do her homework while waiting for her parents to go home, or tag along with her parents while they did their ward rounds. It seems almost inevitable that her boys will end up with the ‘Dr’ honorific. “It’s up to them. Kai has been to the Eye Centre and he knows that we’re doctors,” she says. At the end of the interview, Min Jie—“He’s the more outgoing one” she says—wakes up. She carries him to the door. “Wave bye, Min!” Then she gently closes the door, where she will wait for her husband to come home before getting ready to head to her plastic surgeon sister’s place for a party with the children.
Clearly, as the consummate professional and doting mother, A/Prof Lee, like most women, has to juggle her time. Nights are devoted to the boys and she goes on fortnightly jaunts to the movies with her husband. Saturday afternoons see her shopping or catching up with a group of old school friends over tea. However A/Prof Lee has never considered cutting back on her work. Apart from loving what she does, she is almost destined to be a doctor for hers is a doctor’s pedigree: Her father is a general surgeon; her mother an anaesthetist; her sister a plastic surgeon; her grandfather Yeoh Ghim Seng was the first local professor of surgery, and her greatgrandfather was the first Chinese to study medicine in Cambridge University. In her family are doctors of every ilk, from a dermatologist to a neurosurgeon, spanning Malaysia, USA and Australia. Even her husband is in the medical field: Fellow ophthalmologist Dr Chua Wei Han, a refractive surgeon at SNEC. “There are another three family members who are vets, so if we are not human doctors, we are animal doctors!” says A/Prof Lee with a laugh.
• • •
She is a descendent of Confucius, on her mother’s side. She has perfect eyesight. She plays a mean game of tennis and is in the Ministry of Health’s tennis team, with a few fellow doctors. She watches American Idol (the singing reality show) and one of her favourite contestants was David Cook from Season 7.
the Thomas and Friends series) are Thomas and Percy.” During the course of the interview—during which she gives Kai a piece of paper and pen and seats him next to herself— she turns to the boy several times, patiently teaching him how to hold the pen. To Kai, his mummy is clearly the centre of his world. At work, A/Prof Lee is equally involved. As the only woman in a surgical retina team of three full-timers and four part-timers at Singapore National Eye Centre (SNEC), she was also the first to be conferred adjunct associate professor by the Duke-NUS Graduate Medical School for teaching in SNEC last year. She has taught ophthalmology trainees about cataract surgery, retinal lasers and vitreo-retinal disorders; undergraduate medical students about basic ophthalmology; nurses and allied health professionals about the rudiments of ophthalmic nursing. “Teaching has been fun,” she says. “The culture of teaching at SNEC is very strong.” Her lectures are strengthened by her professional standing, which is garnished with a stellar research record including collaborative animal research with the Lions Eye Institute in Perth, and clinical research in the areas of visual recovery after retinal detachment, diabetic retinopathy and trauma. “I’m happy to have trained in vitreo-retinal surgery and that both my practice as well as my skills are growing. The cases are always challenging, particularly the diabetic retinas. Singapore has a huge diabetic population.” She cites one instance when she saw a young diabetic patient in his 20s or 30s. “The case was challenging because the patient was still so young. If we do not solve the problem the patient would be blind and handicapped.” She adds: “I love my job because I can save sight.” Coincidentally, A/Prof Lee operated on the cataracts of her grandmothers, both of whom are in their 80s.
The Budget From money to water to energy, SingHealth has always kept an eye out on saving resources. In a recession, cost-cutting measures are especially key. We take a look at how two SingHealth institutions worked budgetary magic by thinking out of the box.
