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may/june 2013 MCI (P) 197/03/2013
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Resident Nurses
A select group who is redefining roles Conversations with our leaders Shaping the SGH that we desire
Policies for good Benefitting many through public service
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public service clinicians, defined
The SGH Annual Scientific Meeting 2013
bench press
Medical students research projects
class act
From boss to buddy, Residents pay it forward
03 06 07 08 10 12 14
resident nurses Redefining roles
conversation with our leaders policies for good Lee Jiunn Kee on policies that benefit more people
helping the twain to meet
Feedback Unit colleagues who put themselves between two opposing sides.
in every issue 16 18 20 22 23 24
quality pulse spree in action campus buzz time out your take the last page
contents
LIFE at SGH Campus | May/Jun 2013
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Resident nurses – redefining roles A select group of nurses has been given special training and expanded responsibilities. Recently introduced in SGH and the National Heart Centre, the Resident Nurses are redefining the traditional roles within the healthcare team.
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Advisor Tan-Huang Shuo Mei Contributors Dietetics Dept, Estee Chan, Geoffrey Gui, Chia Kuok Wei, Ratna Abdul Rahman, Vanessa Peters, Jennifer Wee, Claudia Yeo, Carol Ang, Michelle Scully, Goh Sai Luan Distribution General Services Dept, Helen Yang On the Cover Lee Jiunn Kee, Senior Manager, Operations, finds purpose in shaping policies that benefit many people, on Page 7. ----------Life@SGH Campus is published every two months in print and online by the SGH Communications Department
dentifiable by their distinctive pink badges, the Resident Nurses care for patients throughout their journey in SGH, from the clinics to procedure rooms and wards, just as the doctors do. Indeed they are very much part of the medical team, reporting to a clinician supervisor (called a medical preceptor) as well as an Advanced Practice Nurse (APN), with matrix reporting to the ward Senior Nurse Manager. Resident Nurses are trained to do clerking for selected cases within established protocol. Clerking was previously done only by doctors. This involves taking the patients’ detailed medical history, which is key to making a diagnosis, and to carry out physical examinations. They also perform procedures such as removal of surgical drains and tubes, flushing of catheter (post neobladder), and stoma intubation and irrigation.
“We introduced Resident Nurses to complement the healthcare team in providing prompt care to our patients, within established protocols,” said SGH Director of Nursing, Dr Tracy Carol Ayre. “The scheme offers another option for Senior Staff Nurses and Nurse Clinicians who are keen to develop their expertise as practitioners. Resident Nurses will form a pool of highly skilled candidates for us to groom future Advanced Practice Nurses,” she added.
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Resident Nurses – redefining roles (Continued from Page 3)
The first cohort of 26 Resident Nurses took on the rigorous training in September 2012, starting with six months of fulltime classes, clinical attachments and constant assessment conducted by clinicians and senior nurses. They are now performing their six-month internship under the supervision of their medical preceptors and APNs in their own specialty areas. Places in the training programme are first identified by the Heads of clinical departments based on the needs of the service. Candidates apply and are assessed through an interview by the Clinical Head and Director of Nursing. “We look for candidates with at least five years’ experience in patient care, including two years in their specialty areas, and advanced diplomas. Those with Bachelor’s degrees are preferred. Good clinical and communication skills are also prerequisites,” said Asst Director of Nursing (Advanced Practice Nurse) Tan Siok Bee who plays an active role as advisor and trainer in the programme.
Our Resident Nurses tell us more I have gained knowledge and skills which give me the confidence to share my views on patient care with the medical team. “I now get to see the patients through their entire journey in the hospital – in the clinic, at admission, in the wards or operating theatres, to discharge, as well as through all the different procedures such as endoscopy. “Because I get to know my patients well, there have been times when I was able to provide new information otherwise unknown to the clinicians, which helps in making care decisions with a more holistic view. These are the moments when I feel most proud to be a Resident Nurse.“ — Reka Ramakrishnan, Senior Staff Nurse, General Surgery (Trauma), Ward 57, Bachelor of Nursing, nine years in SGH
It can be quite daunting, trying to meet the higher expectation of the Consultants. But they have been open to my suggestions, which combine the benefits of the new medical knowledge and my nursing background, giving a more holistic view of the patients.” “When I don’t understand I would go ahead and ask for explanations. The clinicians have been helpful and supportive. By spending more time with them, I have learnt so much, such as how to communicate clinical diagnosis and diagnostic options to the patients.” “I came through the course despite having less work experience than the others. If you are willing to learn and ready to work hard, you can do it too.” — Karine Sim, Staff Nurse, Urology, Ward 55, Bachelor of Nursing, five years in SGH
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LIFE at SGH Campus | May/Jun 2013
One of the more in-depth things we learnt is taking the patient’s medical history. This is most critical to making a diagnosis. We have to be careful not to miss anything that could be significant. Another is to conduct physical examination – how to listen to the sounds from the heart, the lungs, the stomach etc. “With the training and being part of the medical team, I am more effective as a link – between the clinicians and nurses, and between the clinicians and the patients. To my fellow nurses, I can explain and help them better understand the care plan which improves the quality of care. For the patients, they now have someone from the medical team who can spend more time explaining things to them.” “The course was demanding and we had to work very hard. But I am happy that I can now do more, that I can do better. This is too good an opportunity to miss.” — Lissa V Joseph, Senior Staff Nurse, Orthopaedic Surgery, Ward 76, Bachelor of Nursing, nine years in SGH
In our Bachelor degree course, we learnt general things covering a wide area. But the Resident Nurses programme adds a lot of depth to our knowledge, especially in our specialty. “We are trained to do clerking - taking a comprehensive medical history, and carrying out physical examinations. Other new skills include carrying out specific procedures such as removal of surgical drains and tubes, taking blood specimen for blood culture and male catheterisation. These were previously taught only to doctors.” “The course was very challenging. You need a good foundation, and do a lot of self-study, even before the lessons. Some of our assessments, especially in history-taking and physical examination, were conducted in the same format as the doctors’ tests. It can be very stressful at times, but we encouraged each other. I really enjoyed learning from my fellow Resident Nurses from different specialties.”
