THE FIVE PILLARS OF HEALTH Healthy living is all about making better decisions. KTPH provides the right environment to make these choices easier for patients, the community and staff to achieve the Five Pillars of Health.
The Five Pillars of Health
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CONTENTS
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Foreword
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Khoo Teck Puat Hospital Vision, Mission and Philosophy of Care
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A Healthropolis for the North
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The Five Pillars of Health
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Guiding Principles
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Purpose and Structure of the Manual
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Chapter 1: Eat Wisely
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Chapter 2: Exercise Regularly
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Chapter 3: Be Happy
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Chapter 4: Stop Smoking
85
Chapter 5: Practise Personal Hygiene
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In Closing
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References
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In Appreciation
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Acknowledgements
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FOREWORD Hospitals have traditionally focused on illness care. Some 50 years after independence, Singapore’s healthcare system, built on the philosophy of providing affordable healthcare for all, has grown in strength and depth, catering to the growing needs of an increasingly sophisticated population. Even as advances in medical knowledge, drugs and technology have enabled people to live longer, they have also added significantly to the cost of medical care. Public healthcare has had to grapple with the twin issues of a rapidly ageing population and growing demand. A paradigm shift in mindset is needed. By promoting proactive individual responsibility for wellbeing, and synergizing that with the excellent healthcare provided in our institutions, we can ameliorate many of the pitfalls of ever escalating costs and a growing disease burden. Khoo Teck Puat Hospital was designed as a haven for healing with lush greenery and open spaces, a legacy of the vision of my predecessor Mr. Liak Teng Lit. It has been in the vanguard of health promoting initiatives ever since. Our philosophy of engaging the community we serve in exercise and wellness activities goes beyond care and cure. Educational and exercise programs are as much a part of our daily routines as is value-driven patient care. A vital factor in our continuing endeavor is our people. KTPH staff embrace our values and mission with belief and passion. Their collective energy and daily effort, whether on the frontline or in the backroom, translate our ideals into reality. This book encapsulates KTPH’s vision to promote healing and health. We share our philosophy and a “how to” guide with organizations interested in this journey to promote health. Mrs Chew Kwee Tiang Chief Executive Officer Khoo Teck Puat Hospital August 2017 The Five Pillars of Health
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KTPH VISION, MISSION AND PHILOSOPHY OF CARE KTPH Vision Help our people live a long, healthy life and support them with thoughtful, dignified care to the end
KTPH Mission Provide good quality, affordable and hassle-free healthcare with science, love and wisdom
KTPH Philosophy of Care Care that is good enough for our own mothers without making special arrangements
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A HEALTHROPOLIS FOR THE NORTH Khoo Teck Puat Hospital (KTPH) opened in 2010 as a Health Promoting Hospital guided by the Five Pillars of Health - Eat Wisely, Exercise Regularly, Be Happy, Stop Smoking and Practise Personal Hygiene. With 659 beds, KTPH is an acute care hospital employing 4,300 staff and serves over 700,000 Singaporean residents in the north of Singapore. KTPH’s setting within the Yishun community is unique. It was designed as an eco-friendly hospital, embracing the best features of its natural surroundings into its lush green landscaping. A key feature is the incorporation of Yishun Pond, a familiar community space for leisure and exercise. The continuous flow of the hospital’s grounds and open spaces into the pond area enriches the neighbourhood by retaining familiar community elements while creating a welcoming health-promoting space for residents. The harmonious biodiversity creates a unique environment for healing, exercise and leisure. KTPH is both “a hospital in a garden” and “a garden in a hospital”. Over the years, the hospital has met its intended purpose of engaging the four senses of sight, hearing, scent and touch as these play a crucial role in healing and recovery. Birdsong and the hum of insects amidst the soothing greenery helps alleviate stress for patients, their families and visitors alike, providing many conducive spaces for conversations during visiting hours. Healthy residents in the community use the open spaces for exercise and recreation. By integrating a patient-centric healthcare facility with a wholesome, sustainable environment, KTPH has established itself as a Healthropolis serving the northern heartland of Singapore. The hospital has not stopped there. It has taken on the challenge of promoting health by leading by example. The core of its health philosophy, the Five Pillars of Health, is incorporated into the design and operations of its facilities and services.
The Five Pillars of Health
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THE FIVE PILLARS OF HEALTH While “curative” medicine is delivered to symptomatic patients who seek healthcare, health promotion and preventive intervention aim to modify the livestyles of individuals. KTPH believes in the philosophy of “a sound mind in a sound body”, thus its work-life initiatives and activities are embodied and aligned in a set of values called the Five Pillars of Health.
The Five Pillars guide the creation of an environment that supports the health of its staff and the community it serves and is incorporated into all aspects of hospital planning and facilities. The KTPH Five Pillars of Health are: • Eat Wisely • Exercise Regularly • Be Happy • Stop Smoking • Practise Personal Hygiene
HEALTHROPOLIS CONCEPT CARE LEARN
WORK
EAT & DRINK
PLAY
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LIVE
HEALTHROPOLIS
SHOP
GUIDING PRINCIPLES Beyond treating patients, hospitals are also places where meals and snacks are served daily to patients, and staff and visitors patronize the food outlets. The hospital is thus ideally placed to offer health and nutrition education and promote healthy eating habits by example – by making KTPH a “living laboratory” by constantly exploring new ways to effect positive changes in the public’s health behavior.
The aim is to influence lifestyle choices towards healthier ones by creating a culture of health in the hospital. These efforts in health promotion have been well received and a measure of its success are the awards KTPH has received. In addition to the Five Pillars of Health, KTPH has drawn inspiration from authoritative studies and thought leaders and adapted their core concepts to suit its needs. Some of these publications are shown here.
References for overall guiding principles at KTPH
• Eat real food (not processed foods) • Not too much • Mostly plants
• Change through motivation • Knowing why we do what we do
• Change through nudging • Influencing automatic decision making
• Relate • Repeat • Reframe
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PURPOSE AND STRUCTURE OF THE MANUAL This manual aims to explain the philosophy behind health promoting concepts and lay a systematic framework for the design and implementation of facilities and services for staff and the public. It serves as a guide in policy development, implementation, monitoring, evaluation and research. It seeks to provide practical tips and suggestions, and shows, through tried and tested examples implemented in KTPH, how public institutions and organizations interested in setting up health promoting public facilities can do so.
Structure of this manual
Target audience
In these chapters, we seek to identify the core concepts and measures established at KTPH through the use of specific strategies. These include the guiding principles and framework; and operational tools where applicable.
