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MEDICINE The voice of academic medicine

MICA (P) 143/07/2013

The IT factor

Multiplying the benefits of TeamLEAD beyond Duke-NUS

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Leveraging on technology to deliver practical solutions, SingHealth creates a better environment for patients and staff to heal and work

eamLEAD is an innovative teambased learning pedagogy that forms the core of teaching at Duke-NUS but today, it has captured the attention of educators from around the island.

The NHCS ‘1 Queue, 1 Bill’ system piloted saves patients’ time in queuing and requeuing

Benedict Tan (left) and Prof Loo Chian Min (right) lead SingHealth in making impactful changes in healthcare through IT

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s the healthcare system moves into a more integrated model of the future, innovations in IT become critical tools to enable the transformation of care. As Professor Loo Chian Min, SingHealth’s Chief Medical Informatics Officer, puts it, “IT innovations are here to support decision making, empower patients in their recovery and facilitate research for better care outcomes.” Benedict Tan, Group Chief Information Officer for SingHealth shared, “The challenge is how we redesign existing processes and utilise IT to transform the way healthcare is delivered. Technology is an enabling platform for healthcare workers to collaborate internally, and strengthen partnerships with our patients and other care providers externally.” One such initiative is the ‘1 Queue, 1 Bill’ system designed for patients. Piloted at NHCS, patients just need to register once at the centre upon their arrival as the system allows the same queue number to be used at the various service locations. This saves them time in queuing and requeuing. There is also a single point of payment that combines different charges for the day into a single bill.

Another initiative recently won the CIO Award, an annual award for the regional IT industry. A smart RFID-enabled pharmacy system developed by SGH and IHiS allows more than 80 per cent of patients at SGH’s outpatient pharmacy to receive their medication within 30 minutes. This system is the world’s first such automated solution in a hospital and has improved patient safety, reduced patients’ waiting time and increased staff productivity.

IT innovations are here to support decision making, empower patients in their recovery and facilitate research for better care outcomes. – Prof Loo Chian Min, Chief Medical Informatics Officer, SingHealth Patients can look forward to a smarter, smoother and more integrated care experience thanks to IT. Currently in the works is a patient portal combining integrated internet, telehealth and mobile computing technologies that allows patients to share and find information about their

The SGH RFID-enabled system improves patient safety, staff productivity and waiting time

medical condition. This will encourage greater ownership and management of one’s own illness and better outcomes. There are also plans to digitise and consolidate patient case notes within and across institutions – a move that will further protect patient confidentiality and promote staff efficiency. Benedict said, “We have collected a significant volume of data in the past 10 years from the various IT systems. We are now leveraging on analytics to tap on this data to support SingHealth in operational and clinical decision making, and to support research for the betterment of treatment outcomes. By combining it with other capabilities such as geospatial analytics, we can discover disease causes and target treatment programmes more effectively.” Looking forward, Prof Loo shared the same sentiment. He said, “It is important to reduce unnecessary variation for our patients. By standardising processes, we ensure the same thing is done the same way - and done very well across the entire care spectrum.”

Exploiting innovation’s full potential SERI’s Technology Development programme drives development and commercialisation of promising technologies that can change patients’ lives

Too often, the translational research process is a long and arduous one with outcomes not reaching commercial application. This means that discoveries that can change patients’ lives may fall into a translation gap. Bridging this gap are the numerous technology development and business incubator programmes within SingHealth institutions, which promote innovation and facilitate the transfer of technology, with the aim of commercial application of their most promising discoveries for the patients. One such unit sits at Academia - the Singapore Eye Research Institute Technology Development (SERI TD) Office – which was recently

ISSUE 8, APR 2014

A publication of the SingHealth Academic Healthcare Cluster

established to support SERI researchers in commercialising research outcomes. SERI has a wide and very promising technology portfolio that includes drugs, devices, diagnostics and software. The SERI TD office serves as a one-stop support entity for commercialisation, technology transfer and industry partnering activities. Dr Danny Belkin, SERI’s Director of Business Department, explains, “Basically, the department offers business development support for innovations identified as promising candidates for commercialisation.

