AHA Magazine Apr-Jun 2022 by Yishun Health

aha

ISSUE 2: APR–JUN 2022

A FRAMEWORK FOR SMOOTHER CARE FLOWS

MCI (P) 047/07/2021

Yishun Health has adopted a systematic methodology that puts our patients in the centre of care

ALWAYS HERE TO HELP 14

RESTORING SMILES, ADDING QUALITY OF LIFE

WHEN THE ACID RISES

ontents

COVER STORY A Framework for Smoother Care Flows Our Unified Care Model ensures that all needs are met within each care framework, and that transitions between care frameworks are smooth and seamless

WHAT’S UP Community events, outreach efforts, and more

12 Q&A Health and wellness questions asked and answered! 14 LIVE WELL Always Here to Help Meet the KTPH team who will be the first to greet you when you visit the hospital 18 EVERYDAY HEROES Making Your Stay More Hospitable A Patient Care Officer channels personal tragedy into motivation to serve patients

20 SPOTLIGHT Restoring Smiles, Adding Quality of Life Combining artistry and clinical skill, Soo Miew Hiong creates dentures that restore more than just a smile 24 5 THINGS ABOUT… Obesity Aspects of obesity you may not be aware of 26 DAILY DOSE When the Acid Rises Learn to recognise, manage and prevent heartburn

Part 1 of 3

PUTTING PATIENTS IN THE CENTRE OF CARE

2 |

Yishun Health’s pursuit of person-centred, relationship-based and integrated care for our patients has been an ongoing journey. And the Unified Care Model is a systematic way of enabling and accelerating changes in this process. Extending the focus from medical excellence and evidence-based care, we are improving our management of episodic care with the development of a robust framework to guide our clinical teams in implementing valuebased care throughout our patients’ journey. By using a systematic methodology to improve on-the-ground enhancements and drive collaboration across the spectrum of care, the goal is to create smooth flows that achieve value and best outcomes for our patients.

PUBLISHER Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group. It comprises Admiralty Medical Centre, Khoo Teck Puat Hospital and Yishun Community Hospital. It also includes community extensions such as Wellness Kampung.

EDITORIAL TEAM Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE

28 28 MAKAN TIME Sayur Lodeh with Nasi Impit This spicy vegetable stew is always in demand at Hari Raya Puasa gatherings 30 FIT & FAB Nurturing Strength Through Body-Mind Awareness Some pilates exercises to help you develop more than just a lean physique

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction. A/Prof Tan Kok Yang Bastari Irwan Caroline Tan Fatimah Moideen Kutty Shirley Heng Teresa Foong

www.ktph.com.sg/ about-us/media/publications aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg

Maskless photos in this issue were taken before COVID-19 or with safe management measures in place

aha

ISSUE 2: APR–JUN 2022

A FRAMEWORK FOR SMOOTHER CARE FLOWS

M A N AG I N G D I R E C T O R

Christopher Tay

H E A D, E D I TO R I A L

Chua Kim Beng

Yishun Health has adopted a systematic methodology that puts our patients in the centre of care

C O N T R I B U T I N G E D I TO R

Sheralyn Tay E D I TO R

Dang Hui Ling MCI (P) 047/07/2021

H E A D, C R E AT I V E ALWAYS HERE TO HELP 14

RESTORING SMILES, ADDING QUALITY OF LIFE

WHEN THE ACID RISES

hy aha? The name aha holds much significance for us at Yishun Health. In part, it is a nod to our history; it also stands for ‘Advocates for Health in Action’. Through these pages, we hope to empower you to take charge of your own health and discover those ‘aha!’ moments that lead to a healthier, happier you.

Sean Lee

H E A D, C L I E N T R E L AT I O N S H I P

Jessie Kek

C O N T R I B U TO R S

Lee Lily Vivienne Looi

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 047/07/2021

| 3

hat’s Up

Morale-lifting Visit by Minister for Health O

Mr Ong donned protective gear for safety so that he could spend some time chatting to healthcare workers in the A&E Care Centre

n 23 February 2022, Minister for Health & Member of Parliament for Sembawang, Mr Ong Ye Kung, visited KTPH to express his appreciation of staff efforts in a time of intense healthcare demand. He took a tour of the wards and A&E Care Centre, accompanied by CEO Prof Chua Hong Choon, Chairman, Medical Board A/Prof Pek Wee Yang, and Chief Nurse Ms Shirley Heng. During his walkabout, Mr Ong took time to speak to healthcare workers on the ground to find out how they were coping. He also offered words of encouragement and thanks for their ongoing commitment to patient care.

Another Step in our Journey of Continuous Improvement I

n February 2022, KTPH became the first hospital in Singapore to undergo the MOH JCI-ESS (Ensure Safer Systems) Baseline Assessment. The MOH JCI-ESS is part of a national effort to move beyond accreditation towards building high reliability organisations with a zero-harm culture. Preparations for the assessment began in April 2020, and much effort was taken to translate and align JCI standards to existing policies. New policies, workflows and measures were also implemented. To ensure readiness, mock audits and walkabouts took place to streamline processes and identify gaps. The assessment took place from 21–25 February, and was conducted both on-site and remotely. During the assessment, the surveyors shared a wealth of positive feedback on KTPH’s safety culture, reliability and collaboration. Out of the thousands of elements identified under JCI standards, only 19 areas were flagged for improvement. In response, workgroups have been assigned to address each area. The positive nods from the surveyors were no mean feat, given that all this was conducted against a hectic 4 |

backdrop where KTPH, along with other healthcare institutions, saw a surge of Omicron cases, high bed occupancy, and manpower challenges. CMB A/Prof Pek Wee Yang commended staff for the success. “We need to maintain our culture of safety and remain a learning organisation, continuing to co-design care with patients and their families, and collaborating with partners in and out of healthcare. This will allow us to remain adaptable to the psychology of change and move forward with continuous improvements for our patients.”

