Speech by Dr Amy Khor, Senior Minister, Ministry of Environment and Water Resources & Ministry of Health, at the Temasek Foundation International Healthcare Executives in Asia Leadership (Nursing) Programme

Mr Goh Geok Khim, Chairman, Temasek Foundation International

Professor Ivy Ng, Group CEO, SingHealth

Ms Tan Soh Chin, Chief Nursing Officer, Ministry of Health

Associate Prof Lim Swee Hia, President, Singapore Nurses Association

Distinguished Guests

Ladies and Gentlemen

          It is a pleasure to join you at the opening ceremony of the Temasek Foundation International Healthcare Executives in Asia Leadership Programme for nurses. Supported by Temasek Foundation International, this programme creates a dynamic platform for nurse leaders to share best practices, embrace new ideas and foster collaborations to improve quality and safety in healthcare.

2         I am personally heartened to see more than 170 nurse leaders from 16 countries across Asia gathered here today. I would like to extend a very warm welcome to all our international delegates.

Building a Strong Patient Safety and Quality Improvement Culture

3         The programme’s theme, “A Strong Patient Safety and Quality Improvement Culture - The Central Role of Nurses”, will always be relevant.

4         Patients’ lives are in the hands of healthcare professionals, so it follows that patient safety is paramount and must be ingrained throughout the healthcare system.

5         In Singapore, the Ministry of Health works closely with public and private healthcare institutions to ensure safe and quality care for patients.

6         To build a culture of safety and excellence, our hospitals are encouraged to create a safe environment for staff to speak up and act for patient safety, share best practices to promote mutual learning and exchange ideas to enhance patient safety across the healthcare system.

7         Technology is also being increasingly employed to enhance patient safety – including wearable devices which can monitor patients’ vital signs and detect early deterioration in their condition which could facilitate more timely interventions and appropriate treatment.

8         Wounds can also be more quickly and accurately assessed using technology and artificial intelligence. This helps the nurses to make better care plans to manage the wounds.

Patient safety and nursing

9         Patient safety is a central tenet of nursing.It is a core part of the curriculum in nursing school, and features prominently in post-registration continuing education, work streams, and work culture. With the “no blame” culture, nurses can also report, discuss and learn from adverse events.

10        Over the years, the role of nurses has expanded to encompass nursing research, education and informatics and community nursing. We see the healthcare landscape changing worldwide and nurses are key drivers in this transformation as they continually review and re-design systemic processes to achieve better care outcomes for patients.

11        I am pleased to note that it is recognised that patient safety is second nature to most nurses. This is evidenced by the fact that nurses’ contributions are sought at many quality improvement platforms and committees.

12        Nurses’ constant presence at the bedside and regular interactions with patients and other healthcare professionals anchor their critical role in patient safety - through early detection of changes in patients’ conditions, errors or near misses, and in many cases, they are able to deduce causality and develop workable solutions to improve patient care delivery. Let me share two impactful examples.

13        At Tan Tock Seng Hospital, a group of nurses sought to reduce catheter associated urinary tract infections (CAUTI), 70 to 80% of which are attributed to the use of indwelling urethral catheters.

14        They developed a CAUTI prevention care bundle which included a daily review of the appropriateness of ongoing catheter use, a 4-point catheter care check to minimise risk of infection, and a nurse-led catheter removal protocol to reduce catheter utilisation days. During the trial period, with 100% compliance to the 4-point catheter care and daily review process, there were no cases of CAUTI in the project ward for six consecutive months.

15        The catheter utilisation ratio was also reduced. It is no wonder then that this CAUTI prevention care bundle was subsequently implemented hospital-wide.

16        In another example, nurses at Singapore General Hospital developed a tool to identify patients with a higher risk of Hospital Acquired Pressure Ulcers.

17        Through an analysis of past patient data, they identified eight independent risk factors for which they developed a Surgical Pressure Ulcer Risk Score and three risk stratification categories.

18        By stratifying patients based on their scores, nurses were able to identify patients with a higher risk of developing the pressure ulcer, enabling them to initiate preventive measures early. This tool will also be implemented hospital-wide.

Community nursing and patient safety

19        And as our model of care transforms and community nursing comes to the fore, our nurses will need to be able to operate more independently as they provide care in clients’ homes. Patient safety becomes all the more important in community care settings; for example Home-based care, as nurses will be providing care independently without the direct support that is available at acute hospitals.

20        Community nurses will therefore need to be experienced and well-trained nurses who are able to identify and mitigate factors affecting their clients' care, well-being and safety. They will need to be supported by the appropriate technology, good clinical leaders and a clinical governance framework.

21        We will be focusing on these areas as we grow our community nursing services.

Building Networks of Co-operation

22        Building networks of co-operation across borders has also enabled us to deepen nursing capabilities. Collaborations such as overseas hospital exchange programmes have proven to be beneficial for nurses to broaden their perspectives as they gain insights on other healthcare systems and care delivery processes.

23        In May 2019, Peking Union Medical College Hospital and Peking University First Hospital in China signed a Memorandum of Understanding with SingHealth to advance nursing education.

24        I am pleased to note that more than 500 nurses from 16 hospitals in Beijing are expected to participate in the three-year exchange programme facilitated by nurse educators from the SingHealth Alice-Lee Institute of Advanced Nursing.

25        With a focus on patient safety and quality improvement, the programme will provide a learning platform for nurses, from both countries, to exchange best practices and explore innovative ways to further improve the quality of care and safety for patients. At the end of the programme, the participants will go on to share what they have learned with 700 more nurses in Beijing to multiply the benefits of the programme.

26        Another example is the collaboration between Tan Tock Seng Hospital and the Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka, to develop a 3-year specialist programme for more than 120 healthcare professionals, including 40 nurses from Sri Lanka. Since the programme was completed in 2018, the participants have implemented a total of 37 projects at their respective hospitals to improve patient care and hospital management.

27        Our Singapore nurses also benefit from the wisdom of their overseas counterparts. Every year, about 100 nurses undergo clinical attachments overseas. They bring back with them the knowledge and skills to help build capabilities in areas such as community health, gerontology and respiratory care.

28        I look forward to more of such mutually beneficial collaborations that will help to nurture a strong nursing workforce that is competent in clinical care, education and research in our respective countries.

Closing

29        We look forward to learning from our speakers and delegates. We can achieve so much more when we look beyond our own communities and come together to share experiences and synergise efforts to improve safety and quality.

30        In closing, I would like to thank Temasek Foundation International, SingHealth, and National Healthcare Group, for organising this programme. I wish all of you a fruitful learning and networking experience and, to our international delegates, I hope you will have an enjoyable stay in Singapore.

Thank you.