“For example, we will consider suitable options to achieve this goal, such as directly licensing technologies to industry or spinning off new startup companies. “We also manage SERI’s Intellectual Property portfolio and ensure SERI and its researchers receive the optimal return from their work.” One of the office’s key projects at the moment involves developing and populating the SNEC ophthalmic technologies incubator with innovations that can change patients’ lives and around which new startup companies can be formed.

Continued on page 3

One of the early educators to recognise the powerful potential of the learning approach is Christopher Chee, a teacher formerly with Christchurch Secondary School and now at Spectra Secondary School. After reading about TeamLEAD in Today Newspaper, Mr Chee contacted Prof Ranga Krishnan, Dean of Duke-NUS, about the possibility of adapting the method in his mathematics classes. With guidance from Duke-NUS, a pilot programme was launched in 2013 with a class of secondary 3 normal-technical students embarking on this approach, where they review core mathematics principles online prior to class. Class time is reserved for asking questions, seeking clarifications or doing assessments to ensure understanding. Christopher found that the approach helped the students take charge of their own learning and find greater meaning in their class participation. He says, “Our teachers, having witnessed the transformation in the students, are themselves transformed and now would have it in no other way when conducting their lessons.” Christopher’s proactive step has even caught the attention of Education Minister, Heng Swee Keat, who mentioned that he is excited by the learning opportunities ahead.

TeamLEAD works because it shifts learning away from rote memorisation towards critical thinking. – Associate Professor Sandy Cook, Senior Associate Dean (Medical Education, Research and Evaluation), Duke-NUS Associate Professor Sandy Cook, Senior Associate Dean (Medical Education, Research and Evaluation) at Duke-NUS, believes that TeamLEAD works because it shifts learning away from rote memorisation towards critical thinking. In an effort to extend the benefits of TeamLEAD among local schools, Duke-NUS has organised a series of lectures, school visits, workshops and the Fellowship in Team-Based Learning programmes. The interest in TeamLEAD has been tremendous, with more than 100 educators participating in the various workshops in 2013 alone. These included leaders from the Ministry of Education, schools, Academy of Principals (Singapore) and Academy of Teachers. Belinda Charles, Dean of Academy of Principals (Singapore), was impressed by TeamLEAD. “What was exciting for me was to see how good design and well-posited questions are able to make students think further and deeper about a topic regardless of how superficial had been their acquaintance with the topic earlier.”


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Tomorrow’s Medicine - ISSUE 8, APR 2014

Keep calm and carry on: A journey to innovation

APR 2014 Editors-In-Chief

Our 10-year experience probably illustrates the ups and downs of any innovation journey. What we have taken away from it are lessons in resilience and perseverance.

Tan-Huang Shuo Mei Audrey Lau Editors

Jennifer Wee Arthur Wong Stephanie Jade Pamela Poh Joint Editorial team

Goh Sai Luan (SGH) sub-editor

– Prof Christopher Cheng, Senior Consultant, Department of Urology, SGH

Ichha Oberoi (KKH) sub-editor Eric Lim Wei (SHP) sub-editor Edwin Yong (NCCS) Caroline Chia (NDCS) Jessica Koh (NHCS) Christina Valerie Wee (NNI) Dr Thiyagarajan Jayabaskar (SNEC) Wee Lai Ming (Duke-NUS) Design

Redstone Communications Copywriting

Hedgehog Communications Members of the SingHealth Academic Healthcare Cluster

Singapore General Hospital (SGH) KK Women’s and Children’s Hospital (KKH) National Cancer Centre Singapore (NCCS) National Dental Centre Singapore (NDCS) National Heart Centre Singapore (NHCS) National Neuroscience Institute (NNI) Singapore National Eye Centre (SNEC) SingHealth Polyclinics (SHP) Bright Vision Hospital (BVH) Sengkang Health (SKH)

Partner in Academic Medicine

Duke-NUS Graduate Medical School Singapore (Duke-NUS)

News Over Multiple Channels

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ona Lisa - a robot that helps doctors detect prostate cancer more accurately and safely - has gained interest worldwide. International trials have also recently started. It is a story of perseverance that dates as far back as 2003.

