Special
SingHealth 10th Anniversary – Defining Tomorrow’s Medicine
15 thesundaytimes April 18, 2010
PRODUCED BY THE SPECIAL PROJECTS UNIT, MARKETING DIVISION, SPH
‘Our patients’ health is our bottom line’
photo credits: singhealth, chong jun liang
SingHealth aims to provide affordable and good health care for the people with new technology, highly trained professionals and better service, reports Philip Lee THE biggest challenge facing the Singapore Health Services (SingHealth) is to transform the group and provide health care that is significantly better than the past 10 years, says Professor Tan Ser Kiat (below), group chief executive officer of Singapore’s largest health care cluster. The other challenge is to continue providing patients with affordable health care in the face of rising costs. He says: “SingHealth’s bottom line is not profit. Our patients’ health is our bottom line.” While SingHealth has succeeded in many ways, much remains to be done, he notes. Listing the group’s priorities, he says: “We want to achieve great improvements through the use of better technology, better trained health-care professionals and leverage on the quantum leaps made in medical research and biomedical science here and abroad.” This means making full use of IT and cutting-edge biomedical research, and the recruitment and nurturing of talented medical and allied healthcare workers. All this will translate into better patient care. “The other task is to redevelop our infrastructure, such as the establishment of Academic Medical Centres, like SGH Campus, and the rebuilding of new facilities like the upcoming National Heart Centre Singapore building,” he says. Speaking at his SGH Campus office about SingHealth’s 10 years of health-care services to the people, he identifies the group’s other challenges. “One is to ensure that we have enough money to finance our health-care services and, two, to improve continually the talent of staff. “No matter how much money you plough into health care, it is never enough. So we’ve got to balance this with what is optimal,” he says.
“As for talent, we want to make sure that every single staff member is a totally dedicated worker. I want them to be well-trained, highly skilled and competent professionals. “This is SingHealth’s ideal. We must continue to work at it. “It is like running on a treadmill. You must run faster than the treadmill speed to be ahead. If you are at the same speed, you stagnate.”
He says SingHealth’s future leaders will emerge from its workforce of more than 17,000 and leadership succession is a vital part of the group’s growth strategy. “This is my life’s philosophy – that whoever takes over from me must be at least two steps ahead of me. How do I do that? You select good people at the outset.” On SingHealth’s three pillars — service, education and research — Prof Tan says the SGH Campus, housing Singapore’s second medical school in partnership with Duke-NUS Graduate Medical School, will strengthen them. Better technology is already being harnessed for improved patient care, he says. “We are fairly advanced in the use of IT to access electronic medical records as well as lab results of patients.
“This helps us deliver care faster. And then, of course, we also use the findings of medical research to treat patients better.” More efforts will also be made to deliver health care to patients in their community instead of having them going to the hospital. Patient welfare, he stresses, is at the centre of SingHealth’s public mission, which he describes as endeavours to “heal the body, comfort the mind and soothe the soul.” “We all know that when a person is sick, psychological and social problems are also involved. His family will also be involved. “Our responsibility is to ensure that we not only treat the illness but also provide support to deal with the accompanying upheavals affecting the patient. “For us, treating a patient is like taking a plane. No matter what class you are in, we will take you to your destination safely. “The comforts on board may differ but the quality of care is the same.” Prof Tan says that delivering health care in future will be predictive rather than reactive. With the help of computers, a doctor can identify the genes that are linked to certain diseases. This, combined with a patient’s family medical history and environmental factors, can determine the patient’s predisposition to the disease. “This allows for more effective disease prevention and better screening campaigns for early disease prevention,” he explains. More research and funds will also be channelled towards combating diseases that are prevalent in developed countries, such as cancers, mental health, and the needs of an ageing population. This dedication to heal and comfort is reflected in SingHealth’s motto: “Patients. At the heart of all we do.”
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MeMbers of the singhealth group
Over the last decade, SingHealth, as the largest health-care provider, has been learning and evolving to respond to the needs of Singaporeans. Clinical breakthroughs, quality improvements, infrastructure development, medical advances and innovations achieved all have improvement of patient care as the focus. We will keep pushing the boundaries to set new benchmarks and manage healthcare costs so that care remains affordable to the average Singaporean. We are also committed to creating a working environment where our teaching tradition will continue to flourish together with a spirit of inquiry. Our healthcare professionals today will groom and nurture better doctors, nurses and allied health professionals than themselves to transform the future of health care for tomorrow. Mr Peter Seah Chairman, SingHealth
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Big changes on SGH Campus New clinical services, shorter waiting times, upgraded facilities and more research – these are in the works as the SGH Campus undergoes changes to make things better. Dr Wong Yue Sie, SingHealth’s group chief operating officer, says: “The demands on the Singapore health-care system have continued to evolve as our population ages and chronic diseases become more prevalent.” He says SingHealth’s institutions are responding to meet these needs. “We do this through the introduction of new clinical services and by continuing to invest in clinical research and health-care training and education. This ensures that we are able to deliver cost-effective and clinically appropriate treatments that give our patients the best outcomes.” Dr Wong, who is also the chairman of SGH’s division of ambulatory and clinical support services, says: “Over the next three years on SGH Campus, patients will experience better facilities and expanded capacities at the new National Heart Centre Singapore (NHCS) building. “There will also be a new multistorey car park, which will provide almost 600 more parking spaces. “The new SGH Pathology Building will provide us with the facilities to support clinical research as we seek to discover new treatments through translational clinical research and strengthen our health-care education. This ensures that we have well-trained health-care professionals delivering care to our patients. “In the next 10 years, we will continue to work with the Ministry of Health to transform SGH Campus into a vibrant hub that provides first-class care for our patients, conduct leading-edge clinical research and train our next generation of health-care leaders.” On the new NHCS, Associate Professor Koh Tian Hai, the centre’s director, describes it as a one-stop cardiac facility. “With our new building, which will be ready in 2013, patients can look forward to a three-fold increase in the number of clinics and enhanced features such as self-registration kiosks and one-stop payment systems to help cut down waiting times.” Prof Koh says the NHCS will be a digital heart hospital that harnesses the latest health-care technology to enhance patient safety, improve productivity and patient outcomes. — philip lee