The Resident Nurses programme Conducted under the aegis of the SingHealth Alice Lee-Institute of Advanced Nursing. An examination committee, chaired by Assoc Prof Lim Swee Hia, the institute’s Senior Director, makes decisions with regards to examinations and certification. One year intensive programme, with six months of full-time classes plus six months of internship under the perceptorship of a Registrar or above. This is followed by one-year practice in the ward, where they will join the medical team on ward rounds.
Class of 2013
The first class of 26 Resident Nurses will graduate in September 2013. It comprises Senior Staff Nurses and Nurse Clinicians from the National Heart Centre and SGH, in six specialties: 1. 2. 3. 4. 5. 6.
Urology Colorectal Surgery General Surgery Orthopaedic Surgery Cardiothoracic Surgery Cardiology
Class of 2014
Commencing in October 2013, it will offer six more specialties.
— Leni Guanzon Fernandez, Senior Staff Nurse, Colorectal Surgery, Ward 47A, Bachelor of Nursing, nine years with SGH
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Conversations with our leaders
Open and sincere sharing marked the March edition of the SGH Townhall, Grapevine. Staff took the opportunity to engage GCEO Prof Ivy Ng, CEO Prof Ang Chong Lye and Chairman of Medical Board Prof Fong Kok Yong. These are the highlights. Desired culture
During the discussion, Mrs TanHuang Shuo Mei, Group Director, Communications and Service Quality, asked whether there is a desired culture in campus that needs to be cultivated in order to reach our goals. “People must de-turf and desilo,” said CEO Prof Ang Chong Lye. He stated the importance of a collaborative culture where everyone works together without boundaries. He shared a recent example of such collaboration – on a visit to the new satellite clinic at Camden Medical Centre, he saw IT personnel, therapists and clinicians working closely together to find solutions to improve patients’ experience. “Put patient safety first in everything that we do,” said Chairman of Medical Board Prof Fong Kok Yong. Be guided by our moral compass while pushing to move beyond, he said. If we put our patients at the heart of all we do, step by step, the culture we desire will evolve.
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GCEO Prof Ivy Ng identified three key elements in the desired culture: No boundaries, at every level, between domains, and between institutions. Perseverance. If we are discouraged early, we will not succeed. She cited the example of Thomas Edison who had more than a thousand failed experiments before he invented the light bulb. Ask “Why not?” She quoted thinker George Bernard Shaw who wrote, “Some look at things that are, and ask why. I dream of things that never were and ask why not?”
Doing the right thing
Mr Lee Jiunn Kee, Senior Manager, Operations, spoke for frontline staff who encounter patients who fall through the cracks of the social safety network and need help. He wondered how much can the rules be bent to help them. GCEO and CEO told the audience that as long as our people are
doing the right thing for the right reasons, management is prepared to back up the staff. GCEO cited the example of the rehabilitation facility at the Geylang Polyclinic which was closed because we did not have the right financial model in place to fund it. Despite this, the leadership decided to reopen it while addressing the problem on a more sustainable and systemic level. “If it’s time for a review, we will look at it.”
Evolutionary leadership
Assoc Prof Tay Sook Muay spoke about evolutionary leadership. “If we don’t innovate, we will evaporate,” said the Senior Consultant, Department of Anaesthesiology and Associate Dean of the Yong Loo Lin School of Medicine. "We have a deep heritage of teaching and medical leadership in SGH and on this campus; we are just continuing the journey," she said. She felt that the leadership is enlightened and engaged, knows the challenges on the ground and has been addressing them.
LIFE at SGH Campus | May/Jun 2013
up close
Policies for good
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ince July 2012, we no longer ask patients to pay a deposit at admission, for estimated bills of up to a certain amount. Patients now pay later, at or after discharge. This change is the result of an initiative by Admissions Office, in collaboration with Business Office and the Operations and Performance Management (OPM) team.
Q. Why did we make the change? A. We sometimes received
letters of appeal from Members of Parliament, for us to waive the deposit. Occasionally we even have patients who break down and cry in the Admissions Office because they could not raise the money in time. So, together with Business Office and OPM, we looked at past data to assess the risk and calculate the amount of leeway we could allow.
Q. What was the outcome? A. This has benefitted our
subsidised patients the most. About 80% of them now do not need to pay a deposit. Our data show that we have managed the risks well, since introducing the change. At the same time, we hope to change our image of being uncaring - “no money, no admission”.
Q. How was the change possible? A. Our management is
enlightened. We are providing a
public service, and so we must be different from organisations that are driven by profit. We made a case, supported by data, and the management backed us up. Our people, such as clinicians and nurses, are compassionate and know when to exercise flexibility. For example, there was a foreign worker who lost his job because of his illness. At the Admissions Office, we were hesitant because the employer did not want to foot the bill. But the surgeon said “he’s spent six months walking around with a catheter! We’ll proceed.”
Q. Why did you choose to stay in public service? A. Why did you choose to stay in
public service? Some time ago, at an interview for a part-time course, one of the professors asked me, “What do you want to do after graduation?” My reply was: “to join the private sector.” He then asked me to think about how to use my education to contribute and benefit more people. My professor was a doctor who had dedicated his entire career to public service. He was a great inspiration to me. I am glad that he asked me this very important question. With maturity, I’ve come to realise that it is more meaningful to have a purpose in the work that you do.
