Speech by Mr Chee Hong Tat, Minister of State for Health, at the Singapore Health Quality Service Award 2017, 17 January 2017

CEOs and Healthcare Leaders,
Distinguished Guests,
Ladies and Gentlemen,

Introduction

1.            I am delighted to be here today at the Singapore Health Quality Service Awards 2017 to celebrate the exemplary efforts of our healthcare professionals in delivering high quality healthcare services to the nation.

Sustainable Improvements in Care Quality

2.            Our rapidly ageing population poses twin challenges to our healthcare system – on one hand, demand for healthcare and aged care services will grow, while on the other hand, our labour force growth will slow down. Faced with such a scenario, improving productivity must be a key part of our efforts to achieve good healthcare service for Singaporeans. Through productivity improvement, we can achieve greater efficiency which can then be translated to more convenient, more accessible and more affordable care for our patients, while at the same time achieving equally good if not better health outcomes. We need to use these efforts to make good use of our limited manpower resources, leveraging on technology, reinventing care models and streamlining work processes, so that our healthcare staff can focus more on patient care.

3.            Productivity is a key priority for the MOH family. The Ministry has set up the Healthcare Tripartite Committee for Workforce Innovation and Productivity (HTC) last year to identify and scale up more of such manpower lean and productivity initiatives. We have been working closely with the public healthcare institutions, as well as our partners from the primary care and ILTC sectors to identify and make improvements in the way we deliver care in four key areas: processes and workflows, automation, use of technology (which could include data analytics and infocomms) and patient and caregiver training. Let me illustrate with examples.

Redesigning Processes

4.            A key thrust of our productivity efforts is in reviewing workflows and processes to be more efficient. This may not always involve technology. Rather, it is about thinking through work processes to see how they can be made more efficient, how unnecessary steps can be cut down, and how time can be saved to make these processes better for everyone. The Home Nursing Foundation (HNF) embarked on a project last year to improve its services through streamlining and integrating core service delivery processes and workflows. Currently, nurses, doctors and therapists have to manually collect cash from patients and issue receipts after each visit and then record the services rendered and fees collected. This is quite a labour-intensive process that takes about 10 minutes for each visit. To eliminate the need for manual work and to improve the process for both staff and patients, HNF will be implementing an electronic billing system that can auto-compute fees and generate invoices. HNF will be billing patients at the end of the month, and patients will also have the option to pay through various cashless payment modes. Through these process improvements, HNF expects to save about 20% of the time of their care staff, who can then spend more time on direct patient care.

Automating Labour-intensive Activities

5.            With slower labour force growth, we are automating labour-intensive activities in healthcare. Automation is not about replacing our healthcare workers with machines, as healthcare is a high touch sector that requires a personal, human element. Rather than automating entire processes, we are automating some steps of the care model so that our healthcare workers can be freed up to devote more time and attention to patient care. Most of our hospitals have implemented robotic picking and packing of oral medications. The Outpatient Pharmacy Automation System (OPAS) at KK Women’s and Children’s Hospital’s (KKH) Emergency Pharmacy was further developed to incorporate a new robotic bottle medication dispensing system that automatically loads, picks, and packs bottles. It also automatically fastens water-proof and tear-proof labels onto medication bottles for the safety and convenience of patients. The system was developed in collaboration with partners such as IHiS, local SME Getech Automation, Singapore Polytechnic, A*Star and NCS. Almost all medications dispensed at the Emergency Pharmacy are now picked and packed by robots.  One year into implementation, OPAS has helped KKH to increase its pharmacy workload capacity by close to 30%, while maintaining the same staff strength. Staff now spend much less time packing medications and more time with patients, reducing the waiting time during peak hours at the pharmacy.

Technology to Augment our Healthcare Workforce

6.            Healthcare institutions are also leveraging technology to augment our workforce and bring care closer to patients.  Integrated Health Information Systems (IHiS) developed a common platform for Video Consultation for healthcare providers to pilot new care models. For example, patients of the Institute of Mental Health (IMH) who are residing in nursing homes used to have to travel together with nursing home staff to see their doctor at the IMH outpatient clinics. Now, using this new platform, the same patients can be reviewed remotely by IMH specialists at participating nursing homes. This not only saves patients the time and costs of travelling. It also saves time for the nursing home staff who used to have to accompany them to IMH, but can now spend more time on resident care.

Delivering Safer Care Together With Patients

7.            The last area is about how to deliver safer care together with patients. This is something which I think is important because we want to involve family members and patients as part of the process. Let me share the example of how National Kidney Foundation (NKF) staff, who are amongst the awardees today, have partnered patients to deliver safer care. Recognising that reducing central line-related infection rate is critical for the safety of patients undergoing haemodialysis, a team of nurses at NKF reviewed the operating procedure. They found that hand hygiene non-compliance, poor catheter hubs cleaning protocols and insufficient patient education were key contributors to infections. This led the team to develop and incorporate a catheter care bundle into their standard operating procedure at five NKF dialysis centres.

8.            The catheter care bundle emphasized hand hygiene, catheter hub disinfection and patient engagement. Dialysis catheter workshops were conducted to train nursing staff in the new procedure. To empower patients in self-care, the team also produced an educational brochure, as well as a permanent catheter “E” kit to enable patients to change their dressing safely at their own convenience. Through these efforts, the central line-related infections rates at the participating NKF dialysis centres decreased from 7.14 per 100 patient-months in November 2014 to 1.45 per 100 patient-months in June 2016. This is a reduction by almost four times, a very significant improvement brought about by a simple process of improving patient education and safety.

Conclusion

9.            These examples show us that productivity improvement can take place at different parts of the healthcare system and at different levels. All of us can be involved and play an important role in this journey. Productivity improvement is also a never-ending endeavour and a long marathon we must achieve together in order to deliver better care for, and in partnership with, patients. Through regular reviews of work processes, we can innovate and develop solutions that make the way we work more efficient and effective. These can be simple solutions that need not be expensive or technology intensive, but benefit our patients and colleagues.  

10.         Once again, my heartiest congratulations to all award recipients! Care excellence is a continuous pursuit that runs deeply in all of us. It is the focus of all our efforts in healthcare in order to bring greater value for our stakeholders and patients. I hope that you will continue to work to raise the bar for the benefit of our patients.

11.         Thank you and I wish all of you an enjoyable evening ahead.