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Special
SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
thesundaytimes April 18, 2010
April 18, 2010
Growth of Outram transplant hub THE Singapore General Hospital (SGH) achieved medical breakthroughs last year, with the successful completion of complex transplant surgeries. Last July, surgeons removed a kidney from a 75-year-old woman, Singapore’s oldest living donor and gave it to her daughter, aged 46. In April last year, heart and liver surgeons from SGH and the National Heart Centre Singapore collaborated to complete Asia’s first combined heart and liver transplant, with the recipient getting replacement organs from a deceased donor. In 2001, SGH hit the headlines when it performed the world’s first case of cord blood transplant for a patient with thalassaemia major, a blood disorder. These are among the reasons why the SGH Campus, comprising SGH and the national centres for heart, cancer, neuroscience, eye and dental care in the SingHealth group with more than 40 clinical specialties, has gained a solid reputation as Singapore’s transplant hub. The well-known medical hub at Outram Road made history in 1970 when Singapore’s first kidney transplant was carried out, and this was followed by transplant of the heart in 1990 and the lung in 2000. Cornea transplant was first performed in 1962 while liver transplants have been available since 2006. Professor Ang Chong Lye, assistant chief executive officer of SingHealth, says: “Historically, this is the place to do all these transplants, so we are able to congregate a huge mass. “We do enough where the learning curve of the surgeons is comfortable and when the opportunity comes, they can do more complicated cases.” An organ transplant is a multidisciplinary effort and all the needs of the recipients and increasingly, living donors, are cared for holistically. Besides the surgeons and physicians, the patients are also attended to by transplant coordinators, allied health professionals for post-transplant rehabilitation and specialists from other clinical disciplines, says Prof Ang. “Quite often, the patients will catch infections, so infectious diseases experts
Specialised training for doctors, nurses and health-care professionals keeps SingHealth on top in clinical service, research and education Philip Lee WITH its numerous health-care education and training programmes, SingSing Health could grow to become a tertiary institution one day, according to AssoAsso ciate Professor Colin Song, SingHealth’s group director of education. He says: “We plan to have a critical mass of doctors who can serve both as clinician educators and clinician sursur geons. “There is nothing to stop us from bebe ing a reputable tertiary institute which can really be a beacon for South-east Asia, comparable to what Harvard is on the east coast of the United States and Stanford on the west coast. “Other than doctors, we also provide education and training for nursing and allied health professionals locally and in the region.” Professor Song, who is also the head and senior consultant in the DepartDepart ment of Plastic Reconstruction and Aesthetic Surgery in Singapore General Hospital (SGH), says that SingHealth is now developing itself as an Academic Medical Centre. “In order to realise this aspiration and to deliver quality health care to Singapore and even to the region, we would have to base our efforts on three major pillars: clinical service, research and education,” he says. “To a large extent, we are still very
will come in. If it involves tissues, then even the pathologists.” Medical social workers are also roped in to provide psychosocial and finanfinan cial support. “For living donors, we will do a psychosocial assessment of the famfam ily background, finances, motivation and expectation of both recipients and donors. We will then submit a detailed report to the transplant ethics comcom mittee to deliberate whether the transtrans plant can proceed,” says senior principrinci pal medical social worker Crystal Lim (below). Augmenting these are specific posttransplant care and facilities to ensure the best outcome. “The patients need to be cared for in a very special manner, so we dedicate even an inteninten sive care unit or other very important clinical support facilities for them. Like spespe cial rooms for liver patients, so they’re protected in the immediate aftermath of surgery,” explains Prof Ang, who is also the CEO of SGH. The Human Organ TransTrans plant Act allows the removal of the heart, liver, kidneys and corneas for transplant, and the law is applicable to all Singaporeans and permanent residents above age 21. Singapore has medical teams on standby round-the-clock that can be acac tivated quickly to remove usable organs from dead donors, says Prof Ang. “If we don’t do the harvesting withwith in a certain time, then the tissue is not suitable. So there is always a rush to make sure that after declaring a person brain dead, you need to react within a certain amount of time.” A heart has to be transplanttransplant ed within four hours while a recovered liver must be used within 12 hours. Kidneys have up to 24 hours while corneas can be stored for up to two years. Besides cadaveric donors, more than There are more people are coming forward cialties to be living donors for their loved clinical spe ones who suffer from organ failfail Health in the Sing ure. Prof Ang attributes the trend to increasing public awareness. Group “Because of education, there is less fear. Because of technology and skills, and the support that we give to the patient is much more robust, people are more willing,” he says.
Mr Rahman Abdullah is a familiar figure at the Sembawang beach near his home, where he brisk walks for an hour twice a week. “I’m learning to eat vegetables and fruits,” says the 40-year-old, who used to eat mainly meat. He is also thinking of going overseas for a holiday. “I want to go to Japan to see the snow.” Making such plans were far from his mind at this time last year as he was living on borrowed time, after suffering a massive heart attack two months before. An implanted mechanical heart system, known as paracorporeal ventricular assist device, kept Mr Rahman alive for over seven months. Last October, he got his wish for a donor heart, thanks to a foreigner who was declared brain dead. Recalls Dr C. Sivathasan, co-director of heart and lung transplant at the National Heart Centre Singapore (NHCS): “Our multidisciplinary transplant team was mobilised immediately the evening it was confirmed that there was a heart that was available and suitable for Mr Rahman. “We worked through the night to perform the six-hour surgery to transplant the heart into Mr Rahman.”
Madam Pang now exercises regularly, seen here with her husband, Mr Neo (right) and renal specialist Prof Chan.
3.85
million patient visits to Specialist Outpatient Clinics, Ac cident & Emergency depa rtment, dental and polycli nics
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In order to realise this aspiration and to deliver quality health care to Singapore and even to the region, we would have to base our efforts on three major pillars: clinical service, research and education.