Lee Jiunn Kee, Senior Manager, Operations tells us about being involved in meaningful work that benefits many people.
“It’s time to review our mind set. Instead of having policies designed to guard against the 5% who may abuse the system, why not have policies that benefit the 95% who are honest and honourable?” I had spent six years with OPM and the last two years with Admissions Office. Being in the frontline gave me the opportunity to understand healthcare from the patients’ point of view and do something that impacts them. Being in public service gives me the privilege to be able to do something that I find meaningful.
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Senior Manager Iris Lim used her nursing background to great advantage in the SQ Department.
Helping the twain to meet
Putting themselves between two opposing sides are our colleagues in the Feedback Unit in the Service Quality Department. Who are these people who choose to do the difficult job of trying to get the twain to meet? “Why must I reply to SQ? Isn’t it their job to handle and make the issue go away?” “They always take “Must be a complaint!” the patient’s side.” — staff
“I want to see your CEO!”
“I will write to the Minister/my MP!” — patients
“I will write to the press!”
Calming frayed nerves “Are you out of your mind? Why did you join the Feedback Unit?” That was how former nursing colleagues greeted Iris Lim’s return to SGH in 2006. “And actually I didn’t know then what the Feedback Unit or SQ department was,” said Iris, who had left the hospital in the 1980s for private practice.
job. It also helps if you have some clinical background, to handle the medical-related and more serious issues. Besides Iris, who was a nurse, the unit also has a member who is a trained doctor.
After six years, the senior manager is the first to admit that the work is not easy. “I am still amazed at the emotional heights that people can reach, to become even abusive. But very often, it is distress or anxiety that makes people seem hostile.”
Experienced mentors like Iris inspire and help guide the newer colleagues along. “We have a buddy system to train new comers. We also give them scripts, to teach them to handle some of the more common enquiries or even abusive callers. Department meetings are also training sessions, where we share cases,” said Iris.
Iris lists patience, resilience and tenacity as qualities needed for the
“We watch out for one another. If someone is handling a demanding
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complainant in our meeting room, one of us is always ready to step in to help, if necessary. We even teach our staff to always take the seat nearest the door, to avoid being trapped should the situation turn ugly.” Senior Nurse Manager Ong Soo Lan, who has worked with the Feedback Unit on many occasions, said, “They have to hear both sides of the story, and they need our information for better understanding of the situation in order to respond. It is necessary as they also cannot give the impression that they are siding with us. I have come to appreciate our SQ colleagues and their work.”
LIFE at SGH Campus | May/Jun 2013
From lemons to lemonade “Ms Wendy Chin has given the patient and (me) hope and confidence towards Singapore General Hospital,” wrote the wife and caregiver of a patient who suffers from Parkinson’s Disease. The compliment was all the more remarkable as the wife had earlier sent in a letter entitled Unresolved Problems and Disappointments. Wendy Chin, SQ Executive, relishes the challenge of the work in the Feedback Unit.
“The elderly couple already had a lot to deal with, with the husband’s illness. They became frantic and frustrated when they had problems with their medical insurance forms as some of the information filled by our doctor appeared to be inconsistent.” explained Wendy, SQ Executive. Wendy liaised with the doctor and the patient’s wife to sort out the forms, which were difficult for the wife to understand. At one point, Wendy spent 1.5 hours on the telephone with her, going through the forms line by line, explaining every detail. When the wife returned the next day with more queries, Wendy patiently assisted and guided her through her concerns. “I get satisfaction in knowing I have helped somebody through their difficulties, whether it’s a patient or a colleague. People do appreciate you for being there through hard times. In some ways we play the role of a leader, showing them the way through the problems,” said Wendy. “I asked to be in the Feedback Unit when I joined SGH a year ago. It’s been fruitful and I have learnt a lot. I like the challenge that no two days are the same. The environment here is wholesome, with good seniors to teach and help you, and bosses who appreciate our work. We also have a case management system where colleagues work as a team to share difficult cases,” said Wendy who had spent 15 years in private healthcare. But how does she cope with having to manage upset people every day, who vent their frustrations on her? “One Saturday, I brought my 11-year-old son to work. He was in the backroom when I met with a very angry man, and became quite alarmed – 'I must save my mummy!' My explanation to him was simple – ‘It's okay, the man was not angry with me.’”
What does the Feedback Unit do? Isabel Yong, Director of Service Quality, takes us through: Fronting the issue
“To our colleagues, we say: Let us take care of this for you, so that you can focus on your work, on taking care of patients. Indeed, many cases are resolved at the SQ Department without us having to approach the departments concerned.”
Verification and information gathering
“We do not judge. When we approach staff for information, it does not mean we are taking the complainant’s side. We need the facts to verify the complaint, and to address the issues effectively. If there are shortcomings in our processes, then this is useful feedback for us to make improvements.
Engaging the complainant
“Communicating with the complainant does not mean we are encouraging them. Also, evidence of our efforts to engage them helps our case should the matter go public.”
Risk mitigation
“By providing a channel for patients or the public to air their complaints or concerns, we are also helping the hospital to mitigate risk. If we do not address their concerns, the issue may get escalated to the press, the Ministry or even the Courts. Using us as a channel offers some leeway that may not be possible through the lawyers.”
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Prof Sir Keith Peters from Cambridge University was the keynote speaker at the ASM and Formal Dinner. CMB spoke about our clinicians’ public service mission at the SGH Formal Dinner.
