Seeking Sustainability

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Seeking Sustainability Sustainability entails minimizing our impact on the environment at the organizational and individual levels. As a hospital, we have sought to do this through our architecture, landscaping, placemaking, waste management policies and green culture building.

This book is generously sponsored by CPG Corporation Pte Ltd


CONTENTS Preface

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5

Chapter 1: Designing for Sustainability

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Chapter 2: A Garden in a Hospital, A Hospital in a Garden

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Chapter 3: From Garden to Table: Making Food Sustainable

115

Chapter 4: Building a Green Culture from Within

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Chapter 5: Joining Hands for Sustainability

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In Closing

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In Appreciation

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Bibliography

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FOREWORD When we first took the wheel of the old Alexandra Hospital, we were in dire straits. Indeed, smooth seas never make good sailors, and the early turbulence forced us to attempt unconventional experiments in hospital planning, from which many valuable experiences were gleaned. With a clean slate in the form of Khoo Teck Puat Hospital and the subsequent institutions of Yishun Health, these experiences empowered us to build a hospital that would perform its duty not only to our patients, but to the environment as well. We are committed to performing our primary role as a healthcare provider while proactively minimizing our impact on the environment. Environmental health is a strong determinant of human health. Changes in environmental factors like climate and air quality are slowly but surely affecting human health. This is the bigger picture underlying our belief in sustainable healthcare operations– it would be counterproductive to treat the population if the by-product of our operations is environmental damage, which would in turn harm human health and introduce even more patients into the healthcare system. With this conviction we have sought to minimize the environmental impact of our daily operations wherever possible, without compromising patient care and safety. This book is more than an account of the planning and execution stages of our hospital’s sustainability blueprint. It seeks to demonstrate the very pragmatic benefits of being green, and the tangible rewards that can be reaped from being environmentally responsible. We thank pioneers like Mr Liak, former GCEO of Alexandra Health, government agencies and many more advisors for their thought leadership, partnership and generous support. We hope that these experiences may aid others to sail smoothly on their sustainability journey. This voyage has not always been easy, but it has always been fruitful. Let us work together on the road ahead for a greener future in healthcare and beyond. Mrs Chew Kwee Tiang Chief Executive Officer Khoo Teck Puat Hospital and Yishun Health

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Vision Help our people live a long, healthy life and support them with thoughtful, dignified care to the end.

Mission Provide good quality, affordable and hassle-free healthcare with science, love and wisdom.

Philosophy of Care Care that is good enough for our own mothers without making special arrangements.

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A HEALTHROPOLIS FOR THE NORTH, FOR THE PEOPLE AND THE ENVIRONMENT Khoo Teck Puat Hospital opened in 2010 as a Health Promoting Hospital. We sought to go beyond traditional ideas of a hospital as merely a place where the sick receive treatment. The management envisioned that by influencing the community to adopt healthy lifestyle habits, the risk of disease would decrease, in turn alleviating the stresses of a rapidly aging population on Singapore’s healthcare system. Furthermore, we wished to minimize the inevitable impact of our operations on the environment, recognizing the intimate relationship between environment and human health. Thus, beyond minimizing our own impact through building design, facilities management and policies, we endeavored to nudge the community towards more environmentally responsible choices and behavior in the long term.

"We must prepare for the impact of climate change on Singapore." Prime Minister Lee Hsien Loong National Day Rally 2019

Why Hospitals Should Care for the Environment Environmental health affects public health. While this connection is most evident in regions of the world that have suffered extreme environmental pollution, similar effects are increasingly affecting the larger metropolitan population as well. As the effects of climate change accelerate, we are beginning to see that the threat to human life extends far beyond rising sea levels.1 Scientists have begun to draw a connection between rising temperatures and more aggressive flu seasons.2 The spread of deadly vector-borne diseases such as dengue is made more virulent by a warming climate.3, 4 The heat has even proven fatal in recent years, and meteorologists predict that temperatures in Singapore could reach 40°C by as early as 2045.5 The provision of environmentally conscious healthcare can thus ease the burden of disease, in turn alleviating the stresses placed on the healthcare system in the long term.

Build & Purchase Green

A tropical, responsive façade design with sustainable procurement policy.

Conserve Resources HEALTHY COMMUNITY

SUSTAINABLE ENVIRONMENT

A VISION OF HEALTHROPOLIS

HEALTHY WORKFORCE

Energy-efficient system design and use of renewable energy to offset carbon footprint.

Reduce Waste

Refuse. Reduce. Reuse. Recycle.

Enhance the Natural Environment

A Hospital in a Garden, a Garden in a Hospital. A healing environment that engages the senses of sight, scent, sound and touch.

1. Jolene Ang, “Singapore to shore up defences as mercury and seas rise,” The Straits Times, November 4, 2018. 2. Arizona State University College of Liberal Arts and Sciences, “More severe flu seasons predicted due to climate change,” Science Daily, January 28, 2013. 3. Cynthia Choo, “As temperatures and urbanisation increase, fight against dengue will only get tougher,” Channel NewsAsia, June 22, 2019. 4. Kendra Pierre-Louis and Nadja Popovic, “How Dengue, a Deadly Mosquito-Borne Disease, Could Spread in a Warming World,” The New York Times, June 20, 2019. 5. Youjin Low, “Temperatures in Singapore could hit 40°C as early as 2045 Scientists,” TODAY, July 4, 2019. Seeking Sustainability

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CHAPTER FOCUS Each of the book’s chapters cover a unique area in sustainable corporate action relevant to professionals of differing disciplines. The scope of each chapter may be summarized as follows:

Chapter 1: Designing for Sustainability Architecture, Energy and Utilities Management

Chapter 2: A Hospital in a Garden Landscaping, Facilities Management, Horticulture, Biodiversity Replacement

Chapter 3: From Garden to Table

Food Service, Health Promotion, Urban Farming

Chapter 4: Building a Green Culture from Within Green Culture Building, Waste Management, Community Outreach

Chapter 5: Joining Hands for Sustainability Partnerships

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PREFACE


From Experiment to Experience Early experiments at Alexandra Hospital gave invaluable insights into how a hospital could go beyond being a place the sick go to for treatment. These early breakthroughs in landscaping and environmental stewardship helped lay the foundation for sustainable operations at Khoo Teck Puat hospital.

A Tumultuous Beginning The British Military Hospital of the colonial era would become Alexandra Hospital in the early post-independence period. Despite many early successes, patient satisfaction had fallen to unprecedented levels by the late 90’s. The institution was in need of an overhaul.

1938

The British Military Hospital was opened, spanning three stories with a capacity to house 356 beds.

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1971

The British Military Hospital was converted to a civilian hospital and renamed Alexandra Hospital.


1999

A survey showed that 39% of patients would not recommend the hospital despite its low fees. Patient satisfaction was at an all-time low of 69%. Due to low bed occupancy, manpower costs per patient were the highest among all government hospitals.

2000

Alexandra Hospital was officially placed under the National Healthcare Group on 1 October 2000 as part of the public healthcare restructuring program, setting in motion the transformation of the hospital.

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INTO UNCHARTED WATERS The restructuring called for the formation of a new management team to take the lead in the transformation of the hospital. The journey began with simple steps— from visualizing, simplifying and prioritizing— to radical strategies that challenged the norms.

Early 2000s Uncertainties set in with the hospital hemorrhaging money every month. Nearly half of the staff left the service. While many retired, others left due to resistance to change. Against this backdrop, the team led by then-CEO Mr Liak Teng Lit was determined to revitalize the hospital’s facilities and culture. The hospital grounds were in need of rejuvenation. The scale of the project posed a great challenge but also represented a grand opportunity.

“Doing more of the same is not a viable option. The team needs to chart new paths where none currently exist.”

While some expanses of grass provided the compound with shades of green, the surviving trees were few and far between.

Mr Liak Teng Lit, Then–CEO of Alexandra Hospital

Bare patches of sand and soil gave the impression of a grounds still undergoing construction. As a result, the waning floral life was not conducive to attracting the fauna needed for a healthy and vibrant ecosystem.

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A HOSPITAL IN A GARDEN: THE GERMINATION OF AN IDEA The team held the conviction that the hospital could be more than just a building for medical treatments. They strived to make it a healing environment as well, one that could positively stimulate the senses of sight, scent, sound, and touch to facilitate recuperation. Recent research had further affirmed the therapeutic benefits that greenery could have on patients, encouraging the team to pursue their vision of building a “hospital in a garden” that could

achieve operational sustainability and patient experience through carefully planned landscaping. Despite the tight budget that limited their ability to engage landscape consultants, the team found help in retired staff and volunteers with expertise and skills in the area. With their guidance, the team learnt quickly. The close collaboration built a strong bond between them, with some volunteers still maintaining close ties to this day.

The vision was not to create a hospital with gardens, but a hospital in a garden, such that the living ecosystem would be inseparable from one’s experience of the hospital. The grand scale of the hospital compound, stretching 13 hectares, presented the team with a largely clean canvas upon which to paint this landscape of green. The hoarding around the hospital’s construction was an important platform for us to “speak” to the community. The symmetrical phrase “a garden in a hospital, a hospital in a garden” articulated to the public our promise to build them a hospital set within a green healing space. Children of different staff groups doubled as models. Featured on the site’s hoarding as different healthcare professionals, the children were metaphors for the future of healthcare. This melange of our hopes for the future–of a greener future in healthcare and the future aspirations of our children–was carefully curated to evoke the enthusiasm of our community to join hands with us in the years to come.

Above: The site’s hoarding during the construction phase bore messages to the public articulating our promise to provide the community with a hospital set within a green healing space.

Further developing this idea of synthesizing the natural landscape with the hospital, a mandarin pun that plays on the phonetic similarities between the characters for ‘hospital’ (yuàn) and ‘garden’ (yuán) succinctly describes the team’s aspiration to harmonize the two seamlessly. The Mandarin translation was contributed by Ms Joanne Tan Siew Choon, inspired by the English original.

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CREATING A POSITIVE FIRST IMPRESSION Humans are known to make snap judgements about each other based on initial impressions. We also form quick opinions of places based on sensory cues. The late Minister Mentor Lee Kuan Yew focused on creating a sense of arrival for visitors to Singapore, calling our “airport and the pleasant 20-minute drive into the city… an excellent introduction to Singapore” and “the best… investment we ever made.”6 One of the first places to undergo a garden transformation was the entrance driveway. The area was given priority because it was the first sight visitors would see on arrival. A positive first impression has the potential to influence subsequent interactions with the hospital’s staff and on the overall patient experience. Flowering Cannas along the entrance driveway gave visitors a positive impression.

Construction of Garden Paths and Shortcuts In a sprawling compound where facilities are spread over a distance, commuting between buildings could be a chore for both patients and staff. The nurturing of gardens created the opportunity to pave garden paths that could crisscross each other to form a network of shortcuts, improving accessibility.

BEFORE

A garden path was also created to link the bus stop to the main building, greatly conveniencing patients arriving by public transport. These paths were embellished with shrubbery to create a lush landscape that would welcome patients. With this, a positive impression awaited all patients and visitors arriving to the hospital, regardless of their mode of transport.

AFTER

6. Kuan Yew Lee, The Singapore Story: Memoirs of Lee Kuan Yew (Singapore: Marshall Cavendish Editions, 2015). 10


BEYOND APPEARANCES While at first glance the hospital’s landscaping project may seem to be largely aesthetic, its actual impact took root deep in the organization’s core. Staff morale was boosted as they joined hands to nurture barren plots into gardens. In many areas, landscaping proved to be an elegant and economical solution to various operational challenges such as pest issues.

Fostering Cohesion and Ownership Getting staff to contribute to the garden transformation opened their minds to the other changes that were to come. The shared vision of a garden hospital also helped build closer collaboration among teams, and boosted staff morale in the face of corporate change. Staff who participated in gardening were encouraged to place their names on their plots as a way to foster a sense of ownership and pride.

Staff adopted different plots of the garden and committed themselves to maintaining them. This helped to foster a sense of ownership in the greening project.

Then-CEO Mr Liak Teng Lit leading staff in a planting session. The fact that members of the management walked the talk emphasized the organization’s determination in the rejuvenation.

“The garden became the proverbial doormat – the change in mindset started from the openness to the garden concept and crept into the hospital culture.” 7

7. Alexandra Health System, The Little Hospital That Could – The Transformation Story of Alexandra Hospital (Singapore: Alexandra Health System, 2017). Seeking Sustainability

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PAST EXPERIMENTS THAT TRANSLATED TO THE PRESENT Concurrent to the team’s efforts in ameliorating quality on the medical front, the team began its exploration of using landscaping to achieve operational sustainability and environmental conservation. In many cases, these two goals were met simultaneously, allowing the hospital

to grow from strength to strength. Many of these early experiments affirmed our belief in the value of sustainable action and provided us with the experience to implement more refined solutions after our move to Khoo Teck Puat Hospital.

Sustainability Costs

Operational

Environmental

Manpower

Conservation Impact Reduction

Plant Selection for Sustainable Gardens The tight landscaping budget meant that manpower dedicated to the gardens’ upkeep was limited. For ease of maintenance, only hardy plants were used for the gardens. The conventional approach towards manicured gardens with exotic rarities was shunned in preference for robust, easy-to-maintain gardens. The roster of plants was comprised mainly of indigenous species of the

BEFORE

The transformation of the area around the Admin Block was achieved with simple landscaping using commonly available plants.

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AFTER

region, eliminating the problems that imported plants would be prone to in an unfamiliar environment. This alleviated potential operational costs in the form of plant replacement and related labor costs. The landscaping blueprint of KTPH built upon the success of this principle of using hardy indigenous plants, going even further to include biodiversity replacement as a key goal.


The Butterfly Trail: Building Biodiversity & Community Concurrent to the green transformation of the hospital, the team sought to further biodiversity by nurturing other natural life. Butterflies were a natural choice to complement the emerging gardens. They are instrumental to the success of any garden as they help plants to flower as they flutter from one to the other. Mr Khew Sin Khoon, Mr Gan Cheong Weei and Mr Simon Chan, butterfly enthusiasts who visited our gardens regularly, imparted to the team the “ABCs” of nurturing a butterfly population. “Attracting” butterflies by growing the right host plants, providing spaces for “Breeding”, and “Covering” the butterflies from the elements. With their advice, plants were specifically chosen to attract certain species of butterflies.

A view of the completed Butterfly Trail. Mrs Rosalind Tan, our chief gardener, went the extra mile by breeding caterpillars in her own home before releasing the resulting pupae and butterflies back into the trail.

By 2002, the butterfly trail was home to over 100 different indigenous and threatened species of butterflies, a remarkable achievement considering only around 320 species have ever been spotted in Singapore. The popularity of the butterfly trail among visitors was an epiphany for the team. Building biodiversity did not only yield benefits for the hospital’s occupants, but drew the public to the grounds for leisure as well. The potential for a hospital to engage the public to contribute to its sustainability efforts became a key consideration in the design of KTPH, which is today home to an even wider range of natural life.

Sheltered information boards with images, scientific and common names of the species of butterflies that came to inhabit the butterfly trail.

Construction of the Butterfly Trail in progress. Nectaring plants, like the Pagoda Flower, and host plants, like the Weeping Willow, served to attract butterflies from the surrounding catchment areas.

The gardens in Alexandra Hospital attracted the Common Birdwing, one of the largest species of rare and endangered butterflies in Singapore. The accessibility of the trail made it popular among the photography community. Groups such as ButterflyCircle regularly planned outings to capture rare species in pictures.

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Growing Food Sustainably Building on a series of horticultural successes, the team decided to experiment with cultivating something edible to maximize the utilization of the land. Their first success came in the form of a banana plantation based on a zeroexit to minimal waste policy. Horticultural waste such as leaves and dry grass from the premises were used to make compost and improve the nutrient composition of the soil. It also helped reduce the cost of waste disposal. Composted chicken manure from local farms provided organic fertilizer to the plantation of over 30 species of banana plants, giving the hospital a cost-effective supply of the nutritious fruit.

“Chief Gardener� Mrs Rosalind Tan conducted tours of AH gardens regularly, seen here sharing her experience on composting with gardening enthusiasts.

This foray into in-house subsistence farming proved to be especially fruitful. The experience gained in operationalizing a food supply nourished by sustainable fertilizers inspired the team to continue farming at KTPH. The challenge would be to bring the traditionally rural practice of farming into the suburban heartlands, where large expanses of land are a luxury.

Rosalind helps Chef Han Boon Kwang harvest bananas that would be served to the patients.

The banana plantation maximized the use of vacant land to grow edible fruits to serve our patients and staff. 14


Medicinal Plant Garden With the support of many green and nature enthusiasts such as the Gardening Society of Singapore, Singapore Nature Society and National Parks Board, close to 100 different species of medicinal plants were planted and each with identification of their medicinal properties. This was made possible by the generous sponsorship of Eu Yan Sang International, an established Traditional Chinese Medicine company in Singapore. The book “Plants that Heal, Thrill and Kill” published by the local botanist Dr Wee Yeow Chin, was used as a template to organize the garden. The book was officially launched at the garden.

An Oasis in the Gardens In Singapore, flood-prone areas are vulnerable to becoming mosquito breeding sites. By turning these areas into a marshland and eco-pond, two needs were filled with one deed. A more biodiverse ecosystem was created, including the mosquito’s natural predators. The dragonflies and fishes that were introduced helped to stem the breeding of mosquitoes, in turn reducing the risk of mosquito-borne diseases for the patients. This introduction of a water body imbued the gardens with a calming ambience that patients and visitors enjoyed. It was this experience that influenced the decision to build KTPH in close proximity to Yishun Pond. The eco-pond under construction.

Water from surrounding drains and roof gutters were diverted to turn a flood-prone valley into a calming oasis. Seeking Sustainability

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The Fragrance Garden Sight, scent, sound, and touch are the elements in Nature that stimulate one’s senses and promote recovery. To engage the sense of Scent, the Fragrance Garden was created to curate the various aromas offered by a multitude of plants. All who passed this theme garden were treated to a bouquet of calming fragrances not usually associated with hospitals. The Fragrance Garden enriched the patients’ experience on scent, and acquainted visitors with some common fragrant plants. This inspired the inclusion of fragrant flowers all over KTPH, which serve the added function of attracting butterflies.

The arch at the entrance of the Fragrance Garden.

Ylang-ylang was one of the main features of the garden. Essential oil extracted from the plant is commonly used in aromatherapy.

Giving Old Spaces New Purpose BEFORE Previously under-utilized spaces were beautified and assigned a function fitting their form. Barren grass patches were rejuvenated and repurposed as walking paths for patients’ rehabilitation. The lush greenery helped to turn a chore into leisure. This influenced us to have garden trails close to the wards at KTPH. This ease of access, even above ground level, allows patients to stroll through nature for their physical rehabilitation.

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AFTER


A CHALLENGE FROM THE MINISTER OF HEALTH 2004 The Team Plans its Move to the North “I posed the challenge to the AH rebuilding team: build a hospital… designed with patients unambiguously at the centre of the focus, with technology fully exploited for the benefit and convenience of patients…. It will be a hassle-free hospital.”

Mr Khaw Boon Wan, Former Minister for Health, during the Parliamentary Debate on 17 March 2004

Technology

Wisdom

Love Science Seeking Sustainability

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A VISION OF HEALTHROPOLIS At the early planning stages, the management team had aimed to build more than just a healthcare facility that treated disease in a reactive manner. They envisioned building a Healthropolis that would educate and encourage the community and internal workforce to be healthy and take a preventive approach to disease. A cornerstone in this vision was ensuring that the hospital could care for its community as well as the environment.

HEALTHY COMMUNITY

In addition, a garden hospital could attract nearby residents to visit for leisure, opening a channel to engage them in health education and influencing them to make healthier lifestyle choices. The hope was that a healthy community would translate into lesser patients being admitted to the hospital. In the longer term, this would reduce reliance on healthcare services.

SUSTAINABLE ENVIRONMENT

A VISION OF HEALTHROPOLIS

HEALTHY WORKFORCE

To achieve this, the planning team relied on six design principles:

Patient-Centric

• Ease of Wayfinding • Hassle-Free • Intuitive Clustering • Safety

Hospitable Touches • Neighborly • Warm colors • Welcoming

Technology Enabled • Digitalization • Robotics • Sensors

Scalable Design • Adaptability • Ease of Conversion

Healing Environment • For the Senses • Nature • Restful

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Resource Efficient

• Energy & Water • Supplies • Sustainable Procurement • Wireless


CONSIDERATIONS While bearing in mind the design principles, there were several considerations that the team had to take into account when planning the hospital.

Tropical Heat Operating a hospital in the equatorial tropics is especially energy-consumptive, with day-time temperatures soaring to an average of 33°C. Researchers have suggested that temperatures are set to increase to an average of 40°C by 2045.8 Furthermore, the urban heat island effect causes clustered concrete buildings to trap and radiate heat. Without vegetation and evaporation, such urbanized areas experience considerably warmer temperatures than their surroundings.

The Environmental Footprint of Hospitals The round-the-clock operations of hospitals and the need to precisely maintain various environmental parameters necessitate the expenditure of large amounts of energy and water. On the clinical front, the use of sophisticated equipment and devices for medical procedures are often energy-intensive, while the storage of pharmaceutics at specifically controlled temperatures to ensure their efficacy compounds this. In the areas of facility management, the need to maintain air quality, temperature and hygiene also account for high cost in utilities.

“We are living in a moment in which the twin crises of public health and the environment are merging, the confluence of the two magnifying the destructive power of each.” 9

Finally, if the hospital was to succeed in repeating its success in creating a hospital set in nature, a water-efficient system of irrigation would be required.

8. Youjin Low, “Temperatures in Singapore could hit 40°C as early as 2045 Scientists,” TODAY, July 4, 2019. 9. Health Care Without Harm, “A Comprehensive Environmental Health Agenda for Hospitals and Health Systems Around the World,” accessed August 12, 2019, http://greenhospitals.net/wp-content/uploads/2011/10/Global-Green-and-Healthy-Hospitals-Agenda.pdf. Seeking Sustainability

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BUILDING FOR OUR COMMUNITY Setting our Sights on the Site In February 2004, after careful consideration of several site options offered, the team settled on the one at Yishun for its location beside Yishun Pond. In the decades before, this water body had served as a water catchment area with a utilitarian bareness. The team had perceived great potential in incorporating the pond to create a healthcare oasis set in an urban landscape.

Yishun Pond in 2005.

Getting to Know Our Neighbors Aiming to be a patient-centric hospital that harmonizes with its surrounding community, the hospital organized numerous dialogue sessions with grassroots organizations and the residents of the North. Simultaneously, suggestions began coming in from various avenues. This was the first time a health institution involved the public so intimately in its conception. Invaluable insights from all potential stakeholders– patients, policymakers, the young and the elderly– aided the team in their planning of the hospital.

Another key consideration was its proximity to essential amenities. Nestled in the Northern heartland, the hospital would be accessible to all its new neighbors. Being located a short distance from the train station, it remained convenient yet detached from the hustle and bustle of rush hour.

“The feedback from the public has given us a totally different perspective and will certainly help us design a hospital that is truly for the patients.” Mr Liak Teng Lit Then-CEO of Alexandra Hospital Far-left and Left: The team engaged the residents of the North through numerous dialogue and feedback sessions, inviting them to share their hopes and concerns for the hospital.

Far-left: A workgroup at Alexandra Hospital carefully studied the challenges faced by nonambulatory patients with the aim of optimizing accessibility at the new hospital. Left: Gathered around a model display of KTPH’s proposed design, members of a walking club from the neighborhood imagine the future.

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Design Competition

Design Process

A multi-phase design competition was held to field the best designs from the industry. We challenged the architects to create a hospital with the following criteria: 1) The hospital has to integrate with Yishun Pond; 2) The building must be energy efficient and sustainable; 3) The design must blend in with the neighborhood, complementing the community; 4) Create a “green belt” joining Yishun Town Garden to Yishun Park, using the hospital and the Pond as key linkages. 5) The walking distance between main lobby and various service points should follow the “10-20-50 rule”: the drop-off point must be within 10m of the emergency department, 20m of the specialist clinics, and 50m of the wards; 6) Wayfinding should be intuitive and within a line of sight. It should be stress-free and not raise the blood pressure of our visitors.

Phase 1 22 proposals received. 7 selected for next phase.

Phase 2A 5 proposals received. 4 selected for next phase.

Phase 2B Tender evaluation to select the winning architectural design.

Input collected from the community was shared with the finalists of the competition to help them in fine-tuning their design before the final evaluation. In April 2006, after numerous rounds of evaluation, the design submitted by CPG Consultants and Hillier Worldwide Architecture was selected.

An illustrative drawing from Ecopuncture: Transforming Architecture and Urbanism in Asia, Nirmal Kishnani, 2019 Left: The late Mr S R Nathan, President of Singapore at the time, looks over a model of the hospital’s proposed design.

Right: The evaluation committee was comprised of subject matter experts from various organizations, including Mr Tony Tan, former Chief Architect of the Housing and Development Board. Far-right: Members of the evaluation committee pore over the proposals. From left: Then-HOD of Anaesthesia A/Prof Koh Kwong Fah, Mr Yip Kim Seng (PM Link), then-CEO Mr Liak Teng Lit, Dean of NUS School of Architecture Prof Heng Chye Kiang, and then-Head and Consultant of General Surgery A/Prof Kenneth Mak. Seeking Sustainability

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The Fruition of their Suggestions By the time the team settled on the hospital’s design, some 600 individual pieces of input had been received from the public. Exhibitions of the proposed designs held at Yishun Polyclinic and Alexandra Hospital served as a vital channel for feedback collection and helps to keep the public informed of the progress of the project. Many design decisions were either inspired or further enforced by the suggestions made by our residents through various channels. Many of these suggestions came to the team through letters. Some of their suggestions are visible in the hospital’s premises today.

“It is important for patients to have a peaceful time and space to move around safely. A garden for patients to walk and rest and read and enjoy the days while in hospital will be good.” – Mr Amos Lum

“There should be a free shuttle bus service

“A foodcourt facing the pond with a glass

from Yishun MRT to the new hospital.“

façade and waterfalls with beautiful fishes.”