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Associate Professor Colin Song, SingHealth’s group director of education (below)
much service-oriented, and rightly so. This is to us a strong responsibility, as the largest health-care group in Singapore, to deliver affordable and quality health care to Singaporeans. “We have always had a strong history in medical education, and the opening of the second medical school, the DukeNUS Graduate Medical School in 2007, has encouraged us to put our focus on our medical education efforts. “It was remarkable how, in a very short space of time, we not only have gone through our fourth intake of medical students, but we have also galvanised the time and efforts of many of our clinical faculty to become teachers for the Duke-NUS programme.” “The primary purpose of doing that was to try and nurture a cohort of clinician scientists — people who spend 80 per cent of their time conducting research. “So we have a major focus on the whys and wherefores of disease processes.” Prof Song says he spends part of his time overseeing the US-style residency programmes introduced in March. Under this programme for the DukeNUS and the Yong Loo Lin School of
Medicine at the National University of Singapore, future generations of specialists will be trained under the supervision of fully trained physicians in a clinical setting. Their progress will be continually assessed until they complete their courses. This marks the move away from the traditional British-based system, under which assessments of a doctor’s performance accumulates in intermediate and final exams. This programme is the first of its kind in Singapore and it will groom a new generation of clinician scientists. Says Prof Song: “When you talk about the Duke-NUS Graduate Medical School, it involves all the teaching institutions within SingHealth.” SingHealth also provides continuing education for health-care professionals which involves mentors from its institutions such as SGH, Singapore’s first post-graduate teaching hospital and principal training ground for specialists; KK Women’s and Children’s Hospital, trainer of health-care professionals specialising in obstetrics and gynaecology, neonatology and paediatrics; and Changi General Hospital, which offers health-care education that emphasises on general medicine, surgical practices and “soft skills” training. Other mentors include those from the National Heart Centre Singapore, Singapore National Eye Centre and National Neuroscience Institute. The SingHealth Alice Lee Institute of Advanced Nursing enhances skills and promotes lifelong learning among nurses. Also, the SGH-PGAHI (Post-Graduate Allied Health Institute) provides professional development courses and clinical attachments for allied health professionals. “We do not just train for SingHealth institutions, but for the nation and even the region,” Prof Song says. “This educational collaboration galvanises resources, expertise and infrastructure to support the development of educational activities and build intellectual capital.”
SingHealth Group has
180,000
inpatient admissions every year
You can call this nurse ‘doctor’ A veteran nurse, Dr Tracy Carol Ayre (below right) rose to earn her PhD in nursing from her humble beginnings as a 17-year-old trainee at the Singapore General Hospital (SGH). She is now the deputy director of nursing at SGH. Her achievements were made possible by SGH’s policy of nurturing its staff and upgrading skills through scholarships and other training programmes, she says. Her career in nursing began after she dropped out of junior college for financial reasons. “I have been most fortunate to have excellent mentors when I was a student nurse, right through to today with my work as DN (director of nursing).” She is thankful to the SGH’s Alice Lee Institute of Advanced Nursing for her doctorate studies, SGH for her master’s programme and the World Health Organisation for her basic nursing degree and postgraduate diploma in nursing management. Over the years, she has won many awards, among which were the Gold Medal for Critical Care Nursing (1993) and the President’s Award (2007). Says Dr Ayre: “Sometimes nurses don’t know the impact that they have or potentially can have. “We may feel awe for overseas nurses who speak or present papers at conferences…But my experience when I was studying overseas and when I presented papers at international forums was that overseas nurses feel the same awe for Singapore nurses as they did not realise how advanced we are. “Even the appraisers were full of praise for the good work that Singapore nurses are doing, and they encouraged us to publish more so that others will know. “Each time we present or publish, we are selling Singapore and the organisation. “My vision is for our nurses to speak up, challenge existing practices and to showcase the good work they are doing.”– Philip Lee
Her kidney is a gift of love
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Now, I’m not hooked to any machine. And I can roll over in bed!
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Mr Rahman Abdullah (centre), seen here with Ms Kerk and Dr Sivathasan Adds NHCS’ manager Ms Kerk Ka Lee: “Before Mr Rahman entered the operating theatre, I encouraged him to hang in there since he had already endured so much.” The surgery has changed Mr Rahman’s life significantly. “Now, I’m not hooked to any machine. And I can roll over in bed!” he says. He went home three weeks after the transplant. This was earlier than the usual four to six weeks, thanks to the mechanical heart system which helped
Every year there ar e
PHOTO CREDITS: CHONG JUN LIANG
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A second chance for heart patient
thesundaytimes
Grooming a new breed of specialists
With its growing expertise and extensive clinical facilities, the SGH Campus has gained a strong reputation as Singapore’s transplant hub for vital organs Karen Teng
Special
with blood circulation and kept the other organs in good condition. Besides a monthly check-up, Mr Rahman is on rehabilitation therapy twice a week, putting in 90 minutes on the treadmill and stationary bicycle. He has earned praise from Dr Sivathasan for being “a very motivated and positive patient”. Mr Rahman has donated two valves from his old heart. These can be used to reconstruct the hearts of children born with heart defects or adults with damaged heart valves.