Thank You, Teachers! Y

ishun Health’s Education Development Office (EDO) held a virtual Teachers’ Appreciation Day on 1 March 2022 to thank the many teachers who contribute to the growth and development of

future healthcare professionals and leaders. The annual event — which celebrates teachers, trainers and preceptors across the medical, allied health and nursing settings

— recognised 41 winners who have nurtured students to reach their potential and learn the ethos of what it means to be a medical professional. The awards handed out included: • Teaching Excellence Award (Undergraduates) • Teaching Excellence Award (Postgraduate) • Most Committed Teacher • Best Teacher • Top Clinical Training Team • Top Clinical Instructor Award As part of the event, students showcased pre-recorded musical performances as a way to thank their teachers for their guidance and support. Congratulations to all our award winners!

Kidney Health for All T

o mark World Kidney Day 2022, the Renal Medicine department, in collaboration with Nutrition & Dietetics, held an online panel discussion for the public. This was in line with the theme, ‘Kidney Health for All’. The lunchtime session, streamed over Facebook Live, aimed to educate participants on lifestyle strategies and dietary habits to maintain good kidney health. Dr Lim Eng Kuang, Senior Consultant, Renal Medicine, shared about common kidney diseases and their causes, as well as prevention strategies; while Chong Sin Tzun, Dietitian, highlighted the impact of excessive sodium and sugar consumption on kidney health, and the importance of adequate fluid intake. There was also a cooking demonstration to prepare healthy basil chicken. In addition, the panel used the occasion to launch Yes to Health, a new series on the KTPH Facebook Page that sees health experts answering questions from the public. Check out our FB page — simply scan this QR code:

| 5

Cover Story

A FRAMEWORK FOR

SMOOTHER CARE FLOWS

For some years now, Yishun Health has moved towards achieving its mission of integrated care using a Unified Care Model. The goal is to ensure that care needs are met, and that the experience of care ‘flows’ smoothly across different provider sites, institutions and partners, including at home and in the community. This story, introducing our systematic methodology, is the first in our new three-part series that puts patients in the centre of care — so as to achieve better patient outcomes and experience, and a more sustainable health system.

hen Mr Lee, 64, walked himself into the Acute & Emergency Department (A&E) with a sore arm, he only had one concern on his mind: whether the injury would affect his weekly tennis sessions. Diagnosed with a fracture from when he fell in the bathroom at home, doctors decided he needed to be warded for some tests. While the active retiree was in relative good health, the care team wanted to understand whether it was his high blood pressure or

conditions, but found out that he had early-stage cataracts. They then initiated some early rehabilitation to improve his recovery, set up follow-up appointments with an orthopaedic specialist, and activated the Population Health & Community Transformation team to do a fall-risk assessment of his bathroom and home. In about six weeks, Mr Lee recovered from his injury, and was pleased to resume his tennis matches. Cases such as this underscore the way hospitals are evolving. Even as healthcare institutions

remain. These include delivering acute care, where the focus is on treating and stabilising those who become severely unwell due to a medical emergency, such as a fall, traffic accident, acute illness, or complications from chronic diseases. “This type of episodic care — usually seen at the A&E — typically has a foreseeable endpoint,” explains A/Prof Ng Yeuk Fan, Director, Corporate Development, at Yishun Health. “Every patient requiring inpatient crisis and/or complex care will benefit from

other undiagnosed conditions that led to his fall. After a two-day stay, the care

such as Yishun Health are shifting the paradigm away from hospitals being centres for specialist disease-

having an effective transfer into our hospital setting, from receiving quality care for that crisis period,

team cleared him of more serious

centred care, traditional functions

and from being transferred back

6 |

PUTTING PATIENTS IN THE CENTRE OF CARE PART 1 OF 3

Some of the key members supporting Yishun Health’s multidisciplinary teams in improving care flows include (from left) A/Prof Phoa Lee Lan, Deputy Chairman, Medical Board (Care Integration & Clinical Standards); Thomas Seetoh, Manager, CIFO; A/Prof Ng Yeuk Fan, Director, Corporate Development; Lai Weivien, Manager, CIFO; and Kueh Sin Yee, Assistant Director, CIFO. Absent from picture: Roger Leong, Chief Financial Officer, Finance; Fatimah Moideen Kutty, Asst Chief Operating Officer; and teams from Regional Health Office and Yishun Community Hospital

home and into the community with appropriate support,” says A/Prof Ng, who adds that any Episodic Care management plan must also be aligned with the needs of the person’s Lifelong Care plan. Episodic care represents the outof-the-ordinary health needs arising from crisis and complex events that occur sporadically throughout the person’s life, and how these needs are met. Examples include the healing of a broken bone, recovery from a

“Episodic care represents the out-ofthe-ordinary health needs arising from crisis and complex events that occur sporadically throughout the person’s life, and how these needs are met.” a/prof Ng Yeuk Fan Director, Corporate Development Yishun Health

| 7

Cover Story

The multidisciplinary Total Knee Replacement team is one of the service lines that CIFO is supporting

heart attack, or the surgical removal of an inflamed appendix. Care for this type of ailment has, in the past, been rather fragmented, with teams and plans changing as a patient moves through the healthcare system — Yishun Health is seeking to better integrate the care throughout their journey of recovery. A/Prof Phoa Lee Lan, Deputy Chairman, Medical Board (Care Integration & Clinical Standards), emphasises that this integrated way of looking at care falls under the overarching mission of Yishun Health’s

and to prioritise and streamline interventions and strategies.” But how can care teams ensure that patients receive the same standard of quality, person-centred care that Yishun Health takes pride in? More importantly, how can this care be seamless for the patients, regardless of where they are — be it at the A&E, ward, rehabilitation setting, or home?