The Mona Lisa robot Used for prostate cancer biopsy has an accuracy rate of 90 per cent in the biopsy tests for prostate cancer, the third most common cancer among Singapore men. Previously, the accuracy rate was 70 per cent. The robot also reduces the risk of infection. Surgical Pte Ltd. Mona Lisa was born from the collaboration between SGH, NTU and Biobot. The team then worked tirelessly to overcome technical challenges during the clinical and pre-clinical trials. “The research process was long and arduous with factors beyond one’s control,” said Prof Cheng. Citing the chance discovery of penicillin, he added, “Your intent must be pure, and you need to have the mental latitude to observe, ask questions and not overlook critical questions in the rush. The robustness of a research study depends on intellectual integrity and that is what I am thankful we have here in our campus.

Professor Christopher Cheng, Pro-tem CEO of Sengkang Health and Senior Consultant at the SGH’s Department of Urology, who was involved in creating its first prototype, said that the study arose out of a dire need for accurate biopsies to detect prostate cancer.

“We have also learnt that any innovation journey needs to start with empathy and respect for the unique contributions of partners. In this way, the stage is set for an equal partnership regardless of rank or reward potential. Only then will ideas have the time and room to be generated and explored.”

With traditional biopsy, doctors may miss detecting at least 35 per cent of cancer cases. The traditional method also causes sepsis in 5 per cent of patients and occasional death. Various centres had been working on alternatives for years without success, so they embarked on a journey to find a solution on their own.

Having run the first lap of the innovation process, Prof Cheng passed on the baton to lead the study to his colleagues, Dr John Yuen and Dr Henry Ho, Senior Consultants from SGH’s Urology Department. The Mona Lisa will soon help doctors find a more focused cancer therapy and be used on first-time patients.

Prof Cheng then teamed up with the late Nanyang Technological University (NTU) Professor Ng Wan Seng to create a biopsy machine for prostate cancer detection. In 2007, Prof Ng formed Biobot

Said Prof Cheng, “Our 10-year experience probably illustrates the ups and downs of any innovation journey. What we have taken away from it are lessons in resilience and perseverance.”

Growing and nurturing our people

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uch has been said about talent management, but what is it, really? In essence, it is about growing, nurturing and developing our people, empowering them to improve the way we work.

At SingHealth, we strive to create a conducive workplace for our staff, so that they can have a fulfilling career and contribute towards better patient care.

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Tomorrow’s Medicine welcomes comments from our readers. Write to us at editor@singhealth.com.sg 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, photographers or illustrations. Tomorrow’s Medicine reserves the right to edit all materials submitted for publication. While contributors will be given the opportunity to comment on articles for factual accuracy, this policy is about ensuring a consistent and clear writing style throughout.

There are even more plans ahead. SingHealth is exploring different ways of engaging staff, from recruitment and training to assessment and interaction. In terms of career paths, formalised career tracks have been worked out for clinicians, allowing them to choose different career pathways based on their interests. These career tracks have been or are currently being developed for other healthcare professions, including allied health, nursing and administrators. A major initiative that is being rolled out cluster-wide is the Electronic Performance Appraisal (ePA) system. This IT system with common templates will allow for objective and fair evaluation of staff performance across different SingHealth institutions. With individualised weightages to reflect each person’s job scope, the unique contribution of each staff will be recognised.

The SingHealth Employee Engagement Survey 2012 showed that staff would like to see improvement in three areas: rewards & recognition, innovation and work-life harmony. In response, SingHealth institutions have undertaken various initiatives, including:

Rewards and Recognition • A salary review for all staff in 2012, followed by salary adjustments to ensure competitive pay and revised pay framework for doctors and dentists taking effect in April 2014 (national initiative) • Review of career development paths for various job groups to provide structure and clarity of path progression • Recognition of contributions and achievements via awards, such as the SingHealth Excellence Awards

Innovation • Inculcate a culture of systematic improvement through Enhancing Performance, Improving Care (EPIC) programme and participation in Innovation & Quality Circle (IQC) projects • Empower staff to make improvements at work via staff suggestions schemes • Re-organisation of departments or projects to streamline workflow, such as staggered shifts over long clinic hours

Work-life Harmony • More than 50 per cent increase in staff strength since 2007 for better distribution of workload • More than 40 types of flexible work arrangements • Team building activities to foster bonding and create a more harmonious work environment Talent Management is one of the six key priorities identified at last year’s SingHealth-Duke NUS Strategy Retreat to help sharpen our Academic Medicine strategy. Read more in the latest issue of SingHealth Academic Medicine Planning (AMP) at http://bit.ly/1jncKdp or contact christopher.joel.tan@singhealth.com.sg for a copy.