To Madam Pang Kok Lian (above), She finally relented and agreed her husband of 19 years, Mr Ivor to take her husband’s kidney. The Neo, is “the best in the world”. couple underwent comprehensive Mr Neo, 45, donated a kidney to tests over several months before the her to enable her to live a quality life, transplant could be carried out. away from a dialysis machine. Twice the double surgery was After delivering their second postponed because Madam Pang daughter, Madam Pang developed was not fit for the operation. kidney problems. Through it all, although he was She had chronic glomerulonephritis, poked repeatedly with needles and had says Associate Professor Chan Chong to go without painkillers because of an Meng, head of the renal medicine allergy, Mr Neo didn’t waver. “After the department at SGH. transplant, everything will be okay,” “She was was his view. afraid to undergo In April 2008, a biopsy, so his left kidney was we treated her transplanted to Madam medically as best as Pang, who left the we could. operating room with “Over the three kidneys — her years, her kidney own damaged ones function gradually and his. deteriorated.” After months By May 2007, of recuperation, Madam Pang needed Mr Neo on why he gave his kidney their lives are now to Madam Pang a transplant and “normal” although Madam Pang has to Mr Neo offered his be on anti-rejection kidney. “Since my pills and consult a renal specialist for blood group is a match and I’m the rest of her life. considered quite healthy, I decided Madam Pang, a construction to donate,” says the information company director, now spends less technology manager. She turned him down. “Our children time at work to be with her loved ones and make up for her “downtime”. The are still young. What if the surgery fails? What if both our surgeries fail?” Madam family vacationed in Europe last year. The couple says they were able Pang asked him. Their daughters are to undergo the transplant because now aged 16 and 13 years. of their Christian faith and the SGH Her four siblings were found to be team that took care of them. unsuitable as donors. In November Says Madam Pang: “The hospital that year, she was put on dialysis. staff were very knowledgeable and “Each session took four hours prepared us well, that’s why we three days every week. I felt tired and were quite confident to go through I wasn’t in the mood for anything the operations. Everyone was very else. Everyone was so worried,” says professional.” – Karen Teng Madam Pang, 44.
PHOTO CREDIT: DR TRACY CAROL AYRE
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Since my blood group is a match and I’m considered quite healthy, I decided to donate.
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PHOTO CREDIT: SINGHEALTH ACADEMY
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SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
thesundaytimes sunday April 18, 2010
Special
April 8, 2010
186,00&0day
One patient, one record – all the way
patient np in surgeries are ry year performed eve up ro G in SingHealth
Hospital of the future The road to recovery PRE-ADMISSION
SingHealth patients can download personalised patient education content, including pre- and post-surgery instructions, for review anytime, anywhere from the multilingual, multimedia MyEduCare portal by using a mobile/smart phone, PDA, PC, Mac or iPOD.
Information Technology is transforming traditional health-care practices and going digital will translate into better service for patients anywhere Mike Lee JUST as technology is changing the way we work and play, it is also transforming the way patients get health care in the SingHealth Group. When you seek treatment at any of its hospitals, specialty centres or polyclinics, all your personal information, medical history, treatments and laboratory results are stored digitally in the Electronic Medical Records (EMR) system so you can move seamlessly across the different institutions with them. With a single, comprehensive and timely online presentation of your medical condition, there will be no duplication of treatment, laboratory tests and scans, and doctors will be
able to make better clinical decisions. The EMR is in line with a national Electronic Health Records system that is being set up to create an islandwide digital repository of patients’ medical data under the One Patient, One Record initiative by the Ministry of Health (MOH). It makes information such as a patient’s demographics, allergies, laboratory test results and X-rays available to all health-care providers, including general practitioners, polyclinics and hospitals. SingHealth embarked on a major three-year project titled Mission for Improving Clinical Outcomes (MICO) in 2008 to upgrade its existing EMR infrastructure and integrate the separate systems across its institutions.
But MICO is not just about upgrading the EMR, says Associate Professor Low Cheng Ooi, chief medical informatics officer at SingHealth. His office looks at new applications and technology to enhance the delivery of health care, with the aim of improving clinical outcomes. “What we can do is to take away the current flaws in the analogue systems and use information technology (IT) to enhance and change the way we work.” Alongside the EMR enhancement are various new health-care IT systems being rolled out at SingHealth’s institutions to replace the traditional paperbased system. Changi General Hospital (CGH) is using the Computerised Physician Order Entry (CPOE) system, which allows doctors to place clinical orders such as laboratory or X-rays online via customised templates without the hassle of writing out the traditional order forms. This process is speedier, more ef-
ficient and frees the doctor to concentrate on patient consultation. The system is slated to be rolled out to other SingHealth institutions. More importantly, CPOE has builtin decision support mechanisms for other health-care providers, including pharmacists and nurses, to cross-check the clinical orders, reduce errors and enhance patient safety. When the EMR reaches the required level of sophistication, the next step is to build clinical decision support and clinical analytics systems, says Prof Low. The latter allows quality insights to be drawn quickly from EMRs. With paper records, analysing clinical results and outcomes is time-consuming and difficult. The clinical analytics system in turn will enable the clinical dashboards, which give doctors a better overview of a patient’s condition, adds Prof Low. “With the clinical dashboard, you can see everything in one view instead of flipping through case notes page by
page,” he explains. These IT innovations in the healthcare system provide relevant and timely information to the clinician, and this ultimately translates to better patient care. SingHealth, with support from the Integrated Health Information Systems (IHIS), also collaborates with external partners such as the Agency for Science, Technology and Research (A*STAR) and Microsoft, among others, to develop its IT capabilities. IHIS, a subsidiary of MOH Holdings, pools the IT resources of the public health-care groups in Singapore. When evaluating new health-care technology, factors like cost and hardware requirements, how well the technology integrates with current systems and its scalability, are considered, says Prof Low, who is also chairman of the medical board at CGH. He says that health care is poised for an exciting transformation, just like the old brick-sized handphone that
14,000
babies are delivere d every year in SingHealth G roup
was turned into a small, handy gadget. “That kind of transformation within such a short time of 10 years is going to replicate itself in health care. “A decade from now, medicine is going to be very different to the benefit of everyone — the patients, health-care professionals, and the general public.”
DISCHARGE & FOLLOW-UP
A patient discharged from a specialist outpatient clinic is followed up at the primary care level under the Delivering on Target (DOT) IT system by polyclinics and general practitioners. This enables continued tracking and monitoring of the patient’s health, resulting in improved continual care and service quality.
RECOVERY IN THE WARD DIAGNOSIS ADMISSION
At the A&E department, the doctor uses Mobile Clinical Assistant, a health-care tablet PC with WiFi and Bluetooth wireless technology to access the patient’s medical records at his bedside. The nurse uses the Bed Management System with RFID to check the status of beds to facilitate bed management and planning, thus helping to reduce patient’s waiting time.
ILLUSTRATION CREDITS: VIKKI CHAN
The specialist retrieves the patient’s electronic medical records, including images of scans by using the Mobile Electronic X-Ray Computing or Bedside Medical Workstations to explain his treatment options and care plan as part of the hospital’s point-of-care support system. Through these devices, radiology or laboratory tests and outpatient medication prescriptions are also ordered electronically via the Computerised Physician Order Entry for improved efficiency and better patient safety.