The audiences for this document include:
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• Hospital administrators • Healthcare facilities managers • Workplace managers • Food and beverage vendors • Educators • Other interested partner organizations
CHAPTER 1: EAT WISELY
INTRODUCTION Singapore’s rapid socioeconomic transformation, a result of urbanization, economic development and market globalization, have brought changes in diets and lifestyles that have had significant impact on the health and nutritional status of the population. Although the standard of living and access to services have improved dramatically since independence in 1965, these have gone hand in hand with inappropriate dietary patterns, decline in nutrition and decreased physical activity, in turn leading to a corresponding increase in diet-related chronic diseases. These problems are not unique to Singapore. Increased consumption of an energy-dense diet high in fat, particularly saturated fat, and low in complex carbohydrates, is a global trend. This, combined with a decline in energy expenditure – resulting from sedentary lifestyles, motorized transport and labour-saving devices at home and at work – has resulted in a significant surge of chronic non-communicable diseases (NCD) such as obesity, diabetes, cardiovascular disease, hypertension, stroke and various forms of cancer.
Increasingly, these diseases are significant causes of disability and premature death, placing additional burden on an already overtaxed health system. Finding solutions becomes a matter of great national urgency. A 2015 report by the International Diabetes Federation (IDF) ranks Singapore (for people aged between 20-79 years) as having the second highest proportion of diabetics among developed nations (10.53%), just slightly behind the United States (10.75%). Updated evidence-based data from successful programs and policy recommendations are urgently needed in developing effective national prevention and management strategies to address the increased public health challenges. This chapter helps to identify and tackle the day-to-day challenges that Singaporeans face in their daily life in terms of diet and nutrition. These recommendations can be easily adopted by healthcare and workplace facilities, including schools and educational institutions, and provide models for regional and geographically diverse counterparts across the world.
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EATING WISELY AT KTPH Hospitals have great untapped potential as role models for influencing what people eat. Health professionals understand the connection between healthy eating and good health; given that credibility, they can play an influential role in educating and influencing healthy dietary choices in the community they serve. The quality of the “food environment” has direct links to the health conditions of communities. By extension, positive, strategic marketing practices such as food placement, pricing and signage, can influence the way hospital staff and visitors eat. Food provides energy and nutrients that we need in order to be healthy. These include carbohydrates, proteins, fats, vitamins, minerals, and water. Healthy eating is not hard. The hospital positions the key to healthy eating in four easy mnemonics:
All food and beverage choices matter in the course of the lifespan of an individual. An established, long-term, healthy eating pattern is one of the keys to enable individuals to achieve and maintain a healthy body weight, support nutrient adequacy and reduce the risk of chronic diseases. Choosing a variety of nutrient-dense foods, mostly plantbased, will help keep nutrient needs within calorie limits. A shift to choosing healthier food and beverages with no added sugar, or less sugar and salt is key to healthier eating patterns. To craft its healthy eating strategies, the hospital draws from a wide spectrum of authoritative sources, including its own in-house medical and nutritional expertise and established studies.
KEY ELEMENTS OF EATING WISELY AT KTPH The goal of the hospital is aligned with wider national strategies for healthy living, active lifestyles and active ageing among the general population. The aim is to empower the public to stay healthy, avoid being sick or need the hospital. Good nutrition is an integral component of the Healthropolis concept. The nutritional standards and policies at KTPH are based on two simple principles – promote the sale of healthy food and the consumption of healthy food.
How it is done Based on the philosophy that prevention is better than cure, it is important to influence choice through built-in educational messages that shape knowledge, perceptions and attitudes.
Why it is important Healthy eating is crucial in managing and preventing obesity, and to improve productivity in the workplace. It helps decrease the disease burden, especially diabetes and coronary heart diseases and helps the community stay healthy and productive.
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THE HEALTHROPOLIS FRAMEWORK KTPH has established a successful framework to encourage healthier eating. This chapter outlines the strategies employed to achieve this goal in three sections: • Planning, layout and policy • Strategy • Operations Each section is accompanied by pictorial examples to show precisely how each concept is implemented in practice. The descriptions and pictures serve as guides to model the KTPH experience.
Planning, layout and policy Tender specifications set the expectations and standards for all tenants. Implementation is facilitated by reconfiguring or redesigning the food court and other food and beverage (F&B) outlets when necessary. A well-formulated set of specifications is essential. These specifications: • Help define requirements clearly and accurately • Guide tenants in meeting the specified requirements correctly • Form the basis of the contract with the tenant
The KTPH Experience • KTPH has a set of specifications that a tenant must agree to for the privilege of establishing a business partnership • These specifications are aligned with KTPH’s Healthropolis concept which guides the standards set for day-to-day operations • The agreement allows for inputs from stakeholders and eventual buy-in from F&B tenants, their staff and vendors. It ensures all stakeholders understand preferences and pre-empts potential barriers to implementation • Giving stakeholders ownership encourages compliance in implementation: o The scope of the contract is to offer food and beverages to patients, visitors, community members and KTPH staff in the premises o The aim is to provide healthy, balanced and nutritious foods to all o Stakeholders are encouraged to provide a conducive atmosphere for consumption of nutritious food by presenting them attractively o The tenant is required to provide nutritional information about the menu items and conform to the nutritional requirements set by KTPH
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A TEMPLATE FOR TENDER SPECIFICATIONS Promoting health through increasing awareness 1. Public Health Corner The Tenant shall include a Public Health Corner (with minimally a BMI machine and blood pressure station) as part of their concept layout plan. The Tenant shall be responsible for the maintenance, cleanliness and proper use of the health corner. Health-related information shall be displayed in the corner. The hospital will collaborate with the Tenant through its Operations Department to promote “Eat Wisely� or related health initiatives through education or events on a regular basis. 2. Price differentiation between healthier and less healthy food/drinks There shall be a price difference between the healthier food and drink items and the less healthy ones. The less healthy food and drinks shall be priced higher. More incentives shall be in place to encourage patrons to buy healthier food and drinks (eg: buy two fruits at a cheaper price or pay a smaller amount for the second fruit). 3. Display of food dishes Healthier dishes shall be displayed more prominently in the front, while less healthy dishes shall be placed towards the back of the display. E.g.