A CENTRAL RESOURCE TO SUPPORT CARE INTEGRATION

Value at Yishun Health, explains A/Prof Ng, is about delivering the best possible outcomes — including clinical, functional and experience outcomes — for patients at the most affordable cost. A deeper appreciation of function and wellbeing includes physical, mental, cognitive and social functions. According to Kueh Sin Yee, Assistant Director, CIFO, work began in August 2020 to support 10 service line teams. “CIFO supports these teams in the implementation of value-based care across three

Unified Care Model (UCM). “The UCM represents a comprehensive strategy for care teams to identify

To this end, Yishun Health started the Care Integration & Flow Office (CIFO) to facilitate the improvement

Episodic Care segments: acute medical flow, acute surgery flow, and elective flow,” explains Sin

common care goals for patients,

of value for residents and patients.

Yee. “Our role is to translate the

8 |

PUTTING PATIENTS IN THE CENTRE OF CARE PART 1 OF 3

UCM’s performance framework and implement the patient value compass by breaking down things into actionable steps.” In short, CIFO works with clinical teams to ensure that their patients receive valuedriven care at all stages. To do this,

It starts with the formation of a multidisciplinary team, developing a logic model, and then mapping the patient journey end-to-end. From here, the team identifies areas for improvement and alignment, and moves on to develop solutions that

CIFO has developed a standardised and structured approach to improve patient care and implement patient value outcomes.

can achieve an envisioned future or optimal state. The work processes are then implemented, sustained and scaled.

ACUTE MEDICAL FLOW

Chronic Obstructive Pulmonary Disease (COPD)

Heart Failure

Diabetes

TEAM FORMATION LOGIC MODEL DEVELOPMENT MAPPING THE CURRENT STATE MAPPING THE FUTURE STATE IMPLEMENTATION

Emergencies, Acute Medical Conditions

SUSTAINING AND SCALING

ACUTE SURGICAL FLOW

Stroke

Pneumonia

Cholangitis

Emergency Laparotomy (ELAP)

Renal

Hip Fracture

Emergency Surgery & Trauma

ELECTIVE FLOW

Total Knee Replacement

This move aligns with MOH’s direction on a national level, where indicators are tracked for specific surgical and medical conditions with standardised quality indicators.

CIFO comes in to facilitate and guide the team through this structured process. “To achieve care standardisation and continuous improvement with the service line, it requires a vast amount of preparatory work. This includes literature reviews, engaging with ground staff to understand workflows, process mapping, data collection and analysis, and then facilitating team meetings and helping teams manage the roll-out of interventions and measuring outcomes,” Sin Yee points out. Because many of these teams have their core day-to-day work to focus on, CIFO’s support has become critical in helping them with the more manual and data-driven work processes. “We journey with the team through a structured approach to improve patient care and defining outcome indicators. By doing so, team members are able to see the

| 9

Cover Story

link between their actions and the value generated, and this motivates the team to take ownership and accountability for the improvement of patient value,” she elaborates. One way that CIFO has made an impact is to help the teams collect patient self-reported experiences and outcomes more efficiently. Because these are usually written forms, collecting this data is laborious and time-consuming. “We worked with them to determine what was needed, and implemented a feedback channel to create digital forms using FormSG,” Sin Yee says. This made things much more convenient for patients, and automated the data collection and analysis processes. From low-hanging fruits, such as digital patient forms, the teams can go on to pursue more in-depth and wideranging improvements. Importantly, CIFO’s work in engaging all the various service lines puts them in a position to gain a unique macro-perspective. A/Prof Phoa highlights that CIFO’s work has enabled them to identify common challenges on the ground, and see how improvements can be made at the systems level — whether to improve coordination across the spectrum of care or to review organisational processes. For example, this may mean streamlining referral processes so that patients can transition sooner from an acute ward to a community hospital; or it may entail linking patients sooner to allied healthcare support to enable early discharge. “Apart from helping each service

“The UCM represents a comprehensive strategy for care teams to identify common care goals for patients and to prioritise and streamline interventions and strategies.”

and complex care team uses a standardised methodology across the organisation. When everyone speaks the same language and uses the same tools, it will be a “force multiplier”, he quips. He likens it to the walled-garden ecosystem of Apple, where product-wide integration makes for better user

CIFO’s work will play a big role in

experience and greater value creation. This is where each product works well on its own, but even better when they can be experienced together as a whole. This seamless interaction takes the user experience and outcomes to another level. CIFO is thus the hub that engages and facilitates all these interactions. Furthermore, even as each service line team learns and adjusts its strategies along its journey of improvement, CIFO is doing the same. “CIFO is also continuously learning as they work with our doctors, nurses, allied health colleagues, and primary care partners to determine what the best care strategies are, and what areas of the care process we can standardise,” shares A/Prof Ng. This is why the engagement with the service lines and other partners is so important. The strength of the ecosystem depends not just on individual service lines, but on the strong collaboration between partners. This integrated system of care will not just be about smoothening processes, insists A/Prof Phoa. The framework is simply laying the foundations for a new culture of care. “Care integration under our UCM is about

line individually in their specific area of care, we also see how they can seamlessly help patients transit to

attaining Yishun Health’s UCM, says A/Prof Ng. The end goal is to create a cohesive Episodic Care

driving safe, reliable, value-based quality care through ideals of empathy, person-centredness, and

appropriate services as needed.”

ecosystem, where every crisis

physician-ownership.”

10 |

A/PROF Phoa Lee Lan Deputy Chairman, Medical Board (Care Integration & Clinical Standards) Yishun Health This, emphasises Sin Yee, is how CIFO helps their service lines bridge the gap between the Episodic and Lifelong Care segments. “We want to also look at how patients transit out into the community after discharge, and how we can ensure that there is care continuity beyond the physical campus, until the end of the patients’ episodic care.” This is where CIFO works in strong collaboration with the Regional Health Office (RHO) to develop a care coordination mechanism that will serve patients before, during and after episodes requiring crisis and complex care.

GREATER THAN THE SUM OF OUR PARTS

PUTTING PATIENTS IN THE CENTRE OF CARE PART 1 OF 3

ENSURING CARE FLOWS IN EVERY HEALTH EPISODE MEDICAL CRISIS Mr Lee, 64, fractures his arm in a fall, and seeks care at the A&E. He is an active retiree and relatively healthy, although he has high blood pressure that is well managed and controlled with medication.