PRE-SURGERY
Immersive Technology that uses goggles to display interesting video content helps distract and reduce the anxiety of a child undergoing surgical procedures under local anaesthesia or intravenous cannulation. This contributes to the child’s overall sense of well being and recovery, and reduces the need for sedation or general anaesthesia.
Breaking new ground in medical science Backed by well-equipped research centres, hospitals and top professionals, SingHealth is well-placed to become Asia’s hub for biomedical research Ahmad Osman
PHOTO CREDITS: NCCS
thesundaytimes
SINGHEALTH aims to be Asia’s top biomedical research centre by 2030. Its assistant chief executive officer for research and education, Professor Soo Khee Chee (left) says it has the capabilities to achieve the target. These include three hospitals, five national cancer, eye, heart, neuroscience and dental centres and the Duke-NUS Graduate Medical School, which is SingHealth’s education partner on the Singapore General Hospital (SGH) Campus. The school, the top medical centres and research infrastructure together provide the scientific, academic and research foundations for the SGH campus to be a globally renowned medical research hub. SingHealth is grooming the clinician-scientists who are working on the causes, early detection, prevention and treatment of cancer, diabetes, eye, neurological, heart and infectious diseases. Researchers and clinician-scientists will share ideas, equipment and space in a new research tower in the campus, which will be completed by 2012. The tower is adjacent to SGH’s new home for the pathology department, says Prof Soo, who is also director of the National Cancer Centre Singapore (NCCS). SingHealth is also working with local and international research partners
such as Roche, which is the world’s largest biotech company. Roche is setting up a medical research hub here to expand knowledge of the biology of diseases to develop personalised treatments. “Patients are the ultimate winners when doctors and other health-care professionals are actively involved in research,” Prof Soo says. He cites the examples of significant research projects by some of the national medical specialty centres in the SingHealth Group. One in four deaths in Singapore can be traced to some form of cancer. It is the country’s top killer, which strikes people who are mostly in the borderline and incurable stages of the disease. According to the NCCS, adding chemotherapy to the standard radiotherapy treatment improves the survival rate for head and neck cancer by 20 per cent. The results of a multi-centre clinical trial revealed that Tamoxifen, the drug for treating breast cancer, does not prolong the survival of patients with advanced liver cancer. Prof Soo says: “You must get the most appropriate treatment and this is the concept of personalised medicine for cancer and other diseases. “We are looking forward to tailoring appropriate treatments for patients with the same diseases who have different individual genetic structures and biological systems.”
Speeding up the discovery of a drug for Parkinson’s disease is the aim of National Neuroscience Institute (NNI) researchers headed by Associate Professors Lim Kah Leong and Tan Eng King. They helped to discover another variant of a mutation in the LRRK2 gene in a significant number of Parkinson’s patients. The NNI team created the first fruit fly model of the variant. When these flies age, they have symptoms similar to those in their human counterparts with Parkinson’s disease. Brain cells similar to the human’s start to die gradually in the fly’s brain. Like the humans, it is also tough for older mutant flies to move. Studying the flies can unlock some mysteries surrounding brain cell death in Parkinson’s, which is a debilitating neurological disorder affecting up to 7,000 patients in Singapore. The NNI has started drug screening efforts with the flies. It is talking to drug companies to expedite the process. In another field, SingHealth’s focus on infectious diseases will make Singapore more prepared to deal with public health scares like Sars and the bird flu epidemic. Prof Soo says: “We do not want to be trying to understand the disease when it hits us. It is much better for us to have sufficient information to make the preparations before we are struck by the disease.”
There were other significant medical milestones in the last decade by the Singapore National Eye Centre and the Singapore Eye Research Institute under the leadership of Professor Donald Tan. They put Singapore in the forefront of the global battle to reduce blindness caused by diseased or damaged corneas of the eyes. Prof Tan and his team of researchers introduced new treatment methods, including innovative corneal transplantation surgery, that has been adopted around the world.
46
per cent of all day surgeries in Singapore is performed by SingHealth doctors
Clinical trials to help patients BIOMEDICAL research in the SingHealth Group stretches from the laboratories to the patient’s bedside. Translational research uses scientific discoveries to help patients, says Professor Soo Khee Chee, who is SingHealth’s assistant chief executive officer for research and education, and director of National Cancer Centre Singapore. He says that improvements in medical treatments are determined through clinical research and trials. He cites the results of a clinical trial for patients who had to go through reoperations because of recurrent colorectal, appendix, ovarian and stomach cancers. In normal circumstances, they generally do not make it past a year. But some 70 per cent of such patients who undergo the trial, together with chemotherapy perfusion of the abdomen, survive for at least one year. Half of them made it past the three-year mark. In the first phase of the
trial, new chemotherapy drugs targeting specific cancerous cells and various combinations of treatments were tried on the patients to assess the toxicity and side effects. In phase two, promising therapies were used to assess tumour response and whether the therapies could prolong survival rates and improve the quality of life. In phase three, the new treatment combining surgery and chemotherapy perfusion were compared to the standard palliative chemotherapy to slow down the progression of the cancer and prolong the life of the patient. Phase three trials, which may involve thousands of patients and take up to five years to complete, are necessary because of significant differences in the results of many treatments carried out at different times. Prof Soo says: “True improvements to patient care can be borne out only when they work in large numbers of patients in later stage trials.” - Ahmad Osman
SURGERY
In the Digital Operating Theatre, surgeons can review patient’s radiology images digitally during surgery while medical and nursing staff use SCOTT (Surgical Counting & Operating Theatre Tracking) to track and count all surgical apparatus and consumables. This enhances patient safety, and optimises manpower and operating theatre resources.
