1 Billion Dollar Challenge

09 Nov 2010

By Minister for Health, Mr Khaw Boon Wan, Ministry of Health

Venue: Jurong East Street 21

1. Next week, MM Lee will officially open the Khoo Teck Puat Hospital in Yishun.  This is our newest acute hospital which is now serving over 20,000 outpatients and 2,000 inpatients a month.  Its opening has brought significant relief to Tan Tock Seng Hospital and elsewhere.  TTSH Emergency Department attendances have shrunk by nearly 20% and with it, waiting time by patients for a bed has also come down.

2. Importantly, KTPH has also raised patient care to a higher level.  While it was still being planned, I challenged the KTPH leadership to build a “hassle-free hospital”. 

3. To translate my challenge into an actionable design and implementation plan, the KTPH leadership consulted a wide range of stakeholders: patients, visitors, staff, experts from other industries including the hotel and retail industry.  Out of these consultations, the hospital leadership set out the key attributes of a “hassle-free hospital”. 

4. For example, they decided that patients should be able to find their way around the hospital and access the care they need easily.  From the main entrance of the hospital, the clinics and the wards should all be within 100 m walking distance.  Facilities and equipment should be co-located in such a way that patients rarely have to move around the hospital to get tested or treated.  All the wards, including Class C wards, should have toilet facilities within the wards for easy access by the patients. Their instructions to the architect were that the hospital design and layout should meet these attributes.

5. I have visited KTPH several times.  I have spoken to many patients there.  I am pleased with what I saw and what I heard.  While KTPH is not perfect, it has already left a good impression among its many patients and visitors.  They are still discovering and ironing out teething problems.  They will continue to make improvements.  I am confident that they will make KTPH a hassle-free hospital. 

Outside Hospital Walls

6. Today, we are embarking on another major and exciting project.  We are building a new general hospital and a new community hospital simultaneously. Together, they will serve the healthcare needs of the residents in the west.  Like the KTPH, I have very high expectations of the new Jurong General Hospital.  With the experience of the KTPH, I am sure the JGH will also be a hassle-free hospital.

7. But I am raising the bar.  Now that we know how to make the operation inside a hospital hassle-free, I am challenging the JGH leadership to go outside the hospital to enable its patients a hassle-free experience even after their discharge.  Let me explain.

8. Many patients, especially the young, have an acute medical problem, visit a general hospital, make a full recovery and resume their normal life.  But these are exceptions rather than the rule.  For most patients, especially if they are elderly, after their acute conditions have been stabilised, their underlying chronic disease remains and requires life-long management in the community, by their GP, polyclinic, nursing home, or community hospital. 

9. Take my heart bypass as an example.  My surgery was a success but my underlying heart disease remains. Six months after surgery, I am still on active cardiac rehabilitation and my cholesterol level has to be managed for the rest of my life, with regular visits to my family physician and my cardiologist. 

10. Patients with other medical conditions may require frequent transfers between the hospital and the healthcare providers in the community.  The traditional model of healthcare delivery has typically not ensured good coordination between the hospital and the community care providers.  Patients are left to navigate between these providers, with very unsatisfactory outcomes.  For example, tests get repeated unnecessarily because of information gaps.  Medications are prescribed by different doctors without knowledge of each other’s medical treatment plan. Patients are left to tell doctors what medication they are on, and may not be giving the right information all the time. Patients experience unnecessary waiting because the different providers do not have a commonly agreed protocol for a smooth hand-over of patients.

Hassle-free Health Service

11. My vision is for a “hassle-free health service” where providers coordinate and integrate their care for their patients in a seamless manner, even though they work for different employers and may not even know one another.  I know this is a tall order.  But we should strive to achieve it as it will mean tremendous benefits for the patients when we achieve it. 

12. My challenge to the JGH leadership is to help their patients achieve such an experience after their acute episode in the JGH.  They have started talking to the residents living in the west, to find out what are important to them.  Their wish lists are long and reasonable.  Patients on wheelchairs or are frail find getting to and from hospital a hassle.  If they could see a doctor or go to a centre nearer their home for tests or therapy sessions, that would be good for them.  In addition, some patients need simple nursing support at home. For example, a patient who had a successful orthopedic surgery will require rehabilitation to walk again. Hence, it is important to have good rehabilitation centres in every large HDB town. The patient will then periodically go back to his orthopedic specialist to review his rehabilitation process. We have to build up this capability region by region.

13. To meet my challenge, the JGH team knows that they need to work closely with care providers in the community, including GPs, polyclinics, community hospitals, nursing homes, home care providers and social support groups.  They have set their vision statement as: “Transforming Care.  Bringing health to every home”.  I hope they will succeed and I will do my best to support them to realise their vision. This is my mission for the rest of my term as Health Minister. Hopefully, this vision will translate into a routine way of life for healthcare services in the future.