TRANSITION INTO EPISODIC CARE Efficient and safe transfer into Episodic Care, including attaining sufficient understanding of the patient’s Lifelong Care goals. Formulate Episodic Care Plan

Execute Episodic Care Plan

Transition to Lifelong Care

• •

Rolling out appropriate treatment, comprising • Anticipatory care • Planning for escalation and crisis care • Collaborative care

Efficient planning and transfer back to lifelong care

• •

Targeted needs assessment Effective and efficient diagnosis Person-centred goal setting Early transition planning

Engaging patient and family members in the care-andrecovery process

What examples of care will he receive? Doctors determine the type of fracture and put Mr Lee in a cast. He is also warded for two days for some follow-up tests to check whether his pre-existing conditions or medications contributed to his fall. The team also conducts a fall-risk assessment. Mr Lee is concerned that his injury will prevent him from playing tennis again, so the team begins early rehabilitation to improve his recovery.

After he is discharged from hospital, Mr Lee has follow-up appointments to see an orthopaedic specialist to monitor his healing. He also sees a physiotherapist and occupational therapist for early rehabilitation. The Population Health & Community Transformation team is activated to conduct a home fall-risk assessment, and help improve the fall safety of his bathroom, where the fall occurred. His family is also taught how to support him as he recovers.

After six weeks of treatment followed by six weeks of rehabilitation, Mr Lee recovers from his injury and resumes playing tennis. He continues to see his GP and cardiologist to manage his high blood pressure. He is also given additional followup appointments to consult an ophthalmologist as he has developed early-stage cataracts.

| 11

Questions with

bite

Yishun Health experts answer your frequently asked questions about health, well-being and medical conditions. In consultation with Dr Sophia Yee, Registrar, Dental Surgery, KTPH

I have some missing teeth. The gaps are not very visible, so I’m wondering whether I should get dentures or leave the gaps alone? While the gaps may not be very obvious, there

either side of the gap may shift over time and become crooked; this makes them harder to brush and floss. If you have lost a number of teeth, your face and jaw will also lose some support, which could cause muscles in the face to sag.

are more reasons to replacing a tooth than just outward appearances. Multiple missing teeth make it harder to eat certain

Dentures are just one of the options to address your missing teeth — alternatives include a dental bridge or dental implant. You can discuss all these

foods; it may also affect speech. Healthy teeth on

options with your dentist.

12 |

How long does it take to get a set of dentures made? Every set of dentures is custom-made to ensure an optimal fit for each person. This means the process of making a set of dentures varies, depending on the complexity of the case. The first step is to thoroughly assess the mouth, gums, remaining teeth, and even the jawbone. This

The flask is placed in boiling water to melt away the wax, which is then replaced with acrylic (plastic base of the dentures). The flask and its contents are cured under heat and pressure until the preformed acrylic resin is completely cured.

may involve an examination and X-rays to make sure there are no underlying issues that may cause future complications. To ensure your mouth is in the best health to support dentures that replace missing teeth, you will also need to complete any cleaning, filling or other dental work beforehand.

To begin fabrication of the dentures, your dentist will take an impression of your mouth in order to make stone models.

The plaster is then removed (a process called deflasking) to retrieve the fabricated set of dentures, which will be trimmed and polished for a fitting. During the appointment for the fitting of your set of dentures, adjustments will be made to achieve the best fit possible so that it feels natural and comfortable in the mouth. You may need follow-up visits to fine-tune the fit of the dentures due to changes in the shape of your gums with time.

The stone models register the patient’s jaw relationship (the way the jaw, teeth and bite meet). They are mounted on an articulator (artificial jaw) to mimic the way the dentures will move in the mouth.

3 4

Teeth are then affixed onto the stone models with wax.

The stone model and teeth are ‘invested’ into a holding device, called a flask, and filled with plaster to secure them in place.

| 13

ive Well

ALWAYS HERE

to Help From the moment you enter the Khoo Teck Puat Hospital lobby, our Patient Greeters are the first friendly interaction you receive. Whether it is to help with a wheelchair or offer directions, they add a special human touch to every time you visit the hospital.

ince its inception, Yishun Health has prioritised person-centred care, and this fundamental value has been instilled at every level, even going beyond the hospital and into the community. This mindset is behind the Patient Greeter programme, which has been running since the hospital’s early days when

14 |

it was at Alexandra. “It is all about helping people,

the job satisfying because “helping people is my passion”.

K Tirunakkarasu, a former hotel concierge and affectionately known

making sure they are well taken care of,” assures Leo Nathan, 76, who is among one of 10 Patient Greeters on

This sentiment is echoed by his teammates, many of whom took up the position as a second or post-

as Uncle John. “Last time, I helped tourists; now I help patients,” he states heartily. “Whatever it is, my

the team. The Yishun resident finds

retirement career. Take 68-year-old

service comes from the heart!”

| 15

ive Well

“If you act young, you feel young. When we work, we keep active and learn new things.” Leo Nathan Patient Greeter

This aspect of the job is, according to Erik Goh, 65, one of the reasons he thinks the work feels special, and why it is more than a job. “There are many kinds of work in the world, but in general, there are those that earn money and those that earn virtue,” he says, paraphrasing a Chinese proverb. He hopes that, when he lends a supporting hand to people, they in turn will do the same for others when they get better. The idea that she would be in a line of work where she can help others and bring joy into their lives is also what spurred 66-year-old Woonnathan Thavamoney, or Rani, to become a Patient Greeter as well. She was previously a telephone operator, and was discouraged