Public service clinicians, defined “
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o deliver quality care to every patient through integrated practice, medical innovation and lifelong learning.” That is the compass for our public service mission set by Chairman Medical Board (CMB) Prof Fong Kok Yong. Opening the SGH Formal Dinner on 6 April, CMB shared his definition of leadership as practised by the public sector clinician. The public sector clinician is a leader, by his constant quest to do better for his patients, his sense of public service in treating patients, and keeping the trust and welfare of his staff topmost on his mind – walking the talk and walking the ground. CMB spoke of the need to nurture such clinician leaders and to assure clinicians that the public service offers rewarding careers. One way to achieve this is to give clinicians autonomy in planning their career paths to suit changes in their life stages and the environment. CMB felt that clinicians would find meaning in their work if they are able to reinvent themselves to take on new roles at different stages of their career.
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Academic Medicine saves lives Science and Academic Medicine saved many lives during the SARS pandemic 10 years ago, said Professor Pierce Chow in his welcome address at the opening of the SGH Annual Scientific Meeting (ASM) on April 5. "That not more of us died during the SARS outbreak could be attributed to the efforts of clinician-researchers from major academic medical centres around the world," he said. The science community raced to identify the clinical features of the then-unknown disease, helping clinicians to diagnose the disease and to take steps to limit its spread. Through rapid international collaboration, the virus was quickly identified. “It is only through new knowledge, and the transmission of that knowledge through
LIFE at SGH Campus | May/Jun 2013
Pharmacist Dr Andrea Kwa was one of four winners for Outstanding Research.
Outstanding Research Winner
Title of abstract
Basic / Translational Research Dr Ong Choon Kiat, NCCS
Mutation landscape of Cholangiocarcinoma of different etiology
Clinical Research Assoc Prof Marcus Ong, Emergency Medicine, SGH
Socioeconomic status is associated with geographical variation of bystander cardio-pulmonary resuscitation occurrence for out-of-hospital cardiac arrests in Singapore
Nursing Ms Amy Ong Su Ting, NCSC, SGH
The efficacy of topical EMLA®cream in reducing arteriovenous fistula or graft cannulation pain in patients requiring haemodialysis – a pilot study
Allied Health Dr Andrea Kwa, Pharmacy, SGH
Efficacy of various antibiotics in combination with Tigecycline against extreme drug-resistant (XDR) enterobacteriaceae
Young Investigator
education, that we can significantly improve patient outcomes. New knowledge does not come from experience. New knowledge comes from research,” said Prof Chow in his welcome address as the organising chairman of the ASM.
Bigger, better, younger This year’s ASM has drawn a bigger and better crop of abstracts. There were also more young investigators taking part. A total of 347 abstracts were received, 42 more than the previous ASM in 2011. For the Young Investigators’ awards, the increase was most notable in the Clinical Research category which attracted 42 abstracts, up from the 10 entries in 2011.
Winner
Title of abstract
Basic / Translational Research Mr Nicodemus Oey, Duke-NUS Graduate Medical School
Memory in a single brain cell: Identification of a neuronal epigenetic modification complex associated with network activity
Clinical Research Ms Melissa Tan Si Hui, DukeNUS Graduate Medical School
Vitamin D deficiency is independently associated with ischemic stroke in an Asian case-control study
Nursing Ms Tang Yee Min, MOT Recovery Room, SGH
A comparative study of nurse discharge using post anaesthesia discharge criteria vs doctor discharge in recovery room
Allied Health Ms Cai Yiying, Pharmacy, SGH
Amikacin plus Meropenem plus Polymyxin B is bactericidal against pan-drug-resistant Pseudomonas Aeruginosa and suppress the emergence of resistance up to 120 hours in a hollow fibre infection model
Best Poster Winner
Title of abstract
Basic / Translational Research Dr Wong Peiyan, Duke NUSGraduate Medical School
Pregnenolone rescues schizophrenia-like behaviour in Dopamine transporter knockout mice
Clinical Research Dr Jonathan Yap, NHCS
Predictors of two-year mortality in Asian patients with heart failure and ejection fraction > 40%
Evidence-based Nursing Ms Amy Lim Ee Lin, NCSC, SGH
To evaluate the analgesic efficacy of topical application of EMLA®cream in reducing pain during radial artery cannulation
Allied Health Ms Cai Yiying, Pharmacy, SGH
The role of an anti-microbial stewardship program in an adult renal department in Singapore
Education Ms Tham Shu Qi, Anaesthesiology, SGH
A pilot study assessing effectiveness of a novel method for teaching intravenous cannulation and priming of an intravenous infusion
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bench press The simple setup which allowed students adequate needling practice
Are you afraid of needles?
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he word “needle” often strikes fear in even the toughest person. Some people may even faint at the sight of a needle! Patients are not the only ones who fear needles though; young medical students share this fear too, although for an entirely different reason.
Injecting fear
For them, fear stems from having to set up an intravenous or IV drip for patients. Currently, they hone their skills by practising on costly fake patient’s arms in medical school. The ratio of two arms to more than 20 students means that hands-on practice is limited. It also impedes their thinking process as initial attempts to insert needles in the ‘arms’ create holes large enough for subsequent students to spot. This lack of practice naturally translates into fear and uncertainty when students are asked to set up IV drips for real patients. Thankfully, a pilot study titled “Assessing effectiveness of a
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novel method for teaching intravenous cannulation and priming of an intravenous infusion” could be the solution. The study won the Best Poster Award (Education) at the recent SGH Annual Scientific Meeting.