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4. Menu display board The menu shall include the caloric information for each dish. 5. Nutritional and ingredient analysis of new food items The tenant shall submit the nutrition analysis and ingredient list of the new food items to be evaluated by the Landlord’s Nutrition & Dietetics Department. Only upon approval will the Tenant be allowed to sell the new food item. 6. Display of drinks Drinks with less or no sugar added shall be displayed more prominently at eye level (easy to see and reach), while less healthy drinks shall be displayed at the bottom (out of sight or hard to reach). 7. Healthy salad bar A buffet style salad bar is strongly encouraged. 8. To serve brown rice, wholegrain noodles and wholemeal bread by default Brown rice, wholegrain noodles and wholemeal bread to be served as default. White rice or normal noodles shall be available only upon request with an extra charge. 9. “No added sugar” options The food and drinks served in this food court shall comprise no added sugar options. 10. “Less salt”, “less fat” and “less oil”. Food or drinks served shall comprise less salt, less fat and less oil. Only healthier oil (Healthier Choice Symbol certified) shall be used. 11. 80:20 rule for the entire food court 80% of the food items and drinks served shall be of the healthier variety; 20% may be of the less healthy selections. Most of the food items should be under 500 calories per serving.
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Public health corner at the food court and the convenience store Traditionally, health screening for blood pressure (BP) and body mass index (BMI) are done during appointments with healthcare professionals. With new technology and availability of easy-to-use equipment, these can now be used by anyone, anywhere. KTPH’s public health corners provide the means to get a free, quick and easy check in a few minutes. • The BP self-screening station allows patrons to check their BP, helping to create awareness and prompt more people with high blood pressure to seek the care they need • BMI is a measure of body fat based on height and weight and is a screening mechanism for potential weight and health-related issues like diabetes and cardiovascular disease arising from obesity
Advantages of self-screening stations: • They are free and easily accessible • They help in early detection and the readings act as reminders to adopt healthy eating and lifestyle choices • They help individuals to track their results over time • Food court and convenience store placements are ideal as they provide a daily visual reminder of the benefits of healthier choices
The KTPH Experience The tenant occupying the food court and the convenience store shall designate an area as a Public Health Corner (with minimally BMI and BP stations as part of their concept layout plan)
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Health corner with BP and BMI selfmonitoring stations at the food court
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Health corner with BMI self-monitoring station at the convenience store
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Healthy messaging visuals upon entering the food court Healthy messaging is one of the key strategies to encourage sensible healthy eating. Posters, display boards and pictures of healthy foods within the food court must convey the healthy eating message and should be visually appealing.
Successful promotions inside the food court can generate excitement and interest in healthier food and is an effective way to spread awareness and help customers make healthier choices.
This helps to enhance the dining experience. Other aspects of a pleasant dining experience may include the food court décor and ambience, the serving system layout, packaging and the grooming and appearance of staff.
The stairway in the food court makes an unusual and stunning “message board” visible to patrons who walk around it or climb it to the mezzanine floor. Encouraging messages show the benefits of taking the stairs.
The screen shows a continuous loop of health tips for food court patrons
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80:20 rule for all F&B stalls Nutritional habits have a great impact on the overall health and well-being of a person. The 80:20 rule helps patrons to follow healthy eating habits when the majority of choices, about 80%, are healthier. The rationale for the 80:20 rule is: • It is about choices and moderation • It is not about depriving one of choices • 80% of items in each food and drinks stall are to be healthier choices and only 20% are less healthy options • All less healthy food choices will cost more than healthier ones
A healthy lifestyle is achieved by the sum total of all food choices and is a result of good daily decisions. The intent is not to deprive customers but to give them abundant healthier choices and nudge them towards healthier and more nutritious choices using differential pricing and strategic placement. To influence choice in favor of healthier foods, 80% of food items are healthier and predominantly non-processed foods. This still allows for 20% of less healthy food items for those who want to indulge in them.
Nutrition analysis and ingredient list for each food item • Every tenant is required to submit the nutrition analysis and ingredient list for all food items • The ingredient list and nutrition analysis provided by the tenant will be reviewed by the Nutrition and Dietetics Department of KTPH. The tenant can sell the item only after approval is received
Less salt, less fat, less oil • All foods and drinks served in the food court must have less salt, fat and oil • Only healthier cooking oil must be used in food preparation
The KTPH Experience • Strategically increasing the choice of healthier items e.g. healthier meals, snacks, fruits and vegetables, and access to them, may make it easier for individuals to make the better dietary choices, even if it is at a subliminal or subconscious level. The requirements are: o Make the healthier options as prominent and accessible as possible o Make these choices visually appealing o With abundant options, there is no sense of being deprived • 80% of food items and drinks available for purchase fall into the healthier category • The price of less healthy choices is higher than healthier ones. This price difference is intended to nudge customers towards healthier choices
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The menus in the food court follow the 80:20 rule in the positioning of healthier and less healthy options.
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Encouraging health messages on the staircase inside the food court
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Patrons in the food court cannot miss these four health messages, prominently displayed on the mezzanine floor. Together, they form the core of the healthy eating ethos of KTPH.
The display of health messages in other high traffic locations such as the car park gantry, which is a daily entry point for hundreds of staff and visitors, serves as an excellent avenue for reminding people to adopt healthy dietary habits. Every driver cannot help but notice the healthy eating message on the boom. The Five Pillars of Health
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STRATEGY Price differentiation and pricing strategy Pricing less healthy food and beverage items at a premium over healthier picks can be an effective incentive to nudge customers towards healthier eating.
Healthy bee hoon with vegetables at only $1.50.
Healthy breakfasts at affordable prices
The Healthropolis framework influences customer choice through the following rationale: • Use economic price points to encourage healthy eating • Customers who choose the healthier options will also enjoy the long term economic benefits
The KTPH Experience • Healthier food is served at affordable prices • Brown rice is served by default
Healthy breakfast choices e.g. bee hoon with vegetables are not only priced more reasonably than less healthy variants but are cooked with more vegetables for a more satisfying, wholesome meal.
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• Customers have to ask for white rice and pay more • More vegetables in food servings
Remove or reduce added sugar beverages Sweetened and carbonated beverages are among the biggest sources of calories in the diet. Consumption of these beverages can lead to weight gain, obesity and diabetes. KTPH has made a conscious effort to remove or reduce the supply of these beverages within its premises or place them out of the immediate reach of consumers.
No sugar drinks e.g. Milo Kosong costs less. The display also allows easy comparisons of calories among the many choices.