The Patient Bedside Terminal (PBT) is a touchscreen infotainment system that lets a patient surf the Internet and speak to a nurse on duty through a video call. The patient’s medication is dispensed through the Inpatient Pharmacy Automated System based on the Inpatient Medication Orders and Electronic Medication Administration Systems. To achieve Closed Loop Medication Management, packed medicines (above, bottom right) come with barcodes which nurses use to check against the patient’s identification wristband as part of the Knowledge Based Medication Administration.
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SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
thesundaytimes April 18, 2010
Special
April 18, 2010
thesundaytimes
Networking in the east CGH works with other health-care providers to ensure patients have options that save them time and money Ahmad Osman
Growing talent in public health care
PHOTO CREDIT: CHONG JUN LIANG
SingHealth offers comprehensive training programmes to develop its professionals for a fulfilling career in medical care Philip Lee PROVIDING excellent health care for patients in a warm and healing environment — this is SingHealth’s mission, says its deputy chief executive officer, Professor Ivy Ng (above, second from right). To do this, SingHealth has to recruit the people who share this passion for public health care, she says. “It is critical for us to focus on attracting the right talent and nurture and develop them so that they can deliver this mission of ours to patients who entrust their care to us.” Prof Ng concedes that it is a challenge to find people who have such a passion. “We use various ways by looking at their own career tracks, the things that move them and we also tell them about our organisation as best we can. “Hopefully, the ones who come to us have a sense of this need to serve people.” A high level of competence is the other prerequisite, says Prof Ng, who is also the chief executive officer of KK Women’s and Children’s Hospital (KKH). To achieve this, SingHealth places its health-care workers in the best environment to help them develop their expertise, she adds. “We have a nice tagline: Learn from the best. “We proactively create situations where our staff have good individual mentors in the various departments and we have various programmes to help them gain different skills. “For example, we have the HMDP — Health Manpower Development Plan — awards. “Every year, we give out almost 150 of these awards for people to train in various sub-specialties, both locally as well as overseas. This is for doctors, nurses and allied health professionals.” Prof Ng says that another critical area SingHealth focuses on is its leadership programme.
“Preparing the next generation of leadlead ers throughout the organisation is critical to our continued improvement,” she says. “So if we want SingHealth to be better than it was, than it is now, then we must have leaders who must be better than ourselves.” “We need to identify the ones who have the potential to lead and then nurture them, challenge them and grow them so that they can take on greater and greater responsibilities.” SingHealth uses a method known as the 360-degree peer appraisal system to identify potential leaders. Says Prof Ng: “Every individual is appraised by not just the supervisor but by peers as well as the direct report, or the subordinate. “This way you use everybody’s opinion to identify these leaders.” Those chosen are then put through several leadership programmes.
“We have four formal programmes in SingSing Health that prepare a young potential leader to become a full-fledged leader,” she says. “We have other programmes which are specific to their needs, like performance management, the seven habits of a good leader and so on, that they can use. “Other than these, we also give them different roles as well.” “There is nothing like experience. It trains you for bigger responsibilities,” she notes. Prof Ng says that it is important for SingHealth to retain talent, and one way to do this is to ensure that the workers are well-trained and better qualified to make further progress in their careers. “We are quite pleased that 80 per cent of our staff who reach retirement age choose to continue working with our organisation,” she adds.
SingHealth Group gives more than health-care scholarship s and sponsorsh ips annuall y
500
A mentor who shows the way
PHOTO CREDIT: CHONG JUN LIANG
She calls her mentor a “big sister” — someone who helps to solve her work and personal problems. Says Ms Foo Koon Mian (far left), a senior pharmacist with KK Women’s and Children’s Hospital: “When there’s a problem, she does not just solve it, we also brainstorm the issue and then make changes to the workflow to prevent the problem from recurring.” Her mentor is Ms Irene Quay (left), a principal pharmacist. She shows Ms Foo how to be a good supervisor. This means taking care of staff welfare, delegating work and monitoring staff performance. What Ms Foo admires most about Ms Quay is her quick-wittedness. “Whenever I present an issue or problem and seek her advice, she will suggest several ways that I can approach or solve the problem,” says Ms Foo.
To this, Ms Quay says: “As a mentor, I hope to provide guidance to help the mentee excel in all aspects, be it clinical, professional or administrative work as well as personal growth. “This is crucial as novice pharmacists need someone to look up to and seek advice from, when they run into problems. “The mentee should also be given opportunities to grow in their jobs through empowerment.” Being a role model is part of being a good mentor, Ms Quay says. “A good mentor needs to walk the talk, be well-respected, be caring and look out for mentees and guide them along the way. “The mentor must also guide those under their charge to visualise their goals, groom them for leadership roles and plan for their future development.” — Philip Lee
CHANGI General Hospital (CGH) leads the way in providing better community care for patients living in the eastern parts of Singapore. The regional hospital has a network of partners that provide convenient and afaf fordable health-care services. They include St Andrew’s Community Hospital, general practitioners (GPs), SingSing Health polyclinics and nursing homes. Since 2005, St Andrew’s has been propro viding further rehabilitation therapy for medically stable patients. They are transtrans ferred from the regional hospital while waiting to go home. Daily charges in the community rehareha bilitation hospital are lower than those in the acute care regional hospital, which attends to patients who are very ill. Both hospitals are linked by a sky bridge. Some 85 per cent of the patients in St Andrew’s are from CGH. Most of them are elderly folk going through rehabilitation therapy for strokes and fractures, says CGH’s chief executive officer, Mr T. K. Udairam. Fifty-seven GPs are now managing more than 300 elderly, former CGH patients with stable medical conditions. These patients do not have to wait long for their appointments or pay more to see the specialists in the hospital. Waiting time is shorter in the neighbourhood clinics, where the patients can see their GPs for regular check-ups. GPs who know their patients well can offer more personalised and continuous medical care. Subsidised patients who develop complications and are referred back to CGH get the same level of subsidy. For intensive long-term care and support services, patients get treatment at the polyclinics in the SingHealth Group. They include those who cannot afford the fees charged by the GPs. CGH is also working with nursing homes to provide holistic care for the community in eastern Singapore. The hospital’s specialists and allied health professionals treat patients in the homes, Mr Udairam says. “Going forward, the hospital and community leaders will look into setting up small health centres with dieticians and therapists
SingHealth Group buys pieces of uniform fo r service staff a year
55,000
Dr David Yong of Changi General Hospital attending to a patient in the St Andrew’s Community Hospital. PHOTO CREDIT: SINGAPORE HEALTH
Helping hands, holistic management in HDB estates in eastern Singapore. “When the need arises, GPs can refer patients to these centres to help Singaporeans stay healthy and avoid or delay the onset and progression of chronic diseases.” CGH’s community care partnerships are based on principles in the national Delivering On Target programme initiated by SingHealth in 2005. The programme provides the training and infrastructure for GPs to play a bigger role to prevent and manage chronic illnesses among the growing number of ageing Singaporeans. “Keep yourself healthy,” Mr Udairam says. “If you are sick, see a doctor quickly, do not wait until you end up in a hospital. “Younger people in a hospital get well quite fast. The elderly tend to take a longer time to get better and they need more rehabilitation. “We cannot continue to build more hospitals for our rapidly ageing population. It is better to manage older patients in the community so that they do not need hospital care.” Dr Tan Chee Beng, the chief executive officer of SingHealth Polyclinics, says the collaboration with CGH will provide better co-ordination, care and clinical outcomes for patients who do not have to be in hospitals. Dr Tan adds: “Looking ahead, we will continue to pursue innovation and improve our care delivery systems to meet the needs of our patients.”
