Opening address for Dr Amy Khor, Minister of State, Ministry of Health at the 10th Hospital Management Asia Conference 2011

07 Sep 2011

By Dr Amy Khor
Venue: Resorts World, Sentosa

Distinguished Guests, Ladies and Gentlemen,

1. It is my pleasure to address you at this 10th Hospital Management Asia Conference, an event last held in Singapore in 2006. I’m glad to note that this year’s conference has attracted an all time high of more than 760 participants of which more than 450 of the speakers and delegates are visitors to Singapore. It is encouraging to hear that HMA has evolved into a global platform for local and international experts to huddle and share their knowledge, network with peers and exchange valuable experiences to improve the standards and quality of care for the patients you serve and treat.

2. I understand that for the first time, the conference organiser has invited leaders from the hotel and banking industries to share their stories and experiences on managing for quality and excellence. It is my hope that this cross-pollination of ideas will generate innovative solutions to improve healthcare delivery.

I - Current State of hospital management

3. Healthcare today, regardless of the country we come from, is getting more complex in its delivery and management.  Demand for healthcare services is rising and skilled healthcare professionals are highly sought after. With globalization, these professionals can decide to work anywhere in the world. Singapore has sought to increase the pipeline of clinicians to meet demand through both capacity building with a third medical school in the works, as well as welcoming overseas trained clinicians into our hospitals.

4. In addition to good clinicians, top notch hospital administrators are essential to ensure that patients receive the care that they need. It is therefore critical for hospitals to invest not only in the professional development of clinical but also management staff. All must share the same ethos and mission, which is to put patients first. Clinicians and managers need to work as a team and not in silos with the care continuum organised around patients’ needs and not for the convenience of healthcare professionals. Our hospitals in Singapore have taken this to heart, and have been continuously refining care processes to improve patient care.

5. For example, at the National University Hospital, patients arriving at their emergency department with chest pains or suspected heart problems are sent directly for treadmill, electrocardiogram and blood pressure tests. This allows their medical problem to be determined early and reduces the anxiety of waiting. At Changi General Hospital (CGH), patients suffering from a fit for the first time are given a head scan immediately, instead of being hospitalised for observation. Those with no tumour or bleeding in the head are discharged and given an outpatient appointment to see a specialist within a few days. These process improvements have also resulted in fewer such patients needing hospitalisation, thus enhancing optimal usage of beds. Our public sector hospitals have also invested in real-time bed management systems that track the ones that need to be cleaned and prepared for the next patient. Beds can stay unoccupied for as little as 30 minutes before a new patient is transferred to them thus reducing the waiting times for admission. We are not perfect but we will strive to keep improving and learning from other administrators and hospitals in the region.

6. Our hospitals also work closely with step-down facilities such as community hospitals and nursing homes to help patients find a suitable institution to match their healthcare needs. This enables care to be provided at the right site, while providing seamless transition for the benefit of the patients.

II - Managing Patient Expectations

7. Our patients are changing, not just demographically and epidemiologically but also in terms of their expectations. As the population becomes better educated and IT savvy, patients are able to take a more proactive role in understanding their needs and ask more questions when seeking healthcare. Patients now visit the doctors, well prepared with thick printouts from the internet on clinical symptoms and treatment regime. Even as hospitals seek to rise to the challenges of increasing healthcare demand, we need to learn to manage the expectations of patients.

8. In my other appointment, I chair the government feedback unit, REACH, to listen and gather feedback from the public on government policies. On the subject of healthcare, I observed that Singaporeans in general think that healthcare in Singapore is improving, and we are doing the right things to improve aspects such as keeping healthcare affordable. These views are borne out by the REACH perception survey, a yearly survey we carry out to gauge public perception of key government policies. In 2009 and 2010, more than 90% of those surveyed were satisfied with measures to provide good quality healthcare.

9. There is however always room for improvement. For example, we have recently announced a slew of measures to ensure that good quality healthcare remain affordable and accessible. We will enhance drug subsidies from 50% to 75% to make medications more affordable for eligible middle – low income patients who seek treatment at our public healthcare institutions. Private outpatient primary care will also be made more affordable and accessible for middle-low income patients. The Primary Care Partnership Scheme (PCPS) for private GP and dental care will have its eligibility criteria expanded to include more patients, and the withdrawal limit for Medisave (our health savings account) use for outpatient care will be increased.

10. I have also received many emails on long waiting times at polyclinics and public specialist outpatient clinics, especially when it is perceived to be caused by administrative inefficiencies such as multiple queues to register, pay, etc. These feedback are opportunities to review the way we deliver our services. There are, however, some complaints that are less reasonable. I was informed of a recent case where the patient demanded a food item that was not available on the menu for his lunch and expected it to be provided at short notice and without any charge. Even so, hospital administrators and health delivery staff must remain calm and respectful while being firm in not acceding to such unreasonable requests.

11. Hospital administrators today need to ensure that the standards and services are kept high. This could involve simple innovations, such as clarity of signages, or even including free fresh fruits and wireless access at waiting areas, so that patients and their families can have something to munch and do as they wait. Sometimes, little improvements go a long way in improving the moods of the patients and reducing potential sources of dissatisfaction. Of course, nothing beats a heartfelt smile and concern by healthcare staff.

12. Even as we seek to be more patient centric, we need to also look after the welfare of our staff. There are some lines that should not be crossed. Our healthcare staff should not be mistreated or subjected to verbal and physical abuse.

III - Communicate, Communicate, Communicate

13. What I have gathered from the feedback I received is that patients in general do acknowledge the complexities and pressures faced by healthcare workers. More often than not, it is the lack of clarity in communication rather than the quality of clinical care itself that upsets patients.

14. We need to strengthen communication skills among all healthcare providers. Good and clear communication is vital in keeping patients informed, and in addressing their concerns. Some issues can be sensitive, for example end of life issues for terminally ill patients or a surgery that had an adverse outcome.

15. To communicate well with the patients, healthcare providers must listen respectfully, communicate openly and not attempt to hide.  The rapidly evolving social media landscape calls for hospital administrators and clinicians to adopt new strategies to stay in touch and engage with the patients, even as they recover. They must be mindful of the needs of the patient and  pick the correct place and time for conversations with patients and the family. Discussing the hospital bill with the patient’s family members when the patient is in intensive care fighting for survival is certainly not a good idea.

16. Patient engagements should be planned and systematic to develop a better understanding of patients’ concerns and needs, which should not be restricted to medical care per se, so as to identify potential issues. This will enable hospitals to deal with them as early as possible, and to nip potential problems in the bud. These should then be communicated back to the patients to provide a clear follow-up and to close the loop.

17. With the many challenges that healthcare institutions face and seek to overcome, the HMA Conference provides a unique platform to recognize those who have distinguished themselves. I am told that the Asian Hospital Management Awards recognizes and honors hospitals in Asia that implement best hospital practices. Now in its tenth year, awards are given to hospitals in the region that, in the opinion of the judges and advisers, have implemented or enhanced outstanding and innovative projects, programs, and best practices during the prescribed time period. This year, 315 entries from 84 hospitals/ organisations were received from 11 countries vying for the awards. I hope that all good programs and projects can be shared and adapted by others to raise the standards and quality of patient care and hospital management in Asia.

IV - CONCLUSION

18. The journey to healthcare excellence and safe patient care is one that is long and filled with challenges. However, with every new milestone we strive for, we can look forward to having made care for our patients better and easier.

19. I believe this Conference will allow you to learn from one another, and inspire you to continue striving to improve care for our patients. I wish you a fruitful conference.