– Mr Edward Tan

– Mr Andy Shafri

“Building this hospital was about piecing together all the hopes, dreams, and aspirations of every individual involved in the planning process, from the engineers and architects, to the staff, to the patients and residents in the area.” Mr Donald Wai Director, Hospital Planning 22


THE VISION FOR KTPH As we designed the hospital, we had a vision of a hospital for our patients, community, environment and staff: For our Patients As a hospital, our patients remain our priority. Services were designed and clustered with patients in mind, taking into account the demographic specificities of our neighborhoods. Wayfinding was designed for intuitive and stress-free navigation. Additionally, a lush and green landscape can contribute to the wellbeing of patients, creating a healing environment. For the Community Community outreach is an important element in the holistic delivery of healthcare, as inculcating habits towards good health in the public can reduce the inflow of patients into the healthcare system. Attracting the community to spend time in our premises allows us to engage them in health and environmental advocacy. The hospital was made to be open and accessible to the housing estates in the neighborhood, acting as both a destination and a transiting point. Placemaking strategies were implemented to design a hospital that the public would visit even in good health. For the Environment We believe that healthcare can be delivered with minimal impact to the environment. Energy and resource efficiency guide the design and management of the building and its facilities. A green culture within the hospital, built around the 4Rs of Refuse, Reduce, Reuse and Recycle, will progressively diffuse into the environment. Landscaping is supported by a water efficient design. Beyond setting the hospital in a garden, biodiversity replacement efforts give back to the environment and build a ecosystem that all can enjoy. For our Staff A workplace that encourages healthy living among our people. Gardens and greenery to improve staff wellbeing, morale and productivity. A variety of activities to make the hospital a one-stop space for recreation and exercise, achieving work-life integration.

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CONCLUSION From these early experiments, the team gained valuable experience that helped in crucial design decisions at our new grounds. Yet, as we planned for our move from our old, familiar space to a new one, we asked ourselves: what can we give to the present and future generations? Mindful of the rapidly aging population of Singapore, we honed our clinical abilities to effectively treat the pathologies of our senior citizens. For our future generations, encouraging healthy living to keep them out of the hospitals was our key goal. In addition, we believed that our drive towards sustainable healthcare would allow us to pass on to them a cleaner future in the years to come. We hoped that our active presence in the community would inspire more Singaporeans to take responsibility for their health and the environment.

前人种树 后人乘凉

This key motivation for our comprehensive sustainability efforts are thus embodied in a Chinese proverb: when one generation plants the trees, the next generation enjoys the shade.

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CHAPTER 1: Designing for Sustainability



INTRODUCTION By nature of their round-the-clock operations, hospitals are inevitably energy-consumptive facilities. Being located in the equatorial tropics, the hospital requires energy for dehumidification and cooling purposes. In the healthcare setting, uninterrupted temperature control is needed in maintaining the efficacy of medications and proper function of clinical equipment. In the warm climate of Singapore, this results in massive energy expenditure for temperature control. The architects, planners and engineers from CPG Consultants based their design on the six guiding principles: • Patient-centric • Healing environment • Resource efficient • Technology enabled • Hospitable touches • Scalable design

They laid a foundation on which a sustainable hospital could be built, improving resource efficiency by minimizing electrical consumption in areas such as cooling and lighting. While we have endeavored to minimize our carbon footprint for over a decade, we recognize that more must be done. Recent studies have shown that the threat posed by climate change is fast approaching. In 2019, Prime Minister Lee Hsien Loong recognized climate change as “one of the gravest challenges facing humankind” and a matter of “life and death” for our island nation.1 This chapter will explore the sustainability strategies in the architectural design and facilities management foundations of the hospital that have helped to minimize the hospital’s carbon footprint. It will then dive into the water and energy conservation measures we have taken as an organization. Concluding with the placemaking strategies of the hospital, we will explore the building design touches that have made us a community hub for building health and sustainability awareness in the population.

“We must make this effort. Otherwise, one day, our children and grandchildren will be ashamed of what our generation did not do.” Prime Minister Lee Hsien Loong National Day Rally 2019

1. Matthew Mohan, “NDR 2019: Climate change one of the ‘gravest challenges facing mankind’, impact on Singapore to worsen, says PM Lee,” Channel NewsAsia, August 18, 2019. Designing for Sustainability

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MODERNIZING TRADITIONAL DESIGNS THAT WORK The team was inspired by the resourcefulness and congeniality of old Singapore. Thus they sought to modernize the concept of the kampong (village in Malay), the building block of pre-industrial Singaporean society. Today, the word evokes memories of traditional villages comprising huts built from attap palms. Despite their primitive construction materials, these attap huts espoused frugal ingenuity in their design. Built on stilts to reduce the heat radiating from the Earth, their high ceilings and large doorways facilitated natural ventilation. The architects were guided to reproduce this effect to

Right: A typical caricature of kampong housing in pre-independence Singapore drawn by Malaysian cartoonist Lat. Then-CEO Mr Liak Teng Lit advised the architects to take cues from the structure’s efficient yet simple design.

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aid in reducing temperatures around the hospital. Many corridors are deliberately not cooled by air conditioning because of this. The kampong model also promoted a strong sense of neighborliness through its open-door mindset. Indeed, most houses had only curtains hanging over the doorway. Previous experiences at Alexandra Hospital, where various interest groups frequently visited and contributed their expertise, had shown such a spirit of openness to be mutually beneficial. We wanted to bring this spirit of openness to KTPH.


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FITTING IN Thoughtfully designed, the team of architects, planners and engineers wanted KTPH to relate to the scale of the surrounding built environment, constructed three decades ago. CPG Consultants designed a contemporary looking hospital, keeping in mind that residents had articulated their fears that a futuristic facility would make their homes look dated. Fragmenting the facility into three freestanding blocks opened up spaces for green inputs which would not have been possible with a monolithic structure.

When We First Landed

EAST

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WEST

2011

A Place for the Community Inspired by the town squares of traditional societies around the world, the management team had asked the architects to create a hospital that would extend its welcoming arms to the community. Designed as a V-shaped configuration of blocks delineating a central court, the hospital opens to the North— figuratively to the neighboring residents, and literally to the breezes that first skim over Yishun pond. This design decision was solidified by practical considerations: the angled blocks also serve to reduce heat gain from solar radiation. From the opposite end of the pond, the hospital evokes the image of a hill standing over a lagoon, a traditional eastern motif. Designing for Sustainability

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How can we control our carbon footprint despite an ever-increasing workload?

DESIGNING SOLUTIONS BEFORE ENGINEERING RECTIFICATIONS A key lesson learnt from operating the old Alexandra Hospital was the importance of laying the right foundation in terms of facilities and infrastructure. Having inherited a hospital built in the colonial era, the team experienced firsthand the dilemma where conservative renovation was insufficient, and complete reconstruction unfeasible. Thus the team endeavored from the start to build features into the facility that would reduce consumption of energy and water, thus minimizing the need for retrospective engineering or construction. By pre-emptively designing for sustainability instead of reactively engineering fixes, the hospital has successfully reduced its utilities consumption. Through the strategic orientation of the building and thoughtful architecture and engineering of the structure, the need for artificial illumination and cooling are significantly reduced. The architects from CPG Consultants implemented various passive design elements to achieve these ends. In Singapore’s tropical climate, the need to reduce reliance and expenditure on electrical air conditioning was of particular concern. By first designing passive cooling elements into the building’s architecture, the demand and

environmental impact of air conditioning can be reduced at the source. Drawing inspiration from the high ceilings and large doorways of kampongs, the architects designed passageways with an open structure, increasing wind flow and reducing the need for artificial cooling.

Going with the Flow While private wards are air conditioned, the subsidized wards are naturally ventilated. For this reason, Tower B, housing the subsidized wards, is located closest to the pond, where wind flow remains unobstructed. Various scientific methods, including wind tunnel testing, empowered the architects to orientate the hospital’s three towers strategically to maximize wind flow. Singapore typically experiences two monsoon seasons in a year. Capitalizing on the data provided by scientific research, the architects configured the hospital’s blocks to reduce energy consumed for cooling.

By incorporating natural ventilation and illumination,

8.6 million kWh

can be saved annually, enough to power the air conditioning of 6718 households for an entire year*.

* In 2017, households consumed an average 444.5 kwh of electricity a month. Source: Energy Market Authority. A 2017 NEA survey found that air conditioners accounted for 24% of this consumption. 32

Seeking Sustainability


The orientation of the hospital’s towers facilitate the natural passage of wind through its walls, into the subsidized wards.

N Northeast Monsoon mid-November to early March

Southwest Monsoon June to September Image Source: Google Earth Designing for Sustainability

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CLIMATE RESPONSIVE FAÇADE SYSTEM The architects from CPG Consultants saw the possibility of a passive design that could react to the sun’s movements throughout the day and the wind’s movement throughout the year. The façade system they designed sought to reduce the heat radiated by the sun’s rays while maximizing natural illumination from sunlight. As such, each face of the building has a slightly different configuration depending on the cardinal direction that it faces. The design was the fruition of a long process that involved testing and verification through scientific methods.

Computational Fluid Dynamics, Solar Modeling and Wind Tunnel Testing were conducted in collaboration with the National University of Singapore (NUS) School of Design and Environment to optimize the building’s design. The system consists of three main components: shading and glazing elements that minimize solar heat penetration while increasing natural lighting, and wing walls which channel wind into the building.

The combined effect of these elements of the façade system is a reduction in the number of fans required by

35%

Shading In the subsidized wards, sunshades over the windows protect patients from the direct glare of sunlight and also act as light shelves that re-direct the light towards the ceiling to enhance the brightness of the wards and save on the use of energy. Operable, modular jalousies are used to facilitate enhanced air flow depending on external climatic factors. Jalousies are angled at 45º for the optimum air flow and least rain penetration. Angling the windows also reduces the rate of dust accumulation, reducing the frequency of dusting and freeing up housekeeping staff to perform more productive tasks. Fixed louvers called ‘monsoon louvers’ are integrated into the façade at patients’ bed height to provide minimum air exchange even during heavy downpour.

Glazing Glazing allows light in while deflecting heat. An optimal window to wall ratio compounds this effect, resulting in a 30% reduction in electrical lighting needs.

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Wing Walls Wing walls, comprising of aluminum fins along the building’s façade, are designed to channel the prevailing winds into the building by increasing the wind pressure buildup on the exterior. Wind tunnel tests conducted at the National University of Singapore (NUS) found that these fins enhanced air flow by up to 20-30%.

Putting the Design to the Test The architectural design process was aided by various consultants, including research expertise led by A/Prof Lee Siew Eang from the NUS School of Design and Environment.

In postoccupancy measurements, the microclimate of the hospital’s central courtyard was some 2ºC cooler than spaces just outside the hospital.2

Solar modeling provided insights on how best to angle the hospital’s blocks to minimize heat radiation.

Computational Fluid Dynamics was used to visualize the passage of wind within the premises and its surrounding vicinity.

A detailed model of the hospital’s structure was placed in a wind tunnel to understand the movement of wind throughout the internal structure.

Sensors placed within the model allowed the researchers to acquire precise data on wind flow within the building.

2. Nirmal Kishnani, “Singapore’s Khoo Teck Puat Hospital: Biophilic Design in Action,” Last Modified September 8, 2017, https://blog. interface.com/khoo-teck-puat-hospital-singapore-biophilic-design/. 36

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RECHANNELING COOL AIR Cool exhaust air from some of Tower B’s air conditioned areas is thrown out strategically into the hospital’s central courtyard. This thoughtful design turns what would otherwise be considered waste into a useful resource, allowing additional utility to be enjoyed from the same electrical expenditure.

TOWER

C

TOWER

B

Courtyard

Camouflaged inconspicuously behind the foliage of the Terraced Garden on Level 4 is a row of jet nozzle diffusers.

These jet nozzle diffusers throw out cool air from the air conditioning system strategically into the central courtyard of the hospital. Instead of allowing the air to be exhausted randomly into the atmosphere, this allows it to contribute to cooling the premises.

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NATURAL LIGHTING Daylighting is a passive strategy that not only provides illumination at no cost, but also delivered in the form that most people prefer. Furthermore, an abundance of natural light also brings numerous benefits to the facility’s occupants. Several studies have shown that an abundance of natural light can positively impact outcomes in the healthcare setting by

regulating sleep cycles and the circadian system, as well as enabling critical chemical reactions within the body.3 In addition to this, access to daylight has been linked with increased workplace satisfaction as well as improved performance in visual tasks. It benefits staff and may contribute towards a decreased length of stay for patients.

Having sufficient natural light in the ward can positively impact patient outcomes through the regulation of sleep cycles and facilitating critical chemical reactions within the body.

70%

of the ward floor area is naturally lit by daylight

3. Anjali Joseph, Impact of Light on Outcomes in Healthcare Settings, The Center for Health Design, 2006. 38

Seeking Sustainability


60%

of the hospital’s gross floor area enjoys natural light

This skylight at the main lobby creatively balances natural light with solar power generation. The spaces between the solar panels allow light to shine through while a glass layer keeps rainwater out. In addition, the bougainvillea that were planted on this roof help to cool the roof surface and surrounding air through evapotranspiration.

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The positive effects of daylight include a reduction in pain and depression among patients. Dementia patients were also observed to be less agitated.4

Above: The combination of natural light and warm colors help to create a soothing and welcoming ambience for patients at the Dental Clinic. Below: The abundance of light augments the visibility in the ward, enabling medical staff to make accurate examinations and evaluation of patients’ physical conditions, particularly where wounds are concerned.

4. Anjali Joseph, Impact of Light on Outcomes in Healthcare Settings, The Center for Health Design, 2006. 40

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The oval-shaped skylights that line the Skylight Atrium Garden of the basement floor contribute to the lighting and visibility of the carpark that lies beneath. Carparks are typically dark, utilitarian and industrial spaces. The skylights were a deliberate decision as we wanted our driving visitors to disembark at a brightly lit carpark, making a good first impression while reducing electrical consumption.

Skylights are an excellent source of natural light and admit more than three times as much light as a vertical window of equal size. They make a major contribution to energy efficiency and comfort.5

5. A K Athienitis and M Santamouris, Thermal Analysis and Design of Passive Solar Buildings (New York: Routledge, 2002.) Designing for Sustainability

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SOLAR ENERGY At Alexandra Hospital, solar energy was harnessed to power garden lighting and supplement the lighting needs of the carpark. This small project served as an early experiment to ascertain the feasibility of adopting photovoltaic panels on a grander scale. In the planning phases of KTPH, the team knew that they wanted to reduce the hospital’s carbon footprint by harnessing the sun’s energy on an even greater scale. However, as photovoltaic technology was still in its infancy, the cost of implementation was restrictively high. Fortunately, under the Solar Capability Scheme, KTPH managed to tap on funds provided by the Economic Development Board to offset between 30-40% of the total capital cost.

Solar panels lining the roof of this shelter in Alexandra Hospital powered the lamp post beside it in the night.

1,276 m2 of solar panels harness energy from the sun on-site.

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AN EARLY TESTBED As an early adopter of solar panels in Singapore at the time, the hospital participated in the Clean Energy Research and Testbedding Programme to investigate the characteristics and energy-generating efficiency of three types of solar panels. Thus Monocrystalline, Polycrystalline and Thin Film solar panels can be found in different areas of the hospital, such as the rooftop of our Specialist Outpatient Clinic (SOC) Tower and the ceiling of our lobby driveway.

Types of Solar Panels Monocrystalline

Most Efficient

Polycrystalline

Thin Film

Least Efficient

90 MWh to 115 MWh of power is generated by the hospital’s photovoltaic system annually.

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21,000 L

of the hot water used daily are supplied by solar thermal systems that include 61 sets of solar evacuated tubes along with 27 solar flat bed panels.

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284 MWh less electrical power is needed annually as a result of solar hot water systems and heat pumps.


MOVING FORWARD Expansion of Solar Photovoltaic System The solar photovoltaic generation capacity of the hospital will be augmented by the SolarNova Programme led by the Housing and Development Board (HDB) and the Economic Development Board (EDB). Under this novel leasing business model, building owners do not have to pay upfront costs for the installation of solar panels. In return for rooftop space on their buildings, these owners will be able to buy electricity produced by these panels at a discounted rate while the leasing companies who own the system bear the cost of installation as well as subsequent maintenance.

Floating Solar Panels In the near future, the hospital will generate more sustainable energy by installing floating solar panel platforms on Yishun Pond. Made possible via the HDB’s SolarNova program, the arrangement is a novel utilization of a water body, maximizing the use of land in Singapore.

These enhancements will increase the hospital’s solar power output by 128 MWh annually, the equivalent of powering 288 households* for an entire month. *In 2017, households consumed an average 444.5 kwh of electricity a month. Source: Energy Market Authority

The installation of floating solar panels on the pond’s surface is a novel exploration of space maximization possibilities in landscarce Singapore. The circle represents the proposed pilot location. Designing for Sustainability

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ENERGY EFFICIENCY Together with the architects’ energy efficient design, being environmentally conscious in facilities management is key in minimizing our carbon footprint. Building in sensors all around the hospital has helped us to expend energy only when users are around. Furthermore, in the context of a tropical country, air conditioning typically accounts for a large proportion of energy expenditure. By optimizing the hospital’s chiller system, we can reduce the environmental impact of our cooling needs.

Lighting The carpark lighting was converted to LED type in 2016. It operates on time schedules to meet operational needs.

In our carparks, LED lighting combined with skylights ensure a welcoming and safe light level for our driving visitors.

Sensors Motion sensors are installed in transient use areas like toilets, pantries and infrequently used corridors, achieving savings of 10% when these areas are not occupied. Step sensors reduce the speed of the escalators when they are not in use, reducing energy consumption by up to 30%. Energy efficient lifts with sleep mode and variable speed motor drives use 10% less energy. During operating hours, step sensors keep our escalators moving at a lower speed when not in use to save energy.

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Chiller System The chiller plant system was designed to meet the cooling load demands of the acute hospital efficiently.

The performance of the chiller is comprehensively monitored around the clock on a monitor to allow for corrective actions to be taken if required.

The variable speed drive is able to adjust the speed of the electrical motor according to the needs of the application. This reduces energy consumption and operating costs.

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IMPROVEMENTS IN INFRASTRUCTURAL ENERGY EFFICIENCY Various initiatives over the past decade have allowed the hospital to further improve its energy efficiency to reduce its environmental footprint. These reductions in consumption were the result of technological improvements combined with the conscientious commitment of our Facilities Management team in creating a greener operating environment.

Conversion of Fluorescent Tube to Light Emitting Diode (LED) Lightings At the time of the hospital’s construction, fluorescent tubes were the predominant method for industrial-scale lighting. Since then, advancements in manufacturing and technology have brought down the adoption cost of LED lights, allowing the hospital to progressively convert our lights.

Car Park 407,502 kWh saved per year

Stairwells 56,120 kWh saved per year Plant Room 10,604 kWh saved per year

Waste and Linen Chute System Waste and linen from all around the hospital are conveyed by an exhauster-powered chute to one point for disposal.

By re-calibrating the system to only work during certain periods in accordance with the cleaning staff’s work schedules, the system runs more efficiently and does not operate idly. After

Before 10h

14h

11h

13h

System Idle

System On

System Off

System On

Savings of 66,000 kWh per year

Addition of Variable Speed Drives to Mechanical Ventilation Fans By allowing the mechanical ventilation fans to run at speeds in accordance to operational needs, the hospital saves 98,024 kWh per year.

In total, these savings are equivalent to the electricity needed to power

1436 households* for an entire month.

* In 2017, households consumed an average 444.5 kwh of electricity a month. Source: Energy Market Authority 48

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The open structure of the corridors facilitate wind flow and allows ambient light to illuminate the premises. Designing for Sustainability

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ENERGY DATA ANALYTICS For organizations to set appropriate goals and take effective action on energy efficiency, it is essential to understand their baseline energy usage in detail. Analysis of energy consumption using a range of metrics allows the hospital to evaluate its energy efficiency. Collecting data on the individual infrastructural components allows for areas of concern to be isolated for troubleshooting. Working with the Solar Energy Research Institute of Singapore (SERIS), the hospital first developed an energy tracking system to gauge the efficiency of the various photovoltaic panels around its premises. This eventually expanded to include real-time electricity and water usage tracking. The system sends out a mobile text message the instant utilities consumption rises above 5% of the daily average, alerting facilities managers to the anomaly.

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Seeking Sustainability


Top-left: The energy tracking system provides an overview of the hospital’s water and energy consumption as well as solar generation. MWh

Above: The volume of solar energy harvested is expressed in basic units such as kilowatt-hour, as well as carbon emission avoidance and the offset in tree clearance. Left: The dashboard displays electrical consumption in hourly, daily and 30-day average terms.

KTPH Energy Consumption (kWh)

32,235,890

32,060,174

32,597,049

2016

2017

2018

This proactive commitment to reducing our environmental impact has kept our energy consumption stable. Between 2017 and 2018, we used 1.7% more energy due to upgrading works and new equipment. We are constantly exploring ways to review and analyze the energy consumption of individual areas. Additionally, we are overhauling our air conditioning chiller system to increase its efficiency.

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POND REJUVENATION We first adopted Yishun Pond in 2005 under the Our Waters program. During this time, we planted more than 300 trees around Yishun Pond. In 2007, the hospital partnered various public agencies in an initiative to rejuvenate the Pond into new community spaces for our patients as well as Yishun residents. Under the Active, Beautiful, Clean Waters (ABC Waters) program, a multi-agency collaboration involving the Housing and Development Board, National Parks Board, Public Utilities Board and the Khoo Teck Puat Foundation,

Yishun Pond was transformed into a community park lined with lush flora and fauna. The trans-organizational team redesigned the pond into a space that would attract nearby residents. Prior to this project, the pond functioned mainly as a water catchment reservoir and was not positioned as a recreational space for residents. The team identified the key improvements in comfort that would draw patients to the pond: ample shade from the noon heat and better lighting in the evenings.

2009

Before Rejuvenation Building under construction.

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The former goal would be attained in the elegant stroke that painted a green landscape of trees and shrubs along the length of the pond. The harsh concrete edges of the pond were softened with a gentle green gradient and aquatic plants were introduced to make the water cleaner, creating habitats for aquatic life. Local community groups and neighboring schools aided in the tree planting endeavor.

A walking trail was added, linking the park to the hospital and a nearby residential estate. The pond rejuvenation was a successful collaboration of the 3P Sectors: Public, Private, and People.

2019

After Rejuvenation After a decade of growth.

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STARTING ON A CLEAN SLATE

Above: Hospital staff joined hands with volunteers from the neighborhood to pick litter in the early stages of the pond rejuvenation, laying a clean and green foundation for what was to come. Below: The pond was a multiagency collaboration that brought together the 3P sectors of Public, Private and People. From left, thenActing CEO of PUB Rear Admiral (NS) Chew Men Leong, CEO of HDB Dr Cheong Koon Hean, thenMinister of National Development Mr Khaw Boon Wan, then-CEO of NParks, Mr Poon Hong Yuen, then-CEO of URA Mr Ng Lang, and then-CEO of Alexandra Health, Mr Liak Teng Lit.

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INTRODUCING BIODIVERSITY

Then-CEO of Alexandra Health Mr Liak Teng Lit, a key driver of the pond rejuvenation endeavor, planting young trees along the pond’s perimeter.

Fishes were introduced into the pond ecosystem, serving the function of controlling pest populations at the larval stage.

Butterflies were released to kick start the population and help in the pollination of flowering plants in the surroundings. Minister Khaw Boon Wan, Member of Parliament Dr Lim Wee Kiak, and other members of Nee Soon GRC were present to support the monumental event.

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A POND BUILT FOR THE COMMUNITY 1. Lakeside Promenade With wide steps allowing residents to sit and admire a panoramic view of the pond, this promenade is frequently used for various community gatherings around the year.

2. Medicinal Garden Inspired by the book “Plants that Heal, Thrill and Kill� by Dr Wee Yeow Chin, this garden serves as an educational space for our neighbors.

3. Timber Deck This timber deck is frequently used by joggers and walkers in the evenings for static physical conditioning exercises. Ramps ensure accessibility for the wheelchair-bound to enjoy this space as well.

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4. Flower Trail and Tree Cover This section of the Pond is planted with many species of flowering plants that support the local populations of butterflies, birds and bees. The trees that have been planted around the pond since we adopted it provide shade during the day, and a majestic scenery from the benches.


5. Marshland and Floating Wetlands The roots of the wetland plants that thrive on the engineered floating structures provide a large surface area for beneficial microbes to attach to. These roots also absorb nitrate, ammonia and phosphate from the Pond, improving water quality. They also provide a habitat for rare migratory birds, such as the BlackCrowned Night Heron. 6. Track Around Pond Besides being ideal for a leisurely stroll around the pond, the main trail around the pond measures 1km, making it easy for users to track their running or walking progress.

7. Spillway Channel Allowing excess water to flow into the sea, this channel has been aesthetically integrated with the pond using vegetation, gravel and boulders.

8. Spiral @ Yishun Lookout Tower Featuring a roof that resembles a butterfly, this lookout tower offers panoramic views of the pond. It also connects across the road to Yishun Park via an 84m overhead bridge, creating an extended and seamless park experience for neighboring residents.

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Seamless Integration between the Hospital and Yishun Pond

L1

The water features weave through the landscape courtyard at level 1 and cascade through a waterfall into the basement.

This creates the impression that water is flowing from Yishun Pond directly into the hospital’s ponds.

“Every green environment improved both self-esteem and mood; the presence of water generated greater effects.” 6

6. Kate E. Lee and Katherine A. Johnson, “40-second green roof views sustain attention: The role of micro-breaks in attention restoration,” Journal of Environmental Psychology Vol. 42 (2015). 58

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B1 Inspired by the waterfall at the Shangri-La Hotel Singapore, this cascading waterfall imbues the space with the soothing sounds of running water, giving patients and passerbys a calming space. A pair of swan statues, donated by a patient who had been moved by the space, embellish the waterfall.

The water flowing from the waterfall ends in a mangrove garden. Designing for Sustainability

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CONTRIBUTING TO THE WATER CYCLE The hospital and Yishun Pond share a symbiotic relationship. In exchange for rainwater collected on the hospital premises being channeled into the pond, the Public Utilities Board provides water back to KTPH at a discounted rate. After treatment, the water is used to supplement the hospital’s irrigation needs.

the Pond 1 From Syphonic Rainwater Drainage About 6000m3 of water is channeled from the pond for irrigation needs annually.

Yishun Pond The plants around the pond were chosen for their ability to remove excess nutrients such as phosphorous, nitrates and ammonia.

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Pump Chamber


2 From the Hospital

Syphonic Rainwater Drainage

Rainfall

Rainwater is channeled directly to the pond.

KTPH

Irrigation Network

Water Tank

Irrigation Pump

Automatic Sand Filter

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TOOLS FOR WATER EFFICIENCY A wide range of water efficient technologies have been integrated into the design of the hospital to make daily operations more sustainable. In addition, our Facilities Management team’s efforts have allowed us to keep water consumption in check.

MONITORING SYSTEMS

Sub-meters to monitor areas where the usage of water is high so that corrective action can be taken.

A fault-reporting system to sound an alert on leaks and audit water fittings regularly.

SENSORS

Sensors in the gardens cut off plant watering when it rains. Additionally, routine checking and calibration of toilet flush sensors have ensured that no unnecessary flushing occurs.

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WATER-EFFICIENT FIXTURES

A third of the water fixtures in KTPH have three ticks, the highest rating possible under the PUB Water Efficiency Labelling Scheme. This has resulted in an estimated savings of 39.8% as compared to non-rated fixtures.