“It feels good to be doing this job because we can touch the lives of others.” Woonnathan Thavamoney Patient Greeter 16 |

to switch jobs by her then-boss because it was in a hospital. But the idea of being useful to others in their time of need appealed to her. “My mother loved helping people — my sisters and I all inherited this trait,” she shares. “It feels good to be doing this job because we can touch the lives of others.” Having worked as a Patient Greeter for 12 years, she is a familiar face to many who visit the

hospital. In fact, she is sometimes recognised in the community! “People come up to me in the market to say ‘hello’ and thank me again,” she says with a laugh. “Maybe we’ve done something that they remember, but it’s just all in a day’s work.” Yishun Health’s Patient Greeters do not just man the lobby area and help patients out of vehicles; they also assist them into wheelchairs and push them to their destinations. Others, like Peter Leong, 59, assist at the A&E, where he guides patients and caregivers through the registration process and aids the Patient Service Associates when they are busy. Ultimately, the team feels that their role is to add

“It’s all about adding a friendly face, a human touch, and a sense of compassion.” Peter Leong Patient Greeter because of glaucoma, is grateful

a friendly face, a human touch, and a sense of compassion to all those who visit the hospital. And the work also benefits them, as it is how they remain active in mind and body. Not only does the

work literally keep them on their toes, they also get to enjoy the lush environment and encounters with people from all walks of life each day. Loke Swee Leong, 71, a former taxi driver who had to switch careers

for the work where he can continue to earn a living. Despite his various medical conditions, he keeps going, encouraged by his friends to keep a positive mindset. As Leo — the most senior in the group — puts it, “If you act young, you feel young. When we work, we keep active and learn new things.” He reflects that the work gives them a better appreciation of their own abilities, and that — regardless of age or ailments — they can focus on what they can still do, and still contribute.

PATIENT GREETERS: A CONTINUING LEGACY OF HOSPITALITY The Patient Greeter programme is a continuing legacy from Yishun Health’s early beginnings at Alexandra Hospital. It was part of the effort to integrate best practices from a range of industries, including the hospitality sector. In fact, the organisation drew strong inspiration from leading hotels such as Raffles Hotel and the Ritz-Carlton, and aspired to be a ‘six-star’ hospital. This led to the creation of the Patient Greeter role. Staff were trained in customer service, and have since become walking and talking symbols of the hospital’s commitment to person-centred care. Their

friendliness and warm smiles offer a sense of welcome to patients and visitors, and reinforce the

Yishun Health philosophy of providing care that is good enough for our own loved ones.

| 17

veryday Heroes

making your stay more hospitable For many years, Mark Anthonisz worked in the hospitality industry. These days, as a Patient Care Officer (PCO) at KTPH, he extends his training and innate congeniality towards making his patients’ days a little better. 18 |

ou could say Mark has always been in the ‘people’ business. For 16 years, he worked in the hospitality sector, taking on many roles, from front-of-house to housekeeping. For the majority of his career, he worked in the Food & Beverage sector, dealing with

getting older and, as much as I love the work, the options are more limited with age,” he explains. “I wanted work that would have more ‘longevity’ for me, and healthcare seemed like the place to be.” In fact, he had always had an interest in nursing, but could neither afford the time nor money to pursue

everything associated with the art of dining, from wines to wait staff. But in 2015, he began exploring

formal education in the area. With this in mind, he went on sabbatical to take up a four-month

options for a second career. “I was

course to be a healthcare assistant

for operating theatres, after which he enrolled in a five-week stint at Tan Tock Seng Hospital. He also tried other jobs, such as a Service Hall Officer for Mandai Crematorium on a one-year contract. In all these interactions, he found himself drawn to teamwork and people. In 2017, tragedy struck: his fiancée was diagnosed with Stage 4 lung cancer despite not being a smoker. “I had no sense of time; the world just stopped,” Mark recalls. He became her full-time caregiver in 2018, when her condition became terminal and no more active treatment could be done. He accompanied his fiancée back to the Philippines so that she could spend her last days with her family. “I was very privileged to take care of her,” he says. This experience reinforced his desire to join the healthcare sector. “I wanted to shift the grief into something that makes others feel cared for,” he shares. In May 2021, he joined KTPH as a PCO. In this role, he works in KTPH’s inpatient wards alongside nurses to provide care, performing duties such as serving meals, helping with basic hygiene and toileting, as well as checking blood glucose and other health stats. “Basically, we look out for patients and their needs,” explains Mark. Regina Yeoh, Senior Patient Care Executive, who is one of Mark’s reporting officers, notes that he brings more than an extra set of helping hands to the team. She observes that he is helpful, humble and hardworking, and thus wellliked by one and all. “There have been occasions when patients requested specifically for Mark to assist them with showering because he is patient and able to connect with them,” she adds.

“I feel like I can be a bridge for them, to communicate and assure that their loved one is being taken care of.”

to provide extra care. When he gets a break between his daily tasks, he spends time talking to patients so as to get to know them better. He can

like I can be a bridge for them, to communicate and assure that their loved one is being taken care of.”

sometimes be found giving patients a haircut or shave, or getting them an extra hot drink. “Whatever makes them feel good, feel like a person and not just a patient, I will do it if I can,” he assures. Drawing from his personal experience with illness and grief, Mark is quick to empathise with patients and their families. With the current constraints on hospital visits, he understands why families get frustrated when they are unable to visit their loved ones for as long or as often as they would like to. “I feel

Mark feels a sense of value in providing this comfort, and also in knowing that he is supporting the smooth running of the inpatient ward. Significantly, PCOs such as Mark are alleviating some of the caregiving duties and service management that would otherwise fall on the nurses. “Our nurses are genuinely busy, so we try to fill the gaps when we can,” Mark shares. “As PCOs, we take pride in anticipating the needs of patients, so we can proactively help them even before they press the call bell,” he adds with a smile.