National Heart Centre Singapore (NHC) Savings: $16,000 a year Strategy: Replacing insulating blankets with aluminium foil
The premise is so simple it is mind-boggling: Wrapping food in aluminium foil to keep it warm. So why not use the humble food wrap to keep a patient fresh out of surgery warm? During heart surgery, the patient’s body temperature is cooled down for between four to six hours. Post-surgery, the patient is warmed up to body temperature, but is placed in a room of about 22 degrees Celsius. Bottomline: The patient is cold and those who are ill could even get hypothermia, which can be fatal. To keep these patients warm, NHC used to cover them with special electronically powered blankets called Bair Huggers, costing $28 each. About three to four patients a week would need these disposable blankets, which were thrown away once they were used, to prevent crossinfection. Now, NHC staff simply use aluminium foil. It is not used to wrap a patient mummy-style, rather, the foil is placed between an ordinary blanket and a draw sheet to trap heat, and like the blankets, are used only once for hygiene reasons. NHC uses about 1,200 pieces of foil a year, which translates to $16,000 in cost savings a year over using Bair Hugger blankets.
KK Women’s and Children’s Hospital (KKH) Savings: $81,000 a year Strategy: Using NEWater instead of potable water
Simply using recycled water instead of potable waster to flush toilets, in the cooling towers and the irrigation at KKH can potentially save the institution $81,000 a year. The move to tap on NEWater—which is treated wastewater that is cheaper than potable water— is part of KKH’s Water Saving Programme. The NEWater project, to start in 2010, came about when the Public Utilities Board (PUB) recently built a main water pipeline which could supply NEWater to the hospital. KKH and PUB are still in the process of hammering out more ways to save water, including installing water regulators to control the rate of water flow.
Ex p er t s
Staff share tips on how to save costs and save the Earth as well.
“At home, I set the timer on my air conditioner every night so it switches off after five hours. At work, after using the computer, I always switch it off and take out the electrical power cable.”
“To save electricity, if there is any cleaning or painting job to be done, I do it in the early part of the morning so there’s no need to switch on the light. I also get my kids to do their homework in the same area using one light source.” Theivanayagi d/o Shanmugham, Nurse Manager, KKH
Benny Eng, Administration Executive, SHP(HQ)
At work …
Patient’s room lights should be switched off at 9am after ward rounds.
Switch off computers/ printers when not in use (especially staff who are often not in the room).
At home …
Use a fan instead of an air-conditioner to keep cool. A fan uses less than one-tenth the electricity of an air-conditioner which consumes the bulk of electricity at home.
Office equipment should be put on “save” mode whenever possible, and switched off during lunchtime.
Switch off home appliances at the power socket. Do not leave them on standby power as this can account for up to 10 percent of your home electricity use.
Switch off the television at the patient waiting area when there are no patients or relatives.
Choose an energy-efficient appliance (e.g. air-conditioner, refrigerator) by checking the energy labels.
Draw curtains or blinds over windows during the hottest part of the day, especially for west-facing windows, to keep the house cool.
Do not encourage patients, caregivers, or members of the public to charge their handphone batteries or other electrical appliances in the hospital.
Tips from the SGH Urology Centre
Allow hot food to cool before putting it in the fridge.
Tips from the Energy Efficient Singapore Programme
Hear it from
An Introduction To me+LIVING
Medical Sociology Pavitar Kaur Gill, Research Associate, Policy & Research, reviews two books on medical sociology, including a bestseller by William C. Cockerham, a guru on the topic.
ockerham’s book focuses on the complexity of modern illnesses and how lifestyle and behaviour modifications can really impact outcomes and influence health-related policies. For anyone interested in medical sociology, this book is replete with the most recent and relevant ideas, concepts, themes and issues at the cutting edge. In addition to defining medical sociology and discussing the patient, Cockerham addresses doctor-patient interaction. He observes that cultural and linguistic differences affect communication, and that this can have serious implications for patient compliance and negative impact on health outcomes. Two groups with communication problems have been identified: women and the lower class, especially in their interaction with male doctors. On the other hand, patients from higher social classes are more likely to demand and receive adequate information about their illness while doctors from higher social classes tend to communicate better. Some other topics explored in the book are: the physician’s role in a changing society, the roles of allied healthcare professionals and the function of the hospital as a social institution. Cockerham examines the provision of healthcare beginning with the professionalisation and the socialisation of the physician before moving on to the power structure of American Medicine. Finally he focuses on healthcare delivery systems, discussing rising costs, health reform, and socialised and socialist medicine. He takes the discussion from the US to the global stage. I highly recommend this book as an introduction to medical sociology, which is relevant to all of us. As long as we are a part of society and have needs that can be met by medical professionals, we participate in the interplay between the disciplines of sociology and medicine.