The KTPH Experience Some of the strategies adopted at KTPH aimed at discouraging the consumption of sugary drinks are: • Pricing of beverages o Making sweet beverages cost more than healthier low sugar options. Customers feeling the price pinch are nudged towards a healthier choice
• Placement of beverages o Healthier drinks are placed prominently at eye level on the display shelves to promote visibility and accessibility o Added sugar drinks are still available but are placed on the bottom shelves or at the back of the row and are harder to reach
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Prominent messaging
Healthier choices placed at eye level and are easy to reach
Less healthy choices placed at the bottom are out of immediate reach
Healthier choices are placed at eye level and within easy reach of customers.
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In addition to pricing and placement, other strategies are used in various locations:
Strategy for the food court • Coffee and tea are sold by their local names which denote less or no sugar. The amount of sugar is shown for added visual impact (see key below) • Increase the availability of healthy beverages like water and no sugar-added drinks • Educational posters, displays and information on the benefits of various health promoting initiatives • A TV near the interior staircase playing health videos
Kopi O / Teh O ‘Kosong’
0% sugar $0.70
Kopi O / Teh O ‘Siew Dai’ Kopi C / Teh C ‘Siew Dai’ Kopi / Teh ‘Siew Dai’
25% sugar $0.80
Kopi O / Teh O Kopi C / Teh C Kopi / Teh
75% sugar $1.00
Visuals showing amount of sugar present in various drink options. Key:
Kopi = Coffee Teh = Tea O = Without milk
Siew Dai = Less sugar C = Evaporated milk Kosong = No sugar The Five Pillars of Health
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Strategy for convenience store The convenience store layout is carefully designed to influence healthier choices and even impulse buying. Fruits are located prominently near the entrance and the cashier’s counter. • Healthier food and drinks are positioned in prominent and high traffic flow locations • A prominent Healthier Pick sign directs customers to the healthier choices Less healthy choices are located towards the rear of the store.
Fruits are located prominently near the main entrance and cashier counter to catch the eye of customers and influence their buying decision.
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Healthier items are strategically displayed at the front of the store with prominent healthier pick signs to direct and encourage customers to make more sensible choices.
Healthier items such as multi-grain chips are placed prominently at eye level
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Strategy for vending machines • Only water and unsweetened drinks are sold in vending machines to make healthier drinks an easier choice for patients and visitors • Replacing vending machines with water fountains throughout the hospital
Only water and no sugar drinks are sold in vending machines.
The vending machine is replaced by a water fountain at the visitors’ lounge outside a ward.
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Strategy to encourage healthy eating during festive seasons It is natural for people to throw caution to the wind and indulge themselves during holidays and festivities. Such indulgence during major festivals like Hari Raya Aidilfitri, Deepavali, Christmas, the calendar New Year and the Lunar New Year, celebrated with equal glee by
the multiracial Singapore population, can lead to weight gain when paired with a sedentary lifestyle. Holiday festivities can derail healthy lifestyle practices and make them difficult to return to after the holidays. Creating awareness to pre-empt overindulgence can help keep individuals on track towards their health goals.
A poster (below) and a sticker (right) showing caloric values for popular Christmas and Lunar New Year goodies and the amount of exercise needed to burn off the calories.
Alexandra Health
Wishing You a Happy & Healthy Christmas Wine 2841
6
Candy Cane Ca Can
150 ml / 125 kcal
2 sticks / 100 kcal
2273
BUS STOPS
Fruit Cakek 11
BUS STOPS
Deli Ham
1 slice / 239 kcal
5432
4
The KTPH Experience
2 slices / 60 kcal
BUS STOPS
1363
3
Cheerful and unusual holiday greetings with health messages to remind people to balance indulgent eating with exercise to burn off the excess calories.
BUS STOPS
Fruit Punch 225 2 ml / 108 kcal
2454
5
BUS STOPS
Cookies
3 pieces / 180 kcal
4091
Logg Cake
1 slice / 387 kcal
9795
18
BUS STOPS
Chocolate
2 pieces / 44 kcal
BUS STOPS
1000
1000
8
2* "/ ,# 01"-0 +""!"! 1, 2/+ ,Ć› ),/&"0
2
BUS STOPS
.2&3 )"+1 4 )(&+$ !&01 + " &+ 20 01,-0
BUS STOPS
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OPERATIONS The principles of the Healthropolis framework are made tangible through the physical layout and displays in the food court and other eating or food retail areas. The food court provides a clean, airy cheerful environment for meals and tête–à–tête. The conducive ambience is enhanced by floor to ceiling glass walls providing views of the surrounding gardens and Yishun Pond, mood lighting and contemporary seating arrangements.
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Requirements for food court stall set-up and layout Choosing healthier food is made easy for the customer in the food court. Signs are both visual and informative as counting calories is often a difficult exercise even for the initiated. The caloric count for each menu item is clearly displayed, allowing consumers to have better control of their intake in accordance to their fitness goals.
The KTPH Experience • Placement strategy
• Menu display
o Most people have a budget in mind when they are queuing at a stall
o The menu includes caloric values for each dish to help customers make an informed choice
o The manner in which healthier choices are promoted and placed plays an important role in the purchase decision
o Providing calorie labelling on all F&B items where they can be easily seen and understood at the point of purchase is important
o People usually tend to pick food items nearer to them and stop when their budget is reached or exhausted o To influence choice, healthier items are placed at the beginning of the line and made to look attractive as well o Less healthy items are placed at the end of the line or further from reach, decreasing the propensity to choose them o Healthy foods like fruits are placed at high traffic locations to attract customer attention
Strategic layout of dishes at stalls encourage healthier choices.
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Healthier food is prominently displayed at the start of the queue.
Steamed chicken is prominently displayed in the front of the stall and the less healthy roasted chicken is displayed further from sight at the back. 32
The fruits counter, selling whole and cut fruits, smoothies and juices, is prominently located near the entrance, a high traffic flow location to catch the eye of incoming customers.
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Serving healthier food by default • Brown rice, wholegrain noodles and wholemeal bread, all healthier choices, are served by default • Less healthy choices such as white rice, regular flour or rice noodles are served on request and cost more
The higher price of plain rice or noodles is clearly shown on the menu board.
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Promoting awareness of healthy eating habits KTPH’s responsibility to inform and educate the community about healthier eating extends to road shows and public forums actively organized by the Nutrition & Dietetics Department. Nutrition messages are consistently geared towards promoting health and preventing obesity, cardiovascular diseases and certain cancers. These events, in collaboration with other clinical departments, are guided by a philosophy of holistic care, combining clinical treatment with mindful dietary habits. They are held in the hospital premises or at external venues such as community centres.