Tomorrow’s Medicine - ISSUE 8, APR 2014

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Rethinking healthcare leadership Celebrating a life-long

An increasing number of healthcare educators are actively stepping up to take a larger role in improving the healthcare system by enhancing their leadership skills. Duke-NUS’ Associate Professor Arpana Vidyarthi says that’s a good thing

According to Prof Vidyarthi, one should seek leadership skills on two levels – first by gaining more leadership skills as an individual which will assist in their ability to provide care, followed by taking a role in improving the healthcare system at large. The AM•EI Education Leadership Program (AMLead) aims to equip educators in leadership positions with key skills. Prof Vidyarthi adopts a philosophy that leadership training ought to be at the helm of the entire professional framework, driving effective change in all venues including policy, quality and safety, education, and care delivery.

Although we know a lot about the science of improvement, there’s also a point at which the science reaches its limit, and the art of leading and managing people is what is needed to create sustained and real change. – Assoc Prof Arpana Vidyarthi, Academic Medicine Education Institute (AM•EI)

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n healthcare, more than any other industry, people’s lives are in our hands. So a strong leadership network must power this academic landscape.

This calls for a move away from the reluctant or accidental leader into the deliberate leader. The upcoming AM•EI Education Leadership Program, run by Associate Professor Arpana Vidyarthi at the Academic Medicine Education Institute (AM•EI), facilitates this. “Most of us did not come into healthcare to lead, but we must. As direct healthcare providers in today’s environment, we interact with a complex system of individuals, systems, and social networks that need to be led and managed to deliver care to our patients.

“I grew up in the quality and safety world, and I learnt that behind every checklist and system fix, there are people.

dedication to research and education The Balachandran Kajima Professorship in Academic Medicine continues Prof Bala’s legacy of giving

Sharing and caring must be the hallmark of the medical profession and should be taught by example. – Prof N Balachandran

Throughout his career, Prof Bala was a formidable force in Medicine, improving services in orthopaedics for the chronically ill, handicapped and disabled. He was a strong advocate or research and education in Medicine, believing fervently that teaching others is a privilege. His students and patients remember him best for his compassion and humanity.

“Although we know a lot about the science of improvement, there’s also a point at which the science reaches its limit, and the art of leading and managing people is what is needed to create sustained and real change,” said Prof Vidyarthi. Fortunately for our patients, our people are thirsty for advancement. Prof Vidyarthi has already met with professionals interested in taking the step to the next level. “Some of these individuals who seek me out are generally those who have been in the system for some time and have come upon hurdles or blocks, and recognise that there has to be another way to improve healthcare and care delivery.” She continued, “Another piece of this is that it’s a culture change – understanding what leadership means in all of us and also to translate it into something that makes your job easier and its impact larger.”

Taking the step to the next level?

“In addition, especially during these transformational times, some of us will be asked to expand our scope and lead our organisations. For each of these leadership roles, many in healthcare are ill-equipped,” she elaborates.

The AM•EI has its sights set on nurturing the next few generations of excellent clinician educators through its number of faculty development workshops. Find out more at http://www.academic-medicine.edu.sg/amei

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t is by this noble philosophy that the late Professor Navaratnam Balachandran lived his life and it was a life that touched many. Having devoted 45 years to the medical vocation, “Big Bala” as he was fondly known, was mentor, teacher, humanitarian and friend to countless doctors, surgeons and other healthcare staff at SGH.