Growing as ONE
Dear me+SH, you have kept our team on our toes every quarter! We await in eager anticipation to read every single upcoming issue. It’s been great seeing you grow... Happy Birthday! Jane Cheong, Clinical Governance & Quality Management, SingHealth
Medical Sociology (11th Edition) By William C. Cockerham Prentice Hall, 2009
The Sociology of Health, Illness and Health Care: A Critical Approach (3rd Edition) By Rose Wietz
Wadsworth Publishing, 2003
A must-have for anyone interested in medical sociology. It gives an overview of the US healthcare system and a sociologist’s standpoint on the business of health and illness. Disease is a biological condition, but illness is a social construct. Social disparities are discussed through the lens of gender, age, race and socio-economic status. A great companion to Cockerham’s Medical Sociology.
All drawings by: Dr Andrew Tay Senior Consultant, Dept of Oral & Maxillofacial Surgery NDC
Growing as ONE
We trust me+SH will continue to be informative and educational with a human touch that portrays what SingHealth is. The articles within are just as colourful as the cover. SingHealth Group Procurement Office
I certainly would like to wish me+SH a very happy birthday. It has been a pleasure reading the articles which are very well and concisely written and deal with a variety of issues. I look forward to many happier birthdays! Dr K. Gunasegaran, Senior Consultant, NHC
Three months at Cambridge University Hospital proved to be an eye-opener for Darren Tan, Assistant Manager, Operations, CGH. Clearly impressed and touched by the dedication and passion of staff there, he shares his encounters.
n September 2008, I had the privilege of a three-month attachment with the Cambridge University Hospital’s (CUH) NHS Foundation Trust under the SingHealth Talent Development Fund. I bring home insights on how we can work towards being both a top-notch health services provider and an academic medical centre—like our Cambridge counterparts. Propelled by Tradition and Reputation CUH and the University of Cambridge have an illustrious history and reputation as a premier teaching hospital of choice and an academic powerhouse respectively. Immersing in the culture, I could immediately sense an institutional pride that seemed to exclaim, “We are Cambridge, so we do things differently —we do things better than anywhere else.” Their pursuit of excellence is relentless. Instead of basking in the glory of their achievements, they ask themselves how they can deliver even better value-for-money and quality care to their patients
Darren went on the attachment while he was Lead Analyst, Policy & Research at SingHealth.
The truth is, CUH has its shortfalls, and does at times, fail to meet the mark in its internal and national audits. However, they do not hide behind a veil of excuses. After a period of selfflagellation, they grit their teeth and move on. Their fixation on being better than everyone else is precisely why they are so sought after to treat more complicated conditions and engage in more complex medicine. All Hands on Deck As part of my learning, I had to approach almost 100 staff to arrange for meetings,
exposure attachments and tutorials. Despite busy schedules and the potential inconveniences and intrusion, I was never rejected. Everyone at CUH, from the full-time academics to the mortuary technician, sees it as their responsibility to contribute towards research and education, fulfilling the organisation’s objectives and vision. Similarly, if we are to realise our vision of academic medicine, we need to live the dream bearing in mind that we or our loved ones would, at some point, be consuming the same services we dish out.
The Cambridge Experience An incident that succinctly encapsulates the attitudes that permeate the entire organisation took place during Darren’s tutorial of a postmortem case by the mortuary technician at CUH.
(politely interrupting him midway through his explanation of the differences between the ‘Y’ and the ‘U’ dissections) Mr. X, I
am clearly slowing you down, would you prefer if I stood aside and allowed you to do what you need to do first?
Mortuary Technician No worries, lad. We are used to this.