One day a week, cut out meat D o you k now what you eat c an impac t on your envir onment ?
C ome lear n mor e about sust ainable eat ing !
To encourage healthier cooking at home, the dietitians also work closely with the Food Services Department to conduct regular CookSmart cooking demonstrations using healthier ingredients and food preparation methods for hospital staff to attend free-of-charge.
Above: A poster encouraging people to go meatless once a week. Left: A KTPH dietitian advising a member of the public on healthy sugar intake. Below: CookSmart cooking demonstrations are popular among KTPH staff and are usually fully subscribed.
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The KTPH Experience An in-house food appreciation team meets regularly to randomly taste and assess food from various stalls. This assessment is discussed with the individual stall tenants to seek mutual agreement on the necessary improvements.
An array of dishes laid out for a food appreciation session at the KTPH food court.
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Food appreciation • Food appreciation sessions offer taste testing of a variety of snacks, beverages or meal options that meet health promoting and nutrition standards • Stakeholders in the hospital, namely the hospital administrators representing various departments and food court tenants, help to provide feedback on menu items and suggestions for improvement • These sessions can be held informally. Survey cards or questionnaires are used and the feedback is shared with tenants
Food Appreciation Checklist Name: _______________________ Date : _______________________
D egree of ranking 1 --------------- 5 Lowest
Highest
1. Taste a) Bland / Salty – rating _____ Remarks: ______________________________________
2. Texture a) Not Oily / Oily – rating _____ Remarks: ______________________________________ b) Crunchy / Soggy – rating _____ Remarks: ______________________________________ c) Fresh / Stale – rating _____ Remarks: ______________________________________ d) Well-cooked / Overcooked – rating _____ Remarks: ______________________________________
3. Presentation a) Attractive / Colorless – rating _____ Remarks: ______________________________________ b) Not Oily / Oily – rating _____ Remarks: ______________________________________
A template checklist to record observations during a food appreciation session.
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Availability of home-grown produce Benefits of gardens in the hospital grounds KTPH is unique in having lush vegetable and herb gardens on the grounds. These provide much needed thriving green spaces in the concrete built environment, with the bonus of a regular supply of organically grown produce. Hospital gardens can help foster a sense of community and offer a place of respite for staff, patients and visitors alike. They also create opportunities for members of the community – seniors, students, gardening enthusiasts – to indulge in a hobby, enjoy the outdoors and be involved in the hospital’s community outreach programs. The hospital gardens also serve as demonstration gardens where members of the community can learn and practice organic growing methods, integrated pest management and discover the incredible variety of foods that can be cultivated in a small urban space. The health care industry is beginning to recognize that healthy food is defined not only by nutritional quality but also by how and where it is raised, grown, processed and distributed. KTPH has integrated the natural environment into its design and used the green philosophy to model good nutrition. By demonstrating how abundant fresh nutritious food can be grown in an urban roof top garden and engaging volunteers from the community to tend to it, the hospital is promoting these health concepts to the community. This is enhanced through word-of-mouth recommendations among the enthusiastic volunteers and staff; and nearby residents who eagerly await the thrice-weekly sales of freshly picked fruits, vegetables and potted plants. The varieties of produce are sold in bundles priced from $2.00, a steal when compared to organic produce sold in supermarkets or specialty grocers. It literally means that healthy eating is brought home to the dining tables of residents in the community. Patient menus are developed using the home-grown greens. Such fresh produce helps build appreciation of healthy foods consistent with the promotion of healthy dietary food choices.
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Volunteers selling the organic greens harvested from the rooftop gardens and potted edible plants on the KTPH link bridge. They are a hit with nearby residents and staff alike and are usually sold out within 30 minutes of opening.
The KTPH Experience Weekly market: Every Monday, Wednesday and Friday, freshly picked produce and edible potted plants from the rooftop gardens are sold on the public walkway between Towers B and C of the hospital. They are a hit with staff and nearby residents alike.
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CONCLUSION KTPH has an excellent track record of initiating and maintaining successful health promoting practices with innovative programs, starting with Eat Wisely for a healthy lifestyle. These strategies at KTPH are unique in the sense that they are culturally and geographically aligned with the food habits of Singapore and the wider region beyond. These tried and true initiatives have now become part of the healthy hospital culture at KTPH and can be modelled in other organizations.
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CHAPTER 2: EXERCISE REGULARLY
INTRODUCTION About 65% of Singaporeans over 15 years of age are in the workforce, thereby making the workplace a key setting for promoting the health of adults. Organizations can have a positive influence on the health of their staff by creating conducive and healthy environments and providing health promoting programs and services at work. According to a report in The New Paper in June 2016, a multinational study in 2016 found that the average age of Singaporeans with heart failure is 61, which is about 10 years younger than Westerners. The reasons for this are affluence, stress, dietary habits and a sedentary lifestyle. These factors lead to coronary artery disease, hypertension and diabetes – the three most common diseases linked to heart failure. These findings from the ASIAN-HF (heart failure) study were presented by Associate Professor Carolyn Lam, the principal investigator of the study, at the European Society of Cardiology Heart Failure Congress in Italy in May 2016.
The study found that: • 62 per cent of Singaporeans have coronary artery disease • 70 per cent suffer from high blood pressure • 58 per cent have diabetes These rates are higher than in other parts of Asia, the US and Europe. It also showed that 40 per cent of patients from Asia and the US, and 33 per cent in Europe, had diabetes. The report quoted Prof Lam thus: “The silver lining is that most cardiovascular risk factors are modifiable. In other words, there is a lot we can do to reduce or prevent the risk of hypertension, diabetes and coronary heart disease. The simple acts of walking more, taking the stairs and eating wisely can significantly cut the risk of getting these diseases.” Figures from Singapore’s Health Promotion Board in 2011 showed that 39 per cent of Singapore residents are not active at recommended levels. The top three reasons are: • No time due to work and family commitments • Too tired • Too lazy In addition, increased use of electronic gadgets in recent years has also contributed to this problem.