A clear solution
Ms Tham Shu Qi, a Year 4 student from the Yong Loo Lin School of Medicine, National University of Singapore (YLL-NUS), together with two other schoolmates and her mentor, Associate Professor Chan Yew Weng, Senior Consultant, Department of Anaesthesiology, SGH, conducted a one-day workshop and mini-lecture for 25 Year 4 medical students last year to introduce a novel, self-constructed set-up for honing practical skills in the setting up of an IV drip.
Taking cheap shots
“This actually is the brain child of Prof Chan who used the same method to teach nurses. The set-up is inexpensive, effective and allows personalised teaching.
“All we need to do is twill some rubber tubes around IV drip bottles and pull latex gloves over them. The rubber tubes simulate the patient’s veins, the bottle is the arm and latex glove is the skin which hides the veins. Pressure was also added in the set-up to simulate backflow as it is an indication of whether the IV drip has been properly set up,” said Shu Qi, first author of the study. The results of surveys done after the workshop prove that this method was effective in increasing the students’ confidence when they had to set up real IV drips. The workshop was also able to clarify students’ misconceptions on IV drips. “We intend to conduct another workshop for a larger group of students at the Residency open house and submit a poster for presentation at YLL’s Asia Pacific Medical Education Conference in January 2014,” said Shu Qi. Now, does anyone have any solutions to ease patients’ fear of needles?
LIFE at SGH Campus | May/Jun 2013
A clinician-scientist in the making Shu Qi with mentor Assoc Prof Chan Yew Weng.
that she become a doctor even though her brother is a lawyer and her sister is pursuing a Master’s degree in architecture. It was an attachment at the National Cancer Centre Singapore (NCCS) that opened her eyes and heart to medicine and research. “I was quite undecided about what to do after completing my ‘A’ Levels but had the opportunity to learn from Dr Donald Poon who was then with the Medical Oncology Department at NCCS. He was a very good mentor and took time to teach me many things including the human anatomy,” said Shu Qi.
Successful findings
“Effort only fully releases its reward after a person refuses to quit.” This quote by American author Napoleon Hill aptly sums up the persistence and determination required of individuals to be successful. To be a clinician scientist is no different, but that has not deterred Ms Tham Shu Qi who has set her sight on becoming one. The 23-year-old student from the Yong Loo Lin School of Medicine at the National University of Singapore embarked on a pilot study of a new teaching method for medical students. She undertook this study while juggling classes, school work, examinations and department rotations in hospitals. Thankfully, her efforts paid off. Shu Qi and her team took home the Best Poster Award (Education) at the SGH Annual Scientific Meeting held in April this year.
Experimenting with Research
The youngest in a family of three children, Shu Qi shares that her parents never insisted
After her short stint at NCCS, Dr Poon hired Shu Qi as a Research Associate. The few months of experience allowed her to witness and understand how patients can benefit from research and also led to not just an interest in medicine but also a passion for research. Shu Qi is also grateful to her other mentor, Associate Professor Chan Yew Weng, Senior Consultant, at SGH’s Department of Anaesthesiology, for his guidance in clinical and research work. Prof Chan is one of the four authors of the pilot study. “From the way Prof Chan deals with problems, we can see that he is a very innovative person. He also arranges my schedule to ensure that I see the whole spectrum of work in the Department of Anaesthesiology, where I am now posted,” said Shu Qi. Shu Qi was lucky to have met two good mentors who guided and inspired her. But luck can only get her so far. The rest depends on the efforts she puts in. This, after all, is only the beginning of a very long journey…
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class act High five to good friends and mentors at work. From left: Ms Salimah Mohd Ayoob and Nurshifa Shaik Hussain.
From boss to buddy
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hey were once supervisor and staff. Then they became classmates. This year, they took another step forward in their learning journey together by submitting abstracts for this year’s SGH Annual Scientific Meeting. Senior Staff Nurse Nurshifa Shaik Hussain and Director of Nursing, Bright Vision Hospital (BVH), Salimah Mohd Ayoob tell us how their relationship evolved.
How it all started
Nurshifa: I first met Ms Salimah in Ward 46. I was a staff nurse and she was the Senior Nurse Manager. We didn’t have any conversation beyond work. We met again after I had completed my Advanced Diploma course and a posting to Ward 63. I had to leave my first QI project behind in Ward 63 and I was rather affected. By then, my interest in research had been ignited. Salimah: So I encouraged her to start one in Ward 46 and began guiding her in it. From that beginning, she has now progressed to grant-funded research work.
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She’s always been hungry for more, always asking, “What else can I do?” She is self-motivated and driven, and this has helped her to achieve what she has today.
Study buddy
Salimah: In 2010, Nurshifa started on her Master’s degree studies, paying her own way. Then I received hospital sponsorship to do the same. So we became classmates. I was very apprehensive about my studies. She, however, was very reassuring and encouraging. Nurshifa: At times I felt very driven and at other times, I felt like just giving up. But we spurred each other on. When I first started the course, I was quite intimidated as I was the youngest and most junior nurse in the class. But Ms Salimah would tell me to just do my best. Salimah: We would usually do our course work together, sometimes at our homes. Our families were very supportive. Her parents cooked for us, while my husband was the “IT support”.
Nurshifa: Ms Salimah’s guidance goes beyond work and school. She is even trying to match-make me!
Life coach
Salimah: It was Nurshifa’s idea to submit our posters to the Annual Scientific Meeting. “We’ve already done the work, why not submit it?” Nurshifa’s poster was about Registered Nurses’ Knowledge in the Administration of Biologic Drugs - An Audit Survey, while my study was on The Introduction of a Structured Orientation Programme for Registered Nurses’ in a Community Hospital in Singapore. Nurshifa: Ms Salimah wasn’t appointed my mentor, it just came about naturally. The connection was important, and I think that’s why we’re still so close now. Salimah: I’ve been with SGH 33 years now, and am thankful for the many opportunities. It is, therefore, important to me that I pay forward what I have gained. I hope to influence more of our younger nurses to do the same.