We are a teaching hospital and it is my responsibility and privilege to teach. You are not going to faint on me, are you?
I’m all right (as I kicked myself for leaving my ‘hong-yew’ in the changing room).
*hong-yew is hokkien for smelling salts
Constant renewal in the medical community, undergirded by firm fundamentals, has contributed to countless breakthroughs benefitting the lives of fellow human beings. Here are some inspiring events.
In recent years...
A New Look & Feel: me+SH, a staff publication, was born as an active platform for staff engagement and information.
From not too long ago... 20-22 May 2009
Inaugural Teaching Course: Conducted by SNEC doctors at Jinan Municipal Central Hospital (Shandong, China). Performed surgery on 11 patients and discussed further expansion plans on implant training centre.
New Home of NCCS: The National Cancer Centre Singapore moves into its own building at 11 Hospital Drive.
From a little further back in time…
*Historic Conference: Dr Wu Lien-teh (伍连德), who first modernised China’s medical services and education, chaired the International Plague Conference in Mukden (Shenyang).
**First Flu Vaccine: The first approved inactivated vaccines for influenza were developed by the US military for World War II.
* Source: http://en.wikipedia.org/wiki/Wu_Lien-teh (21 May 2009)
**Source: http://en.wikipedia.org/wiki/Flu_vaccination#Influenza (21 May 2009)
Upcoming Events In conjunction with GCEO Excellence Awards & Launch of SingHealth Academy
Pulse of SingHealth 2009: A New Era –Transforming Healthcare Pulse of SingHealth 2009 - Sessions Pulse of SingHealth Keynote Address
Pulse of SingHealth @ Outram Campus
Pulse of SingHealth @ KKH
Pulse of SingHealth @ CGH
Tue 21 Jul 09 12 pm to 2 pm HPB Auditorium
Wed 22 Jul 09 12 pm to 2 pm SGH Void Deck
Mon 27 Jul 09 5 pm to 6.30 pm KKH Auditorium
Tue 28 Jul 09 5 pm to 6.30 pm CGH Auditorium
Join us at Pulse of SingHealth 2009. Celebrate with the winners of the GCEO Excellence Awards. Journey with us in building a thriving medical campus of excellence and witness the launch of SingHealth Academy. For more details, visit SingHealth Desktop Portal>>http://mysinghealth
Your THIS ISSUE’S QUIZ:
Liked the pictures you saw in our Outram Campus centrespread? Send in your own photos of your institution and stand a chance to win Golden Village movie passes! Please email your photograph with a short caption (together with your name, department/institution, and contact number) to firstname.lastname@example.org by 10 July 2009. Three lucky winners will each receive a Golden Village movie pass worth $28.
opinion? Here are the answers to the last ISSUE’S quiz: Q1. What is the welcome message (listed under ‘Recent News’ on the webpage) on me+SH Facebook homepage? Ans: Welcome to me+SH! Take part in discussions, post photos or videos, doodle on our wall! This place is all about you, so tell us how you want it to turn out! Q2. What are the five key areas of focus in the SingHealth Workplan 2009? Ans: Patient Care; Education and Research; Operations Integration, Infrastructure & Technology; Building Leadership, Retain Talent and Drive Performance; and Ensuring Long-Term Financial Sustainability. Q3. What is the main focus of SingHealth’s latest annual report? Ans: Our patients.
And the winner is... Susanna Siew, Senior Admin Assistant, SGH
She will receive a $50 Harvey Norman voucher. me+SH will be contacting you shortly with prize collection details.
We want to hear from you! Are you a wizard of words? Do you have a keen eye for capturing images? Would you like to use me+SH as an outlet to express your thoughts and expressions? If so, we welcome your contributions! Send your comments, feedback, story ideas, photos and even videos to email@example.com Be sure to check out me+SH online (http://mysinghealth/singhealth/mesh), as well as me+SH on Facebook!
- H1N1: working hand-in-hand - GCEO Excellence Awards 2009 - me+SH turns One!