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BENEFITS OF EXERCISE Research points to the benefits of physical activity in reducing the risk of chronic health conditions. Engaging in regular physical activity can reduce medication dependence, help maintain functional independence and improve the quality of life for older adults. According to the Health Promotion Board (HPB), small daily activities may be useful to counter the smalll energy imbalance responsible for obesity in most adults. It recommends measures such as taking the stairs regularly, walking to run errands instead of driving, alighting one or
of moderate-intensity aerobic activity at least five days per week for a total of 150 minutes; or
more MRT or bus stops earlier to walk to your destination, or breaking up sedentary periods longer than 90 minutes with five to 10 minutes of standing or moving around. Regardless of age, it is important to keep oneself healthy and active. The HPB also recommends moderate to vigorous exercise for adults to acquire substantial health benefits. Such exercises cause a noticeable increase in breathing and heart rate. Similarly, the American Heart Association provides simple guidelines for overall cardiovascular health. They are:
of vigorous aerobic activity at least three days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity; and
Moderate to high-intensity muscle-strengthening activity at least two days per week for additional health benefits
For lowering blood pressure and cholesterol: An average 40 minutes of moderate to vigorous-intensity aerobic activity three or four times per week
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Physical fitness should include a combination of strength, balance and flexibility exercises. Such exercises offer these important health benefits: • Help maintain and control weight • Keep bones, muscles and joints strong to improve balance, coordination and mobility • Reduce the risk of high blood pressure, heart disease, diabetes, stroke and certain cancers • Reduce stress and anxiety, thus improving one’s mood, overall well-being and quality of life In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a “miracle cure”. The Academy conducted a huge meta-analysis of many randomized controlled trials to examine the effect of exercise therapy on outcomes in people with chronic diseases. The report on this study, carried in the New York Times on 20 June 2016, stated that for people (mostly middleaged men) who had had a heart attack, exercise therapy reduced all causes of mortality by 27 per cent and cardiac mortality by 31 per cent. Fourteen controlled trials showed physiological benefits in those with heart failure. Exercise has also been shown to lower blood pressure in patients with hypertension and improve cholesterol and triglyceride levels. The study also found that people with diabetes who exercise have lower HbA1c values, which is the marker of blood sugar control; low enough to probably reduce the risk of complications from the disease.
Twenty randomized controlled trials have shown that patients with chronic obstructive pulmonary disease can walk farther and function better if they exercise.
The KTPH workplace By virtue of its location, KTPH serves the needs of more than 700,000 residents and has a staff strength of over 4,300. Its unique location next to the beautiful natural setting of the Yishun Pond, a biodiverse area with trees, shrubs, butterflies, dragonflies, birds and water fowl, offers opportunities for leisure and exercise, and for extending the health education efforts of the hospital to the community at large. The designers of the hospital took advantage of this natural green lung in the heart of Yishun to build in spaces for events that bring staff and community residents together for mass workouts or just for daily exercise. Open walkways, multiple public access points and a large promenade on the banks of the pond act as natural draws. Ideal as a space for exercise and a restful break from the hospital bed for recovering patients, the promenade doubles up as a large outdoor stage. KTPH regularly spreads its cheerful active lifestyle messages by staging mass workouts like Zumba and aerobics for staff and residents alike. Participation by families and friends is actively encouraged.
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KTPH staff on the running track around Yishun Pond 44
Mass workouts like this on the promenade by Yishun Pond often attract residents, patients and their visitors. Those who can are encouraged to join in.
Seniors can engage in line dancing as a moderate intensity exercise, enjoying the music, company and getting a workout at the same time.
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11
A L E X A N D R A H E A LT H I N A C T I O N
Get fit at the Promenade with a million-dollar view! Fitness “drivethru” stations for exercise at the Promenade
KTPH is aiming to make residents in the North the healthiest in Singapore. The health-promoting hospital is taking steps to make access to exercise facilities and spaces as easy as possible. The promenade, located right at the doorstep of KTPH, is the perfect location to promote exercise and Ätness. Boasting a wonderful waterfront view, convenient location, and a range of health and wellness activities for all ages and Ätness levels, it is fast becoming a popular community space. Resident groups enjoy the space by gathering at the promenade for health-promoting activities such as Qigong and Taichi. There is also a Ätness “drive-thru” where residents can use the different stations for exercises such as sit-ups, pushups and stretches. In the spirit of bringing back “kampung” games, there are also hopscotch stations at the timber decking to the side of the promenade, free for public use. A recent new addition to the promenade is the “target shooting” station. Residents can hop on the stationary bicycle and pedal away to generate a stream of water to “shoot” at targets. This game is a fast prototype by KTPH, as a means of getting people to have fun and do exercise at the same time without realising it! Improvements will be made to this bicycle exercise station over the next few months. Staff of KTPH are also playing their role to be ambassadors and role models for the community. They often jog around Yishun Pond donning t-shirts with health-promoting messages. By “walking the talk”, KTPH staff hope to inspire Yishunites to take charge of their health by staying active and keeping Ät.
Riding on this stationary bicycle is both fun and good for health!
Need a brisk walking or jogging ‘kaki’? Always wanted to learn Tai chi? Join KTPH staff at the Promenade and get ðt! Activity
Join us!
Jogging
Every Tuesday, 6 – 7 pm Distance covered: 5 to 8 km
Brisk Walking
Every Thursday, 6 – 7 pm Distance covered: 3 – 5 pm
Taiji By The Pond
Every Friday, 5.30 pm – 6.30 pm
Article highlighting the excellent location and exercise facilities available to residents in northern Singapore, located on the doorstep of KTPH.
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OVERALL GUIDING PRINCIPLES FOR EXERCISE AT KTPH One of KTPH’s important guiding principles as a health promoting hospital is the strong belief that the staff should be role models to their patients to motivate them to lead a healthy lifestyle. Activities such as health screening sessions and the Fitness Challenge are held every year to help staff gauge their progress in keeping fit and healthy and identifying areas for improvement. Alan Deutschman, in his book “Change or Die” outlines three keys to successful change. They are: Relate: Forming a new and emotional relationship with a person or community that inspires and motivates you to make a change.
Repeat: Doing the new and desired behavior over and again, until it becomes a habit. Reframe: New ways of thinking about your situation and your life. These keys can help to change deep-rooted patterns of behavior – how people think, feel and act. Behavioral change is not easy and it takes effort to make it work. At KTPH, the management and staff continuously strive to take charge of health and health-related activities that set an example for their patients and the community they come in contact with.