Compete To Deliver

14. They will not be alone in this endeavour. The KTPH team is also going to create a hassle-free health service for the residents in the north.  Both will compete to deliver this vision.  The existing hospitals too are working on similar ideas for their respective regions.  They have a slight disadvantage as they have to deal with old traditions and legacies.  For example, some hospitals in Korea have already gone “4-less”: paperless, filmless, script-less and chart-less, while we are still struggling to go “paperless”. Although we are better than some countries, we can do more, but legacies have prevented us from moving forward.

15. For JGH starting from a clean slate, you are less encumbered and should be able to achieve much more and faster.  You must not waste the opportunity.

16. For example, building the community hospital and the general hospital as one project should allow you to push integration and coordination to the maximum.  It will enable you to achieve multiple physical connections between both entities, not just for smooth movement for patients and families, but also to encourage mingling of doctors and care staff and sharing of information and services, while observing patient privacy. They can then share services such as the pharmacy, kitchen, medical records and purchasing systems as well as training facilities like the auditorium.  This will reduce the operating cost. The two hospitals will also be wired up for IT connectivity and Digital Imaging so that both hospitals can tap on the same resources.  This will greatly benefit the patients who need to move between the general hospital and the community hospital as their medical conditions evolve.  Without integration and coordination, each transfer can be a big bureaucratic hassle.  With integration and coordination, doctors on both sides should be able to co-manage the patients as if they were one team, sharing medical records and formulating joint treatment plans. 

Heavy Investment In Health

17. My Ministry is investing heavily in this two-in-one project in Jurong.  A capital expenditure budget of nearly $1 billion has been approved by MOF.  This is a very heavy investment on the part of the Government and has not even factored in land cost. Hence, the total cost is way above $1 billion.  It reflects our commitment to raising the healthcare service standard for Singaporeans, especially for those in the lower income group.  75% of JGH’s 700 beds, or 3 in 4 beds, will be in the heavily subsidised Class B2/C wards. 

18. In the KTPH, we have enhanced the facilities for the subsidised wards.  Many patients have written to me positively about it.  In the JGH, we should be able to do even better.  Last weekend, former GPC Chair, Mdm Halimah Yacob, officiated the MOU signing between JGH and St Luke’s Hospital.  After she viewed the mock-up of the JGH ward, she was inspired to email me her comments:

“The new hospital will benefit my residents in Jurong GRC. More importantly, I really like the co-location concept, providing seamless and integrated care to patients. I think that this is an excellent idea as it minimises cost and disruptions to the elderly who are already mobility impaired. It would also reduce the burden on care givers.

I am also very impressed with the C class wards - airy, a bit more room with a window looking out at the greenery for every patient and, of course, a toilet in the room itself. I believe that this would certainly help to reduce their stay in the hospital and minimise infections.

The Jurong Hospital will add on to the improvements that we are already seeing at KTPH. It shows that our government really cares for the low income as most of the improvements will benefit the subsidised wards.”

Conclusion

19. Hassle-free health service for the west goes beyond just the general hospital and the community hospital.  It must also reach out to eldercare services in the community.  For example, we are building two new subsidised nursing homes in the west, which will open by 2013. This represents a change in the concept of nursing homes. Nursing homes are not old folks’ homes. Nursing homes have patients, who should go through rehabilitation so that they can return home. However, not many nursing homes fit that bill, and we must upgrade their standards. We also need to invest in the ‘software’ for the new nursing homes, such as employing more physiotherapists, occupational therapists, etc. We could audit whether patients’ abilities to carry our Activities of Daily Living (ADLs) worsen or improve during their stay at the nursing home and publish the information. Hopefully St Luke’s Hospital can do it. I am pushing Ren Ci and other nursing homes to do so as well. This requires passion, compassion and a sense of seriousness about the patients. 

20. The JGH team will also reach out to non-healthcare community partners – grassroots organisations, employers, sports and other interest groups - to help keep the residents as healthy as possible.  Success of their mission is not measured by how many sick patients they treat.  Their success should be measured by how many Singaporeans they help to stay healthy in the community, away from the hospital.  This ultimately is the litmus test of a good healthcare system.

21. The recent results from HPB showed that our obesity rates had jumped from a single digit, 7% to a double digit, 10.7%. This could signify the turning point for our obesity rates to keep climbing. This could lead to trouble down the road, as obesity is associated with many health issues such as diabetes. As the Health Minister, I am unsettled by the rise. Singaporeans should also be unsettled by this, as only then can we fix the problem. The message is simple: “eat less, move more”.