BE A PATIENT CARE OFFICER Love looking out for people and playing a part in their hospital care and recovery? Become one of our Patient Care Officers (PCO)! As a service professional, you will work closely with our doctors, nurses and allied health staff to provide quality care service and endto-end care coordination for our patients in a ward setting. The role of a Patient Care Officer consists of three broad areas: • Caregiving duties to support patients, in collaboration with other healthcare professionals • Engaging patients and family members/visitors to understand patient needs and manage expectations in the area of service delivery • Providing operations/administrative/clerical support in the wards, and ensuring facilities (medical, non-medical and IT equipment) are safe and functional Anyone with a Diploma in any discipline, with or without working experience, can apply. Most importantly, you should have a heart for service and care, good learning attitude, and the ability to work in a dynamic and challenging environment. Please send queries to pco@ktph.com.sg with the subject header, ‘Patient Care Officer’.

Mark often goes out of his way

| 19

potlight

RESTORING SMILES, ADDING QUALITY OF LIFE Dentistry is as much about artistry as it is about clinical skill — this is especially the case with prosthodontics, the specialty of restoring and replacing missing or damaged teeth. Dental laboratory technicians such as Senior Dental Technician Soo Miew Hiong support this craft with skilled experience, passion and a focus on patients.

20 |

“Dental technicians like Miew Hiong provide vital support every step of the way. Our collaboration as a team ensures that we are able to achieve effective patient management with the best treatment outcomes.” DR LOW HUEY MOON SENIOR CONSULTANT, DENTAL SURGERY, KTPH

here is nothing quite so satisfying as bringing a smile to patients — and for the prosthodontics team at KTPH’s Department of Dental Surgery, they quite literally do just that. The team specialises in restoring smiles through the fabrication of dentures, crowns, bridges and implants. This work is an example of multidisciplinary teamwork and collaboration, from the clinician to the technician level. Besides replacing missing teeth with dentures, the team also fabricates

A MATTER OF CRAFT AND PRECISION

maxillofacial prostheses to restore missing parts, such as for the palate, lower jaw, nose, ear, eye

in fabricating dentures and maxillofacial prostheses. Miew Hiong shares that it was

socket and more.

a love for working with her hands

While prosthodontists play a role in treatment planning and providing clinical interventions, a lot of the technical procedures go on behind the scenes, carried out by dental technicians like Miew Hiong. Miew Hiong, who has 46 years of experience to her name, plays a significant role in crafting the prostheses that patients end up using. Initially trained to provide technical support for braces, crowns and bridges, she has, over the years, honed her skills

| 21

potlight

stone model replica of the patient’s mouth and teeth to positioning the denture teeth one by one, Miew Hiong adds her own artistry to the process (read about the steps for denture-making on page 13).

MORE THAN REPLACING TEETH

The team also fabricates maxillofacial prostheses to restore missing parts, such as for the palate, lower jaw, nose, ear, eye socket and more

that first drew her to take up the craft. “I like repairing things that are broken,” she says, adding that it seemed natural for her to go into an area of work where she could ‘fix’ smiles.

22 |

Her job making dentures involves a lot of practical skill, as well as creativity and an eye for detail. Every patient’s mouth is unique, so every denture is individually crafted to be one of a kind. From creating a

According to prosthodontist Dr Low Huey Moon, Senior Consultant, Dental Surgery, KTPH, the skills and experience of Dental Technicians are invaluable, as they work alongside clinicians to achieve more than just a smile. Dr Low notes, “Dental technicians like Miew Hiong provide vital support every step of the way. Our collaboration as a team ensures that we are able to achieve effective patient management with the best treatment outcomes.” A maxillofacial prosthesis, such as an artificial eye or a well-made set of dentures, goes a long way in ensuring not just a good cosmetic outcome, but overall self-esteem, which contributes to quality of life. Dentures do not only improve self-confidence, but are vital to a person’s overall good health and wellness. Dentures enable a person to eat well and get sufficient nutrition, and play an important role in interpersonal communication. It takes a challenging combination of precision, clinical skill and technical craft to make each set of dentures; this is why the process generally takes several stages and appointments. Each set of dentures take an average of eight hours to make, Miew Hiong explains, and every step requires a lot of attention to detail. This makes the work quite

“I love seeing the results of the work. I am motivated to do my best each day when I see our patients happy and satisfied.” SOO MIEW HIONG SENIOR DENTAL TECHNICIAN, DENTAL SURGERY, KTPH

demanding — not just in terms of the time it takes to create a set, but because the volume of cases is high as well. On top of her regular workload, there are also times when Miew Hiong puts in additional hours for emergencies, such as when a denture breaks or a new set is needed urgently. Miew Hiong takes all these challenges in her stride, and chooses to celebrate each new smile. In fact, she has no plans to slow down. “I’m never bored. Every day is interesting because every patient is unique,” she shares. It brings her joy to apply her long-honed skills and knowledge alongside a team of prosthodontists to restore smiles. She also feels utmost satisfaction to see how her work positively impacts patients’ lives. “I love seeing the results of the work. I am motivated to do my best each day when I see our patients happy and satisfied.”

| 23

Things About...

Obesity

Obesity is a leading risk factor for a host of chronic diseases, but there is more to it than just excess fat in the body. Dr Benjamin Lam, Senior Consultant, Family & Community Medicine, KTPH, and Clinical Director, Integrated Care for Obesity & Diabetes, KTPH, highlights five points about obesity that you may not be aware of.

OBESITY IS A CHRONIC DISEASE

Weight (fat stores) is regulated in the body. Obesity results from an abnormal weight regulation such that a higher weight is maintained, leading to negative health consequences. How obesity develops is complex. In general, it is due to an increasingly obesogenic (obesity-causing) environment involving factors such as processed foods and sugar, lack of physical activity, poor or inadequate sleep, stress and distress, and medications, against a background of genetic susceptibility. This means that some people are more inclined than others towards obesity when exposed to this environment.

24 |

when they are not. Furthermore, BMI does not indicate the distribution of adiposity (excess fat). Abdominal obesity, on the other hand, is more targeted and measured by waist circumference. Together with BMI, it refines an individual’s risk profile for metabolic and cardiovascular diseases.

body), while males tend to accumulate more abdominal fat (the classic ‘apple’-shaped body). This difference between males and females exists until menopause, after which males and females experience similar fat distribution. • Age: With age, there is a higher tendency to gain more abdominal or visceral fat.