Prof Tan Ser Kiat, SingHealth Board member, was Prof Bala’s junior and holds firm to his mentor’s belief: “We would have failed in our duties and responsibilities if our younger clinicians who come after us are not better than us.” The Balachandran Kajima Professorship in Academic Medicine commemorates Prof Bala’s legacy in shaping the lives of future generations of clinicians. It aims to nurture academic leadership in medical teaching and research and will allow the distinguished recipient to pursue advanced research that will make a lasting impact on patients’ lives. Kajima Overseas Asia has generously pledged S$1 million dollars towards the establishment of this Professorship and in total, Singhealth hopes to raise S$2.5 million to attract a dollar-to-dollar Government matching grant, potentially bringing the total endowed fund to S$5 million. For more information on the Professorship and how you can support it, email angela.chen@singhealth.com.sg

Exploiting Innovation’s Full Potential Continued from Page 1

I believe it is a matter of time before our number of successes create a positive feedback loop that will fuel substantial interest in technology development by researchers as well as funding from private and public sources. – Dr Danny Belkin, Director, Business Development, Singapore Eye Research Institute (SERI) The TD office hopes to license two potentially impactful technologies originating from research carried out at SERI together with its academic partners in Singapore, that will form the base of two startups very soon – the first being a Singapore-based company which will focus on sustained drug delivery for the treatment of glaucoma; and the other, to be formed in Canada, will be focused on the clinical development and commercialisation of a novel class of antimicrobial molecules. Dr Belkin opines that while Singapore is at a nascent stage of medical technology commercialisation compared to established medical innovation centres in US or Europe, the opportunity here is huge, with world class researchers and innovative technologies. The challenge Singapore still faces is to grow the talent pool since there is a lack of critical mass of experienced manpower such as clinician scientists, inventors and accomplished medical entrepreneurs.

He said, “I believe it is a matter of time before our number of successes create a positive feedback loop that will fuel substantial interest in technology development by researchers as well as funding from private and public sources.” Dr Belkin is not alone. A collaboration of SingHealth institutions, each with its own similar technology development team, together with the SingHealth Office of Research, is currently developing the SingHealth Technology Development and Commercialisation strategy. Also in this joint forum is Associate Professor David M Epstein, Head of the Duke-NUS Center for Technology and Development (CTeD) and Associate Dean of Research at Duke-NUS. CTeD aims to facilitate translation into commercial application of research from Duke-NUS under their five Signature

Dr Danny Belkin (Left) leads the SERI Technology Development Office, with the support of (L-R) Nur Asyura Mansoor, XiaoQin Fang and Tarun Kumar Maheshwari Research Programmes. Not only are they working towards a positive return on the investment made to drive the biomedical field, it is also aiming to facilitate manpower development for the Singapore biomedical industry. Prof Epstein said, “We are looking at putting in place an entrepreneur-in-residence programme that mirrors the support that

Associate Professor David Epstein heads the Centre for Technology and Development at Duke-NUS

venture capitalists in US and Europe receive.” To this end, CTeD has also brought in an external advisory board with expertise in both commercial and biotechnology investment. “We hope to bring in interested individuals with the aptitude and attitude to develop research technology that leads to more startups.”

Web exclusive During the year after it was established, the SERI TD Office has been busy starting initiatives and being involved in negotiations. Visit http://goo.gl/ZS1hiX to view: • Highlights of SERI Technology Development Office’s work • More about Dr Danny Belkin and Assoc Prof David Epstein


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Tomorrow’s Medicine - ISSUE 8, APR 2014

Improved pre-op imaging for breast cancer KKH study may result in more specific pre-operative imaging evaluation for breast cancer patients compared to breast MRI

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cquired under a grant co-funded by SingHealth and the Agency for Science Technology and Research (A*STAR), MAMMI is a dedicated two-ring breast Positron Emission Tomography (PET) scanner. An improvement on the existing one-ring scanner design, it allows high resolution breast PET scans to be performed at lower radiation doses than scans by existing single ring systems or traditional whole body scanners. Commenced in June 2013, a clinical research study by KKH aims to determine the best method of pre-operative imaging evaluation for patients with breast cancer using MAMMI. Funded by a grant from the National Medical Research Council, the