RAINWATER COLLECTION

13,140m3 of rainwater, the equivalent of 5.25 Olympic-sized swimming pools, are collected on-site annually.


RESULTS Saving Potable Water Potable water is an important source of water in Singapore. Every drop of water is precious and it is essential to use it wisely. Water efficient fittings and equipment are used in the hospital to ensure the correct amount of water is used for every process. Between 2017 and 2018, we were able to reduce the consumption of potable water by 4.1% by installing more water-efficient fittings.

KTPH Potable Water Consumption m3 100,000 80,000 60,000 40,000

All these water saving measures combined have helped us to manage our water consumption. Between 2017 and 2018, total water consumption (NEWater and potable water) increased by 1.1%.

2017

2018

Composition of KTPH Water Consumption

Potable Water

NEWater is a major source of water in Singapore. The Public Utilities Board uses microfiltration, reverse osmosis and ultraviolet technologies to reclaim water. NEWater is potable and also used for industrial applications. In the hospital, NEWater is used for flushing toilets and cooling towers that form part of the central air conditioning system.

Controlling Total Water Consumption

89,798

20,000 0

Supplementing Water Needs with NEWater

93,617

35%

NEWater

65%

KTPH Total Water Consumption m3 300,000

262,933

272,844

2017

2018

150,000

0

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SCALABILITY OF DESIGN The planners and architects had specifically designed the hospital to be able to adapt to future challenges. Due to Singapore’s rapidly aging population, it had been foreseen that the demand for hospital services would increase sharply in the subsequent decades. Furthermore, the Severe Acute Respiratory Syndrome (SARS) epidemic

that had affected Singapore in 2003 had impressed upon the team the need for lockdown contingencies. Thus various spaces within the facility were built with the expectation of future conversion for clinical use.

Conveniently Convertible for Clinical Use In 2012, in response to the continued surge in the demand for subsidized beds, the decision was made to convert the rooftop garden at Tower B into an additional subsidized ward. After a mere 5 months of renovation, the new ward B106 was opened, adding another 32 bed spaces to the hospital’s capacity. This conversion of patient recreational space into clinical ward could happen at such speed as the mechanical and electrical infrastructures had been designed to be easily extended to service non-clinical spaces.

Such pre-emptive planning for future expansion not only allows for swift reconfiguration, but minimizes construction costs as well. This flexibility enables the hospital to more swiftly adapt to changing public healthcare needs reflective of demographic shifts.

Modular Segmentation of Clinics The clinics were designed in modules – 4 modules per pod with independent toilet facilities to allow for scaling of operations depending on patient load. For example, the Eye Clinic was designed with 2 subsidized and 2 private clinics. If patient load is low, only 1 clinic is utilized. When the patent load is high, 2 or 3 modules would be utilized

Subsidized

with the option of patients flowing from subsidized to private clinics. The adoption of an 8.1m x 8.1m structural grid throughout the hospital’s design contributes to this flexibility in planning a redesign.

Private

Having clinic spaces divided into equal units facilitates conversion between subsidized and private treatment areas, allowing the clinic to easily reconfigure itself to meet changing demands for services.

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Before The sky garden at the top of Tower B was conceived as a recreational space for patients of the adjacent ward B105, providing them with a space for therapeutic or rehabilitative activities.

After The rooftop garden could be converted into an entire ward within five short months of renovation because of inbuilt scalability.

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PLACEMAKING The concept of placemaking was a key part of the hospital planning process and continues to be consciously practiced in KTPH today. Placemaking refers to the observation of how people live, work and play and creating spaces for them to fulfil their needs and aspirations, thereby maximizing the shared value of public spaces. Good public spaces can promote health and well-being of people. Guided by the principles developed by Project for Public Spaces (PPS), a nonprofit organization, we built on the factors that determine successful placemaking: safety, comfort, shade, proximity to food and opportunities for social interaction. We were privileged to have Mr Fred Kent, founder of PPS, visit us to share placemaking strategies and insights which helped us design our hospital.

With an open concept, public spaces in the hospital were designed for patients, visitors, community and staff to heal and rest in comfort. Beyond the walls of clinical areas, the hospital has attracted people from the neighborhood to gather by the gardens, where quiet niches have been created for groups to have peace and privacy for reflection and interaction. The community can find spaces in and around the hospital to pursue their interests, conduct their activities and enjoy social interaction.

Comfort & Image

Access & Linkages

• Adequate Seating • Attractiveness • Cleanliness • Provision of Shade

• Connected • Walkable • Convenient

With abundant seating and resting spaces, the hospital has many quiet corners for patients and family to have peaceful moments. The calm serenity of these spaces were thoughtfully designed for important and potentially life-changing discussions to take place.

Not only are the hospital’s three towers well connected, the hospital itself is linked to nearby amenities and housing. The hospital is a short walk away from the Yishun Integrated Transport Hub, Northpoint City shopping mall, Yishun Park and the Nee Soon East Community Centre.

Source: Project for Public Spaces 66

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The remainder of this chapter will delve into each of the following elements of what makes a place “good”, and the design thinking and hospitable touches we have added to attract our neighboring community.


“It is an accepted truism that a lush, green environment makes people feel better. I have never seen people feel so welcome in a hospital environment.”

Placemaking What makes a good place?

Dr Ho Hua Chew Vice-Chairman of the Conservation Committee of the Nature Society of Singapore

Sociability

Uses & Activities

• Neighborly • Welcoming • Cooperative • Volunteerism

• Active • Fun • Real • Useful

The hospital was designed as a hub open to the nearby residents. This has successfully attracted not only transient visitors, but also committed volunteers who contribute their energies as urban farmers, lobby greeters and patient befrienders.

Yishun Pond is regularly used by walkers and joggers of the neighborhood. The wooden promenade that borders between the hospital and the pond is regularly used for mass workouts and other fun activities.

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Sociability, Uses & Activities Through careful planning, we have made our hospital a suburban oasis for our neighboring residents, attracting them to visit our gardens and public spaces. This affords us the opportunity to influence them towards healthier lifestyle choices and greener consumption habits, inculcating a sense of personal responsibility towards health and the environment. It is our hope that through our educational outreach and soft nudging efforts, we will be able to reduce the number of patients admitted to the hospital in the long run.

Right: Since the hospital’s opening, our gardens and ponds have been a popular destination for family visits. By providing the community with spots for relaxation and bonding, we also gain the opportunity for health advocacy and raising environmental awareness. This family on the right was enjoying our garden’s nascent stages in 2012. Below: Many of our regular visitors have become volunteers with us.

Above: Our main lobby periodically becomes a stage for a diverse mix of cultural performances by members of the public. This has ranged from established performers such as the Singapore Philharmonic Orchestra to our own neighboring community groups. This Taichi display (above) was put up by an interest group formed by nearby residents.

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“KTPH believes in inculcating a sense of responsibility when one is young. To this end, our pre-schoolers enjoy nurturing activities in the gardens during their formative years. This inculcates an appreciation of not only flora and fauna but of the environment as a whole.� Ms Eunice Tong Mentor Principal Little Skool-House By-The-Lake

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Accessibility to Services and Linkages to the Community Besides designing for sustainability, the team also made sure to ensure that the patient’s experience would be as calming and stress-free as possible. Hence, services are clustered to aid wayfinding as well. Nothing is more frustrating than to arrive in an unfamiliar space and be unable to locate your destination. This frustration is further aggravated if one is already feeling unwell and may cause patients’ blood pressure to elevate.

Visitors arrive to a panoramic view at the main lobby, allowing them to establish a straight line of sight to their destination. This greatly facilitates wayfinding to the three towers. The distance between one’s arrival point and destination was deliberately planned with consideration of the urgency of the visit. Thus, from the drop off point, it is a mere 10 meters to the emergency department, 50 meters to the clinics, and 100 meters to the subsidized wards.

10 0

m

Subsidized Wards

Emergency Department

Clinics

50m

10m

Drop-off Point

Distance to: Residential Blocks........................................................100m Yishun Park...................................................................160m Nee Soon East Community Centre..........................300m Northpoint City Shopping Mall.................................370m Yishun MRT and Bus Interchange.............................600m

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Right: There are no physical barriers to entering the hospital’s public spaces, allowing the community to enter our premises and affording us the opportunity to influence them towards healthy living and sustainability. Below: The three towers of the hospital are connected on the first, third and fourth levels, allowing patients and staff to conveniently make their way to their next destination without returning to the ground floor. The open-air design of these linkages also expose them to doses of greenery throughout the day, improving their mood and morale.

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A Welcome for the Senses: Comfort and Image We wanted all who stepped foot onto our premises for the first time to feel welcome, rather than intimidated by their preconceptions of what a hospital would be. Many thoughtful touches came together to positively engage the senses on the first impression. In traditional hospitals, the

Sight Flowering Cannas along the entrances greet patients and visitors on arrival in KTPH. Soothing colors were chosen to avoid evoking feelings of anxiety and worry. Occasionally, butterflies may be observed dancing in the courtyard with orange Bauhinias cascading in its background. The colorful bursts of nature add variety to a soothingly green landscape.

Scent Plant species were carefully selected for their fragrance: Pandan leaves were introduced in the ponds and streams around the hospital while Murraya were planted to line the long corridors of the hospital. The use of floral scented cleaning agents in non-clinical areas provides a change from the typically sterile scent of hospitals. Signages and our lobby greeters remind taxi drivers to switch off their engines while waiting, keeping the air clean for all to enjoy.

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sterile scent of sanitized spaces and clinically white walls, stimuli associated with sickness, may in fact exacerbate feelings of unease and anxiety. Thus the team set out to create a lush, vibrant environment that would stimulate the senses to evoke a sense of rejuvenation and positivity.


Sound The sound of water flowing from the water feature at the entry garden by the Main Lobby and the central waterfall creates a soothing and calming effect. Sounds of nature echo throughout our grounds with birds chirping and leaves rustling with the wind. Emitted by such inhabitants of our green spaces as the Oriental White-eye and Oriental Magpie Robin, these sounds enhance the sense of immersion in the natural environment.

Touch A conscious effort was made to avoid materials that may invoke an impression of artificiality or coldness, such as plastic and steel. Instead, wood and stone furniture in the public spaces complement the natural elements and impart a sense of warmth to the open environment. Plants of different textures like the Indian Borage and Rosemary were planted to trigger memories of the kampong era and its simple pleasure of discovering nature’s flora and fauna.

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Designing with Nature Interior design elements have also played an important role in creating a healing environment. KTPH deviates from the usual industrial feel of traditional hospitals that utilize concrete and steel. By liberally incorporating natural building materials to complement the rainforest aesthetic, a warm and calming environment is created for all to enjoy.

Choice of Materials

Handrails made from Balau wood were used to create a warm touch compared to the typical industrial metal handrails which give a cold and unwelcoming feeling. They also weather well.

Natural Imagery

Artistic nature-themed displays are used to soften hardscaping with texture. Leaf imprints on the concrete flooring of the basement courtyard evoke images of the leaf litter of jungle earth. Actual leaves from the hospital were used to make the mold for these tiles.

Wooden tables and benches line the perimeter of the ground floor courtyard, allowing next of kin to sit comfortably while waiting for prognoses.

From afar, the textured tiles give our basement floor an organic detail that harmonizes the concrete with the earth, trees and water. 74

Seeking Sustainability


Images of the hospital’s flora and fauna embellish selected lift doors, bringing bursts of color to an otherwise steely exterior. The names of these flowers are also included to cultivate interest in our ecosystem.

The ceiling of every patient lift is adorned with images of plants found in Alexandra Hospital (AH). Besides providing patients with a natural scene to enjoy while they are conveyed by bed, they are especially poignant for our patients who have followed us from AH to KTPH, evoking nostalgia for our former residence. These photos were taken by our former Chief Dietitian Ms Gladys Wong.

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Harmony in Colors The appropriate application of colors can create a positive impact on a building’s occupants that extends beyond aesthetics. Harmonizing colors can improve the mood and wellbeing of patients and aid visitors in wayfinding. Early experiments in Alexandra Hospital had shown us that the color of flooring had certain cognitive effects on older patients. This may be attributable to age-related deterioration of sight and mobility. Light colored flooring, due to reflecting downward lighting, could create a false sense of space under their feet, affect their sense of being grounded as they walk. Dark colored flooring, by absorbing downward lighting, can give the sensation of sinking into the ground, hindering their pace of movement.

Pendant signages that are clearly visible from a distance aid in wayfinding by establishing a straight line of sight. Consistency in the color coding of the three towers further helps patients to orientate themselves at any level.

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At KTPH, we resolved to harmonize colors for the benefit of our patients and visitors. Earth tones were favored to complement the abundance of wooden surfaces in the hospital. We began with a blank canvas, allowing us to observe the interaction of colors with space as we continued to fine-tune our palette. We decided that each tower would be identified by its own individual color, with the application of red being limited strictly to the Emergency Department. It was only two years later, when we had settled on these colors, that paintings were added to embellish our walls harmoniously.

Taking into consideration the dark oak fixtures of the private class wards, orange was chosen. An energetic color, orange is also monochromatic to oak’s dark brown shade. The strokes of orange add a “pop” that spruces up the private ward spaces. Flower motifs embellish the stretches of orange and were chosen deliberately as Tower A is furthest from the pond. The shapes of flowers recall landscape paintings of the impressionist style and serve to add cheer to our walls.


HD/SIOH-SUB-DWG-

Refer to the process schedule

CPG CONSULTANTS PTE LT

100%

TOWER

C M Y K

B

90%

70%

= 75% = 0% = 100% = 10%

M1

3mm thick Aluminium Box in designated colour.

M2

Digitally printed graphics on self adhesive vinyl sticker to cover entire face of signage.

M3

M4 3mm white translucent acrylic M6 Process Schedule Silkscreen P1 Spray Painted P2 Colour Schedule

CP7A-01, CP7A-02

REVIEW OF C&S / ARCH / M&E SHOP

Option 1 3mm thick Aluminium, 90 bend in a straight angle, finish with heavy duty “timber” looking vinyl self adhesive sticker. Option 2 Box-up with heavy duty wood laminate to match. 5mm thick black acrylic spacer

APPROVED FOR CONSTRUCTION APPROVED WITH COMMENTS NO RESUBMISSION REQUIRED

RESUBMIT TO COMPLY WITH OUR COMMEN

PC1

White - Oxyplast PR 12/9210/CSIT (Powder Coated Paint)

PC2

Blue - Oxyplast RAL 5005/ PR12/3251/CSIT (Powder Coated Paint)

PC3

Green - Oxyplast RAL 6029 PR12/2234/CSIT (Powder Coated Paint)

PC4

Orange - Oxyplast RAL 2000 PR12/650/CS5 (Powder Coated Paint)

PC5

Maroon - Oxyplast FF160/509/C41 (Powder Coated Paint)

PC6

Grey - Oxyplast PR12/2138/PC1 (Powder Coated Paint)

PC7

Red - Oxyplast RAL 3020 PR12/526/CS31 (Powder Coated Paint)

PC8

Beige - Oxyplast RAL 1014 PR12/70167/CS13 (Powder Coated Paint)

PC9

Black - Oxyplast PR12/732/CS4 (Powder Coated Paint)

EN1

Orange - Dulux Gloss Finish Orange Peel - GL 27181 (Enamel Paint)

EN2

Green - Dulux Gloss Finish Gem - IGL 3185 (Enamel Paint)

EN3

Blue - Dulux Gloss Finish Sky Boat -Gl21400 (Enamel Paint)

EN4

Grey - Dulux Gloss Finish Executive Grey - GL 104 (Enamel Paint)

EN5

Red - Dulux Gloss Finish Signal Red - GL 437 (Enamel Paint)

EN6

Maroon - Nippon Bodelac 9000 9004 Vermillion (Enamel Paint)

EN7

Black - Nippon Bodelac 9000 9045 S/Matt Black (Enamel Paint)

REMARKS:

APPROVAL OF THIS SUBMISSION DOES CONSTITUTE A COMPLETE CHECK BUT ONLY THAT THE DESIGN, GENERAL ME CONSTRUCTION AND DETAILING IS SAT APPROVAL DOES NOT PERMIT ANY DEV THE CONTRACT REQUIREMENTS AND M CONSTRUED AS TO RELIEVE THE CONT HIS RESPONSIBILITY FOR ERRORS IN D DETAILS, SIZES ETC. OR FOR CO-ORDIN INSTALLATION AND OR CONSTRUCTION CONDITIONS AT THE SITE. IT IS CONTR RESPONSIBILITY UNDER CONTRACT TO COORDINATE ALL DRAWINGS AND OTH DOCUMENTS REQUIRED TO EXECUTE T

DATE RECEIVED :

EM1

White - ICI, Shades of whites, Lily White SP 25809 (Enamel Paint)

EM2

Blue - ICI, Supreme 3 in 1 Flo Blue SP 21801 (Enamel Paint)

EM3

Green - Nippon, Wild Mint 46A-1A (Enamel Paint)

EM4

Orange - ICI, Supreme 3 in 1 Fiesta Orange SP 27801 (Enamel Paint)

EM5

Grey - Nippon Vinilex 5000 Low Odour 5069 Galaxy (Enamel Paint)

EM6

Light Blue- Nippon Vinilex 5000 Low Odour 5051 Continental Blue (Enamel Paint)

EM7

Light Green - Nippon Vinilex 5000 Low Odour 5028 Willow Green (Enamel Paint)

EM8

Light Orange - Nippon Vinilex 5000 Low Odour 5050 Tangerine (Enamel Paint)

DATE

SIGNATURE / DE

DATE RETURNED

CP7-01, CP7-02, CP7-03, CP7-04, CP7-08

REV

:

DATE

SUBJECT

NAME

KEY PLAN

SECTORC

EN8

White - Nippon Bodelac 9000 9067 Matt White (Enamel Paint)

SECTORB

VATION

Transmittal No:

Refer to the colour & material schedule

Material Schedule

SEC

SECTORA SECTORB

VATION

Reference Symbols

WER N

B

Job Title

PROPOSED ERECTION OF 10 STOREY H WITH 2 BASEMENTS ON LOT 2450X PT, 2 2047L PT, MK 19 AT YISHUN CENTRAL

KHOO TECK PUAT HOSPITAL

Lobby

KHOO TECK 90 Yishun Ce SINGAPORE Tel : + 65 65

CONSULTANTS

Varies (Dimension to be advised)

HEALTHCARE & INST CPG CONSULTANTS 238B THOMSON ROA NOVENA SQUARE, SI TEL: 6357 4715 FAX:

CONSULTANTS

DESIGN CONSULTANTS

EM7

EM3

EM1 900

H

Reference Symbols

Hillier Transmittal No:

Refer to the colour & material schedule

B C

EM5

100% 1920

960

CPG CONSULTANTS MAIN CONTRACTOR:

Material Schedule

TOWER

Lift Lobby

TEL: +1 212 629 4100

Refer to the process schedule

180 170

TOWER

Hillier ARCHITECTUR 275 Seventh Avenue, 2

New York, NY 10001-6 HD /SIOH-SUB-DWG-

EM1

CP7-06, CP7-07 CP8A-01, CP8A-02

C M Y K

= 100% = 60% = 0% = 0%

75%

45%

M1

3mm thick Aluminium Box in designated colour.

M2

Digitally printed graphics on self adhesive vinyl sticker to cover entire face of signage.

M3

Option 1 3mm thick Aluminium, 90 bend in a straight angle, finish with heavy duty “timber” looking vinyl self adhesive sticker. Option 2 Box-up with heavy duty wood laminate to match.

5mm thick black acrylic spacer M4 3mm white translucent acrylic M6 Process Schedule Silkscreen P1 Spray Painted P2 Colour Schedule

PTE LT

REVIEW OF C&S / ARCH / M&E SHOP

ENGINEERING & CONSTRUCTION CO APPROVED FOR CONSTRUCTION Website : Http:// www.hdec.co.kr 140-2 Kye-dong, Chongro-Ku, Seoul, Ko APPROVED WITH COMMENTS Tel : 82-2-746-1114 Fax. 82-2-743-8963 NO RESUBMISSION REQUIRED SUB-CONTRACTOR:

RESUBMIT TO COMPLY WITH OUR COMMEN

CRIMSIGN GRAPHICS PTE LT 80 Genting Lane Ruby Industria #06-04 Genting Block Singapore Tel : 65-6745 5012 Facsimile : 6

REMARKS:

PC1

White - Oxyplast PR 12/9210/CSIT (Powder Coated Paint)

PC2

Blue - Oxyplast RAL 5005/ PR12/3251/CSIT (Powder Coated Paint)

PC3

Green - Oxyplast RAL 6029 PR12/2234/CSIT (Powder Coated Paint)

PC4

Orange - Oxyplast RAL 2000 PR12/650/CS5 (Powder Coated Paint)

PC5

Maroon - Oxyplast FF160/509/C41 (Powder Coated Paint)

PC6

Grey - Oxyplast PR12/2138/PC1 (Powder Coated Paint)

PC7

Red - Oxyplast RAL 3020 PR12/526/CS31 (Powder Coated Paint)

PC8

Beige - Oxyplast RAL 1014 PR12/70167/CS13 (Powder Coated Paint)

PC9

Black - Oxyplast PR12/732/CS4 (Powder Coated Paint)

EN1

Orange - Dulux Gloss Finish Orange Peel - GL 27181 (Enamel Paint)

RESPONSIBILITY DRAWING NO:

EN2

Green - Dulux Gloss Finish Gem - IGL 3185 (Enamel Paint)

COORDINATE ALL DRAWINGS AND OTH CG/KTPH/CARPARK/CP7

EN3

Blue - Dulux Gloss Finish Sky Boat -Gl21400 (Enamel Paint)

EN4

Grey - Dulux Gloss Finish Executive Grey - GL 104 (Enamel Paint)

EN5

Red - Dulux Gloss Finish Signal Red - GL 437 (Enamel Paint)

EN6

Maroon - Nippon Bodelac 9000 9004 Vermillion (Enamel Paint)

EN7

Black - Nippon Bodelac 9000 9045 S/Matt Black (Enamel Paint)

EN8

White - Nippon Bodelac 9000 9067 Matt White (Enamel Paint)

EM1

White - ICI, Shades of whites, Lily White SP 25809 (Enamel Paint)

EM2

Blue - ICI, Supreme 3 in 1 Flo Blue SP 21801 (Enamel Paint)

EM3

Green - Nippon, Wild Mint 46A-1A (Enamel Paint)

EM4

Orange - ICI, Supreme 3 in 1 Fiesta Orange SP 27801 (Enamel Paint)

EM5

Grey - Nippon Vinilex 5000 Low Odour 5069 Galaxy (Enamel Paint)

EM6

Light Blue- Nippon Vinilex 5000 Low Odour 5051 Continental Blue (Enamel Paint)

EM7

Light Green - Nippon Vinilex 5000 Low Odour 5028 Willow Green (Enamel Paint)

EM8

Light Orange - Nippon Vinilex 5000 Low Odour 5050 Tangerine (Enamel Paint)

AS-BUILT

APPROVAL OF THIS DOES E-mailSUBMISSION : projects@crimsign.com CONSTITUTE A COMPLETE CHECK BUT DRAWING TITLE ONLY THAT THE DESIGN, GENERAL ME CP7 AND DETAILING IS SAT CONSTRUCTION APPROVALTower DOES NOT PERMIT ANYDire DEV B Lift Lobby THE CONTRACT AND M - WallREQUIREMENTS Graphics CONSTRUED AS TO RELIEVE THE CONT DRAWN FOR DESIGNED SCALE HIS RESPONSIBILITY ERRORS INCH D ASDETAILS SHOWN, SIZES ETC. OR FOR CO-ORDIN JIN YAN DATE ISSUED INSTALLATION AND OR CONSTRUCTION

25.11.09 CONDITIONS AT THE SITE. IT IS CONTR UNDER CONTRACT TO

DOCUMENTS REQUIRED TO EXECUTE T

CLASSIFICATION

DATE RECEIVED :

DATE

SIGNATURE / DE

CP8-01, CP8-02, CP8-03, CP8-04

REV

:

DATE

SUBJECT

NAME

KEY PLAN

SECTORC

DATE RETURNED

SECTORB

VATION

We chose green, the most restful color to the eye, as we endeavored to aid our patients to recuperate within the shortest length of stay possible. Green was also chosen for the cooling effect it has, as the Tower’s wards are naturally CPG ventilated. The motif of this tower relies on the silhouettes of trees to evoke the surrounding greenery.

SEC

SECTORA SECTORB

VATION VATION

YISHUN

CP7-05

150

VATION

CLIENT

WER N

C

Job Title

PROPOSED ERECTION OF 10 STOREY H WITH 2 BASEMENTS ON LOT 2450X PT, 2 2047L PT, MK 19 AT YISHUN CENTRAL

KHOO TECK PUAT HOSPITAL

Lobby

YISHUN

Tower C, which houses our Specialist Outpatient Clinics, offers panoramic views of the pond. It was thus natural for us to choose blue, known to be a calming and serene color. Motifs of nature that have an affinity with water such as fish and CPG dragonflies were applied to our walls.

CP8-06

KHOO TECK 90 Yishun Ce SINGAPORE Tel : + 65 65

CONSULTANTS

Varies (Dimension to be advised)

CONSULTANTS

HEALTHCARE & INST CPG CONSULTANTS 238B THOMSON ROA NOVENA SQUARE, SI TEL: 6357 4715 FAX:

DESIGN CONSULTANTS

EM1

H

900

TOWER

Hillier

Hillier ARCHITECTUR 275 Seventh Avenue, 2 New York, NY 10001-6 TEL: +1 212 629 4100

MAIN CONTRACTOR:

Designing for Sustainability 20

EM2

180 170

EM6

0

VATION

CLIENT

77

ENGINEERING & CONSTRUCTION CO


CONCLUSION Many of the experiences gleaned from our time at Alexandra Hospital influenced the building decisions of our present space. By pre-emptively planning for sustainability in the areas of architectural design and facilities management, we have successfully reduced our environmental footprint in the face of increasing workload. While many design features have passively contributed to our energy efficiency, proactive monitoring and subsequent implementation of improvement measures have further aided us in our green journey. The rejuvenation of the pond was a key element in our vision of creating a Healthropolis: healthy community, healthy workforce, and sustainable environment. Today, the pond is visited frequently by our neighbors, who make their way into our gardens for a respite from urban life. A conscious effort in placemaking was made to create a welcoming environment for our residents. Inviting them into our grounds has allowed us to influence them to take care of both their own health and that of the environment as well.