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Story featuring the book “Change or Die” in the Alexandra Health in Action (AHA) magazine. 48
RUNNING FOR
HEALTH HOW A KTPH STAFF MEMBER WENT FROM COUCH POTATO
BY MARGARET PERRY, CORPORATE COMMUNICATIONS
S
ufaad Bin Mohd Sukri was shocked when he went for an employment health screening last year and found out he had
a cook in the kitchen at Khoo Teck Puat Hospital (KTPH), became concerned about his well-being, but he was reluctant to start taking medications at such a young age. “I wanted to lower my weight and cholesterol naturally by exercising more and eating less, but it was hard to motivate myself to do more than a 2km run a week,” says Sufaad. To help him improve his health, Sufaad’s supervisor and members of KTPH’s LifeWorks! Committee, which promotes healthy living among at Standard Chartered Marathon Singapore 2016. testing at KTPH Sports Medicine Centre. Principal Physiotherapist Gregory Fam designed a weekly training programme for Sufaad
and duration of training were gradually
A story in the KTPH magazine shows a staff member living the “Exercise Regularly” lifestyle and how it changed his health. The Five Pillars of Health
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Health screening The hospital’s “Birthday Month Health Screening” program is an important assessment that shows the individual how the various exercise and diet-related efforts are bearing fruit. KTPH firmly believes that prevention is better than cure and that a healthy individual is also a productive individual. On their birthday month, staff are encouraged to undergo a health screen that includes the following: • Health & Lifestyle Practices Survey • Height and weight measurement (Body Mass Index) • Waist circumference measurement • Blood pressure • Fasting blood glucose • Fasting lipid profile (total cholesterol, triglycerides, HDL and LDL) • Personal Health Report
In addition to the basic package, staff can opt for more specific tests.
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The health screening exercise has two objectives: • To promote health awareness in the workplace so that everyone may take responsibility for his own health • To encourage everyone to adopt a health-oriented lifestyle and get the most out of life Preventive health screening gives a metric for determining the improvement seen when staff follow the health promoting activities. It shows the tangible benefits of living healthily and encourages staff to go for regular check-ups. Where staff may have a predisposition to disease, the health screening exercises create awareness in the individual and encourages him to take measures to improve his health. Health screening also provides a report card that shows the actual health status of an individual. It is a good indicator or wake-up call for those whose health status is not ideal and helps encourage them to start engaging in healthy lifestyle practices.
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The pooled data from the health screening exercise is stratified into three health profiles: Lifestyle Maintenance (Low Risk) Those in this group have normal blood investigations and no risk factors. They should continue to maintain their healthy lifestyle and continue to have routine health screening. Lifestyle Modification (High Risk) Those in this group have risk factors or features in the survey or blood investigations that may indicate some risk. They need to modify and improve some aspects of their lifestyle to minimize future disease risks.
They should be encouraged to take part in company organized disease or lifestyle intervention programs. Disease Modification (Chronic Disease) Those in this group have known diseases such as diabetes, hypertension, high blood cholesterol or are newly diagnosed from blood investigations. They may be aware of their current condition and are encouraged to follow up with their doctor and medication. If they are unaware of their condition(s), they are encouraged to see a doctor to follow up.
KTPH’S ORGANIZATIONAL HEALTH PROFILE The 2016 health screening exercise showed that KTPH staff are generally healthy. Of the 3092 staff screened, 85% were in the low to moderate risk group. Those who fall into the lifestyle modification or disease modification
groups are made aware of the risks and are encouraged to modify their habits to lower their risks and aim for better health.
Body Mass Index (BMI) Profile of KTPH Staff BMI Range
Staff Surveyed
%
Low to Moderate Risk (BMI < 27.5 kg/m2)
2643
85%
High Risk (BMI > 27.5 kg/m2)
449
15%
Health Profile of KTPH Staff BMI
Low to Moderate Risk High Risk
Lifestyle Maintenance
Lifestyle Modification
Disease Modification
522
1591
530
0
187
262
Traffic light indicator showing the health status of an individual. 52
Of the 3092 staff screened, only 187 (6%) in the Lifestyle Modification group would need to lose weight to minimize any risk of cardiovascular disease and any chronic diseases related to obesity. In the Disease Modification group, only 262 (8.4%) of their colleagues are at high risk of cardiovascular disease and would need to lose weight to better control their conditions. The rest of the staff were assessed to be at low to moderate risk of cardiovascular disease. A comparison of total cholesterol status with the latest available National Health Survey in 2010 shows that KTPH staff measure well against the average Singaporean.
Some 63.2 per cent of KTPH staff have desirable total cholesterol levels. This is 14.8 per cent better than the national average of 48.4 percentage points. Those with borderline high cholesterol levels are 6.3 per cent lower than the national average – 27.8 per cent against 34.1 percentage points. Of those with high cholesterol, KTPH staff are at 8.9 per cent – 8.5 per cent lower than the national average of 17.4 percentage points.
Total Cholesterol Status (%) 80
% Participants
60
40
20
0 63.2
48.4
Desirable (< 5.2 mmol/L)
27.8
34.1
8.9
Borderline line li ne H High igh igh mmo o ( 5.2 - 6.1 mmol/L)
17.4
High 2 mmol/L (>= 6.2 mmol/L)
6QVCN %JQNGUVGTQN %NCUUKƂECVKQP KTPH Health Screening 2016
National Health Survey 2010
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EXERCISE INTENSITY The Academy of Medical Royal Colleges report also examines what exercise intensity means. Moderate intensity is anything that gets the heart rate at between 110 and 140 beats per minute.
Moderate intensity activities are those that get one moving fast enough or vigorously enough to burn off three to six times as much energy per minute as one does when sitting quietly.
These activities could be as simple as walking briskly, at about three to four miles per hour or cycling slower than 10 miles an hour.
The following table from the Harvard School of Public Health website gives examples of light, moderate and vigorous intensity activities for healthy adults.
Light
Moderate
Vigorous
• Walking slowly
• Walking briskly (4 mph)
• Hiking
• Sitting at the computer
• Heavy cleaning (washing windows, vacuuming, mopping)
• Jogging at 6 mph
• Mowing the lawn (power mower)
• Carrying heavy loads
• Standing, light work (cooking, washing dishes) • Fishing while sitting • Playing most instruments
• Shoveling
• Bicycling fast (14-16 mph)
• Light bicycling (1,012 mph)
• Basketball game
• Recreational badminton
• Soccer game
• Doubles tennis
• Singles tennis
KEY ELEMENTS OF EXERCISE AT KTPH In addition to Eat Wisely, Exercise Regularly is the second most important component of the Healthropolis concept at KTPH. It is taken very seriously and has evolved over the years to become a sustainable practice. It is also continuously reassessed to make it current and innovative. Several key strategies closely aligned to the principles of Healthropolis have been adopted. These are: • Influencing choices through strategies with built-in educational messages
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• Applying the principle that prevention is better than cure vis-à-vis the onset of disease or relapse post treatment • Empowering voices from the grassroots and building a program from the ground up rather than top down • Positive reinforcement with light-hearted and cheerful messages • Continuously innovating and adapting
STRATEGIC PLACEMENT OF SIGNS AND MESSAGING Public areas
Upon entering the car park
KTPH firmly believes that as a Health Promoting Hospital, it needs to set an example such that the practices that are initiated and practiced at KTPH are adopted by the community.