THERE IS A DISTINCTION BETWEEN GENERAL OBESITY AND ABDOMINAL OBESITY

Obesity is defined as having excess fat. This is determined by the Body Mass Index (BMI), which is a calculation of a person’s weight in proportion to their height. However, while BMI gives a good overall indicator of whether one is heavier than ideal for one’s height, it does not differentiate between muscle weight and fat weight. This means that, at an individual level, it may wrongly classify some people — bodybuilders, athletes with high muscle mass, pregnant ladies — as obese

THREE MAIN FACTORS AFFECT WHERE FAT IS STORED

Three main factors can increase abdominal fat accumulation compared to normal subcutaneous fat. • Ethnicity and genetics: For a given BMI, Asians tend to have higher abdominal fat than Caucasians. • Sex: Females tend to accumulate more subcutaneous fat (the classic ‘pear’-shaped

WHERE YOUR FAT IS DISTRIBUTED AND STORED AFFECTS YOUR HEALTH RISKS

Fat can be stored under the skin in the subcutaneous adipose tissues (subcutaneous fat) as well as in the abdomen, in the visceral adipose tissues (abdominal or visceral fat). In general, subcutaneous fat does not cause negative effects. Conversely, abdominal fat is located inside the abdominal cavity, packed between organs such as the stomach, liver, intestines and kidneys. This is linked to inadequate blood supply and inflammation that can lead to metabolic complications and cardiovascular diseases. Excess abdominal fat is associated with an increased risk of: • Insulin resistance • Impaired glucose tolerance • Cancer • Cardiovascular diseases: hypertension, heart failure, coronary heart disease and heart attacks, heart valve conditions, irregular heartbeat • Respiratory diseases: sleep apnoea, chronic obstructive pulmonary disease • Impaired brain health and risk of brain diseases: stroke, reduced brain size, grey matter and cognitive function, dementia

TO REDUCE ABDOMINAL FAT, YOU HAVE TO ADDRESS OBESITY

There is no treatment that targets abdominal fat specifically. Body-contouring procedures such as cryolipolysis, high-frequency ultrasound or liposuction only target subcutaneous fat. However, if the underlying issues driving excess fat storage are not addressed, the fat accumulation will just recur. The simple message is that, to lose abdominal fat, obesity must be addressed in a holistic manner; various factors — diet, physical activity, sleep, mental-health wellness, medical conditions — need to be addressed as a whole. For this, you may wish to seek help from a healthcare professional trained in obesity management.

| 25

aily Dose

WHEN the acid rises

Heartburn — often described as a burning sensation in the chest — can happen occasionally after meals, especially when one has overindulged. Learn how to spot and manage the symptoms, as well as ways to prevent this. In consultation with Dr Ho Gim Hin, Consultant, Gastroenterology, General Medicine, KTPH

eartburn, a common symptom of reflux disease, can happen when acidic stomach contents flow backwards after a meal, from the stomach to the oesophagus (food pipe). This irritates the oesophagus, resulting in a burning sensation in the chest or at the back of the throat.

Acidic contents from the stomach can then ‘leak’ up the oesophagus, causing a burning sensation. Another cause for heartburn is the presence of a hiatal hernia, which occurs when the upper part of the stomach bulges through the diaphragm in the chest into the chest cavity.

WHAT CAUSES HEARTBURN?

HOW IS HEARTBURN DIAGNOSED?

In most cases, the cause of heartburn is usually acid reflux. This happens when the muscle or valve that separates the stomach and oesophagus — called the lower oesophageal sphincter — does not close properly.

Heartburn can be diagnosed from a combination of symptoms, a gastroscope procedure, and 24-hour pH or reflux testing.

26 |

HOW IS HEARTBURN TREATED? Heartburn can be treated either by lifestyle modification, medication or surgery. You may also opt for over-the-counter treatments that neutralise your stomach acid (antacids) or form a barrier to protect the gut from gastric acid (alginates). These usually contain aluminium hydroxide, magnesium hydroxide, calcium carbonate, and sodium bicarbonate in various combinations. Do limit the intake of over-the-counter treatments to no more than four times a day. You may also get a pharmacist’s advice or a doctor’s prescription for drugs such as a histamine blocker or proton pump inhibitor, both of which reduce gastric acid production. For cases in which hiatal hernia is present, a surgical procedure, known as fundoplication, may be required. Part of the stomach will be attached to the lower oesophageal sphincter, which helps reduce acid reflux.

WHAT FOODS OR DRINKS SHOULD I AVOID? You should abstain from certain foods that could trigger the lower oesophageal sphincter to relax or increase the acidity of the stomach, such as: • Acidic foods, such as tomatoes, vinegar and citrus fruits • Oily or fatty foods • Spicy foods • Peppermint • Alcohol • Carbonated drinks • Caffeinated foods and drinks, such as coffee, tea and chocolate

HOW DO I MANAGE HEARTBURN WITHOUT MEDICATION? eartburn can be managed with lifestyle H modification. Simple steps include: • Eat smaller, more frequent meals instead of fewer large meals • Chew your food thoroughly • Wear clothing that does not constrict your abdomen • Lose excess weight, as obesity is a risk factor for heartburn • Avoid lying down for at least one hour after a meal • Quit smoking, as nicotine relaxes the muscle that separates the stomach and oesophagus • Prop your head up when sleeping so that your head and chest are higher than your waist

WHEN IS HEARTBURN SERIOUS? Having the occasional sensation of heartburn is normal. However, if symptoms persist, seek advice from a doctor. They will conduct further evaluations to exclude other conditions that can mimic heartburn symptoms, such as heart diseases and asthma, and look at other complications of heartburn. These include: • oesophagitis (inflammation of the food pipe) • sinusitis (inflammation of the sinuses) • dental or enamel decay • strictures (narrowing in the food pipe) • Barrett’s oesophagus (change in the cells lining the food pipe, which can lead to early cancer) • oesophageal cancer