Patients in hospitals and specialist centres under the SingHealth Group can get psychosocial and emotional support from groups of families, caregivers, health-care professionals and individuals who face similar situations. Cancer support groups are driven by holistic management for patients and their families to maintain a high quality of life, says Mr Gilbert Fan, head of the psychosocial oncology department at the National Cancer Centre Singapore. He adds: “We hope to help patients make informed and effective decisions, communicate and bond well with their loved ones, and maintain a normal lifestyle as far as possible.” Some of the support groups are:
ASTHMA SUPPORT GROUP
Contact: Clarybell Fernandez Tel: 6850-3692 E-mail: clarybell_fernandez@cgh.com.sg Website: www.cgh.com.sg
CHILDREN’S DIABETES SUPPORT GROUP Contact: Joyce Lim Tel: 6394-3771/2094 Website: www.kkh.com.sg
NASOPHARYNGEAL CANCER SUPPORT GROUP Contact: Teo Thiam Chye Tel: 6436-8117 E-mail: mss@nccs.com.sg Website: www.nccs.com.sg/pat/09.htm
NHCS HEART/LUNG TRANSPLANT PATIENT SUPPORT GROUP Contact: Kerk Ka Lee E-mail: 6436-7689 Website: www.nhcs.com.sg
RP (RETINITIS PIGMENTOSA) SUPPORT GROUP Contact: Linda Chan E-mail: low_vision@snec.com.sg Website: www.retina-singapore.org
SINGHEALTH Humanitarian Relief Programme (SHRP) plays an important role in providing acute medical aid and longterm recovery projects to help the victims of natural disasters in the region. It has taken part in humanitarian projects in the Sumatran earthquake in Indonesia, Cyclone Nargis in Myanmar and Typhoon Ketsana in the Philippines. Formed last year, SHRP is a SingHealth Group’s initiative. Its roots go back to 2001 when its staff provided disaster relief services to communities affected by the Gujarat earthquake in India. SHRP has 90 active volunteers comprising doctors, nurses and allied health profes-
on three missions. Valuable lessons can be learnt to enrich the experience of SHRP’s volunteers and prepare them for future missions, he adds. “One memorable encounter was the seizure of our team’s cargo by the custom’s authority on arrival at the disaster area. It taught us that we have to respect the regulation and policies of the health authority of the affected country. We later found out that much of the medical supplies can be purchased in the country.” The challenges aside, it is a fulfilling undertaking for SHRP’s volunteers, he says. “What motivates one is usually the grateful smiles and relief on the faces of the beneficiaries. Giving is the best form of human satisfaction.”
SGH COLORECTAL CANCER SUPPORT GROUP Contact: Nurse Clinician Ong Choo Eng Tel: 6326-5162 Website: www.sgh.com.sg
STOMA CARE SUPPORT GROUP Contact: Chia Swee Khim Tel: 6850-3370 Website: www.cgh.com.sg
THE REVIVAL CONNECTION
Contact: Brandon Goh Tel: 6436-8117 E-mail: therevivalconnection@yahoo.com.sg Website: www.nccs.com.sg/pat/09.htm
WOMAN TO WOMAN, MENOPAUSE SUPPORT GROUP Contact: Clinic K nurses Tel: 6394-1499 Website: www.kkh.com.sg
Big savings from smart buying Acquiring medical supplies in bulk and good procurement practices help SingHealth to cut costs in health care Alex Lim PUBLIC hospitals in Singapore used to have 17 different brands of lancets or sursur gical knives, which are used to draw blood. The Group Procurement Office (GPO) of the SingHealth Group narrowed them down to just two brands after a product rere view with clinicians and nurses. Generating economies of scale through integrated procurement and bulk buying is a concept that SingHealth, Singapore’s largest health-care group, has embraced with much success. In five years from 2003, the GPO managed to save $92.5 million through astute decideci sions on the acquisition of hospital supplies. The GPO buys more than 10,000 types of hospital items annually, from medical dispos dispos-
Volunteers in SingHealth provide humanitarian relief to survivors of natural disasters in the Asian region sionals within the group’s network of hospitals, polyclinics and specialist centres. The team works with the Ministry of Health and local humanitarian groups such as the Singapore Red Cross and Mercy Relief. “Other organisations have strengths in logistics and communications. This partnership enables us to collaborate and cooperate for the benefit of the community,” says Dr Mark Leong, head of SHRP. He is also chief of Singapore General Hospital’s department of emergency medicine. To further develop its volunteers for future missions, SHRP will be working with its partners on attachments and secondments. “This will allow for more exposure for our volunteers in sustained recovery and rehabilitation work,” says Dr Leong, who has been
Contact: Nurse Clinician Usanee Chotphoksap Tel: 9295-3331 Website: www.sgh.com.sg
This list is not exhaustive. Please refer to respective SingHealth institutions’ websites for more information on other support groups.