LIFE at SGH Campus | May/Jun 2013
From left: Dr Mark Cheah, Dr Tanujaa Rajasekaran and Dr Andrew Ong.
Residents pay it forward
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eer pressure takes on a positive meaning at the SingHealth Residency Internal Medicine (IM) Program. With the introduction of Cadence – a peer-teaching initiative led by IM Residents Dr Jonathan Yap and Dr Mark Cheah – in June last year, the passing rate of the MRCP PACES exams has risen significantly by more than 20% to above 80%.
preparing me for the exams has only made it natural that I should do the same for my peers.” Indeed, Cadence has helped bring the IM community together. “We feel down when our peers don’t make it through the exams, and will all help to get them through it the next time around,” said Dr Andrew Ong who has also benefitted from this initiative.
Doing what is natural for friends
Spirit of sharing rubs off
Dr Tanujaa Rajasekaran, who recently passed her exams, shared, “The fact that someone has been so dedicated in coaching me and following through,
Adapted from SingHealth Residency Medical Students Connect Issue 01.
Cadence systemises the peer teaching culture of IM, providing an avenue for those who are willing to step up. The word "cadence" means running in rhythmic steps together, and the initiative thrives on the concept of paying it forward. Residents who have just passed the MRCP exams take on the role of Resident-mentors and guide an assigned group of Residents once a week, over a three-month period.
The faculty are likewise inspired by their Residents. “I am very proud of the outstanding PACES results of our Residents. I am even more proud of the strong community spirit that exists amongst our Residents, and how much they care for their juniors. Their energy and enthusiasm in running Resident-led peer support initiatives such as Cadence (PACES support) and Reach (residents-as-teachers) inspires us to work harder to provide them with the best learning experience,” says Program Director, Dr Phua Ghee Chee.
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quality pulse
Brought to you by Service Operations, a unit of Operations and Performance Management
QI chat Ms Linda Lim Heng Moy, Manager of Admitting Services, has been with SGH for 40 years. The former nurse combines her knowledge of patients’ needs and leadership to spur her team to constantly improve processes to smoothen the way for those they serve. change?� What advice will you give to such people?
1. How has the QI culture in SGH transformed over the years?
Years ago, we even had to engage business consultants to study our processes to help us along our QI journey. Today, the QI culture has become part of us. It definitely has for me. We constantly look for ways to improve our existing process. When introducing new services, we apply quality improvement thinking during the planning and execution.
2. Which project(s) have left an impression in you?
I have been involved in many smaller, quick-hit type of projects, called Rapid Improvement Events. One stood out for me - the FailSafe project which achieved the TE-IQC Gold award. We used SMS to remind patients to claim the valuables left with us for safekeeping, before their discharge from SGH. The improvement was amazing - 600 packets of unclaimed properties in the store were reduced to 25 which could fit into a drawer!
3. “We have been doing this all along and it is working fine. Why 16
It is natural to dislike changes, but these changes are crucial to our hospital. Fundamentally we want to improve for our patients and ourselves too. It can be challenging at times to work with other units on these projects, but that is often because we bring different viewpoints. It may take a while to build rapport, but you will reap the harvest eventually. So, press on!
4. How have you applied QI in your personal life?
I do use it in my community work and personal life. The quality improvement tools can be very helpful in decision making. Take the decision tree for instance - I use it to logically consider what to invest in or if I can buy a bigger house! I think these tools can be handy for those looking for life partners as well - set your SMART target!
5. What motivates you to improve? What are you passionate about?
I believe in treating patients like my own family members, and giving them the best service we can provide. One foreign patient came to look for me when he returned to Singapore a few years later. He waited for two hours while I was in a meeting, just to say hi and thank you. This is what motivates me.
LIFE at SGH Campus | May/Jun 2013
Safe and secure charging.
The tough gets going
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What do patients really value?
Value should be seen from the patients’ perspective. Not all processes in our healthcare system add value to the patients. For patients to have the best experience, we should eliminate or minimise activities that do not add value.
t was tough keeping an eye on the Toughbooks, the laptops issued to our doctors to use as they move about seeing patients.
To recharge the batteries, doctors would use any power outlets in the wards that are convenient. Invariably, there is a risk of misplacing or losing the Toughbooks.
It is pointless to wait for registration and billing when I just want to see the doctor and get my medications.
Such incidents cause disruption to work, especially if it requires reports to the hospital and police. More importantly, they also mean a breach of confidentiality as medical records are accessible via Toughbooks.
Solutions
After first-hand encounters with the problem, Team ODIE from Ward 73 got going. They came up with lockers that double up as charging stations. Ventilation was factored into the design, as there is a risk of fire hazard posed by the battery charging.
It would be nice if registration and billing can be simplified or eliminated!
Toughbooks are now labelled to identify the users, to avoid mix-ups. Signs with security messages were also put up to remind users to exercise care.
Results
Feedback from staff was positive and getting buy-in from the doctors was a breeze. Best of all? No more misplaced or lost Toughbooks.
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spree in action an sgh moment
"Prison break" at SGH
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convict tried to escape from custody while warded in SGH but she proved no match for our eagle-eyed and alert security officers.
Security officer WPC Siti Norsimah Aziz was on duty at the lift lobby of Block 5 when she noticed a female patient leaving the visitor gantry bare-footed. Before she could approach, the patient started running.