• Manage your stress levels

| 27

akan Time

28 |

cut & keep

SAYUR LODEH WITH NASI IMPIT Sayur lodeh is a welcome dish to the family table, especially during the season of Hari Raya. Here, we’ve made this hearty vegetable stew healthier with the use of low-fat milk and rempah that can easily be prepared at home. Recipe provided by Sous Chef Muazzin Shah Bin Mohd Shah, Food Services, KTPH, in consultation with Nutrition & Dietetics, KTPH

INGREDIENTS Serves 4 585g rempah 50g lemongrass 800ml low-fat milk 120g long bean, cut into batons 120g carrot, cut into batons 220g sweet turnip, cut into batons 450g firm tofu, sliced into 1-inch pieces • 260g nasi impit, steamed and sliced • • • • • • •

METHOD: 1. To make the rempah , blend all the aromatics, spices and salt to form a paste 2. In a medium pot, saute the rempah and lemongrass till fragrant 3. Add the low-fat milk and bring the mixture to a boil 4. Add the vegetables — carrot, long bean, sweet turnip and tofu — and cook for about 10 minutes till the vegetables are tender 5. Serve hot with steamed

nasi impit

Rempah • 200g onion • 50g garlic • 50g ginger • 30g turmeric • 100g chilli paste • 5g lower-in-sodium salt

NUTRITIONAL INFORMATION (PER SERVING) Energy

575kcal

Carbohydrates

79g

Protein

30g

Fat

11.9g

• Saturated

>3.1g

• Polyunsaturated

>4.8g

• Monounsaturated

>2.4g

Cholesterol

>10mg

Dietary Fibre

19.6g

Sodium

491mg

Potassium

>1,315mg

Phosphate

>504mg

| 29

it & Fab

Nurturing strength

through body-mind awareness Pilates was first developed as a method for rehabilitation in the 1920s. Today, it is recognised as a way to strengthen the body, promote flexibility, and nurture the body-mind connection. In consultation with Bernice Lim, Physiotherapist, Rehabilitation Services

hile Pilates has been around for some time, it was only in the early 2000s that it took the spotlight as the exercise of choice for Hollywood stars and famous singers. Devotees lauded the system for its ability to confer strength, tone muscles, and develop a lean physique. It was created by Joseph Pilates for rehabilitation purposes. Born in Germany, he developed a series of exercises — initially called Contrology — as a form of mental as well as physical conditioning. Today, the workout retains its popularity, especially as a way to improve flexibility, strength and body awareness. This is achieved through controlled movements that condition the muscles. Pilates involves a series of lowimpact exercises that are done with control and awareness. The exercises are suitable for people of all ages, and can also be modified to suit the various needs and physical fitness of each individual. While some Pilates exercises need the use of a reformer (a special type of equipment), a large number of moves do not require any equipment — all you need is a mat. Try the following simple but powerful exercises for strengthening your core. Your core is important for stabilisation and prevention of injury. It comprises the muscles in the abdomen, back and pelvis — essentially the torso — all of which support the way you move.

30 |

1&2 PELVIC CLOCK Having core strength and mobility helps in functional health, which is the ability to move and do everyday tasks with ease. A strong and stable core is also important in preventing and improving the body’s ability to recover from injury.

Benefits: mobilises the lower back, strengthens the abdominal muscles, improves awareness of hip and lumbar movements

1. Lie down with both knees bent, feet hip-width apart; imagine that there is a clock on your pelvis 2. As you inhale, tilt your pelvis towards the 6 o’clock position as your lower back lifts off away from the mat 3. As you exhale, tilt the pelvis towards 12 o’clock position and feel your lower back touching the mat 4. Gently rock back and forth * Challenge yourself: move additionally towards the 3 o’clock and 9 o’clock positions, coupled with circular motions

SWAN

1&4

Benefits: engages the core, improves muscle endurance

1. Lie down with arms reaching overhead and legs straightened 2. As you exhale, roll up one vertebra at a time 3. Continue rolling up until your arms are parallel to the ground; round your back and gaze at your navel 4. As you inhale, stack the spine back up until you are sitting tall

1. Lie face down, hands by the side of your chest, and elbows close to the body 2. As you exhale, roll an imaginary marble on the tip of your nose forward as your push away from the ground, peeling the front of the body from the mat, keeping your abdominals engaged 3. At the top, feel a stretch across the collar bones while ensuring your shoulders are pushing downwards and not up by your ears 4. As you exhale, return to the starting position, letting the thighs, hip, abdomen and,

Challenge yourself: interlace your hands and place them

lastly, chest, touch the mat As you do these movements, keep reaching the navel into the spine so that

Challenge yourself: lift your hands

behind your head

the lower back is not hyperextended.

and legs off the ground.

ROLL UP Benefits: improves body awareness and control, mobilises the segments of the spine

2&3

| 31

Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the North. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting. Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)*

115 Chong Pang

260 Nee Soon East

765 Nee Soon Central

Blk 115 Yishun Ring Road #01-495, Singapore 760115

Blk 260 Yishun Street 22 #01-87, Singapore 760260

Blk 765 Yishun Street 72 #01-366, Singapore 760765

6257 4702

6257 4802

6257 4842

*In light of COVID-19 safe management measures, please check the KTPH website for the centre schedule and call in advance to see if there are vacancies for group activities.

Admiralty Medical Centre (AdMC) AdMC is a one-stop medical centre for specialist outpatient consultation, day surgery, rehabilitation and diagnostic services, as well as community health outreach activities.

Khoo Teck Puat Hospital (KTPH)

KTPH is a 795-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore. It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

YCH provides intermediate care for recuperating patients who do not require the intensive services of an acute care hospital. Situated beside KTPH, the two hospitals provide an integrated care experience for patients.

676 Woodlands Drive 71, #03-01 Kampung Admiralty, Singapore 730676

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800