Rebuilding lives in disaster areas Esther Yi
SGH PARKINSON’S DISEASE SUPPORT GROUP
Dr Gene Ong from the KK Women’s and Children’s Hospital (far left) and Dr Teo Eng Yee of Changi General Hospital attending to villagers affected by the earthquake which struck in Padang, Indonesia, in September last year.
roup buys SingHealth G pieces over and more of dressings, pieces than per year of bandages
1 million 400,000
PHOTO CREDIT: SHRP
Mr Tan (above) works with hospital staff to save costs on medical supplies. PHOTO CREDIT: CHONG JUN LIANG
ables and medicines to clinical equipment. “Price is not the only determinant of the total cost when buying a product or a service,” explains Mr Tan Jack Thian, SingHealth’s group procurement officer. “There are many hidden costs that are passed on to a buyer,” adds Mr Tan, who is also chief operating officer of the KK Women’s and Children’s Hospital. Examples of hidden costs could include internal costs for transportation, purchase administration or buying products of higher specifications than actually needed. The GPO staff works closely with the hospitals and clinics to understand their needs and make better purchasing decisions for their supplies. “After we are satisfied with the quality of the products, steps are put in place to ensure that the goods and services are acquired at the most cost-effective price,” says Mr Tan. The GPO also works closely with its key suppliers to cut costs and improve service. “The drive for innovation and finding new ways to do things is carried out to reduce joint holding costs for both sides,” says Mr Tan. The GPO has extended its expertise beyond the SingHealth Group to help other hospitals, the Singapore Civil Defence Force and the Ministry of Defence acquire medical supplies. Since January this year, it has been collaborating with the Agency for Integrated Care to buy things such as milk and diapers for 30 community health-care institutions and nursing homes. It is estimated that the two-year pilot project could achieve savings of up to a quarter of a million dollars.
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Special
SINGHEALTH 10TH ANNIVERSARY — DEFINING TOMORROW’S MEDICINE
thesundaytimes April 18, 2010
Major milestones in SingHealth 2010 n A leader in transplant services
2009 n Laparoscopy at KKH
SGH successfully performed three complex transplant operations — Asia’s first combined heart and liver transplant, a kidney transplant for Singapore’s oldest living donor aged 75, and a dual kidney transplant using both kidneys from a deceased donor over the age of 60.
KKH doctors were among the first to remove corneal and ectopic pregnancies, and perform a hysterectomy through single port laparoscopy that is done through an incision as narrow as two centimetres in the navel. KKH was also the first in Singapore to remove choledochal cysts in children through laparoscopy.
n Online health portal
SingHealth launched Healthxchange, a one-stop online health-care portal that gives Singaporeans easy access to comprehensive and reliable healthcare information tailored for Asians through interactive platforms.
n A leader in robotics surgery
Since performing the region’s first robot-assisted surgery for prostate cancer in 2001, surgeons at SGH Campus have performed more than 500 surgical procedures using the da Vinci robotics system. In April 2010, SGH added the latest generation da Vinci Si dual console surgical robot to support minimally invasive surgery across a broad range of clinical specialties.
n Humanitarian aid
The SingHealth Humanitarian Relief Programme was launched to consolidate the efforts of SingHealth’s medical expertise and staff volunteers who provide medical aid, sustainable community recovery and reconstruction aid to victims of calamities in the Asian region.
2008 n Chronic disease management SingHealth first launched the Delivering On Target (DOT) programme that achieved improved clinical outcomes for diabetics in 2005. Its success led to its extension as the national DOT programme that provides quality and cost-effective care for those suffering from chronic diseases.
n Cutting-edge dental imaging
The National Dental Centre introduced the new cone beam CT scanner that generates improved threedimensional images of patients’ jaws, teeth and surrounding soft tissue to enhance treatment planning for patients undergoing dental implants and corrective jaw surgeries.
2007 n Digitally integrated operating suite
The world’s first state-ofthe-art digitally integrated operating suite housed in SGH’s major operating theatres allows surgeons to perform more complicated surgical procedures in less time with improved patient outcomes.
2006 n Family Physician Clinic SingHealth Polyclinics started the Family Physician Clinic for patients with chronic diseases. There is longer consultation time and greater patient-doctor engagement.
2005 n Clinical breakthroughs
National Cancer Centre Singapore defined the global standard in treating locally advanced nasopharyngeal cancer (NPC) with a randomised clinical trial showing benefit for adding chemotherapy to radiation. It also performed the world’s first successful sibling blood stem cell transplant and upfront T cell immunotherapy for advanced NPC.
2004 n ‘Tooth-in-eye’ surgery
Eye surgeons from the Singapore National Eye Centre and a dental team from the National Dental Centre successfully collaborated to restore vision to the most severe cases of corneal and ocular surface patients by implanting a tooth in the eye.
2002 n Changi Sports Medicine Centre The Changi Sports Medicine Centre is now the largest multidisciplinary Sports Medicine Centre in Singapore. It actively champions sports safety development and provides medical coverage for high profile events such as the Formula 1TM SingTel Singapore Grand Prix.
n Drug eluting stent
The National Heart Centre Singapore introduced the revolutionary drug eluting stent that prevents re-narrowing of arteries by releasing an antibiotic. This benefits diabetic patients and those whose arteries are naturally small.
Special PROJECT EDITOR EDITOR
Karen Teng l
Lee Kim Chew l
ADVERTISING SALES
WRITERS
Ahmad Osman, Philip Lee l
CREATIVE DIRECTOR
Jacqueline Wu Boey l
Martin Boey (9620-1358), Alfred Lee (9673-3578)
CONTRIBUTORS
Mike Lee, Alex Lim, Esther Yi l
CHIEF SUB-EDITOR
Uma Venkatraman l
ART AND DESIGN
ADMIN MANAGER
Kimmie Tan, Lynnette Chia, Vikki Chan l
PHOTOGRAPHER
Chong Jun Liang
Zain Afridi
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