This information may reduce costs and delays from additional procedures, minimising discomfort and anxiety for the patient. – Principal Investigator Dr Teo Sze Yiun, Head and Senior Consultant of the Breast Imaging Unit at KKH

study involves the evaluation of magnetic resonance imaging (MRI) alongside PET scans of participating newly-diagnosed breast cancer patients at KKH. The findings of these various imaging methods are analysed with the histopathology of the surgical specimen as the reference standard. “Our aim is to determine the best presurgical imaging regimen for Asian women with breast cancer – one that provides the most accurate anatomical and functional information,” said Principal Investigator Dr Teo Sze Yiun, who is also Head and Senior Consultant of the Breast Imaging Unit at KKH.

higher cost and possibly delayed treatment. In contrast, the MAMMI Breast PET scanner is able to provide functional information. Existing clinical research indicates that PET imaging offers sensitivity equal to MRI, while offering improved specificity. Dr Teo explained, “Breast MRI is sometimes performed to assess for additional sites

of malignant disease within the breasts in a patient with newly diagnosed breast cancer. By looking at metabolic information, PET imaging may reduce the number of false positive findings compared to breast MRI. This information may reduce costs and delays from additional procedures, minimising discomfort and anxiety for the patient.”

Breast MRI has been shown to provide the most accurate assessment of tumour size compared to mammogram and ultrasound. It is also able to detect additional sites of disease within the same breast that may not be detectable via clinical examination, mammography or ultrasound. However in an MRI, images of malignant tumours may overlap with normal breast tissues or other benign conditions. Hence, patients may need to undergo additional procedures before their definitive breast surgery, resulting in greater patient anxiety,

A patient undergoing a breast scan using the world’s first two-ring breast PET scanner

SingHealth Office of Research Grant Call Reminder Grant

Closing Date

Grant Amount

ExxonMobil-NUS Research Fellowship for Clinicians FY2014

28 April 2014

Matching salary for the time spent on research up to Registrar’s salary

Singapore-Stanford Biodesign (SSB) Fellowship Program 2015

30 April 2014

SSB Fellows will receive stipend, tuition and international travel support

Duke /Duke-NUS Research Collaborations

Open throughout the year

• USD$50K to USD$150K to Duke PI • S$50K to S$150K to Duke-NUS PI

NMRC Clinical Trial Grant - Co-Development Scheme (Co-D)

Open throughout the year

<S$5M for a period of 3 years

MOH Industry Alignment Fund (IAF Cat 1)

Open throughout the year

<S$500K; <S$1M; <S$1.5M (3 subcategories) for a period of 3 years

Khoo Mentored Research Award (KMRA)

Open throughout the year

<S$300K for a period of 2 years

Khoo Pilot Award

Open throughout the year

<S$30K for a period of 1 year

For more information on funding sources and support for research in SingHealth, visit http://research.singhealth.com.sg or email office.research@singhealth.com.sg

AMRI Events For details and registration, contact the Academic Medicine Research Institute (AMRI) at amri-info@duke-nus.edu.sg. WORKSHOPS

25 Apr, 9.00am-5.00pm: Advanced manuscript writing: How do I get my research message out? 29 Apr, 9.00am-5.00pm: Introductory Stata Workshop

EVENTS & SEMINARS

25 Apr, 12.30pm-2.00pm: Research Round @KKH: Oxidative stress in critically ill children

TRANSFORMING VISION INTO REALITY A signature event showcasing the synergy in the SingHealth and Duke-NUS’ joint a  cademic partnership – this Scientific Congress brings together thought leaders and healthcare professionals to share insights in care improvement, research and education to improve patients’ outcomes.

SUBMISSION DEADLINE EXTENDED TO 2 MAY 2014

AM•EI Events Open to all SingHealth and Duke-NUS staff. For details and registration, contact the Academic Medicine Education Institute (AM•EI) at amei-info@duke-nus.edu.sg. For membership enquiries, email amei-members@duke-nus.edu.sg FACULTY DEVELOPMENT WORKSHOPS

28 Apr, 1.00pm-5.00pm: What is the best instrument for my research outcomes? 27 May, 4.30pm-7.30pm: Designing effective objectives and quality multiple choice questions 28 May, 9.00am-1.00pm: Becoming a leader in Academic Medicine: Honing and developing your skills

RESIDENTS DEVELOPMENT WORKSHOPS

5 May, 2.00pm-4.30pm: “I never get any feedback!” – Strategies to improve feedback


Tomorrow's Medicine Issue 8 - Apr 2014