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CHAPTER 2: A Garden in a Hospital, A Hospital in a Garden



INTRODUCTION Transforming the undergrowth of the old Alexandra Hospital into a healing garden taught the team invaluable lessons. These early experiments helped in the realization of KTPH as a hospital set within a recuperative garden. In the old hospital, landscaping had yielded benefits that went beyond the ornamental. Filling unutilized spaces with greenery had aided in the patients’ recovery while attracting visitors to contribute their time and energy to the hospital’s vision. The team hoped not merely to

replicate this success but to surpass it in indicators such as biodiversity and community involvement. This chapter will first detail the potential benefits of greenery for the occupants of a facility, whether they are patients, visitors or staff. It will then go through the sustainability considerations involved in maintaining such an extensive area of landscaping. Finally, it will share the milestones in our journey to nurture biodiversity.

A Garden in a Hospital

A Hospital in a Garden The landscaping endeavor of KTPH is elegantly characterized by the above phrase, coined by Ms Joanne Tan Siew Choon in the hospital’s early days. In Mandarin, the syllables denoting “Hospital” and “Garden” are phonetically identical, differing only in the tone of pronunciation. The rhyming symmetry of the phrase when read both ways represents the organization’s aim to harmonize the two by having one flowing seamlessly into the other.

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81


RISING ABOVE PLOT SIZE Moving from Alexandra Hospital (AH), the team found itself on a plot of land that was a quarter of what they were accustomed to. This necessitated that the new hospital be a high-rise facility in order to accommodate a similar patient load. With this in mind, various strategies were employed to preserve the sense of “a hospital in a garden� amidst the towering concrete blocks. The landscaping of the hospital therefore had to extend far above ground level. Every level of the hospital is thus landscaped to varying degrees. This ranges from fully formed gardens to balconies of potted plants, evoking images of terraced fields in the middle levels. In order to sustain this, the troughs of the garden plots were designed to be deeper than they would be on ground level. This helps to counter the effect of strong winds and heavy rainfall at the higher levels as the depth of soil is sufficient for the plants to fully extend their roots for anchorage.

From AH to KTPH

Alexandra Hospital 13 hectares

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Green Plot Ratio Formula Surface Area Covered by Greenery (m2) Land Area (m2)

133,294.39 m2 34,002.88 m2

KTPH has a green plot ratio of 3.92, meaning that it has nearly four units of green area for each unit of ground area.

KTPH 3.4 hectares


BIOPHILIC DESIGN Our architectural and landscaping design was guided by a simple premise: immersing people in the natural environment would improve their wellbeing. While we referred to this as a “healing environment”, researchers have identified and verified this phenomenon since the 1980s. The case for biophilia— human beings’ innate desire for nature— was first articulated by Edward O. Wilson in 1984. He suggested that humans possess an innate “urge to affiliate with other forms of life”. Since then, continuing research has validated this notion, with researchers in Japan finding that spending time in forests improves immune system function.1

Biophilic design brings the community into our grounds, allowing us to transmit health and environmental awareness to them.

In contrast, when deprived of nature and faced only with concrete walls, humans exhibit pathological symptoms. The sick building syndrome (SBS) is used to describe a situation where occupants of a building experience acute health- or comfort-related effects that seem to be linked directly to the time spent in the building. This further strengthened the case for augmenting the hospital’s built environment with flora and fauna. With the validation of scientific research, biophilic design has become an increasingly relevant theme in sustainable architectural design. In line with our vision, the team from CPG Consultants, which included expertise in landscape design, created a building immersed in nature. It was our hope that the hospital’s landscape could benefit all our stakeholders. It would help our patients on their journey to recovery, and alleviate the anxieties of their visiting friends and family. The gardens would attract the nearby residents to our premises, giving us the opportunity to influence them towards a healthier lifestyle. For our staff, the sights, sounds and light of nature would boost their mood, morale, productivity and work satisfaction.

Various places are designed to give families the calm needed for important discussions. We wanted to alleviate the stress they may feel when faced with difficult decisions.

The hospital is a regular pit-stop for joggers and walkers in the area. The calming ambience provides our urbanites with a space for meditation and reflection.

1. Q Li et al, “Forest bathing enhances human natural killer activity and expression of anti-cancer proteins,” International Journal of Immunopathology and Pharmacology Vol. 20 No. 2 (2007): 3-8. A Garden in a Hospital, A Hospital in a Garden

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2010: BEFORE

Previous experiences with landscaping had shown that the benefits of imbuing a space with flora and fauna extended far beyond aesthetics. The thoughtful addition of plants can give spaces a therapeutic quality that elicits feelings of wellness and positivity. Numerous studies have supported the recuperative benefits of landscaped spaces. Thus KTPH sought to subvert the stereotype of hospitals being immaculate, white boxes of sterile concrete, opting instead to create a lush rainforest to further its therapeutic aims. Once the building was completed, hundreds of trees and thousands of shrubs were planted, adding to the 300 trees that had been planted around the pond for its revitalization.

Visual Access to Greenery Inpatient blocks have balconies with planters so that greenery can be seen from our patients beds. In this way, patients can feel grounded even at the higher floors.

The view from a bed in the Intensive Care Unit is one of unblocked greenery that also allows the room to be bathed in natural light, supporting the patients’ circadian sleep cycle.

“Patients in hospital rooms with plants and flowers had significantly more positive physiologic responses evidenced by lower systolic blood pressure, and lower ratings of pain, anxiety, and fatigue than patients in the control room.”2 2. Seong-Hyun Park & Richard H. Mattson, “Ornamental Indoor Plants in Hospital Rooms Enhanced Health Outcomes of Patients Recovering from Surgery,” The Journal of Alternative and Complementary Medicine 15(9) (2009): 975-980. 84

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2019: AFTER “All other things being equal, patients with bedside windows looking out on leafy trees healed, on average, a day faster, needed significantly less pain medication and had fewer postsurgical complications than patients who instead saw a brick wall.”3

The young plants that took root when the hospital was first built have since grown into a veritable rainforest, creating an observable ecosystem.

3. Deborah Franklin, “How Hospital Gardens Help Patients Heal,” Scientific American, accessed 28 July, 2017, https://www.scientificamerican.com/article/nature-that-nurtures/. A Garden in a Hospital, A Hospital in a Garden

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LANDSCAPING OUR COMMUNITY The biophilic elements of KTPH were intended to draw nearby residents into its premises not only during episodes of sickness, but also in the pink of health. More than a place for healthcare, it also serves as a tranquil space where the local community can educate themselves on health-related topics through public forums and exhibitions. Except for patient care and office areas, the hospital was designed to be freely accessible by the public. This was a deliberate decision to welcome nearby residents to visit us in their leisure time, giving us the opportunity to influence them to choose a healthy lifestyle. We believe that this would reduce the number of patients coming to the hospital in the long run. Researchers keen to investigate the effects of the hospital’s biophilic elements on its visitors have reported positive results. The findings of their investigations have affirmed the therapeutic effect of the hospital’s natural environment on our visitors.

Our landscaping endeavor was undertaken with the patients as well as the surrounding community in mind. We wanted the hospital to be an everyday part of the community’s life, not just in episodes of poor health.

15%

Response of Visitors to KTPH’s Environment 4.2

“I feel calm and relaxed here.”

4.0

“I feel less stressed here.”

4.2

“I feel close to nature here.” 1 Sample Size: 190

Strongly Disagree

2

3

4

5 Strongly Agree

of people visit the hospital simply for leisure.4 This gives us the opportunity to influence them towards healthier lifestyle habits.

4. Kishnani Nirmal and Giovanni Cossu, “Ramboll Research Project: Enhancing Blue-Green and Social Performance in Dense Urban Environments,” Ramboll Foundation, 2016. 86

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HAPPY WORKPLACE Building a vibrant ecosystem within the hospital’s grounds has intangibly improved the working conditions for staff. Studies suggest that breaking the monotony of concrete walls with the sights and sounds of nature can improve staff mood and thus morale.5 Furthermore, even short-burst exposure to greenery has been found to sharpen attention and cognitive function, in turn improving performance.6 KTPH supports the health of our community and staff through the Five Pillars of Health— guiding principles that lead to a lifestyle supporting health and deters illness: 1) Eat Wisely; 2) Exercise Regularly; 3) Be Happy; 4) Practise Personal Hygiene; and 5) Stop Smoking. The vibrant ecosystem has supported our efforts in building the third pillar, “Be Happy”. The five pillars, as well as the various strategies to encourage them, are discussed in detail in a separate book entitled “The Five Pillars of Health – The KTPH Experience”.

The seamless transition to the natural surroundings encourages our people to get outside to maintain their own physical fitness while building bonds with their co-workers.

When I look at the greenery, it reminds me that there is color and life all over the hospital. It is a calming environment; patients don’t feel stressed. They want to go out for a walk and enjoy the environment. Mdm Lim Chai Meng (left) Principal Physiotherapist Long Service Staff of 51 years

5. Jo Barton and Jules Petty, “What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis,” Environmental Science & Technology Vol. 44 Issue 10 (2010). 6. Kate E. Lee and Katherine A. Johnson, “40-second green roof views sustain attention: The role of micro-breaks in attention restoration,” Journal of Environmental Psychology Vol. 42 (2015). A Garden in a Hospital, A Hospital in a Garden

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AN ABUNDANCE OF GREEN SPACES FOR PATIENTS AND THE COMMUNITY

9300 m2 of greenery adorn the hospital’s premises

1.4 km of plants line our corridors

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5 levels

of corridor planters

81

balconies of planter boxes

A Garden in a Hospital, A Hospital in a Garden

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AT A GLANCE: 13 GARDENS INCLUDING 8 ROOF GARDENS Atrium Skylight Garden (B1) Glass skylights that illuminate the underlying carpark embellish the green landscape that runs along a 50m long stream. Within these ponds, fishes can be seen swimming from the mangrove trees at one end to the waterfall cascading from the ground floor at the other.

Medicinal Garden (L1) The first iteration of this concept took root at the old Alexandra Hospital. Planted by staff from the hospital, the current Medicinal Garden trail on our grounds is not only an educational journey, but also a habitat for our butterflies.

Rooftop Vegetable and Herb Farm (L7) The evolution of our subsistence farming project at Alexandra Hospital, this rooftop farm is maintained with the efforts from nearby volunteers, most of whom are retirees in their silver years. Find out more in the next chapter!

40%

of green spaces are accessible to the public

Recessed Deck Garden (L1) 90

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Geriatric Garden (L4) Adjoined to the adjacent Geriatric Clinic where group rehabilitation activities take place, the Geriatric Garden welcomes our elderly patients to channel their creativity for their art therapy sessions to the tunes of visiting birds, or simply to take a stroll along the flowers.

Private Ward Garden (L8) The highest-lying garden in KTPH, this sky garden includes umbrella trees that not only look majestic, but also contribute to purifying the surrounding air.

Garden Plaza (L1) The centerpiece of our ground level landscaping, this plaza is a busy thoroughfare for staff and visitors. The streamlike aquascape gives the impression of water flowing in from Yishun Pond, cascading into the basement floor through a waterfall.

De-stress Corner (L1) The iconic washroom of the first floor blends nature and the built structure through the thoughtful coordination of colors and textures such as stone, wood and plants. The open-air design of the structure facilitates the natural evaporative drying of the floor, lowering the frequency of mopping required.

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The bamboo garden on the basement floor, with its oriental aesthetic.

At the Specialist Outpatient Clinic Tower, the cascading rows of Bauhinia are topped by the green expanse of the Rooftop Farm.

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Preserving Native Biodiversity

Over 70%

of plants are indigenous, including many rare endangered species.

“Local animals and plants evolved over millennia to suit conditions here. If exotic, non-native species were to be brought in, there may be unexpected consequences on the ecosystem.” Dr Ho Hua Chew Vice-Chairman of the Conservation Committee of the Nature Society of Singapore

In the basement, the water flowing from the waterfall ends in a mangrove garden. A common feature of primary forests in the tropics, mangroves have been shown by satellite imaging to have greater carbon dioxide storage than other forests.7

7. M. Simard et al, “Mangrove canopy height globally related to precipitation, temperature and cyclone frequency,” Nature Geoscience 12 (2019): 40-45. A Garden in a Hospital, A Hospital in a Garden

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PLANNING FOR SUSTAINABLE LANDSCAPING Designing for landscaping activities at the initial stage of planning is essential. Most plots tend to be less fruitful as they are added to the facility as an afterthought. In such cases, the facilities and engineering provisions necessary to the plot’s success are no longer technically or financially viable. For example, increasing the floor load capacity of an existing rooftop to accommodate urban farming would be challenging.

Designing for Landscaping During planning, the volume and weight of soil required for landscaping must be accounted for in the architectural design. Otherwise, any landscaping endeavor will likely be limited in scale. The architects from CPG Consultants were committed to realizing the vision of a hospital in a garden from the start, building in structural provisions for landscaping into their designs. To support landscaping above ground level, special attention was given to the waterproofing process. The architects incorporated a root-resistant membrane which prevented the roots of plants from penetrating the underlying structure, which would cause leaks to the lower floors.

Saving Water Mist and drip irrigation systems help avoid water wastage that would occur with the more common method of hosing plants. Mist irrigation also helps to wash off the pollutants that may remain on the leaves after a dry spell.

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Planter Reservoirs A reservoir system within planter pots and boxes can dramatically improve the health and longevity of plants by maintaining an optimal level of moisture within the soil that is conducive to growth while preventing root rot. These planters can be embedded within larger plots of soil, allowing for plants to be transplanted with minimal damage. This facilitates the reconfiguration of our gardens at a lower cost in the event of any future contingencies.

Plant

Lightweight Expanded Clay Aggregate (LECA) reduces evaporative loss of water from the soil Root Ball Geotextile prevents the erosion of soil out of the planter Soil Lower layer of LECA provides roots with increased oxygen levels Overflow Holes prevents flooding of soil and consequent root rot Drainage Cell separates the soil from the reservoir

Soil Depth Planters need to provide for a soil depth of at least 300mm for turfing, 600mm for shrubs and ground cover, and 1000mm for trees. This is essential at higher levels, where the plant has to contend with stronger winds to keep rooted. Sinking planters into the ground such that they are leveled with the flooring helps to give a more natural and open look.

300 600 1000

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BIODIVERSITY REPLACEMENT The hospital’s landscape is predominantly composed of trees that are hardy and require less maintenance. Respecting the native biodiversity, local and Southeast Asian species were favored, with special attention given to revive endangered species that were once native to this part of the world. Apart from this, fast-growing plants were also chosen to achieve the look of a mature rainforest in a short timespan. Trees that could grow tall to form a canopy were instrumental in this endeavor.

living, breathing ecosystem, attracting a plethora of new species to move in. These have ranged from the colorful bursts of butterflies that have fluttered in, to the visiting otters that have wandered into the pond. The remainder of this chapter will provide key information on our hospital’s biodiversity. It will also serve to elucidate the qualities of the more remarkable organisms that have made our grounds their home.

Through the years, what began as young gardens scattered across the hospital have intertwined to form a

“I ENJOY SEEING BIRDS AND BUTTERFLIES HERE”

3.88 Strongly Disagree

(N=172)

Strongly Agree

Tiger Moth on a Lantana

Blue Butterfly Bush

White-bellied Sea Eagle

8. Kishnani Nirmal and Giovanni Cossu, “Ramboll Research Project: Enhancing Blue-Green and Social Performance in Dense Urban Environments,” Ramboll Foundation, 2016. 96

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Fostering Flora and Fauna In the hospital’s opening year, our staff launched a concerted effort to kickstart the healing rainforest ecosystem that we envisioned for our patients and community. This effort aptly coincided with World Biodiversity Day. This entailed planting host plants that

would attract butterflies, installing pots for dragonflies to inhabit and continuing the tree planting efforts that had begun in 2005. By consulting experts in ecology, we were able to carefully calibrate our efforts to nurture a balanced ecosystem.

Left: Staff continued the tree-planting effort that had begun around the pond even before the hospital’s construction. Right: The numerous submerged potters all around KTPH were designed specifically to attract dragonflies, the natural predators of the mosquito.

KTPH Biodiversity Day 2010 Left: Our nursing colleagues figuratively roll up their sleeves to plant a bed of the hardy Philodendron. Right: From left, Mr Ng Cheow Kheng (NParks), Ms Pauline Tan (CPG Consultants) and Mr Lee Chiu San planting host plants to attract butterflies at our Entry Garden. Subject matter experts were key in helping us build a well-balanced ecosystem.

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A RAINFOREST OASIS The young trees that we planted during our hospital’s early days have since grown into a dense canopy, providing not only shade and respite for our urbanite population, but also a home for more than 300 species of butterflies, dragonflies, birds and fish.

780

Trees spanning

115 Species

“KTPH’s gardens were designed to create a healing experience that goes beyond the four walls of the hospital.” Mr Glenn Bontigao Senior Principal Landscape Architect CPG Consultants Pte Ltd

Thanks to Mr Richard Seah and Mr Tan Meng Koon for contributing their photography. 98

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A Floral Palette of Every Shade

Butterfly Pea

Mexican Heather

Mexican Hydrangea

Water Lily

Pentas

Rhododendron

Asystasia

Periwinkle

Frangipanni

Lotus

Hongkong Orchid

Mussaenda

Red Hibiscus

Ixora

Torch Ginger

Bauhinia

Heliconia

Peregrina

Balsam Flower

Costas

Lantana

Yellow Hibiscus

Maiden’s Jealousy

Peanut Flower

Passion Flower

White Water Lily

Mexican Sword Plant

Fragrant Ginger

Dillienia

Peace Lily

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ROOFTOP FARM EDIBLES

During the planning phase, we already envisioned a plot for urban farming on the hospital’s grounds, having been inspired by the success of our banana plantation at Alexandra Hospital in providing a sustainable source of nutrition for the patients. The architects helped design a high-rise farm where edible produce could be continuously cultivated on the roof of Tower C. These are just some of the vegetables and fruits grown there.

Trellises help to maximize the space available for farming, allowing climbing plants to take advantage of the sun while providing shade.

Passionfruit

Winter Melon

Bok Choy

Chiku

Red-leafed Spinach

Grape

Cherry Tomatoes

Jackfruit

Custard Apple

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Basil


50 VARIETIES OF FRUIT TREES 51 VARIETIES OF VEGETABLES AND HERBS The heaviest pumpkin ever grown in our gardens weighed 11.95kg, winning the 1st prize at the 2016 National Parks Board’s Community Garden Edibles Competition. Golden Papaya Pumpkin

Lady’s Finger

Banana

Bittergourd

Red Banana

4 species of gourds can be found on our rooftop.

Chili Padi

Butterfly Pea Flower

Volunteers putting together an eclectic mix of vegetables to form a salad for public sale. This salad is unique for its inclusion of the butterfly pea flower.

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A SANCTUARY FOR 99 SPECIES OF BUTTERFLIES Butterflies are essential to the health of any garden as they help plants to flower as they flutter from one to the other, bringing with them pollen to fertilize the plants. Additionally, they are an important component in the larger ecosystem, forming part of the complex food web for other fauna. To kickstart the butterfly population, a few enthusiasts among our staff nurtured caterpillars into butterflies, releasing them into our grounds. Simultaneously, our gardeners adhered to the ABCs of “Attracting” butterflies by growing the right host plants, providing spaces for “Breeding”, and “Covering” the butterflies from the elements. These efforts combined helped in our hospitals’ metamorphosis into a sanctuary for our fluttering friends.

Green Baron

Leopard Butterfly

Painted Jezebel

Plain Tiger

Malayan Eggfly

Blue Pansy

Thanks to Mr Simon Chan, Mr Khew Sin Khoon, Mr Richard Ong and Mr Tea Yi Kai for contributing their photography. 102

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Blue Glassy Tiger Clipper

Clipper Thought to be extinct since the 90s in Singapore, it was sighted once more on 10 October 2018 at KTPH.

Black Veined Tiger

Common Birdwing The largest butterfly by wingspan in Singapore. Its flight is slow and graceful, propelled by its large wings. Common Rose Voted by the Singaporeans as the national butterfly of Singapore for its resemblance to the national flag.

Common Rose

Common Birdwing

Tawny Coster

Lime Butterfly

Orange Emigrant

Common Mime

Yellow Palm Dart

Leopard Lacewing

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A WETLAND FOR 29 SPECIES OF DRAGONFLIES Ponds and streams are habitats where dragonflies can be found. They have an important place in the food chain, helping to control the mosquito population. While dragonfly larvae, or nymphs, feed on mosquito larvae, adult dragonflies feed on adult mosquitoes. This helps to curb the spread of diseases of which mosquitoes are a vector. “The best time to observe dragonflies is from 9:30 am to 11:30 am on a sunny morning, when most species are active,” advises Mr Tang Hung Bun, our volunteer and dragonfly enthusiast. “If the ponds and streams are well vegetated and have good water quality, one will be rewarded with a richer variety of dragonfly species of different colors, sizes and behavior. A pair of close focus binoculars is essential to make good observation of these fascinating insects.” Crimson Dropwing

Common Parasol

Chalky Percher

Green Skimmer Dragonfly

Banded Skimmer The males of this species are often seen patrolling the side of a pond, guarding its territory against other males. Banded Skimmer

Grenadier

Thanks to Mr Simon Chan and Mr Tang Hung Bun for contributing their photography. 104

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Striped Grenadier This uncommon dragonfly has a uniquely shaped abdomen that broadens markedly from the middle of the abdomen and narrows again towards the apex.

Ornate Coraltail

Sapphire Flutterer This small dragonfly, with a body length of about 25mm, prefers water with better quality and can be used as a bioindicator of unpolluted water.

Dingy Duskhawker

Dancing Dropwing

Pinhead Wisp

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A BORDERLESS AVIARY FOR 82 SPECIES OF BIRDS Unbeknownst to most, many of our avian visitors are actually tourists from the South-East Asian region, often making our hospital a pit stop on their long-haul flights. Some previously threatened species have made a comeback in recent years, gracing us with their colorful presence and mellifluous birdsong.

Eurasian Tree Sparrow

Blue-crowned Hanging Parrot Oriental Reed Warbler

Long-tailed Shrike

Laced Woodpecker

Olive-backed Sunbird Common Kingfisher Paddyfield Pipit

Brahminy Kite

Yellow-vented Bulbul

Slaty-breasted Rail

Thanks to Mr Jimmy Chew, Mr Lee Tiah Khee and Mr David Tan for contributing their photography. 106

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Collared Kingfisher

Black-backed Kingfisher A migratory species, it is among the smallest of the kingfishers. Pied Triller

Cattle Egret

Blue-tailed Bee-eater

Crested Honey Buzzard

Emerald Dove

Crimson Sunbird Voted by Singaporeans as the national bird in 2015.

Purple Heron

Black-crowned Night Heron

Large-tailed Nightjar

Little Spider-hunter

Blue-winged Pitta Every birdwatcher’s dream is to capture this migratory bird in photos.

Purple-throated Sunbird

Peregrine Falcon The world’s fastest animal, the Peregrine Falcon can dive at speeds of up to 320km per hour.

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A STREAM FOR 100 SPECIES OF FISH Besides providing visitors with a calming sight as they glide gracefully through our ponds, the fishes around the hospital help to manage pest populations as well. In most of our ponds, the feeding of the fish is done entirely by the public, who buy the fish feed from the nearby vending machines. It is common to see a few generations of a family feeding the fish together.

Common Walking Catfish

Zebra Danio

Empurau

Redline Torpedo

Arowana

Common Archer Fish

Arowana Believed to be symbols of good luck and prosperity, the endangered Dragonfish, as it is commonly called, is highly prized in Singapore, having at times fetched prices exceeding S$10,000. Empurau When caught in the wild, its meat has fetched up to S$667 per kilogram. Its Mandarin nickname (勿忘我) translates into “unforgettable”, though there is no consensus on whether it is the taste of its flesh or the price it commands that lingers in one’s memory. 108

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Kuhli Loach

Harlequin Rasbora

Weather Loach

Common Frill Fin Goby

Apollo Shark Minnow

Tin Foil Barb

Clown Loach

Kissing Gourami

Sultan Fish

“This area of Yishun used to be filled with farms irrigated by ponds and laced with canals. This made Yishun home to many species of local fishes. We are trying to bring back some of this aquatic biodiversity.� Mr Lee Chiu San Volunteer and Avid Nature Lover

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POINTS OF INTEREST In most of our ponds, the feeding of the fish is done entirely by the public, who buy the fish feed from the nearby vending machines. It is common to see a few generations of a family feeding the fish together.

A partially submerged island structure donated by our landscaping partner, Tropical Environment, has helped make Yishun Pond and KTPH a sanctuary for rare migratory birds. Inset: As many as six herons have been spotted perching on the island at once.

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Pangolin Tortoise

Otter Monitor Lizard Above-left: Otters have been gaining popularity in Singapore since becoming a fixture in some local parts. Despite their adorable appearance and endearing family dynamics, otters can become aggressive if threatened. In Singapore, they have been seen squaring off against crocodiles — and emerging victorious. Above: Despite their menacing appearance, monitor lizards serve an important function as scavengers through biomass decomposition and recycling. They naturally stay away from humans and do not attack unless provoked.

Bees

Left: A pair of bees with sunflower floret in their hind legs as they extract nectar at our rooftop gardens. Insects are an important part of the hospital’s ecosystem as they help to disperse pollen as they go about their daily life.

Thanks to Mr Simon Chan and Mr Ha Lai Wah for contributing their photography. A Garden in a Hospital, A Hospital in a Garden

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OUR CHIEF GARDENER One person’s passionate dedication in particular has supported the landscaping vision of our organizations at both Alexandra Hospital and KTPH. Many of our achievements in this area can be attributed to her infectious enthusiasm for horticulture that continues to inspire the people around her. Mrs Rosalind Tan, 79, was Chief Occupational Therapist at Alexandra Hospital. In 2002, after 39 years in the profession, she decided to change careers and became our “Chief Gardener” at Alexandra Hospital. Her contribution to our organization’s sustainability drive grew from there, as she organized events such as Clean and Green Week to raise awareness on environmental issues. It was thus natural that she would be a pioneering member of the hospital’s first Green Committee. At KTPH, this energetic grandmother of 3 continues to supervise the landscaping of our hospital and serves as a reminder to our colleagues that one is never too old to take up new challenges.

After a career switch, Rosalind joined the Operations department and was informally known as our “Chief Gardener”.

Above: Rosalind acts as the ambassador for our hospital’s gardens, showing Cabinet Ministers and Members of Parliament around our hospitals. Left: The signature fruit and vegetable baskets that we present to distinguished guests is composed of ingredients from our Rooftop Farm, artfully arranged by Rosalind. The very first basket of vegetables and fruits was given to the late Minister Mentor Lee Kuan Yew, the guest of honor for our hospital’s opening on November 15, 2010. Below: At a staff appreciation event in 2014, we celebrated Rosalind’s 50th year of service.

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Left: Rosalind as the Chief Occupational Therapist at Alexandra Hospital in 1985. Below: Rosalind with her husband, Mr Tan Wee Lee, who has frequently volunteered his talents in photography and design over the years.

“To all the people who are my age: you can continue to find fulfilment in old age doing new things. Stay connected, be active and pursue your passions!”