WPC Siti Norsimah Aziz
Quick on the uptake, Officer Siti asked the staff at the registration counter to contact the security office for assistance before giving chase. Senior Security Officer Ritwan Rafil swiftly responded and joined in the pursuit. The patient boarded a taxi but Officer Siti managed to stop the vehicle while Officer Ritwan requested for the patient’s cooperation. By then, two officers from the Central Narcotics Bureau showed up. Our security officers handed the woman over to the CNB officers and helped to escort her back to the ward.
Senior Security Officer Ritwan Rafil
SGH Moments Award We are on the lookout for special meaningful acts performed by our colleagues that exemplify our SPREE qualities and SGH Core Values. These SGH Moments will be recognised with a special award to be given out every quarter. Watch this space for more!
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LIFE at SGH Campus | May/Jun 2013
Inspired by patients and caregivers We draw inspiration from patients and their families who amaze us with their strength, perseverance and indomitable spirit. This year, we honoured 43 patients and caregivers at the Singapore Health Inspirational Patient and Caregiver Awards 2013. “This award aptly raises awareness of how the best SGH patient Mdm Leong Wah Kin healthcare outcomes received the Inspirational Patient Award from SingHealth Chairman Peter Seah. can be achieved when patients, caregivers and family members work together with healthcare professionals to facilitate their healthcare journey,� wrote GCEO Prof Ivy Ng.
What it should have been We had incorrectly identified the two Best Team winners of the Singapore Health Quality Service Awards in the last issue (March/ April). They should be:
Best Team Award
Service Initiative Improvement
Safely Receive, Soundly Sleep
Best Team Award
Clinical Practice Improvement
Among the winners is 76-year-old cleaner Mdm Leong Wah Kin. Single, feisty and fiercely independent, she climbed 12 flights of stairs, three times a day for two years to recover from her stroke. Despite her own hard life, she looks out for neighbours like her who are old and single. She cooks regularly for one of them and accompanies another for medical appointments. Read their personal stories online at http://mysinghealth/ sgh/quality/servicequality/inspirational-patients-andcaregivers/inspirational-patient-and-caregiver-award-2013
NICU Team
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campus buzz
Taking no chances
Laboratory staff have to don protective gear to inspect the cargoes should there be any incident during transportation.
How does one move a laboratory that handles high risk biological agents? This is one of the many challenges we face as the clinical laboratories prepare to move into Academia, particularly those classified Bio-Safety Level 3 (BSL3), which handle high risk pathogens like the tuberculosis (TB) bacterium and the HIV virus. “Which direction is the wind coming from?” This question stumped everyone at the drill premised on the breakdown of a delivery truck, requiring the transfer of hazardous TB organisms. “You don’t want to be standing downwind if there is a spill,” pointed out Safety Network Senior Manager David Lam, a Biosafety specialist. The emergency exercise on Saturday 23 March 2013 involved staff from the Division of Ambulatory and Clinical Support Services (ACSS), the Pathology laboratories that work with high risk pathogens, Safety Network, Security as well as the crew of the specialist movers. On the same day, the laboratories also held a dry run to test and finetune the processes planned for the move. During the actual move of the laboratories, the Emergency
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Response Team will be in place to attend to any incident, including postponing the operations should the weather be adverse.
Special processes and packaging materials are used for the biohazard agents.
The BSL3 checklist The movers. These are specialist movers trained and certified to handle shipping infectious substances. Even the drivers are required to have special licences to transport hazardous materials. Packing. The specimens are triplepacked in three layers of bio-hazard bags, a requirement of international air transport authorities. The exterior of the package is decontaminated before it is passed through an air-hatch to the “clean” zone to be placed in foam boxes filled with dry ice. As many as 40 Pathology staff have been trained in this packing process.
Strong boxes. About 500 boxes will be used during the move of the Central TB Lab, for example. The cartons are subjected to about 10 tests, including drop test, water-resistance and puncture test. Extreme care is taken when moving the boxes, as any toppling is considered a spill. This means the boxes will not be stacked in the trucks enroute to the Academia. Accountability. “Lose a specimen, and it’s a police case.” Besides detailed checklists, every carton and every shipment has to be security-sealed, logged and tagged as well as accompanied at all times by a lab staff.
LIFE at SGH Campus | May/Jun 2013
Outpatient services move off-campus SGH’s new Orthopaedic Sports and Joint Centre, located at the Camden Medical Centre, started operations in end-March 2013. Comprising of clinics, physiotherapy, diagnostic radiology and pharmacy services, this one-stop centre caters to both subsidised and private patients. The Health Assessment Centre, previously located at Block 7 Level 1, has also been relocated to Camden Medical Centre since December 2012. “Due to space constraints, we are not able to locate these clinics on SGH campus at the moment. Camden Medical Centre is not too far away from SGH and easy for patients to get to. We were also able to negotiate for reasonable rents,” said James Toi, Chief Operating Officer (Ambulatory Services).
Developing our expertise More than 190 SingHealth staff have been given awards to train at renowned medical institutions, locally and overseas to further their skills and knowledge. At the awards ceremony in March, past recipients also shared their learning experiences and how they have translated their knowledge and skills to better patient care. Ms Norwati Bte Hussin, Senior Staff Nurse, NHCS, spoke about her clinical attachment at Brigham and Women’s Hospital and Massachusetts General Hospital on the Management and Operations of Short Stay Unit & Ambulatory Cardiac Services.
Dr Bok Chek Wai, SGH Consultant in Rehabilitation Medicine, talked about best practices in the management and rehabilitation of patients with brain injuries, which has since led to the implementation of an integrated referral pathway for patients admitted through neurological services. The awards from SingHealth Health Manpower Development Plan (HMDP) and Talent Development Fund are funded by the Ministry of Health and the SingHealth Foundation.