Highlights of an Illustrious Career

Rosalind, pictured here at our Rooftop Farm in 2018, continues to inspire colleagues and volunteers with her passion for horticulture.

• Led the landscaping design of various theme gardens with the help of AH staff and volunteers helping AH to achieve: • Hospital with Healing Garden certified ISO 1400 in 2002 • Winner of Environmental Achievement Award in 2002 • One of the first batch of individuals to be awarded the Community in Bloom Ambassador Award in 2008 • Encouraged AH staff to take environmental ownership by spearheading various schemes such as the Adoption Scheme, Staff Gardening Day, educational talks and visits • Mobilized AH staff to help other organizations in sprucing up their gardens, including: • Alexandra Village in October 2002 • Blangah Rise Primary School in 2003 • Mun Fatt Tong Nursing Home in 2004 • Kwong Wai Shiu Nursing Home in 2005 • Institute of Mental Health in 2006 • Actively involved in the planting of 100,000 native plants for the South West Community Development Council • Facilitated the Linedancing and Taichi interest groups at KTPH for the last nine years • Has served on the Executive Committee of the Singapore Leprosy Relief Association and Henderson Daycare Centre for more than 35 years.

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CONCLUSION The seeds for our vision of a hospital in a garden were sown since our days in Alexandra Hospital. The various gardens were positively received by both patients and the public, convincing us to continue our biodiversity efforts at KTPH. We integrated a naturalistic environment into our suburban surroundings for our patients. We held the conviction that working together with science and medicine, nature would nurture them back to health. The architectural design by CPG Consultants afforded us green pockets around the hospital which have grown over the years, intertwining to form a lush miniature rainforest. Lessons learnt since Alexandra Hospital have helped us to keep sustainability at the fore of our landscaping operations, saving water while maximizing the longevity of our plants.

We have extended the usual scope of organizational sustainability management to include the preservation and restoration of biodiversity. We began with our landscaping, seeking to revive endangered species that were once native to this part of the world. As our grounds blossomed into a natural sanctuary, more lifeforms gradually felt welcome enough to make our gardens their home. We are proud to say that we have successfully brought our vision into reality: a hospital in a garden for our patients; a garden in a hospital for our community.

“I was one of the hospital’s early volunteers and spent time after work with the team to plan, design and landscape the hospital grounds. The vision was to bring more greenery and cheer to the sterile environment in the hospital. The spirit of transforming hospitals into healing oases that de-stress our minds, refresh the senses, and bond people together grew from there. Khoo Teck Puat Hospital and Yishun Health are testament to the farsighted vision and strong will of its leadership, as well as to the efficiency and pragmatism of the pioneers.� Mr Ng Cheow Kheng Group Director Horticulture and Community Gardening National Parks Board

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CHAPTER 3: From Garden to Table: Making Food Sustainable


Front from left: Irene Tay, Tina Tng, Vivian Lee, Wong Yoke Chan, Lim Ah Sien, Benjamin Chia, Rosalind Tan, Teresa Teo, Patrick Wee Back from left: Hur Tze Huan, Lim Siam Ee, Yong Chin Kuok, Simon Chan, Lim Chew Eng, Jeffery Tay, Joe Lum, Robert Lo, Low Lum Soon


INTRODUCTION As trusted institutions, healthcare organizations have the credibility and, indeed, the responsibility to influence the lifestyle decisions of the people in the interests of improving public health. KTPH espouses healthy living through the Five Pillars of Health, which guide internal policies as well as our conversations with the public. Eat Wisely is an important component of these tenets, as many medical conditions can be averted or reversed through mindful dietary choices. Not merely places of treatment, hospitals are also where meals are served daily to patients in the wards and to the visitors who patronize their food outlets. In this respect, the hospital is ideally

positioned to offer health and nutrition education to promote healthy eating habits that can simultaneously lead to more environmentally friendly diets as well. This chapter will explore how KTPH’s policies and initiatives have contributed to sustainable food consumption. This is achieved through three main areas: 1) In-house organic farming; 2) Encourage the public to consume more plant-based nutrition; 3) Reduction of food wastage.

Five Pillars of Health

The five pillars of health, as well as the various strategies to encourage them, are discussed in detail in a separate book entitled “The Five Pillars of Health - The KTPH Experience”.

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SHIFTING TOWARDS PLANT-BASED DIETS The link between diet and the environment is not immediately obvious. This is attributable to the consumer being far removed from the food production process. In particular, global production of meat on the industrial scale is environmentally taxing. More than a decade ago, a United Nations study had already reported that meat production releases more greenhouse gases into the atmosphere than all forms of transportation combined.1 More recent studies have consistently and increasingly shown that reducing meat consumption can also be

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As a healthcare provider committed to environmental stewardship, KTPH actively encourages the reduction of meat consumption to the public and our patients. However, it should be noted that elderly individuals on a vegetarian or vegan diet may be at risk of not eating adequate plant-based proteins, leading to muscle wasting, or sarcopenia.

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beneficial to one’s health. In 2015, the International Agency for Research on Cancer, which is the World Health Organization’s cancer agency, classified processed meat as a “carcinogen”, and red meat as a “probable carcinogen”.2

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Within the Hospital

In 2015, the average Singaporean ate 77kg of meat, or 86% more than the global average of 41.3kg.3

Spreading Awareness

1. Hening Steinfeld et al, “Livestock’s Long Shadow: Environmental Issues and Options,” Food and Agricultural Organization of the United Nations: 2006. 2. Veronique Bouvard et al, “Carcinogenicity of consumption of red and processed meat,” The Lancet Oncology Vol. 16 Issue 16 (2015): 1599-1600. 3. Abigail Ng, “Meatless in Singapore,” The Straits Times, March 28, 2017. 118

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Reduce Meat Consumption for Our Health and the Environment For The Environment

Conserve more water4 Much more water is needed by livestock than plants. An estimated 13,000 – 15,000 litres of water go to produce one kg of beef, while it only takes about 500 litres of water to produce one kg of potatoes.

Reduce dependence on fossil fuels5 About 40 calories of fossil fuel energy go into every calorie of beef produced from rearing cattle in the United States, compared to the 2.2 calories needed to produce one calorie of plant-based protein.

Minimize your carbon footprint6 According to the United Nations, the meat industry generates nearly one-fifth of the man-made greenhouse gas emissions – far more than emissions from transportation. Plant-based diets are more environmentally friendly because they require fewer natural resources – like water and fossil fuels – to produce, thereby minimizing environmental damage.

Prevent cardiovascular diseases8 Vegetarians have a 13–19% decreased risk of developing cardiovascular diseases as their diets help lower risk factors such as abdominal obesity, high cholesterol and blood pressure, and improve organ and body functions.

Combat obesity9 Research shows that a plant-based diet is generally lower in calories and in turn, can help you achieve a lower body mass index (BMI). BMI determines if a person has a healthy weight based on their height; the higher the number, the higher the risk for high blood pressure, heart disease and diabetes.

For Your Health 6.2

Lower the risk of diabetes7 Vegans, who abstain from all animal products, and lacto-ovo-vegetarians, who include eggs and dairy in their diets, were found to be 62% and 38% less likely to develop diabetes, respectively. This suggests that people with Type 2 diabetes can benefit from vegetarian diets as it may control their blood glucose levels. In general, eating more fruits and vegetables can reduce the risk of developing Type 2 diabetes.

4. M M Mekonnen and A Y Hoekstra, “The green, blue and grey water footprint of farm animals and animal products,” Value of Water Research Report Series No. 48. UNESCO-IHE (2010). 5. David Pimentel and Marcia Pimentel, “Sustainability of meat-based and plant-based diets and the environment,” The American Journal of Clinical Nutrition 78 Issue 3 (2003): 660-663. 6. Meatless Monday, “Environment,” accessed August 20, 2019, https://www.meatlessmonday.com/research/environment/. 7, 8. Academy of Nutrition and Dietetics. “Position of the Academy of Nutrition and Dietetics: Vegetarian Diets.” The Journal of the Academy of Nutrition and Dietetics 116 (2016): 1970-80. 9. Meatless Monday, “Health,” accessed August 20, 2019, https://www.meatlessmonday.com/research/health/. From Garden to Table: Making Food Sustainable

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COMMUNITY FARMING AND VOLUNTEERISM On the roof of the Specialist Outpatient Clinic Tower lies a farm that is partially tended to by volunteers from the neighborhood. A diverse group comprising primarily retirees, these volunteers painstakingly cultivate and harvest local vegetables and fruits. Their efforts provide a stable supply of organic produce for the hospital’s kitchen to prepare patient meals. This closedloop does not end on the patient’s meal tray. Food and crop

waste is composted and returned to the soil as nutrients, minimizing any wastage of inputs while reducing the waste outputs of the farm. Beyond the practical benefits of our farming endeavor, there are health and social benefits for the volunteers as well. Their time on the farm brings them out of their home in their silver years, keeping them active and healthy in both mind and body.

720 m2

The area of arable land on the main rooftop farm.

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PATIENT MEALS The organic produce harvested from the rooftop farm supplements the ingredient supply of the kitchen and are served in patients’ meals. Adequate nutrition, supplemented by fresh organic ingredients, aids our patients along the road to recovery. Having an in-house source of ingredients reduces the carbon footprint of the meals, as less emissions are produced for transportation and preservation of the produce.

KTPH ROOFTOP FARM GREEN SALE Any excess produce from the farm is sold to the public at affordable prices at thrice-weekly harvest sales. The roster of produce rotates periodically to feature plants that are not found in supermarkets. These rarities, such as the Oyster Plant and Prunella, create opportunities for public engagement and education. All proceeds from the sales go to our Sustainability Fund, which is used for the maintenance of the landscaping and farming activities of the hospital.

30 kg

About of organic produce is harvested for each farmers’ market sale.

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A SUSTAINABLE SUPPLY OF ORGANIC PRODUCE As a small country, Singapore has limited agricultural land and domestic food production. In 2014, only one percent of land in Singapore was designated for agriculture, meaning that it depends almost entirely on imports for food.10

Reviving the pre-war agricultural heritage of the region, rooftop farming at KTPH provides a healthy and environmentally sustainable supply of fresh vegetable produce.

With the rapid onset of urbanization in the post-war period, farming has all but disappeared from Singapore. While Yishun was once the home of large rubber and pineapple plantations, it is today a densely populated suburb.

Having a direct food source on the hospital grounds means that there are no emissions arising from the transport of food, a significant environmental footprint resulting from the importation of food.

10. Government of Singapore, “Farming Area,� accessed August 5, 2019, https://data.gov.sg/dataset/farming-area. 122

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PLANTING THE FIRST SEEDS While rooftop farming was planned for from the start, it was a coincidence of events that brought our first volunteer to our doors. During the construction phase of the hospital, our CEO at the time, Mr Liak, visited the residents’ garden plot at the nearby Yishun Central Park Garden with a group of colleagues. Wishing to observe how urban farming was conducted there, the group met Madam Lim, who had been farming there for over 20 years. She lamented that the community plot would soon have to make way for a new development. After this chance encounter, we extended an invitation to Madam Lim to continue her farming here for the benefit of our patients. Bringing with them green thumbs and knowledge passed down for generations, these volunteers worked together to nurture the first organic rooftop farm in a hospital.

‘’I’m happy to be able to continue pursuing my passion.’’ Mdm Lim Chew Eng Former Kindergarten Teacher Volunteer for nine years

‘’I enjoy sharing my experiences on gardening with others.’’ Mr Ronnie Chew Former Maintenance Manager Volunteer for nine years

A strong advocate for sustainability, he initiated the use of composting soya bean fibre waste and growing lettuce in boxes to solve the space constraints that building additional soil beds would pose.

“Retirees need something worthwhile to do. This is our hobby. Of course working under the sun is hard work, but seeing the plants grow and bear fruit gives us a sense of satisfaction. Even when plants die, we treat it as a challenge for the next harvest. We identify the reasons for failure and won’t commit the same mistakes again.” Mr Low Lum Soon Former Maintenance Engineer Volunteer for 6 years From Garden to Table: Making Food Sustainable

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79

The age of our two oldest volunteers

Though mist irrigation is the primary mode of delivering water to the plants, manual watering is sometimes required. To avoid wasting water, spray nozzles are used instead of hosing the plants directly.

Ms Josephine Chua, 79, has been volunteering for more than a year. She is both our oldest and newest volunteer and demonstrates that one is never too old to take on something new!

28

volunteers contribute their time and effort to the rooftop farm. Ms Tina Tng, our volunteer for eight years, holds a handful of Belimbing. A popular local fruit since the kampong days, the Belimbing is in fact from the same family as the starfruit.

Ms Vivian Lee harvesting the oyster plant. The “KTPH Sling�, prepared with oyster plant, rock sugar and young ginger, has become our signature drink for hospital events.

The bulk of the volunteers’ efforts include planting, maintaining, and harvesting their crops.

Mr Robert Lo harvests a winter melon, one of our most productive plants. He has been volunteering for eight years.

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Many Helping Hands While our volunteers do the bulk of the everyday work, many helpings hands have come together since the farm’s early days to contribute to its fruition. It has served as a formative and educational experience for young and old alike.

Above and left: In the early days of the rooftop farm, students from various institutions, such as Singapore Polytechnic (above) and Methodist Girls’ School (left) contributed their time and energy to the farm. Below: Three generations of a family coming together to bond over gardening.

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FARMING SUSTAINABLY

Composting The 24 composting bins on our rooftop farm were donated by several generous individuals and have followed us since our days at Alexandra Hospital. They not only help us divert organic matter away from the waste stream, but also minimize the need for external fertilizers, thus reducing costs and allowing the farm to be as self-sufficient as possible. Combined with the coffee grounds from Bettr Barista, a social enterprise tenant of the hospital, the end result is a nitrogen-rich soil conditioner that nourishes our crops.

Crop Rotation Over time, growing the same crop on the same plot of soil will deplete it of certain nutrients. This can adversely affect the land’s productivity in subsequent harvests. By practicing crop rotation, this scenario can be avoided as the soil has time to replenish those nutrients, allowing it to remain productive over a longer term. The frequent rotation of crops also serves to disrupt the assault of potential soil-borne pathogens and pests.

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A Sustainable Loop of Nutrition Rooftop Farm

Organic Fertilizer

A local source of food cuts out the emissions incurred by importing food by land, sea or air. Patient Meals

Using only organic fertilizers means that heavy metals such as nitrates do not find their way into food, water or soil. The organic matter in the soil allows it to retain moisture and nutrients more effectively.

Food Waste Recycling

Composting

24 composting bins on the rooftop convert dead plant matter into nutrients through the heat of the sun. Coffee grounds from the hospital’s F&B tenants are added into the mix for their nitrogen content.

A 500kg food waste digester uses microbes to quickly break down food scraps contributed by the hospital’s kitchen into a mineral-rich soil, which in turn fertilizes the hospital’s gardens.

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SUSTAINING OUR SENIORS Visitors often wonder what inspires our volunteers to commit themselves to hours of laborious work weekly, even in their silver years. The survival and longevity of KTPH’s rooftop farming program, that has gone strong for nearly a decade, may be attributed to three key factors: 1. Sense of Purpose 2. Personal Growth 3. Interpersonal Bonds

Sense of Purpose To know that the literal fruits of their labor end up in the nutritious meals of our patients and the public gives our volunteers a sense of purpose in their work. This in turn encourages them to continue their good work, harvest after harvest. More recently, the volunteers have expanded into leading Horticultural Therapy sessions for suitable patients. The brainchild of the other 79-year-old volunteer, Mr Hur, these sessions allow patients to receive positive stimulation in the senses of sight, scent, and touch while gaining horticultural knowledge.

The sessions begin with a short self-introduction allowing patients to socialize and address each other by name and continue with a short singalong of nostalgic classics. The horticulture segment then begins proper. The volunteers guide the patients in naming common plants in multiple languages, before guiding them to transplant young plants into new pots.

“Horticultural therapy is making use of people’s innate closeness to plants and nature to help patients recover faster and feel happier. We want to help them by improving their mood and well-being.’’ Mr Hur Tze Huan Certified Horticultural Therapist Retired Agriculturist Volunteer for three years Above and right: Mr Hur and fellow volunteers conducting a horticultural therapy session for patients of a Geriatric ward. Left: Rows of plants potted by patients are displayed at the balcony of the ward, labeled with the name of the patient who potted them. Patients are encouraged to tend to them during their stay and will bring them home upon discharge.

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Thus, our occupational therapists decided to bring the garden to these patients. By creating mobile horticulture kits, they very creatively found a way to make horticulture accessible to all patients in the wards for therapy and activity engagement. This has brought about great improvements in patient engagement and well-being, helping to facilitate their functional recovery.

With the mobile horticulture kits, patients who are able to stand can participate in the program by their bedside, encouraging activity. The program’s early nickname was “Gardens by the Bed”, parodying the famous Singaporean attraction, Gardens by the Bay.

n=30 15

No. of Patients

While Horticultural Therapy proved to be well received and beneficial for our patients’ well-being, bedbound patients were unable to participate due to the distance to the outdoor gardens. Bedbound and elderly patients tend to be at increased risk of functional decline during hospitalization due to prolonged bed rest.

Pre-Activity

Post-Activity

During Activity

10

5

0 1st

2nd

3rd

4th

5th

6th

7th

8th

9th

10th

Time (min) Engaging constructively

Feeling pleased

The occupational therapists have found that the activity consistently improves patients’ scores in the area of constructive engagement and pleasure.

Even bedbound patients can enjoy a new dimension of patient engagement. Being able to hold and feel the plants not only improves their well-being, but also engages the fine motor skills of their hands.

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Personal Growth The physical and practical challenges of urban farming enable our volunteers to keep active in their silver years. This helps stave off physical and mental health issues that idle aging can cause, such as muscle loss and cognitive impairment.

While selling their harvest, the volunteers engage in meaningful interaction. Chatting with the public and sharing useful gardening and food tips is a great self-esteem building opportunity that benefits both parties.

“Growing up in the kampong, I watched my mum grow a lot of vegetables. But it was only when I began volunteering here that I learned about plants and how to cultivate them. After one year of volunteering here, I brought my husband along. We leave the house together in the morning for the hospital and return home together after farming.” Mdm Wong Yoke Chan Volunteer for seven years Housewife Wife of Mr Lim (below)

“Nowadays many elderly people are cooped up within four walls. We need to come out and be active. Since I began farming with my wife, I don’t leave the house alone in the mornings anymore. It has bonded us.” Mr Lim Ah Sien Volunteer for six years Former shop owner Husband of Mdm Wong (above) 130

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Interpersonal Bonds: A Family of Friends The rooftop farm is also an avenue of rich and fulfilling social interaction for our volunteers. Loneliness and social isolation are health risks for the elderly. Working closely with each other on the farm regularly builds strong bonds between our volunteers. The sense of shared achievement from each harvest gives an added sense of fulfilment.

From left: Teresa Teo, Carol See, Tina Tng and Vivian Lee celebrate a successful eggplant harvest. The camaraderie between the volunteers keeps them coming back harvest after harvest.

From left: Low Lum Soon, Patrick Wee and Jason Loke hold up an especially bountiful harvest of winter melons with pride. The heaviest winter melon ever harvested from our roof weighed 18.18kg.

As a result, the volunteers are a close-knit group of friends. Besides working together on the farm, they also celebrate one another’s birthdays and sometimes go on learning trips together to learn from other farms. There is a welcoming culture among the volunteers that helps newcomers assimilate easily into the group. Since 2011, the size of the volunteer group has doubled to 28 in 2018.

Mr Simon Chan (left) and Mr Mark Lim (right) of our landscaping department also share a close camaraderie with our volunteers.

On a short learning trip to a commercial farm in Malaysia, the volunteers were able to observe farming on an industrial scale and the practices required to ensure productivity.

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ENCOURAGING PLANT-BASED NUTRITION

STARTING IN OUR OWN BACKYARD

For Our Community Seeking to encourage a more healthy and environmentally conscious diet, KTPH became the first hospital in Singapore to launch a Meatless Monday campaign through a three-day educational roadshow held in March 2017, coinciding with KTPH’s Dietitian Day 2017. Yishun Health’s dietitians were present in full force to educate staff and the public about the multi-faceted benefits of eating less meat. In conjunction with the roadshow, the dietitians also conducted a nutrition forum for the public, teaching participants to prepare meatless dishes that are nutritionally balanced. They also shared tips to reduce food wastage and pointers on how to grow edible plants at home.

Senior Dietitian Ryan Ong introduces the benefits of plant-based proteins to a member of the public.

With the help of educational brochures, Dietitian Magan Ho advocates the health benefits of eating more vegetables. 132

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FOR OUR PATIENTS AND STAFF

For Our Staff All in-house catering provided by the hospital kitchen on Mondays have reduced meat content. This applies to events as well as for departments who have their meals provided by the kitchen, such as the Operating Theatres.

For Our Patients In the wards, nurses and dietitians encourage suitable patients to choose vegetarian meals in support of the Meatless Monday campaign. Vegetarian options are also available every day of the week for patients to select.

What is

“…appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases.” 11

Meatless Monday is a global initiative co-founded by The Monday Campaigns and the Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health in the United States. The movement aims to build awareness on the benefits of reducing meat consumption on both personal health and the environment. Since its inception in 2003, it has been observed in over 40 countries.

11. Academy of Nutrition and Dietetics, “Position of the Academy of Nutrition and Dietetics: Vegetarian Diets,” The Journal of the Academy of Nutrition and Dietetics 116 (2016): 1970-80. From Garden to Table: Making Food Sustainable

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ENCOURAGING THE PUBLIC TO COOK AND EAT GREEN Yishun Health also launched the “Garden-to-Table” recipe cards – developed by KTPH dietitians and chefs, Wellness Kampung staff and our gardening volunteers. The cards feature healthy, tasty, yet easy-to-prepare plant-based meals and were printed with the sponsorship of a generous philanthropist. These 16 recipes range from side dishes, to main courses and even to desserts, offering a wholesome variety for one to whip up a healthy dish easily anytime, anyday.

The launch of the Garden-to-Table recipe card series during the Public Nutrition Forum held at KTPH in March 2017.

A chef from our kitchen demonstrates the preparation of various plant-based dishes to the public during a cooking demonstration.

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FOR OUR PATIENTS AND STAFF

Recipe cards featuring healthy, tasty, yet easy-to-prepare meatless meals with useful tips on planting and storage methods as well as health benefits of the ingredients. Look for the complimentary cards included at the back of this book, or find out more at https://ahsnutrition.health.blog. From Garden to Table: Making Food Sustainable

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SPREADING THE WORD

TO OUR DINERS

In conjunction with KTPH Dietitians’ Day 2018, Foodfare @ KTPH has been promoting ‘’Meatless Monday’’ since 12 March 2018. Besides eye-catching posters promoting the initiative, each food stall began offering at least one meatless dish every Monday. To ensure variety, each stall also offers a different dish from a roster of meatless specialties. Messages encouraging plant-based dishes and their health benefits are displayed on the television screens within the foodcourt to educate and encourage diners towards plant-based nutrition. The ‘meatless’’ dish for each Monday is displayed prominently at the start of each stall’s queue, nudging patrons’ to go meatless in their meal choices. These meals are also available on any other day.

Proportion of Meatless Meals Consumed The consumption of Meatless Monday specials at Foodfare @ KTPH has increased steadily since the initiative’s inception.

Total number of meatless dishes sold

Consumption of Meatless Dishes in KTPH Foodfare 4000 3500 3000 2500 2000 1500 1000 500 0 Apr’18

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Jul’18

Oct’18

Jan’19

Apr’19

Jul’19


OUTREACH TO THE WIDER COMMUNITY

The dietitians further extended their community outreach to the larger vicinity, going to four neighboring Community Centres in Yishun to give nutrition talks to residents. During the sessions, a team of dietitians espoused the benefits of consuming less meat and provided practical

Senior Dietitian Chong Sin Tzun engages residents by teaching them about the nutritional content of everyday food products.

tips in planning plant-based diet. Participants were delighted to receive easy and healthy plant-based recipe cards featuring dishes with local flavors such as “3 Treasure Brown Rice” and “Old Cucumber Soup”.

Besides empowering the residents with a deeper understanding of nutrition, the dietitians also encouraged the residents to reduce their meat intake by pledging to go meatless on Mondays.

Our outreach efforts helped to spread awareness to residents at four Community Centres in Yishun. From Garden to Table: Making Food Sustainable

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HEALTHY AND SUSTAINABLE PATIENT MEALS Apart from the many considerations to ensure that meals are balanced, delicious and safe to eat, Food Services goes the extra mile to be environmentally conscious as well. Through various process improvements over the years, the kitchen has tried to reduce the carbon footprints of meals served at the hospital. This begins with the planning of meals and optimizing the meal ordering process. In the preparation of meals, prudent use of water and ingredients reduces wastage and costs. Vegetable and meat scraps from the food preparation process are also reused and recycled wherever possible.

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Before

Optimizing the Ordering Process

Cycle 2. Friday Breakfast – D/1/4 Please ! one choice only.

£ £ £ £ £ £

The Electronic Meal Ordering System (eMOS) was implemented in 2013, followed by the e-Inventory System in 2015. These systems combine to reduce human errors in meal collation. It also enables more accurate projection of meal trends, thus reducing the overproduction of meals. Data from the systems are used daily in the catering of patients’ meals. They empower the kitchen to design a roster of fixed menu dishes for patients to choose from, avoiding wastage that could arise from the unnecessary preparation of ad-hoc meal orders.

Types of Rice:

Types of Rice:

Yam Cake (Vegetarian)

Mixed Brown Rice* / Brown Rice~ / Soft Rice / Porridge / Pureed Porridge

Mixed Brown Rice* / Brown Rice~ / Soft Rice / Porridge / Pureed Por

Oats w/ Cheddar Cheese Sandwich (Soft)

Puréed Oats (Pureed)

Vegetarian Mee Goreng (Vegetarian) Oats w/ Cheddar Cheese Sandwich (Soft) Oats (Minced)

Please ! ONE choice only.

! ! !

! ! !

Chicken w/ Mixed Mushroom^

! ! !

Mutton Curry w/ Potato ^

Chinese

Fish Porridge (Minced)

French Toast w/ Country Syrup (Regular)

Vegetarian Chicken w/ Celery ^ (Vegetarian) Chicken with Rice in Soup (Not suitable for minced & pureed)

! ! !

Sambal Ikan ^

!

Mutton w/ Basil Sauce

Chef’s Specials !

Orange juice

! Only one (1) hot beverage: £ Coffee £ Tea £ Milo £ Other: _________ (with milk / no milk) (with sugar / no sugar) Your meal may differ if you are on a therapeutic diet.

Patient’s Sticky Label

Pumpkin Kalia (Vegetarian) ^

Dietetic Instructions: ! Vegetarian

Bed:

After

(Only for Regular diet)

Szechuan Prawn w/ Bell Pepper ^

2 servings of fresh fruits per day are encouraged!