Good buying practices Your friend turns out to be also a vendor – how should you conduct yourself? At conferences, is it alright to accept dinner invitations from commercial sponsors? You like the workmanship of the hospital’s renovation contractor, but is it wise to engage him to work on your home? To raise awareness among staff of such issues and potential conflicts of interest when working with vendors, the SingHealth Group Procurement Office (GPO) has started a series of briefing sessions at various institutions. At the session, GPO staff also shared lessons learnt from lapses found by the Attorney General’s Chamber in its annual audit of public institutions. “The objective is to protect our staff, so that they do not get into situations of obligation to vendors. Through the talks, we hope to build awareness about good practices and the processes that have been put in place to help them,” said Ms Wong Lai Yin, Asst Director, Strategic Development and Operations in the GPO. “Keep to two key principles – maintain transparency and guard the integrity of the organisation and yourself,” advised Mr Mun Leng, Deputy Director, Strategic Procurement (Supplies & Services). “The GPO is also working on simplifying and synchronising some of procurement processes across the group to make the procurement process easier and more efficient.”
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time out
Don’t pass the salt!
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xcessive sodium intake is the focus of our Dieticians’ health promotion campaign this year. Learn more from their sodium wheel placed outside Kopitiam. We get most of our sodium from salt and sauces in our food. Watching what we eat will help to cut our sodium intake. Excessive sodium increases the risk of high blood pressure, a major risk factor for stroke, heart disease and kidney disease.
How much is too much?
80% of Singaporeans take way too much sodium. Here’s how much: Our daily need
Our daily limit
Our actual intake
500 mg
2000 mg
3320 mg
Facts and tips
1. Many food containing sodium do not taste salty. You can’t always judge the sodium content of food by its taste For example: mee, bread and fruit. Read food labels to find out the amount of sodium content and choose the healthier option. 2. A preference for salty foods is acquired, not inborn. Gradually lower your sodium intake and you won’t even notice the difference over time. 3. Instead of using salt and sauces to add flavour to your food, use fresh ingredients as well as herbs and spices. 4. You can cut your daily sodium intake by up to 40% simply by leaving the soup behind when eating out. Or ask for less gravy.
Down on the street
“The golden colour of the chicken wings and the trails of smoke caught my eye. I enjoy capturing such details in my photos.”
— Kelly Woh, Administrative Assistant, Nursing Administration
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Our Pick!
Kelly, please contact us to collect your $20 prize voucher.
LIFE at SGH Campus | May/Jun 2013
Cross culture Máirín is ainm dom (Maureen is ann-am dom): My name is Máirín Sláinte (slawn-teh): Good health (cheers!) Slán (slawn): Goodbye! “Here are a few English language words which have a unique meaning in Ireland.”
Sound Irish
Hailing from the Emerald Isle, Mairin Gabrielle Whelan, Occupational Therapist shares, “Something most Asians don’t realise about Ireland is that we have our own native language, Gaeilge (Irish). If you meet an Irish person, and there are a few of us around SGH, try throwing a few of these phrases into your conversation.” Dia dhuit (jee-ah gwitch): Hello!
Acting the maggot/ being a scut: being cheeky Jacks: Toilet Minerals: Soft drinks Press: cupboard Shift: kiss Yoke: something that you can’t think of the name right now
Irish loaf
One thing a lot of Irish people miss when they’re away from home is homemade soda bread. Every family will have their own recipe. Since moving to Singapore, I have
“With her glance, the girl links the two adults. The intimacy of their bond is a contrast to the rest of the crowd at Hong Lim Park. Streets scenes are my forte, capturing moments of our society. I shoot in black-and-white to give an added dimension to the photos.”
started to make my mother’s bread when I feel like a taste of home. BROWN BREAD 3 mugs white flour 1 mug wholemeal flour 1 tsp bicarbonate of soda 1/2 tsp salt 1 tsp brown sugar 250ml buttermilk 1 egg 100g butter Sunflower seeds to sprinkle on top. METHOD: 1. Sieve all the dry ingredients. 2. Rub in butter. 3. Beat egg & buttermilk and add in. 4. Put into greased loaf tin. 5. Brush top with buttermilk/egg leftover drops. 6. Sprinkle seeds on top & lightly press down with back of fork. Bake at 180 ºC for 50 minutes.
NEXT: shapes
Make us ponder, make us wonder. Submit your most interesting shot with a short explanation, and you could win a prize. Send it to mysgh@sgh.com.sg. Closing date: 31 May 2013.
— Stephen Lee, Retail Sales Assistant, Pharmacy
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st a l theage p “I’ve heard of how a sales rep would buy plastic skeletons for tough prospects. He would put a skeleton in a large envelope and attach his business card with a note saying, This is me waiting for you to call me!” — MATTHEW TAN, Respiratory Therapist
Creative ways to chill that cold call “You’ll have to summarise your objective and what’s in it for me in two minutes because I get impatient.” “When they ask to meet me, I tell them that I work shifts and that usually works!” — PEGGY CHENG, Nurse Clinician, Ward 48
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“When the callers try to sell something, offer to sell them your own product.” — SYLVIA LEOW, Management Info Analyst, Operations & Performance Management
“Maybe not the most creative, but definitely the most efficient way is to just hang up!” — LUM XIN YING, Human Resource Executive, Staffing
— ADELINE TEO, Assistant Manager, Division of Community Outreach and Philanthropy, National Cancer Centre, Singapore
“I will listen patiently to all they have to say, then offer to call them back... which I never. However, if the husband is around, I will simply pass the phone to him.” — MUMTAZ BINTE SHEIK UDUMAN, Associate Executive, Call Centre