Side Salad & Choose only one (1):

£ Fresh Fruit of the Day £ Dessert of the Day Your meal may differ if you are on a therapeutic diet.

Dietetic Instructions: ! Cut Chili ! White Rice ! Vegetarian

Patient’s Sticky Label

Ward:

Beancurd w/ Mock Char Siew ^ (Vegetarian)

Seafood with Rice in Soup (Not suitable for minced & pureed

M alay / Indian (Halal)

Mutton Porridge (Not suitable for minced & pureed)

Western (Halal) (Only for Regular diet)

Cornflakes with Milk (Regular)

Ward:

Chinese

Sweet & Sour Fish ^

Malay / Indian (Halal)

Puréed Oats (Pureed)

£

~ Brown Rice is suitable for Regular Diet only. Not suitable for Renal, L/Phosphate, L/Potassium, L/Purine, L/Oxalate, L/Residue & L/Fibre diets. * Mixed Brown Rice is suitable for L/Purine diet. ^ Served with vegetables.

Please ! ONE choice only.

Mee Goreng w/ Minced Mutton & Veg (Regular)

Apple juice

Diet Texture:

~ Brown Rice is suitable for Regular Diet only. Not suitable for Renal, L/Phosphate, L/Potassium, L/Purine, L/Oxalate, L/Residue & L/Fibre diets. * Mixed Brown Rice is suitable for L/Purine diet. ^ Served with vegetables.

Oats (Minced) Fish Porridge (Minced)

£

BEFORE

Bed:

Vegetable Dalcha ^ (Vegetarian) Chicken Porridge (Not suitable for minced & pureed)

W estern (Halal) (Only for Regular diet) !

Steamed Seabass w/ Laksa Curry Sauce

!

Szechuan Prawn w/ Bell Pepper ^

Chef’s Specials

(Only for Regular diet)

£ Fresh Fruit of the Day £ Dessert of the Day

Your meal may differ if you are on a therapeutic diet.

Dietetic Instructions ! Cut Chili ! White Rice ! Vegetarian

Patient’s Sticky Label

Ward:

Bed:

Paperless and fewer errors Patients order their meals themselves or with the nurses’ help using iPads at their convenience. This eliminates errors as meal orders are systemized and captured in eMOS. The paper and sticker labels used amounts to S$25,000 annually.

Hassle in kitchen Food Services staff had to collate all faxed meal slips or collect physically from wards, count them and plan for the amount of ingredients needed the following day.

2 servings of fresh fruits per day are encouraged!

Side Salad & Choose only one (1):

AFTER

Paper and errors Nurses had to take meal orders from patients 3 times daily using paper meal slips. Errors such as wrong meals or diets were sometimes caused by illegible handwriting.

300

Yam Cake (Regular)

! Any one (1) fresh fruits or fruit juice: £ Papaya £ Watermelon

This has vastly improved efficiency over the outdated and inaccurate method of manual ordering and prediction and aided in providing our patients with well balanced and nutritious meals. Finally, eMOS intelligently generates personalized menus for each patient in accordance with their medical condition, preventing them from ordering a meal that may not be appropriate for their medical condition. This not only ensures the patient safety but also reduces food wastage due to discarded meals.

Calls From deciphering handwritten notes on the meal order forms, there were sometimes ambiguity in the meals ordered. Needing reconfirmation, about 300 calls per day would be made between Food Services and the wards.

Regular / Soft / Minced / Pureed

Western (Halal) £ £

Cycle 2. Friday Dinner – D/1/4 Please CIRCLE the appropriate options.

Malay / Indian (Halal) £ £ £ £ £ £

Cycle 2. Friday Lunch – D/1/4 Please CIRCLE the appropriate options. Diet Texture: Regular / Soft / Minced / Pureed

Chinese

Hassle-free kitchen Food Services staff can now plan the production of meals in advance according to the meal summary report generated by the system.

Fewer calls eMOS has slashed the number of such calls by 60 percent.

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REDUCING WASTAGE IN MEAL PREPARATION Maximizing Food Ingredients Food waste is reduced at the production level. Vegetable and meat scraps are used to make richly flavored soup stock while fruit trimmings are used for desserts such as pies.

Water Conservation The preparation of food necessitates the use of a large volume of water every day in three main processes: 1. Food processing 2. Food production 3. Cleaning

The efforts of the Food Services Department has helped to reduce water consumption in the face of an increasing patient load. While patient days have increased annually at the hospital, water consumption at our kitchen has dropped steadily since 2015, with a total reduction of 50%.

Water Consumption in KTPH Food Services 18,873

15,747

11,441

9,388

2015

2016

2017

2018

25,000

Cubic Meters

20,000 15,000 10,000 5,000 0

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Water Saving Practices Best practice guidelines set out by the Public Utilities Board (PUB) 12 for water efficiency have been a particularly useful tool in helping Food Services control their water consumption. Below are some of the recommendations for saving water in the kitchen that we have applied in our operations:

Turn off the dishwasher when not in use. Run dishwashers at full load.

Use pressure sprays to prerinse pots effectively to reduce water consumption. For manual washing of pots, have 3 compartment washing basins for soaking, washing and rinsing separately so as to reduce water use and enable easy recycling of rinse water.

Use a suitable detergent and avoid excessive use of it. Pre-soak utensils and dishes before cleaning for easy removal of stubborn food residue.

Do not defrost food or wash vegetables under running taps. Defrost in the thawing fridge to facilitate the defrosting process.

Wash pots in a filled sink instead of under running taps.

12. Public Utilities Board, Best Practice Guide in Water Efficiency – Buildings Vol. 1 (Singapore: APP Content and Concepts, 2018). From Garden to Table: Making Food Sustainable

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KITCHEN WASTE MANAGEMENT Kitchen Waste Management In tandem with the composting of horticultural waste on the rooftop farm, the hospital’s kitchen also recycles food waste through a low-energy process. A food waste recycler is used to process food remnants from the kitchen,

Food waste is collected from the kitchen’s food preparation stations.

recycling it with the help of a mixture of microbes that are carefully calibrated to the kitchen’s food waste profile. The result is a fertilizer that is rich enough to supplement the hospital’s landscaping needs.

The food waste is loaded into the machine where microbes decompose the scraps in an energyefficient process

24 Hours Later

The food waste recycler contributes to making our landscaping operations more self-sufficient.

An organic fertilizer is produced that can contribute to the hospital’s landscaping needs.

From time to time, excess fertilizer produced by the recycler is given out at the hospital’s sustainability-focused events.

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Reusable Crockery Where possible, Food Services uses reusable crockery for in-house catering functions. At Alexandra Hospital, we stopped using foamware for catering and switched to plasticware in the name of convenience. Over the years, we have progressively switched to more eco-friendly alternatives. We first switched to single use biodegradable plastic utensils with the intention of reducing the environmental footprint of our catering. Despite being made of biodegradable compounds consisting of plastic and corn starch, such utensils still contribute to the waste burden at landfills. We have since reduced the use of such single-use utensils by using washable melamine crockery and stainless steel utensils. Even for the Food Services’ twice-daily food tasting audits, where up to 40 dishes may be sampled in one sitting, stainless steel spoons are used. The costs involved in washing the utensils for reuse are negligible compared to the total environmental costs of producing, incinerating and landfilling single use plastic spoons.

Tea Break Vending Machines The use of vending machines to cater tea breaks for in-house courses has resulted in a reduction in food wastage. Tea breaks were previously provided as a spread, where staff would help themselves to the snacks and drinks. Now, with the use of vending machines, food wastage in the form of leftovers is reduced. Each course participant is handed a card that they can use to redeem the refreshments allocated to them. This is also a Healthy Promoting strategy to encourage portion control and discourage overeating.

Turning Cooking Oil into Biodiesel Used cooking oil is stored in a covered barrel and sold to NEA-licensed used oil collector. The used oil will then be processed to be recycled as non-edible commodities such as biodiesel. Approximately 700 liters of cooking oil was recycled in 2018.

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HEALTHIER AND GREENER VENDING OF DRINKS In addition to phasing out sugar-sweetened beverages from existing vending machines, vending machines themselves are being phased out and water fountains being installed to reduce consumption of unhealthy added sugar beverages. This has also resulted in a reduction of single-use cans discarded and eliminates plastic bottles from our vending machines.

2010 • 18 drink vending machines • Among the beverage selection, 60% were healthier choice and 40% less healthy.

Beverage Selection

18

Vending Machines

2013 • 14 drink vending machines • 80% of beverages were healthier choice options and 20% less healthy.

2018 • Drinks vending machines selling only no added sugar drinks

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Healthier Choice

40% Less Healthy

Beverage Selection

14

Vending Machines

2016 • Left 3 vending drinks machines • 80:20 (80% no added sugar, 20% healthier choice) • 35% of overall sales were from no sugar drinks • All vending machines at the ward visitors’ lounges are replaced with water coolers

60%

80% Healthier Choice

20% Less Healthy

Beverage Selection

3

Vending Machines

3

Vending Machines

80% No Sugar Added

20% Healthier Choice

No Sugar Added

100%


All ward visitor lounges are equipped with water coolers in replacement of vending machines

The reduced number of vending machines do not carry plastic bottled drinks. From Garden to Table: Making Food Sustainable

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CONCLUSION As a healthcare institution, KTPH endeavors to educate the public on healthy habits, including healthy eating. Encouraging a shift towards plant-based nutrition and a corresponding moderation of meat consumption has been a key message in this regard. Simultaneously, we have sought to raise awareness on how individuals’ food choices not only affect our personal health, but that of the environment as well. To these ends, our Dietitians and Food Services have been proactive in getting the message out to our patients, staff and community. Beyond dietary choices, making food sustainable requires looking at the supply chain holistically. As a small nation with a modest agricultural output, Singapore relies heavily on food imports. Inspired by our success in urban farming at Alexandra Hospital, we planned for a sustainable community farming program on our rooftop to reduce our dependence on imported ingredients. In the last decade, our Rooftop Farm has grown from strength to strength, thanks to the contributions of our silver-haired volunteers from the neighborhood. It is a

“For one day a week, cut out meat. It may no longer be our choice, but our responsibility to adopt sustainable diets to save our Earth.” Ms Gladys Wong Senior Principal Dietitian Nutrition and Dietetics

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win-win situation— our patients enjoy fresh organic fruits and vegetables while our volunteers gain a sense of fulfilment with each fruitful harvest. As the next link in the chain, our colleagues in Food Services have continually sought to find more environmentally friendly ways to cater food that will aid in our patients’ recovery. By reducing utilities consumption and wastage of food, they ensure that nothing goes to waste. Depositing food remnants from the preparation process into a food waste recycler allows us to return waste output to the farm as a nutrient input. We have taken a holistic approach in making food sustainable, through education, production, procurement, preparation and waste management. The combined commitment of several departments including Food Services, Landscaping, Nutrition & Dietetics and Tenancy has been instrumental in yielding positive, sustainable results.


CHAPTER 4: Building a Green Culture from Within



INTRODUCTION Waste reduction in the context of a Singaporean healthcare institution must confront two realities. On the first front, Singapore’s rapid development into a first world country has caused consumption– and thus waste– to balloon exponentially. According to the National Environment Agency (NEA), growth in Singapore’s population and economy have contributed to a six-fold increase in the volume of solid waste disposed. While the figure stood at 1,260 tons in the 1970s, the island state disposed of 8,443 tons daily in 2017.1 Secondly, hospitals inevitably produce a comparatively higher volume of waste. This is attributable to a typically heavy workload that is compounded by the need for high level of hygiene. Hospitals in particular utilize supplies that have very short life cycles, with many items, such as syringes, being single-use.

Our hospital’s strategy in tackling these two challenges has been to build a tangibly green culture within the organization that emanates outwards into the community. Within the hospital, policies are in place to minimize waste generation and maximize rates of recycling. Secondly, we influenced our tenant partners to join us in environmentally conscious action. Thirdly, we join the community in events of environmental stewardship. This chapter will detail the efforts we have taken to build a green culture in our hospital, including the waste reduction policies that have guided us as an organization and as individuals.

Creating a Ripple Effect with Green Action Internal Action

We conserve for tomorrow as an organization Community Outreach

Joining our community to care for the environment Involving Partners

Influencing our partners to care for the environment

1. National Environment Agency, “Waste Management,” Accessed August 14, 2019, https://www.nea.gov.sg/our-services/waste-management/overview. Building a Green Culture from Within

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LEADERSHIP Sending a clear signal of the leadership’s commitment to environmental stewardship can in turn encourage even the most junior of staff to spearhead green initiatives. Thus a feedback loop is formed that encourages a sense of communal responsibility to the environment that extends beyond the workplace.

Ever the hands-on leader, our former GCEO Mr Liak Teng Lit (left) meticulously pruned the young plants of the rooftop farm.

Our CEO Mrs Chew Kwee Tiang has been a strong advocate driving our organization’s green culture.

Our Chief Nurse Ms Shirley Heng (center) leading the way at Operation: We Clean Up 2015.

Our Director of Nursing Mdm Chua Gek Choo rallying nurses to care for the environment at World Water Day 2015.

Staff members of all levels regularly take part in our litter-picking sessions in the constituency.

“Sustainability must be more than a corporate concept; it must be internalized in the individual’s everyday actions and choices. The management of KTPH has taken a very proactive approach.” Mr Anthony Seah Chairman of Alexandra Health Infrastructure Committee 150

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GREEN COMMITTEE Our people have been, without a doubt, our most valuable resource on this journey to becoming a more sustainable organization. Of particular note is the Green Committee that has been the main conduit channeling the efforts of our people into meaningful action. Since its formation in the Alexandra Hospital days, the Green Committee’s mission has remained the same: • To create a culture of environmental awareness • Ensure effective management of resources especially water and electricity • Measure and monitor progress of each project initiated • Encourage buy-in and participation from all stakeholders to share in the mission. Comprising passionate members from various departments, the team’s combined wealth of experience empowers the organization to share best practices and push forward with new initiatives. The core of members from the Operations Departments, such as Environment Service and Facilities Management, allow for targeted action to be taken in waste and energy management.

Finally, the team ensures coherence in the organization’s sustainability measures through awareness and dialogue. The aim is to foster collaborative efforts rather than top-down enforcement. The Green Committee is now in its third generation of members. Each generation has focused our people’s energies into different areas of focus. The first generation looked into how the organization could be more efficient as a whole by managing electrical and water consumption. Simultaneously, this committee set in motion our biodiversity replacement drive. The second generation approached sustainability through the inculcation of personal habits, focusing on resource conservation on the individual level and building a self-cleaning culture among staff. It also expanded our biodiversity enrichment efforts to fishes, dragonflies, birds, plants and fruits. The third generation promotes green practices among the staff in the areas of energy reduction, waste management, water conservation and green advocacy. Recognizing the importance of collective effort in building an appreciation for the environment, this Committee also focuses on partnerships with vendors and community outreach.

Top-left: The first generation of the Green Committee at Alexandra Hospital’s Clean and Green Week in 2005. Left: The second generation of the Green Committee, pictured here at the plot that they planted at Hort Park. This plot was designed by our volunteer Mr Tan Wee Lee, a retired architect. Above: Members of the third generation of the committee gathered for KTPH’s World Water Day 2017. Building a Green Culture from Within

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BUILDING A GREEN CULTURE FOR ALMOST TWO DECADES Fostering awareness on the need for our staff and public to take care of the environment began since our days at the old Alexandra Hospital. While environmental consciousness has increased in the last decade, the environment was not a common concern for Singaporeans in the early 2000s. The formation of the National Environment Agency in 2002 helped focus the public’s attention on sustainable living in both private and public spheres.

Internally, the management team had begun encouraging a green culture at Alexandra Hospital through education and policies targeting both staff and the visiting public. While the Green Committee began as a top-down initiative to encourage green action, staff and public have increasingly become initiators, meeting the committee halfway with bottom-up efforts.

A Snapshot of our Early Efforts Fostering Awareness

Encouraging the 4Rs

2nd Generation Green Committee Chairperson Ms Jolia Low (rightmost) explains the environmental benefits of composting to visitors at KTPH’s Family Day in 2010.

Encouraging people to use the 4Rs to guide their actions began at Alexandra Hospital. Besides the flea market pictured above that encouraged reuse, the team placed recycling bins around the premises to facilitate recycling.

Building Biodiversity

Spreading the Green Spirit

Fostering biodiversity began in Alexandra Hospital with the first Green Committee. Beginning with butterflies, we have since nurtured an ecosystem of more than 600 species of flora and fauna.

Our volunteers lent a helping hand to Kwong Wai Shiu Hospital (above) and other institutions for their greening endeavors. We believed that helping others along would facilitate a mutually beneficial sharing culture which would further drive sustainability capabilities.

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REFUSE, REDUCE, REUSE, RECYCLE BUILDING A CULTURE OF 4RS

For a newly joined employee of KTPH, environmental responsibility is emphasized at the orientation phase. This sense of duty to the environment is further strengthened at various green events and sharing platforms throughout the year. Nurturing a green culture in an organization requires a clear framework to guide staff attitudes towards waste. While the 3Rs of Reduce, Reuse and Recycle are commonly heard, the hospital has actively implemented a fourth R of Refuse.

The 4Rs Approach

Most Frequent

The order and frequency of the 4Rs matters. KTPH’s waste hierarchy takes a preventive approach to waste. By first refusing non-biodegradable or single use items and reducing consumption, less new items are acquired, and even less will eventually go to the incinerator or landfill.

Refuse 1ST

Refuse the consumption of things we do not need, especially single use or non-biodegradable consumables.

Least Frequent

Reduce 2ND

Reduce the volume of items disposed through prudent consumption. Reduce the consumption of resources and utilities through frugality.

Reuse 3RD

Reuse items to maximize their lifespan. Repair items if required to continue reusing them.

Recycle 4TH

Recycle wherever possible instead of discarding into general waste streams. Building a Green Culture from Within

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REFUSE “Refuse” is the first of the four “R”s and also the most important. Inculcating the habit of first refusing to purchase or consume where there is no absolute need has a profound impact on the downstream management of waste. Refusal to consume is practiced on the institutional level as well as the individual level. The hospital influences both its internal and external community to reject frivolous or

environmentally irresponsible comforts, such as single use plastic packaging or polystyrene foam. Strategies for encouraging the practice of “Refuse” differ from the institutional level to that of the individual. Within the hospital, there are policies in place in relevant realms such as procurement. On the individual level, persuasion through education has been key in influencing staff and public to adopt the first “R” in their daily lives.

Bringing our Tenants on Board: Refusing Disposable Consumables Our tenant partners have answered our call to reject single use plastics and other non-essential consumables.

Paper Receipts and Plastic Bags Touchscreens at Foodfare @ KTPH cashier stations allow the food court’s diners to decline paper receipts. Outlets like Subway and FairPrice Xpress charge 10c for plastic bags in a bid to discourage the use of non-biodegradables.

Take-Out Boxes and Cups Most food establishments in KTPH offer a discount incentive to patrons who bring their own cups or take-out containers. Some of our tenants have taken this initiative further. Bettr Barista, for example, conducted a 1-for-1 Bring Your Own Cup campaign from April–July 2018, which saved more than 250 cups.

Our Newest Partner Comes Onboard Our most recent partner redesigned their product packaging to facilitate consumption without a straw. Our orange juice vendor, iJooz, modified their packaging to a paper seal to facilitate drinking without a straw. From this one change alone, 800 plastic straws are avoided monthly. Across two orange juice vending machines in a year, nearly 10,000 straws are saved!

Plastic Straws As an advocate for the environment, KTPH has done away with disposable plastic straws. Our tenants, such as Subway and Mr Bean, have supported this change. In May 2018, our food outlets began by putting up awareness posters and kept plastic straws out of sight. A three month period allowed customers to educate themselves on the environmental merits of the initiative, easing them into accepting it. In September 2018, we went completely plastic straw-free.

2. Sara Grosse, “Mosquito fogging has ‘severe limitation’: NEA,” Channel NewsAsia, September 18, 2016. 154

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Green Tenancy Contracts Our Green Philosophy is Formalized in our Tenancy Contracts The Tenant is required to adhere to the Green Policy set up by the Hospital. The Tenant is encouraged and shall advocate the use of recycling bins to the public. General Guideline of Green Policy Design of the outlet’s mechanical and electrical planning shall be energy efficient. Choice of fittings and materials shall be energy saving and environmentally friendly. Environmentally friendly carriers shall be provided to customers. Use of straws, polystyrene foam disposables cups, plates and takeaways containers shall be strongly discouraged. Environmentally friendly substitutes shall be recommended. Air conditioning shall be set between 23-25°C. All electrical appliances in use shall be energy saving. Proper disposal of waste i.e. paper, cans, plastic and glass shall be observed. To incorporate food waste recycling and food composting practices.

Internal Procurement Practices We refuse the use of goods and services that are environmentally detrimental. Procurement policies are set in place such that environmentally hazardous consumables are neither purchased nor used in the hospital. The evaluation process also scores how green a vendor is.

Paints and chemicals must be certified by the Singapore Green Labeling Scheme. This not only ensures that the premises are safe for our patients, but also that any waste discharged is safe for downstream handlers and the environment.

For external caterers, we reject single use polystyrene foam products in favor of reusable melamine ware. Where absolutely required, biodegradable disposables made with paper or cornware are used.

Fumigation is not used to control the mosquito population. This reduces the possible impact on the hospital’s patients, staff, flora and fauna. Most importantly, fogging would kill dragonflies, which are the mosquito’s natural predators.2

All vendors are made aware of our procurement philosophy: We encourage vendors to offer cost effective and sustainable products and services. If your company offers product/ services that deliver environmental / social benefits while meeting the required specifications, please include them in your tender offers.

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REDUCE Organizations have a much larger environmental footprint than individual households. Especially for organizations that operate round-the-clock, even seemingly modest reductions can have a magnified impact in the long term. Reducing our impact on the environment can be achieved through group effort or personal diligence. Individually we can exercise better judgement in the frugal utilization

of resources. Together we can reduce our environmental footprint through commitment to green office policies. Additionally, the Green Committee works with the Facilities Management Department to set and meet utilities conservation goals, maintaining vigilance over our power and water consumption rates and continually enacting energy management policies.

Small changes in the office setting can have a great impact in reducing our environmental impact. Cultivating green habits among individuals in the workplace can influence their personal choices as well.

Green Office Practices Encouraging Paper Recycling Instead of having bins at every workstation, multiple workstations share a general wastebin. The bulk of office waste is paper. The increased distance to the bin nudges them to sort their waste and dispose paper into the recycling bin instead. Furthermore, usage of plastic bin liners is dramatically reduced.

Workspace

Paper Recycling Bin

Personal Waste Bins are removed

General Waste Bin

Printer Paper Usage The default setting for all printers across our campus is double-sided printing, potentially halving the usage of paper. Motion Sensors Motion sensors are installed in transient use areas like toilets, pantries and infrequently used corridors, achieving savings of 10% when these areas are not occupied. Reducing Individual Carbon Emissions A fleet of bicycles are available for staff to loan without charge for them to get to and from work. Helmets are also available for the staff to use to ensure their safety. The organization also encourages carpooling among staff.

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Raising Awareness in the Community Throughout the Year We observe and commemorate various events throughout the year which remind the larger community to reduce our consumption of natural resources. These events are open to public participation so as to raise awareness in the community on the need for frugal consumption of our Earth’s limited resources.

Earth Hour Earth Hour, an initiative launched by the World Wildlife Fund for Nature, has been observed by our organization annually since our days at Alexandra Hospital. The observance is a very visible and public manifestation of our organization’s commitment to the environment. Air conditioning and non-essential lightings are switched off for an hour each year, serving as a reminder to both the community and staff to reduce their own domestic electrical consumption wherever possible.

World Water Day Another event observed annually on our premises is World Water Day. Organized in conjunction with the Public Utilities Board and the constituency, this public event brings together the neighboring residents and our hospital’s staff to raise awareness on the need for water conservation. A key element of each year’s observance is the pledge-taking where participants young and old commit themselves to being conscious about their water consumption habits. Non-essential lights turned off during the evening for Earth Hour 2019.

Member of Parliament for Nee Soon GRC Er Dr Lee Bee Wah addressing the participants at the 2018 observance of World Water Day. Our activities on this day usually incorporate a litter-picking trail around the neighborhood.

In 2014, the students of the Institute of Technical Education created a mural made up of 10,000 badges. The effort made it to the Singapore Book of Records. Positive messages about water conservation were written on each badge which were given to members of the public after the event. Building a Green Culture from Within

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REUSE All around the world, decades of economic development and manufacturing advancement have created a climate where consumers only see the upfront monetary cost of their purchases, but remain largely unconscious of the downstream environmental harm arising from their choices.

Where consumption is unavoidable, the application of the third “R”, “Reuse”, helps us to maximally utilize items that were manufactured to last long past a single use. This in turn reduces the rate of consumption and waste generation.

Encouraging the Public to Reuse Bags at the Pharmacy The public has joined hands with us to encourage the reuse of plastic bags among our pharmacy patrons.

Back in Alexandra Hospital, the Green Committee had already attempted to provide patients with reusable bags to bring their medication home in. Used plastic bags donated by staff through a weekly collection drive were given to the pharmacy for this purpose. However, the initiative ultimately failed due to the inconsistent condition of the plastic bags donated. In July 2016, KTPH’s pharmacy revived the initiative through a ground-up effort, the Reusable Bag Collection Drive (RBCD), to collect clean and dry reusable shopping bags from our staff, patients or visitors. A collection box was placed in the outpatient pharmacy for anyone to donate clean and dry reusable shopping bags. Our Corporate Communications team also designed a reusable bag, made available for the public to purchase at the Pharmacy, to encourage consumers to shift away from plastic bags.

Members of the public can donate their paper and reusable bags to the Pharmacy. Only clean, dry bags are accepted for redistribution.

Plastic bags usage at Pharmacy

60000 50000

These initiatives combined have reduced the Pharmacy’s usage of plastic bags by

40%. 158

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17%

70000

40000

27%

57,197 47,271

30000

34,366

20000 10000 0 Year 2016 Plastic bags usage

Year 2017

Year 2018


One Man’s Trash, Another Man’s Treasure While individual departments have come up with various strategies to reuse consumables where possible, on the organizational level we have facilitated the passing on of unwanted but still-usable items through pass-it-on drives.

Win with Waste Day 2015 In order to encourage staff members to maximize the lifespan of their items and reduce waste generation, the Green Committee initiated the Win with Waste Day in 2015. All were invited to bring unwanted but still usable items from their work areas to a central collection point. Staff could come by throughout the day and pick out items that they had a need for, bringing it back with them freeof-charge. At the end of the day, all remaining items were passed on to a recycler. 1,242 kg of waste was collected in one day.

Nurse-Led “Reuse” Flea Market This same concept was adapted for a nurse-led flea market in 2017 to encourage “Reuse”. Staff brought items from their homes to sell in a bid to raise funds for nursing homes while reducing the waste produced by their households. All proceeds from the sale went to the benefit of our five partners: • Catholic Welfare Services, • HCA Hospice Care, • Villa Francis Home, • Singapore Christian Home, • Sree Narayana Mission.

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CREATIVE

REUSE: UPCYCLING

Though reusing items is usually a straightforward affair, a little creativity and effort can sometimes generate an even greater impact. Upcycling through the creative reuse of otherwise unremarkable objects has brought about cost savings for our patients, while improving their

quality of stay and safety of care. The following projects were collaborative efforts involving nurses and our Linen Department. Even more impressive is the fact that many of these projects utilized reused materials salvaged from other projects, reducing our waste footprint in the process.

Many of the upcycling projects from the Linen Department are realized by the precise needlework of Lisa, our in-house seamstress.

Ms Kong Lee Wei, who heads the Linen Department, lends her resourcefulness and collaborative spirit to the upcycling projects. She also manages the projects with the environment in mind. Thus, many of the projects utilize repurposed fabrics and materials.

Contributions to the upcycling effort come from other departments as well. Siew Yen, who oversees the issuance and return of staff uniforms, meticulously dismantles zippers from condemned uniforms for the Linen Department to use in other projects.

Left to right: ANC Soh Lay See, Ms Kong Lee Wei, Ms Lisa and Mr Irme Zakwan. ANC Soh secured donations of a generous quantity of curtain samples for the Linen Department to upcycle into toiletries bags for patients. 160

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UPCYCLING FOR OUR PATIENTS

Salvaging Blankets With some ingenuity, the Linen Department has salvaged many torn blankets that would otherwise be disposed of. Due to wear and tear over time, small holes began appearing on the blankets that proved too large to sew up. Each month, up to 50 torn blankets need to be disposed. Fortunately, the Linen Department came up with a simple solution to help the organization save cost and brighten up our patient’s day at the same time! Using a trusty embroidery machine to create beautiful embroidered butterflies to patch up the tears, Lisa is able to salvage up to 30% of the blankets and give them a new lease of life. This simple fix greatly extended the lifecycle of the blanket and kept them serviceable for years to come.

“Many items can have a second life. We just need to put some thought into it.” Ms Kong Lee Wei Senior Executive, Linen Department

In-house Manufacture of Hand Mittens It was observed that many patients from low-income families were less likely to purchase hand mittens, deterred by the costs. This often resulted in them detaching IV lines and catheters on their own, disrupting the care process and adding to the workload of the nursing staff who had to repeatedly replace the implements. Using the cloth that remained from previous projects, 40 pairs of low-cost hand mittens were produced for loan to patients free-of-charge. They are laundered regularly for re-circulation, incorporating a design that is less restrictive on the patients’ fingers and also less abrasive to their skin.

590

patients have benefited from the free loan of the hand mittens since 2013.

An Affordable Holter Bag for Cardiology Patients Another project by the Linen Department involved custom-making holter bags to save costs for the hospital. The holter bags hold monitors that record heart and blood pressure over 24 hours at the Cardiology Clinic. Unfortunately, commercially available bags cost up to $400, making it expensive to maintain surplus stock. This results in frequent shortage of holter bags for circulation. Our nimblefingered colleague incorporated recycled fabrics to stitch together a cheaper alternative that costs only $16. This cheery, yellow bag serves as a reminder to our staff of how easy it is to make a positive difference, benefitting both patients and the organization. Building a Green Culture from Within

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THE ABLE STUDIO – PASSING IT FORWARD For the last 14 years, Nurse Clinician Sim Lai Kiow has worked with palliative patients, tending to their comfort and ensuring their dignity at the end of life. Wherever possible, she supports patients in their wish to spend their last days in the familiarity of their own homes. Apart from empowering caregivers with the confidence and skills to care for their loved ones, Lai Kiow also assesses the need for medical equipment, such as adjustable beds, oxygen concentrators, and suction pumps for needy families who cannot afford to buy or rent these items. Noticing these unmet needs, she started her own mini-program to match equipment donors to those in need to reduce their financial burden and giving the equipment a new lease of life. For many years, the Medical Social Workers and Lai Kiow would request that patients’ families hold on to the equipment in their own homes while she looked for people who needed them and organized the transfer.

Mr Edmund Lee (Executive) and Nurse Clinician Sim Lai Kiow in their equipment storeroom.

“These not only help the patient, but caregivers, too,” she points out. Beyond offering more comfort and dignity to patients at the end of life, the equipment goes a long way to support the caregiver and make it easier for them to carry out their caregiving duties. In collaboration with the ABLE Studio (an in-house retail outlet retailing medical related accessories and equipment) located in Khoo Teck Puat Hospital, this Recycling Medical Equipment for End-of-Life patients initiative has since benefited some 100 patients and families who could not afford the range of equipment, such as hospital bed, air mattress, oxygen concentrator, suction pump, wheelchair, commode and more. Lai Kiow and Edmund with their team (from left): Daniel Sii (Staff Nurse), Mr Saw Aung Thurak (Senior Pharmacy Assistant), and Ms Hazeena Banu bte Shaik Alaudeen (Senior Staff Nurse).

The ABLE Studio is an in-house retail space that empowers people to be proactive in managing their condition. Spearheaded by Dr Wong Sweet Fun (Chief Transformation Officer & Senior Consultant, Geriatric Medicine), the space encourages the adoption of elderly-friendly products and solutions in the domestic setting. The space includes a simulation corner styled after IKEA showrooms where customers can experience the benefits of various solutions first-hand before purchasing. These home improvements include handrails, walking aids and other conditionspecific equipment. The space was conceptualized in consultation with Mr Phillip Wee, former General Manager of IKEA Singapore.

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“All these contributions add up to a lot. It makes a big difference to help someone spend their last days at home, where it is more comfortable and familiar.” Ms Sim Lai Kiow Nurse Clinician


THE SERIAL INNOVATOR Working on the ground and close to patients, nurses are not only the backbone of patient care, but also the ‘eyes’ and ‘ears’ on the ground. Advanced Practice Nurse (APN) Toh Hai Moy, lives and breathes innovation. Apart from her APN duties in Respiratory Care, she continuously look for innovative ways to improve nursing workflow or deliver better care to patients. APN Toh has spearheaded many successful innovation projects over the years, many of which are in practice throughout Khoo Teck Puat Hospital. While coming up with creative ideas and prototypes, APN Toh remains mindful of the need to be environmentally friendly. Where possible, she keeps the cost down by recycling or reusing old materials. The prolific inventor continues to innovate and has come up with a range of everyday devices and improvements that enhance patient comfort and quality of life. Known as the Angie inventions, each piece is a response to an inconvenience that patients often encounter. Some of these devises are in partnership with the Mother & Child project as part of the hospital’s Corporate Social Responsibility movement to support and create income opportunities for single mothers.

“The greatest motivation for me is seeing my patients gain greater mobility and independence with the use of items I’ve invented. Seeing them return home with confidence and joy gives me the greatest satisfaction.” Ms Toh Hai Moy Advanced Practice Nurse Nurse for over 40 years

Angie Cargo Pants – comes with a special pocket to contain and conceal urine bags for those on an indwelling urinary catheter drainage

Angie Headband – keeps nasogastric intubation and feeding tubes (or NG tubes) neatly tucked out of sight along the hairline.

Angie Potty – a urine measurement and specimen gadget which is sturdy, compact and easy to sanitize for reuse. The receptacle can be lowered directly into the toilet bowl and washed during the flush and is clearly marked. Building a Green Culture from Within

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BRINGING THE SPIRIT OF REPAIR TO THE COMMUNITY The hospital’s care has reached beyond its physical premises into the community. Through Wellness Kampungs®, a trio of wellness and network centres for residents of the North, health and social programs can be offered to support the health of our community. One such program that has sprung up through the residents’ initiative has had positive environmental and social merits. This initiative, Repair Kaki, is modeled after Repair Cafés, a global community movement to reduce waste, maintain repair skills, and strengthen social cohesion. Kaki is Malay for “leg”, but in colloquial speak also means “friend” or “buddy”. In short, Repair Kaki consists of friends who repair your broken items, extending their lifespan. Here, volunteers with electrical, electronic and other DIY skills assemble to fix appliances brought in by residents. It was started last year as a way to engage a wider range of senior residents, like these men. Since then, they have worked on 80 items and enjoyed a success rate of roughly 80%. Many of the volunteers, like Mr Chu Siew Wah, 74, worked as electricians or were in the electronics or engineering fields. “Repairing things is my hobby,” he says. “I decided to join because this is my interest.” Mr Gary Ong, 68, a retired electrician, finds the activity challenging and meaningful. Repair Kaki creates a triple win situation: residents get their items repaired at minimal cost, volunteers enjoy a sense of satisfaction in serving their neighbors, and less waste is generated by salvaging the items.

Above: Mr Chng Kai Guan, 73, using a Power Drill to build a DIY Stand for an Electric Keyboard. Right: Repair Kaki is held at Wellness Kampungs®, making access to other health-related support easy for the kakis. 164

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Repair Kaki provides simple repair to help residents improve their wheelchairs’ performance and reduce likelihood of any strain injury.

100 wheelchairs have been repaired by the volunteers of Repair Kaki since 2018.


Mr Tay Kay Hock, 75, and Mr Tia Oon Lai, 63, learning to use the soldering iron during their workshop.

An Increasing Number of Items Saved from Disposal

2017

2018

Items Received by Repair Kaki

12

23

Items Repaired Successfully

10

17

Monthly Average

Mr Chu Siew Wah contributes his electrical repair skills, helping residents in the community while reducing unnecessary waste generation.

‘’It keeps my mind active because I learn a lot from those who are more experienced. Also, it is very satisfying when you manage to fix something.’’ Mr Gary Ong, 68 Retired Electrician

Above: The main goal of the program is not actually repairing things, but to increase social participation and overall wellness. Research shows that better social networks and greater participation in social activities are associated with lower risks of cognitive decline and higher levels of psychological and physical health. Right: Mr William Goh, 59, serves not only as a repairman, but also as a handphone tutor. “I teach them to use their handphones, apps and watch movies so that they can live a more colorful life”.

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RECYCLE At present, Singapore has only one landfill left. Each year, we send 200,000 tonnes of solid waste and incineration ash to Semakau landfill. It is estimated to run out of space by 2035.3 Increasing our rate of recycling can lessen the stress on our landfill, reverting waste into raw material.

Though the increased awareness of recycling in recent years is a great step forward, we should not let the option of recycling encourage increased consumption and waste generation in the first place. Viewing recycling as a last resort second only to disposal can help us to keep our consumption in check.

Facilitating Recycling to Reduce Landfilling and Incineration Encouraging the public and our people to recycle has helped us reach ever increasing rates of recycling, while keeping the volume of general waste constant.

The availability of recycling bins around the hospital has enabled people to recycle more of their waste. Photographic visuals on recycle bins help the elderly to correctly dispose of their recyclables.

Tons

Keeping general waste under control

Tons

2000

200

1500

150

1000

100

500

50

0

The waste we recycle has increased

0 2015

2016

2017

While we were able to decrease general waste in the early years, there has been a recent increase. We have since been deep diving to stem this increase.

2015

2016

Simultaneously, an increasing recycling rate has allowed us to divert waste away from incineration and landfilling

3. Ministry of the Environment and Water Resources, “Managing our waste,� accessed July 16, 2019, https://www.mewr.gov.sg/topic/landfill. 166

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2017


RECYCLING IN THE WARD To support the provision of care at the wards, a large volume of clinical supplies and hygiene products are required. Bearing the brunt of the hospital’s workload, it is thus inevitable that the inpatient setting becomes a key generator of waste within our organization. To mitigate the environmental impact of inpatient care, the nurses at the

wards diligently process and recycle these supplies. This includes cutting the plastic bottles in half to empty their contents before rinsing them with water where required. This additional effort ensures that the plastic remains in a recyclable condition when it arrives at the recycling facility.

The recyclables at the ward include hand hygiene products such as hand rubs and soap, intravenous infusions and other sterile supplies such as antiseptic solutions and sterile water.

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COMMUNITY OUTREACH Besides building a green culture within our organization, the hospital is also active in reaching out to the public to spread awareness on environmental issues. It is our hope that through our efforts, the public will increasingly take personal responsibility for the health of the environment.

We believe that fostering a self-cleaning culture within the hospital will free up our housekeeping staff, giving them more time to ensure the hygiene of our patient-facing areas.

Fostering Awareness

The annual Clean & Green Week encourages the community to uphold public hygiene and environmental stewardship. In 2016, our theme was waste reduction through reuse and repair.

Members of the Green Committee conduct an educational storytelling for the young students of Little Skool-House By-The-Lake for World Water Day 2019, sharing with them the importance of clean water and water conservation.

Public Hygiene for Public Health The maintenance of public hygiene supports public health. Singapore is known internationally for its cleanliness, thus it is easy to forget the early post-independence period where hygiene in public spaces was once lacking. Ensuring hygiene in public spaces arrests the proliferation of pests, resulting vector-borne diseases, and infections in general.

In Singapore, the high standards of cleanliness are supported by a sizeable pool of cleaners. Even so, their numbers have been dwindling, from 70,000 registered cleaners in 2013, to 56,000 in 2018.4,5 The responsibility of maintaining public hygiene must therefore shift progressively to the public.

Far-left: For the annual Keep Clean Singapore event alone, we have helped to pick up 3,462kg of litter since 2013. The volume of litter has been decreasing over the years, a sign that residents are becoming increasingly civic-minded and disposing their waste properly. Left: Starting environmental awareness at a young age can have a profound impact on maintaining green habits into adulthood. For Earth Day 2019, these young children from the Little SkoolHouse By-The-Lake do their part by picking litter and sorting them into recyclable categories.

4. David Ee, “‘Cut number of cleaners’ to keep Singapore clean,” The Straits Times, June 11, 2013. 5. Tim Mcdonald, “The cost of keeping Singapore squeaky clean,” BBC, October 29, 2018. 168

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ENCOURAGING A SELF-CLEANING CULTURE 12. Butterfly stickers.pdf

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2:48 pm

Building a “Mini Japan” The management implemented policies to encourage a more considerate culture among all who come to the hospital. We looked to Japan as a role model for its ubiquitous cleanliness maintained by an exceptionally considerate society. This comprised three broad areas: 1. Promoting Health 2. Promoting a Self-Cleaning Culture 3. Promoting a Considerate Culture Of these three, we will discuss the latter two in the light of hygiene and sustainability. The promotion of health within the hospital is an extensive topic discussed in a separate compendium, “The Five Pillars of Health: The KTPH Experience”. Top-left: Self-cleaning stickers in cheerful colors, motifs and clear messages are displayed prominently to remind users of the facilities to clean up after themselves. Top-Right: An example of a self-cleaning sticker on a communal table to encourage and promote the self-cleaning culture.

Encouraging People to Clean After Themselves Reminders are placed around public spaces to encourage visitors to clean up after themselves before leaving. Staff are also expected to pick up any litter that they come across, taking ownership of the workplace as if it were their own home. Combined, these strategies free up our housekeeping staff to do more specialized cleaning tasks for the safety of our patients. In addition, a cleaner environment lowers the rate of infection within the compound, aiding in the recovery of our patients while preventing our staff and visitors from falling sick.

Self-cleaning and sorting culture in the foodcourt The foodcourt, being a well patronized place by the public and staff, is a good platform to promote the self-cleaning culture lead by staff as ambassadors to advocate and nudge other customers to practice likewise. This also helps to cultivate positive hygiene habits within oneself and to influence other people in the community to be considerate of others.

Self-sorting stations are strategically located in the center of the KTPH foodcourt.

Our nurses model good behavior by clearing up after their meal. Walking the talk cues the public to do the same.

Messaging on the tables encourage customers to return their trays and utensils after their meals.

The provision of tissue paper at every table encourages diners to be hygienic and keep the table clean after their meal.

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LITTLE THINGS ADD UP Teaching the Public to Upcycle At various events over the years, we have taught the public to upcycle unwanted items instead of purchasing new ones. Among these upcycling ideas are the conversion of used t-shirts into fabric bags (bottom-left and center) and the repurposing of plastic drink cartons as planter boxes (bottom-right).

Staff-Initiated Repair Projects The staff of the Specialist Outpatient Clinics volunteered their own time in the weekend to undertake the reupholstery of worn out chairs from the clinics.

The DIY reupholstery of worn out chairs saved

S$10,465

Top-left: Clinic staff dismantling the chairs after a short introductory training. Bottom-left: The team celebrates their first successful reupholstery. Bottom-right: The first completed batch of reupholstered clinic chairs.

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Decorating our Gardens with Recycled Materials For Clean & Green Week 2017, our colleagues added a whimsical touch to our gardens using recycled materials. As part of the “Enchanted Gardens Decoration Contest”, departments stepped forward to fashion recycled materials into decorative ornaments for our gardens. Their colorful creations complemented our gardens, with butterflies (right) and comical flowers lining our ponds (farright), among the many creative pieces. The special display was aimed at eliciting the curiosity of passerby, surprising them with the limitless potential of recycled materials.

Upcycling Projects by Staff Our colleagues from the Facilities Management Department repurposed a cable spool left from the construction of Yishun Community Hospital to create a table set with six chairs. The leftover cloth used in the refurbishment of the clinic chairs was used for this project. The project helped us to avoid purchasing a new table set, and has since served to facilitate many office discussions.

Reusing Donated Decorations Larger-than-life lantern frames have decorated the hospital’s main lobby and numerous events through the years. However, the story behind how they came to be donated to us is known to few. On a weekend afternoon, a staff member had sighted the tall ornaments at Paragon Shopping Centre and wondered what would happen to them after the festive season. After some enquiring, the management generously agreed to donate them to the hospital after the festival.

Right: The lanterns as they originally appeared at Paragon Shopping Centre. Bottom and bottom-right: The lanterns have been reembellished and repainted for use in many events over the years.

The lanterns have since brought cheer to visitors, patients and staff alike, embellishing the décor for many a celebration. More recently, we have even lent them out for grassroots events as well, considerably extending their originally intended length of use.

Chinese New Year 2015

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CONCLUSION Back in Alexandra Hospital, we had already begun laying the foundations of what would become the green culture of KTPH today. While environmental awareness in Singapore was not as strong back then as it is today, we persevered with our efforts within our organization. While the impetus to pursue more sustainable hospital operations came from the management, it is ultimately our people who have supported our vision with steadfast commitment. Indeed, the 4Rs would be ineffectual if our colleagues did not adhere to them. With the guidance of the 4Rs, many of our colleagues have tapped on their ingenuity to both minimize our impact on the environment while benefitting our patients. They have demonstrated that being green can not only help to reduce operating costs and our carbon footprint, but also profoundly impact the quality of care for our patients. Beyond our organization, we have involved ourselves in community outreach, in the capacity of both initiator and collaborator. We recognize that even more can be done as the community grows increasingly conscious of the need for environmental stewardship. We believe that our efforts thus far have built a stable foundation for us to create a greater impact in the next leg of our green journey.

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CHAPTER 5: Joining Hands for Sustainability



INTRODUCTION Over the years, we have joined hands with many likeminded partners to minimize the impact of our activities on the environment. Our partners are a key element in our sustainability endeavor. A network of green partners is able to share new ideas and best practices, in turn creating a multiplier effect in the implementation of greener operating solutions. Many of these partners are suppliers and service providers of the hospital. They have met our challenge to operate their businesses with the environment in mind with enthusiasm and commitment. Many have pursued sustainability in their own arenas, achieving green breakthroughs and recognition for their efforts.

Abroad, we have partnered organizations which champion best practices in sustainability in the healthcare setting. These partnerships have opened our eyes to green paradigms from other parts of the world and equipped us with new systematic ways of managing sustainability. This chapter will highlight the contribution of our sustainability partners to our vision of a greener hospital, and recognize their own impressive achievements in this field. We hope that sharing their stories will demonstrate the very practical benefits of being green in any industry, and encourage others to create a similar triple-win positive impact for the environment, the community, and their businesses.

Locally, collaborating for sustainability has seen the galvanizing of efforts from the 3P sectors: Public, Private and People.

Our partners affirming their commitment to sustainability at the Yishun Health Sustainability Conference in 2018.

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GREEN BUILDING CPG Corporation Our partnership with CPG Corporation began more than a decade ago, when CPG Consultants was appointed the architects of our hospital. Their commitment to our vision of a hospital set in a garden has since set the foundation on which we have nurtured a healing environment for our patients. In commemoration of this longstanding partnership, CPG Corporation has generously undertaken the cost of this book. CPG Corporation’s approach to designing our hospital incorporated an integrative design and implementation process. This was supported by collaborative participation from many stakeholders, including healthcare operators, design consultants, builders, patient representatives, and the community. Guided by the leadership of both our organizations, the end design outcome epitomizes and validates our shared beliefs in championing biophilic designs for the built environment. By satisfying man’s affinity

with the surrounding natural environment, biophilic design brings the benefits of natural and living systems into the built environment. This in turn supports enhanced well-being and productivity, while creating opportunities for communities to engage in environmental stewardship. The personal belief in sustainability displayed by the architects and designers that we have worked with is evidenced in their work. With this conviction and alignment with our vision of a green healing hospital, building design, landscape design and placemaking were all synergistically manifested in the final design proposal. We would like to thank CPG Corporation for their partnership and generosity in making this book a reality and believe that they will continue to create even more sustainable developments in the coming years.

Above: Mr Khew, CEO of CPG Corporation, presenting the proposal for a green hospital. Above-right: Ms Pauline Tan (left) and Mr Jerry Ong (right), architects of CPG Consultants, lending a hand. Right: Mr Glenn Bontigao, in the capacity of landscape architect, contributed to the design of the hospital’s many green spaces.

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GREEN FACILITIES SERVICES Amozonia As our landscaping partner, Amozonia shares our belief in creating a green healing environment for our patients and the larger community. Landscaping waste such as leaf clippings, tree branches and other organic litter are collected daily from their various landscaping sites. They are then sent to a recycling plant to be shredded before being composted. The compost is then segregated into several different grades for tree planting, shrub- and vegetable-growing. This is then mixed with topsoil, sand and other soil conditioners for their final landscaping applications. By recycling landscaping waste, Amozonia improves the cost effectiveness of their operations while reducing waste output.

UEMS Our environmental service partner since 2013, UEMS Solutions Pte Ltd has championed green behavior at the staff level. Heeding our call to reduce the use of plastic disposables, UEMS gave out complimentary lunchbox sets to the entire department during KTPH ESD Day 2017. A total of 250 housekeeping staff from UEMS and KTPH received the lunchboxes at the event. Besides using these lunchboxes on a daily basis, the staff also bring them to UEMS’s monthly “Happy Staff, Happy Customer” staff appreciation lunch, where no disposables are provided, and all attendees must bring their own lunchboxes and utensils. UEMS staff have used discarded materials such as old tires to create planter boxes and have enthusiastically contributed to the gardening effort.

Synergy Synergy FMI, our Facilities Management partner from 2015 to 2019, exceeded expectations by going the extra mile in their duties. Vigilant inspections of critical areas to ensure efficiency in energy and water usage helped us to safeguard against wastages. This included active calibration of toilet flush sensors, helping the hospital to reduce water consumption despite an increase in patient load during these years. The technicians of Synergy also actively employed their skills, crafting useful items from recycled materials, helping to keep them out of the landfill while creating value for others. Their craftsmanship has contributed to numerous projects, from creating tables and chairs from recycled cable reels, to equipping KTPH staff with the knowhow to reupholster clinic chairs through a weekend workshop. They have helped us to mitigate our environmental impact through the 4Rs, particularly Reduce and Reuse. Joining Hands for Sustainability

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GREENER FOOD & BEVERAGE Foodfare @ KTPH Foodfare @ KTPH has been a supportive partner of our healthpromoting and green initiatives over the years. In our push to encourage healthier food choices among patrons, Foodfare took the lead by making available a wide selection of healthier meal choices. They were awarded the Eco-F&B certification by the Singapore Environment Council (SEC) for implementing sustainable features in their food court. They continue to support our sustainability efforts by encouraging plant-based nutrition and discourage the usage of plastic disposables among diners. Discounts are given for diners who bring their own containers, plastic straws are no longer given out, and the paper cups used for takeaways are certified to be sustainably produced by the SEC. Separately, Foodfare is also working with the National Environment Agency to better manage and reduce food wastage at KTPH. Reusable Straws

No Plastic Straws

Bring-Your-Own Containers

No Plastic Stirrer

Decline Receipts

Biodegradable Bags

FairPrice Xpress The FairPrice Xpress outlet at KTPH actively discourages the use of plastic bags. On top of this, reusable bags are available for shoppers to buy, encouraging them to shift away from plastic bags. Reusable Straws

No Plastic Straws

Charge for Plastic Bags

Subway A popular international sandwich restaurant, Subway was also a Gold Award Recipient in 2015 for NEA’s Singapore Packaging Agreement. By reducing the thickness and size of their food wrapping paper, they have drastically reduced their paper usage. The KTPH outlet was also one of the first to join hands with us in rejecting plastic straws. Director of the KTPH outlet, Mr Koh Chyn, admits to that he was initially apprehensive about being the first Subway in Singapore to go totally straw-free. He believes that the success of the initiative shows “the growing maturity and awareness” of the community regarding environmental issues. Reusable Straws 178

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No Plastic Straws

Bring-Your-Own Containers


Heavenly Wang Beyond serving the staff and patrons of KTPH with their signature kopi and kaya toast, Heavenly Wang is also doing their part for sustainability. Fans are used to cool the dining area instead of air conditioning. The outlet was also designed to be cooled predominantly by natural ventilation, saving energy and reducing its carbon footprint. Heavenly Wang has also supported our green movement by using eco-friendly paper cups and stopping the issuance of plastic straws. Reusable Straws

No Plastic Straws

Biodegradable Bags

iJooz Operating two orange juice vending machines in our premises, iJooz redesigned their packaging to incorporate a paper seal, facilitating consumption without a straw and saving up to 10,000 straws annually. The orange peels that result from the juicing process are also collected and given to produce a natural enzyme detergent. This is then offered to hawker centers for general cleaning purposes, reducing dependence on chemicals.

Sushi Deli Serving Japanese fare, Sushi Deli has embraced our straw-free movement and is 100% plastic straw-free. Reusable straws are available for purchase as a green alternative, and only 100% biodegradable bags are provided to customers upon request. Reusable Straws

No Plastic Straws

No Plastic Straws

Biodegradable Bags

Food Waste Recycling

Mr Bean A leading soya bean food and beverage retailer in Singapore, Mr Bean is known for delectable treats using only soya beans that are non-GMO (non-genetically modified organisms). Waste soya fiber from the production of soya milk is also used to make their healthy granola bars. Reusable Straws

Biodegradable Bags

Bring-Your-Own Containers

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GREEN SOCIAL ENTERPRISES AND MORE

Bettr Barista

Dignity Mama

Founded in 2011, Bettr Barista is a social enterprise and the 2017 President’s Challenge Social Enterprise of the Year. They are focused on igniting social change through holistic training for marginalized women and youth at risk, direct and sustainable trade with coffee producers as well as sustainable and eco-conscious practices. Bettr Barista has been a steadfast partner in our green campaigns, launching various initiatives by their own volition. They are 100% plastic straw-free and retail reusable straws as a green alternative. Their used coffee grounds are given to our Rooftop Farm to be composted, and discounts are given when customers bring their own coffee mug, helping to cut down on disposable waste.

Part of award-winning homegrown social enterprise, Project Dignity, Dignity Mama is a retail brick and mortar that has been empowering caregivers and young adults with special needs since 2012. Operating on a triple bottom line, the enterprise encourages conscious consumerism through sales of gentlyused books and upcycled handicraft. With support from the public and KTPH staff, it has kept 50,000 books out of landfills and employed 38 parent/child teams and individuals. Expanding to 4 locations in Singapore hospitals within a decade, the brand is a successful integration of business with sustainability and social impact.

Reusable Straws

No Plastic Straws

Paper Bags

Reusable Coffee Mugs

Food Waste Recycling

Operated by CPAS, these pushcarts give trainees an opportunity to work independently and gain vital retail and community interaction experiences. The use of plastic bags is discouraged through a charge. Charge for Plastic Bags

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Sustainable Bookdrop

Bring-Your-Own Containers

Cerebral Palsy Alliance Singapore

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Recycled Plastic Bags

Xpressflower.com Our main retailer of bouquets and recovery hampers has been progressively shifting towards using paper bags instead of plastic ones. They are also moving towards the use of recycled baskets for their hampers.

Paper Bags


GREEN SERVICES

Zero Spot Zero Spot is KTPH’s linen laundering partner. Operating on an industrial scale, they have implemented various energy and water saving measures to reduce their carbon footprint. Continually upgrading their equipment has helped them to maintain a highly water efficient laundering process. Recovering heat from the boiler process allows it to be reused for heating water, reducing diesel consumption by 104,000 litres annually. They have also redesigned the ventilation system of their premises to reduce the energy required for air conditioning. Zero Spot’s various premises have also been recognized by the PUB as Water Efficient Buildings.

Ollo Ollo operates an automated laundromat service at KTPH that is used by the public and staff. They have reduced the environmental footprint of their operations by replacing plastic bags with reusable woven bags. The kiosk is also intuitively designed to encourage the reuse of the clothes hangers provided by the service.

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GREEN CULTURE PARTNERS Public Sector Partners Many of the community outreach efforts mentioned previously have been realized through close collaboration with various public sector partners. In particular, the Housing and Development Board (HDB), National Environment Agency (NEA), National Parks Board (NParks), Public Hygiene Council (PHC), Public Utilities Board (PUB) and Nee Soon GRCs have been close partners.

Our people join in Nee Soon South’s Litter Picking with Advisor activity in June 2019.

Over the years, we have participated actively in the public hygiene activities of the GRC. The monthly litterpicking sessions with Er Dr Lee Bee Wah since 2013 have galvanized the community to keep the estate clean. Our former GCEO Mr Liak, who was a strong supporter of the effort, encouraged active participation among our staff. Since its inception, the sessions have seen a decreasing amount of litter collected, evidence that the public has grown increasingly conscious of the need for upholding community hygiene.

Water Wally, PUB’s official mascot, makes an appearance at World Water Day 2019. We have organized observance activities annually in partnership with PUB. NEA provided the litter-picking equipment used by the participants.

Our other partners have enabled us to extend our outreach efforts. Through mutual support in organizing annual conservation and environmental stewardship activities such as World Water Day and Operation We Clean Up, we have attracted the active participation of the nearby residents. These activities have helped to foster awareness on the need for environmentally responsible habits in the domestic sphere. We would like to thank the HDB, NEA, PUB and PHC for their valuable partnership on this front.

The rejuvenation of Yishun Pond was undertaken in partnership with HDB, NParks and PUB, with donations from the Khoo Teck Puat Foundation.

Our colleagues participating in Operation We Clean Up 2018, organized by the PHC for the annual Keep Clean Singapore initiative.

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Little Skool-House By-The-Lake Since 2010, The Little Skool-House By-The-Lake, a preschool located within the hospital’s premises, has been an active partner in inculcating the values of environmental stewardship in our future generations, as well as their parents. The Little Skool-House’s curriculum incorporates elements that develop the children’s environmental consciousness through an appreciation of flora and fauna. Topics like recycling and the ecosystem are made understandable for the young children through outdoor activities in our gardens and visits to the Rooftop Farm. Parents are kept informed with paperless progress reports sent through a mobile app and asked to bring their own reusable lunchboxes and cutlery for school events. The children are key advocates in transmitting the green message to their parents and elders. Exposing children to the natural environment in their formative years is important in shaping their subsequent perspective on environmental issues, developing them into caring and responsible citizens.

The teachers of Little Skool-House By-The-Lake foster an appreciation for the natural environment in the students through educational activities in our gardens.

City Developments Limited (CDL) As a major developer and landlord in Singapore, CDL has been a strong advocate for green buildings and the UN Sustainable Development Goals (SDG). Our organizations have similar aspirations in encouraging greener and healthier lifestyles in the community. In October 2018, we joined CDL’s SDG City Challenge in a bid to promote green, active and healthy lifestyle in our urbanized society. Right: In May 2019, Yishun Health supported City Developments Limited by donating 1,420 plastic bottles and helped to set up an art installation at Marina Barrage to raise awareness on plastic pollution.

Siloso Beach Resort The Siloso Beach Resort’s genesis bears many similarities to our own. The resort prides itself in its dedication in preserving the natural state of its surrounding habitats, going to great lengths to ensure harmonious integration of built and natural environments. We have learned much from their green initiatives, particularly in landscaping and waste management. Right: Our landscaping team learned how insects such as the Black Soldier Fly can facilitate the composting process.

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LEARNING ACROSS BORDERS FROM INTERNATIONAL PARTNERS Tzu Chi Foundation On 8 March 2015, we joined hands with Taiwan’s Tzu Chi Foundation to organize the Health Promoting Hospital & Environment Symposium. A Taiwanese international humanitarian non-governmental organization with presence in Singapore for 25 years, the Tzu Chi Foundation and its hospitals are a role model in sustainability practices within the healthcare setting.

Since then, we have had exchanges with Tzu Chi Foundation’s hospitals and its affiliates to learn more about their strategies for providing green healthcare. These exchanges have given us insights on initiatives they have driven in inpatient operations as well as waste management and processing.

Our organizations also signed a Memorandum of Understanding, jointly committing on research, health promotion and green healthcare.

Signing of Memorandum of Understanding between Tzu Chi Foundation and Alexandra Health in 2015 to promote the philosophy of green healthcare.

Our Green Committee went to Taiwan to learn more about Tzu Chi Foundation’s recycling program, getting hands–on in the process.

Members from Tzu Chi joined us in our litter picking session during World Water Day 2015.

A sharing by Dr Ming-Nan Lin during the Green Conference in January 2019 held at KTPH.

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Global Green and Healthy Hospitals Network (GGHH) KTPH joined the GGHH network in 2016, committing ourselves to promote the health of both our people and the environment. Since then, we have participated in the network’s knowledge sharing platforms, supporting their conferences with subject expert speakers. As a partner and venue sponsor for the 5th Green Hospitals Asian Conference 2019 in October, KTPH has joined hands with the organization under a Memorandum of Understanding to establish a platform for hospitals in Asia to share and learn from each other in the realm of sustainability practices. Top right: KTPH team attending a GGHH conference in Indonesia in 2016. Right: Signing of Memorandum of Understanding between GGHH and KTPH in 2019 for the upcoming 5th Green Hospitals Asian Conference. Bottom: Publicity for the upcoming 5th Green Hospitals Asian Conference at KTPH from 8 - 10 October 2019.

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CONCLUSION As the saying goes, “no man is an island�. Our partners are a key element in our sustainability endeavor. Through mutual influence and creating a network of green practice, we can achieve more together. As the collective consciousness grows increasingly aware of the need for environmental stewardship, the days ahead hold new possibilities for collaborative action. We are heartened by the increasing number of likeminded organizations who have joined hands with us. Many of them have achieved success in transforming their operations to be more sustainable, demonstrating the very practical organizational benefits of being green as well. Our partners from the public and private sectors have been instrumental on this journey, aiding us in magnifying the impact of our green efforts. Our green allies from other parts of the world have taught us much and enabled us to make a contribution to sustainability on the international level.

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IN CLOSING Thank you for allowing us to share our journey towards sustainability with you. While the voyage has not always been smooth, it has always been rewarding. Moving forward, we welcome all who would like to collaborate for a greener future in healthcare and beyond to reach out to us.

nurturing this green ecosystem would benefit the wellbeing of our occupants and visitors, and we are heartened that independent research has affirmed our beliefs. In the last decade, the number of species housed in our miniature rainforest has grown in tandem with it.

Environmental health is a strong determinant of human health. Indeed, human beings have thus far been able to adapt to deteriorating environments to survive through invention and technology. However, we need only look to the alarming rates of extinction befalling natural life to realize that we will one day experience the same threat to our survival. This is the bigger picture underlying our belief in sustainable healthcare operations– it would be counterproductive to treat the population if the byproduct of our operations is environmental pollution. This would in turn harm human life, pushing even more patients into the healthcare system. With this conviction we have sought to minimize the environmental impact of our daily operations wherever possible without compromising patient care and safety.

Food production practices and dietary choices go a long way in sustainable living. While people today benefit from a wide choice of food imports arising from globalization, many do not realize the environmental costs incurred in the food production and transportation processes. We have worked to mitigate these detriments through subsistence farming at our organic rooftop garden as well as educating the public to make literally greener dietary choices.

Our pioneers have put every effort into creating a hospital facility that is energy efficient. In the design of our hospital, passive elements minimize our energy consumption all-year round. The integration of Yishun Pond into our landscape was a deliberate decision aimed at welcoming residents into our gardens, giving us an opportunity to influence them to take care of their own health and that of the environment. Over the last decade our Facilities Management team has worked vigilantly to keep our consumption of utilities in check. Their efforts have been especially important considering the challenges of an increasing patient load.

People are the most important resource in effecting green action. The commitment of our people to the environment has built a green culture that is tangible to all who come through our premises. Our proactive participation in environmental stewardship out in the community has influenced our neighbors to step forth in ever-increasing numbers to do their part for the environment. The future holds more exciting challenges for us in achieving sustainable healthcare. While we seek to expand our existing capacity for sustainable healthcare, demographic shifts in the next decades and manpower challenges will necessitate creative problem solving and a greater need for intelligent systems that exploit high technology solutions. We continue to be on the lookout for areas where innovation can create positive outcomes for our patients, community, environment and staff.

Our landscaping project is unique in its commitment to biodiversity preservation. We held the conviction that

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MANY HANDS ON DECK Many green features of the hospital were the result of ideas contributed by various passionate individuals and interest groups that had become friends since our days at Alexandra Hospital. Most of them are subject matter experts in diverse fields as architecture, botany, hydroscaping and entomology.

Their invaluable contributions had helped the hospital achieve the vision of a hospital in a garden and also in the eventual attainment of many accolades for its green and sustainability efforts.

Mr Liak Teng Lit, former GCEO of Alexandra Health, was a key figure in the hospital’s overarching sustainability project. A strong believer in environmental conservation, he had a grand vision of hospitals that could treat patients while remaining environmentally sustainable. Beyond this, he championed the synthesis of the natural environment with the built hospital structure, with the hopes of improving the wellbeing of our patients, aiding them in their recovery. Beyond healthcare, his other notable appointments are reflective of his passion for the environment. As an environmentalist, he headed the National Environment Agency as Chairman. A strong believer in the responsibility of individuals in upholding public hygiene, Mr Liak headed the Public Hygiene Council, serving as a main driving force for the Keep Singapore Clean Movement. Many of KTPH’s green policies and design elements originated from Mr Liak, shaping the hospital to be patient-centric, environmentally sustainable, and a place for the community, all in one.

Mr Ho Peng Kee, then-MP for Nee Soon East GRC, who aided in the initial master planning.

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Ms Wong Swee Yin (in white) and Mrs Pauline Ong (in blue) gave us many insights as our Advisors.


Mr Tan Wee Lee (Architect, spouse of “Chief Gardener” Rosalind Tan) volunteered his service in the planning and design of the gardens. He also contributed many photographs for this book.

Mr Richard Ong has helped us identify more than half of our 99 butterfly species, skillfully curating them through macro photography.

Mr Ng Cheow Kheng, a botanist by training, advised us on plant selection, in particular around Yishun Pond.

Dr Wee Yeow Chin (Botanist and author of the book “Plants that Heal, Thrill and Kill”) gave talks, donated plants and inspired the creation of the Medicinal Plant Garden.

Mr Lee Chiu San regularly provides advice on how best to maintain the fish population and the healthy equilibrium of our aquatic ecosystems.

From left: Mr Khew Sin Khoon, Mr Gan Cheong Weei and Mr Simon Chan taught the team everything about butterflies since our days at Alexandra Health, inspiring the creation of the Butterfly Trail.

Dr Tan Hwa Luck, besides bringing with him a passion for ecology, also contributed various fish species to our ponds.

Mr Ronnie Chew introduced to our rooftop farm a hybrid hydroponic system built from recycled materials. He has been a regular volunteer since the farm’s inception.

Dr Ho Hua Chew contributed valuable insights on how to build a welcoming habitat for birds.

Mr Rajendran of Amozonia Pte Ltd, our current landscaping partner.

Mr Tang Hung Bun, avid dragonflywatcher and photographer, has supported us through the years in ensuring the viability of the dragonfly population.

The late Mr Jickky of Tropical Environment Pte Ltd, which helped in the early landscaping of the hospital.

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IN APPRECIATION The hospital’s vision of providing environmentally responsible healthcare was made possible by the effort and expertise of countless partners. We would like to extend our deepest gratitude to all who have helped in this endeavor in ways big and small. While it is not possible to list every one, we would like to thank the following people who have contributed to this book as well as in the actualization of sustainability in each chapter’s domain. Preface Ms Rosalind Tan and Mr Tan Wee Lee. Chapter 1: Designing for Sustainability CPG Corporation Pte Ltd for their partnership and commitment to realizing our vision: Mr Khew Sin Khoon, Group Chief Executive Officer, CPG Corporation Pte Ltd, Mr Jerry Ong Chin-Po, Senior Vice President (Architect), CPG Consultants Pte Ltd. The researchers who have optimized our energy efficiency with their expertise: A/Prof Lee Siew Eang, School of Design & Environment, National University of Singapore, Dr Nirmal Kishnani, School of Design & Environment, National University of Singapore. Mr Donald Wai, Director, Hospital Planning & Infrastructure, KTPH Mr Stewart Tai, Manager, Facilities Management Department, KTPH Mr Richard Jang, Senior Engineer, Facilities Management, KTPH KTPH Facilities Management Department. KTPH Hospital Planning Department Chapter 2: A Hospital in a Garden, A Garden in a Hospital Chief Gardener Ms Rosalind Tan, Mr Simon Chan and Mr Mark Lim of our Landscaping Department. The subject matter experts who volunteered their knowledge to get us off the ground (in alphabetical order): Mr Simon Chan, Mr Ronnie Chew, Mr Gan Cheong Weei, Dr Ho Hua Chew, Mr Khew Sin Khoon, Mr Lee Chiu San, Mr Ng Cheow Kheng, Mr Richard Ong, Dr Tan Hwa Luck, Mr Tan Wee Lee, Mr Tang Hung Bun, Dr Wee Yeow Chin. Mr Glenn Bontigao, Mr Jickky and Mr Rajendran for their contribution to our hospital in a garden. Chapter 3: From Garden to Table: Making Food Sustainable Our rooftop garden volunteers for their unwavering commitment over the years in growing vegetables for our patients. Food Services Department, Nutrition and Dietetics Department, Operations Department, Tenancy Department. Ms Shirley Goh, Executive, Tenancy Department, KTPH, for galvanizing our partners for green action. Chapter 4: Building a Green Culture from Within Our Green Committee for leading our people in sustainable action, Mr Chin Yew Leong, Deputy Director, Operations Support Services, KTPH and Chairman of the Green Committee, Ms Jolia Low, Senior Manager, Operations Department, KTPH, for leading the “Mini Japan” movement. Operations Department. Last but not least, all our staff who have shown through their actions a belief in our vision of sustainable hospital operations. Chapter 5: Joining Hands for Sustainability All our tenants, vendors and partners who have joined us on this journey towards sustainability.

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Sponsors This book is made possible by the generous contributions of CPG Corporation Pte Ltd. Advisor Ms Yen Tan, Chief Operating Officer, Khoo Teck Puat Hospital and Yishun Health Editor Mr Jack Lau, Senior Executive, Operations Department, KTPH Writers Shirley Goh, Executive, Operations Department, KTPH Jack Lau, Senior Executive, Operations Department, KTPH Jolia Low, Senior Manager, Operations Department, KTPH Dr. Vidya Schalk, Ph.D Design Support Ms Rachel Tan Rui Qi, Executive, Operations Department, KTPH Photographer The Fat Farmer Designer Barking Dogs Design Pte Ltd Printer Print Dynamics (S) Pte Ltd

Khoo Teck Puat Hospital September 2019 ISBN 978-981-14-2560-8

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AWARDS AND RECOGNITION The accolades that we have received over the years have greatly encouraged our people to continue energizing our sustainability programs. Awards and certifications are not merely affirmations of an organization’s efforts. They also act as a guide for organizations to align their policies and activities towards achieving sustainability goals. 2006 • Architectural Design Competitions 2006 Urban Planning Category 1st Prize 2009 • Building & Construction Authority Singapore Green Mark Awards 2009 Platinum Award 2010 • SIA-NParks Skyrise Greenery Awards 2010 1st Prize • Emerson Cup 2010 New Project Category – Special Mention • Public Utilities Board Inaugural ABC Waters Certification Award 2010 • National Parks Community in Bloom Awards 2010 Platinum Award

2011 • Landscape Industry Association of Singapore Awards of Excellence 2011 Gold Award & Best of Category (Implementation, Commercial), Silver Award (Turnkey) for Yishun Pond • FuturArc Green Leadership Award 2011 Institutional Architecture Category Winner • MIPIM Asia Awards 2011 - Silver • International Rooftop Landscaping Association World Best Green Roof Award 2011 • Singapore Institute of Architects Architectural Design Awards 2011 Building of the Year, Design Award for Healthcare Facility • Design & Health International Academy Awards International Sustainable Design (High Commendation), International Health Project Over 40,000sqm (High Commendation) • Building & Construction Authority Singapore Universal Design Awards 2011 Gold Award • President’s Design Awards 2011 Design of the Year 2012 • National Parks Board Community In Bloom Awards 2012: Platinum Award, Best Community Garden 2012 • Building & Construction Authority Construction Excellence Awards 2012

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2013 • Taiwan Ministry of Health and Welfare (Health Promotion Administration) International Environment-Friendly Hospital Team Work Best Practice Award 2013 • National Parks Board Landscape Excellence Assessment Framework (LEAF) Awards 2013: Certificate of Recognition for Development Projects with Outstanding Greenery • Eco Action Day 2013 Longstanding Eco Action Award

2016 • National Parks Board Community In Bloom Award 2016 Diamond Award, for attaining third consecutive Platinum banding Community Garden Edibles Competition 2016 Heaviest Pumpkin – 1st place (11.95kg) 2017 • Ministry of Environment and Water Resources The President’s Award for the Environment 2017

2014 • Singapore Standard 577 Water Efficiency Management System Certification 2014

• National Parks Board Community Garden Edibles Competition 2017 Heaviest Pumpkin – 2nd place (4.77kg) Heaviest Wintermelon - 5th place (13.68kg)

• Building & Construction Authority Singapore ASEAN Energy Awards 2014 1st Runner Up – Tropical Building Category

• United States Green Building Council (USGBC) and International Living Future Institute (ILFI) Inaugural Stephen R. Kellert Biophilic Design Award Winner

• Public Utilities Board Water Efficient Building Awards 2014 – Gold Award

2018 • National Parks Board Community In Bloom Awards 2018 Platinum (Organizations), Special Mention (Edible Gardens)

• World Green Building Council Asia Pacific Leadership in Green Buildings Awards 2014 Finalist • National Parks Board Community In Bloom Awards 2014 – Platinum Award, Best Community Garden 2014 • Cityscape Awards 2014 Winner – Community & Culture Category, Winner – Sustainability Category

Community Garden Edibles Competition 2018 1st Place – Heaviest Pumpkin (5.56kg) 2nd Place – Heaviest Wintermelon (18.18kg) • Singapore Environment Council Singapore Environmental Achievement Award 2018 (Public Sector)

2015 • Landscape Industry Association of Singapore Awards 2015 Best of Category & Gold Award in the Maintenance – Non-Residential Category • Public Utilities Board Watermark Award 2015 • National Parks Board Community Garden Edibles Competition Heaviest Pumpkin – 1st place Heaviest Wintermelon – 2nd place

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BIBLIOGRAPHY Foreword and Preface

Alexandra Health System, The Little Hospital That Could – The Transformation Story of Alexandra Hospital. Singapore: Alexandra Health System, 2017. Ang, Jolene.“Singapore to shore up defences as mercury and seas rise.” The Straits Times, November 4, 2018. Arizona State University College of Liberal Arts and Sciences. “More severe flu seasons predicted due to climate change.” Science Daily, January 28, 2013. Choo, Cynthia. “As temperatures and urbanisation increase, fight against dengue will only get tougher.” Channel NewsAsia, June 22, 2019. Health Care Without Harm. “A Comprehensive Environmental Health Agenda for Hospitals and Health Systems Around the World.” Accessed August 12, 2019. http://greenhospitals.net/wp-content/uploads/2011/10/Global-Green-and-Healthy-Hospitals-Agenda.pdf. Lee, Kuan Yew, The Singapore Story: Memoirs of Lee Kuan Yew. Singapore: Marshall Cavendish Editions, 2015. Low, Youjin. “Temperatures in Singapore could hit 40°C as early as 2045 Scientists.” TODAY, July 4, 2019. Pierre-Louis, Kendra and Nadja Popovic. “How Dengue, a Deadly Mosquito-Borne Disease, Could Spread in a Warming World.” The New York Times, June 20, 2019.

Chapter 1: Designing for Sustainability

Athienitis, A K and M Santamouris. Thermal Analysis and Design of Passive Solar Buildings. New York: Routledge, 2002. Joseph, Anjali. Impact of Light on Outcomes in Healthcare Settings. The Center for Health Design: 2006. Kishnani, Nirmal. “Singapore’s Khoo Teck Puat Hospital: Biophilic Design in Action.” Last Modified September 8, 2017. https://blog.interface.com/khoo-teck-puat-hospital-singapore-biophilic-design/. Lee, Kate E. and Katherine A. Johnson. “40-second green roof views sustain attention: The role of micro-breaks in attention restoration.” Journal of Environmental Psychology Vol. 42 (2015). Mohan, Matthew. “NDR 2019: Climate change one of the ‘gravest challenges facing mankind’, impact on Singapore to worsen, says PM Lee.” Channel NewsAsia. August 18, 2019.

Chapter 2: A Hospital in a Garden, A Garden in a Hospital

Barton, Jo and Jules Petty. “What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis.” Environmental Science & Technology Vol. 44 Issue 10 (2010). Franklin, Deborah. “How Hospital Gardens Help Patients Heal.” Scientific American. Accessed 28 July 2017. https://www.scientificamerican.com/article/nature-that-nurtures/. Kishnani, Nirmal and Giovanni Cossu. “Ramboll Research Project: Enhancing Blue-Green and Social Performance in Dense Urban Environments.” Ramboll Foundation, 2016. Lee, Kate E. and Katherine A. Johnson. “40-second green roof views sustain attention: The role of micro-breaks in attention restoration.” Journal of Environmental Psychology Vol. 42 (2015). Li, Q et al. “Forest bathing enhances human natural killer activity and expression of anti-cancer proteins.” International Journal of Immunopathology and Pharmacology Vol. 20 No. 2 (2007): 3-8.

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Park, Seong-Hyun & Richard H. Mattson. “Ornamental Indoor Plants in Hospital Rooms Enhanced Health Outcomes of Patients Recovering from Surgery.” The Journal of Alternative and Complementary Medicine 15(9) (2009): 975-980. Simard, M. et al. “Mangrove canopy height globally related to precipitation, temperature and cyclone frequency.” Nature Geoscience 12 (2019): 40-45.

Chapter 3: From Garden to Table: Making Food Sustainable

Academy of Nutrition and Dietetics. “Position of the Academy of Nutrition and Dietetics: Vegetarian Diets.” The Journal of the Academy of Nutrition and Dietetics 116 (2016): 1970-80. Bouvard, Veronique et al. “Carcinogenicity of consumption of red and processed meat.” The Lancet Oncology Vol. 16 Issue 16 (2015): 1599-1600. Government of Singapore. “Farming Area.” Accessed on August 5, 2019. https://data.gov.sg/dataset/farming-area. Meatless Monday. “Environment.” Accessed August 20, 2019. https://www.meatlessmonday.com/research/environment/. Meatless Monday. “Health.” Accessed August 20, 2019. https://www.meatlessmonday.com/research/health/. Mekonnen, M M and A Y Hoekstra. “The green, blue and grey water footprint of farm animals and animal products.” Value of Water Research Report Series No. 48. UNESCO-IHE (2010). Ng, Abigail. “Meatless in Singapore.” The Straits Times, March 28, 2017. Pimentel, David and Marcia Pimentel. “Sustainability of meat-based and plant-based diets and the environment.” The American Journal of Clinical Nutrition 78, Issue 3 (2003): 660-663. Public Utilities Board. Best Practice Guide in Water Efficiency – Buildings Vol. 1. Singapore: APP Content and Concepts, 2018. Steinfeld, Hening et al. “Livestock’s Long Shadow: Environmental Issues and Options.” Food and Agricultural Organization of the United Nations: 2006.

Chapter 4: Building a Green Culture from Within

Ee, David. “‘Cut number of cleaners’ to keep Singapore clean.” The Straits Times, June 11, 2013. Grosse, Sara. “Mosquito fogging has ‘severe limitation’: NEA.” Channel NewsAsia, September 18, 2016. Mcdonald, Tim. “The cost of keeping Singapore squeaky clean.” BBC, October 29, 2018. Ministry of the Environment and Water Resources. “Managing our waste.” Accessed July 16, 2019. https://www.mewr.gov.sg/topic/landfill. National Environment Agency. “Waste Management.” Accessed August 14, 2019. https://www.nea.gov.sg/our-services/waste-management/overview.

Seeking Sustainability

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Seeking Sustainability

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