Every day, nearly 700 people park at KTPH and drivers get their own special messages on the boom at the entry and exit points, such as:
The hospital is easily accessible from many points and has strategically planned cheerful, happy messages to encourage exercise and healthy lifestyle to patients, visitors and staff alike. Bright cheerful signs, graphics and picture exhort one and all to exercise, take the stairs instead of the lifts and to eat healthily and wisely.
ar pa T he c
r k bo
om w
h
t he tering en en
hospit
• Have you exercised 3 times a week? • Have you had 2 servings of fruits today? Once out of the car, drivers and their passengers cannot miss the positive messages in the lift areas and staircases: • Let’s climb the stairs to fitness instead! • Step up to better health. • Have you exercised 3 times this week?
al.
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At the Main Lobby As one enters the Main Lobby at KTPH, the escalator on Level 1 of Tower C has these health messages: • Eat Wisely • Exercise Regularly • Stop Smoking • Be Happy • Practise Personal Hygiene
Eye catching health messages on the escalator at Level 1 of Tower C to encourage people to use the stairs. 56
A light-hearted message next to the lift buttons to encourage use of the stairs.
Messages on all lift lobbies and staircases The cheerful encouraging messaging carries through to the lift areas which are near the staircases. Bright graphics and cheerful colors draw attention to the messages.
A light-hearted message next to stairs to encourage people to use them instead of the lift.
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Messages on all outdoor staircases Signs on outdoor staircases display the same amusing and positive message graphics. Pictures serve as highly visible encouragement to staff, visitors and caregivers to take the stairs to the clinics instead of the lifts. These cheerful messages are more palatable and more likely to elicit a positive response. They are complemented by pictures of fit, cheerful KTPH staff as models of health with the messages: • “Exercise Need Not Be a Drag!” • “Love Your Heart!”
A staff member giving his heart a lift by taking the stairs at Tower C.
Targeted positive messaging in staff areas To encourage KTPH staff, equally cheerful signs are posted in areas accessible only to them. These are typically high traffic areas and the messages are seen by a wide crosssection of staff. They are effective in delivering these targeted messages that nudge them towards healthier habits. One important way is to encourage the use of stairs instead of lifts and escalators. The benefits of using the stairs are persuasively spelt out: • Climbing stairs delivers benefits by improving cardiovascular health, joints and muscles • It provides aerobic exercise benefits and builds muscles in the lower body and burns calories The buildings in KTPH have internal service areas and staircases accessible only to staff. Light-hearted, amusing messages are used in these areas. The models in the pictures are easily recognizable colleagues.
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Internal staircases carry messages to encourage staff to take the stairs.
Use of encouraging and informative messages on stairs in staff areas A variety of exhortations in bright attractive colors are used to encourage stair climbing in staff areas: • “Stair climbing is the best way to reduce body fat and burn calories.”
• “15 minutes of stair climbing a day can extend your life by 3 years.”
• “Climbing the stairs everyday improves your cardiovascular fitness in 3 weeks.“
• “Climb the stairs to a healthier heart.” • “7 minutes of stair climbing a day can halve the risk of a heart attack over 10 years.”
Internal staircases carry encouraging messages to motivate staff to take the stairs
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YEAR ROUND ACCESS TO EXERCISE SPACES AND FACILITIES Basement corridors Singapore, being situated just north of the Equator, experiences hot weather outdoors year-round and torrential rains frequently during the monsoons. KTPH has made innovative use of its basement corridors to help staff get exercise during times when the outdoors is not conducive.
The corridors double up as a running track, enabling staff to maintain their exercise habits and regimen during inclement weather. Distance markers placed on the walls along the basement corridors allow users to calculate their distances covered. One lap around the basement corridors is equal to 500m. These indoor areas also provide an alternate venue to host events when it rains. With alternatives such as the basement corridors and gyms available, there are few reasons or excuses for not exercising daily.
Running track at Basement 1 common corridor. One lap around the hallway is 500m.
Indoor gym facilities KTPH has two in-house gymnasiums in the Sports Clinic located in Tower C, used by patients for rehabilitation therapy. They are open to all staff come rain or shine.
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PLANNING AND ORGANIZING FITNESS ACTIVITIES AT KTPH Launch of LIFEWORKS! LIFEWORKS! is both a philosophy and an all encompassing program to enable staff who work together to exercise and stay fit together. It aims to improve staff engagement and increase retention of talented staff by creatively championing the Five Pillars of Health.
LIFEWORKS! was launched in conjunction with the Alexandra Health System (AHS) Active Day on 31 Oct 2012. The program enables staff to work together while helping each other to stay healthy and actively engaged.
LIFEWORKS! launch poster announcing its role in the former Alexandra Health System’s ‘human ecosystem’.
Objectives of LIFEWORKS! The Work-Life Vision Statement of KTPH is dedicated to the creation of an environment that supports wellrounded individual work and personal life effectiveness. LIFEWORKS! was inspired by this vision statement and helps serve the exercise needs of KTPH staff and
its surrounding community. Various types of fitness activities that incorporate balance, strength, endurance and flexibility are chosen by LIFEWORKS! to help staff incorporate these activities easily into their daily routine and provide benefits in their daily caregiving work.
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Incorporating the Five Pillars of Health into LIFEWORKS! activities In addition to Exercise Regularly, LIFEWORKS! also incorporates the other pillars, namely Eat Wisely, Be Happy, Stop Smoking and Practise Personal Hygiene. All activities organized by LIFEWORKS! carry the color coding of the Five PIllars and are easily identifiable by the benefits they offer. Many of the LIFEWORKS! activities welcome visitor and community participation. When the health promoting activities were first started, they were driven by management. It soon became apparent that this topdown approach did not work. Some initial challenges of this top-down approach were the alignment of many different planned activities and
generating enough momentum among staff. To ensure success, passionate individual involvement was critical. An assessment by a staff psychologist was the key to turning the program around. To get the desired staff buy-in and participation rates, the assessment concluded that initiatives had to be from the ground up and activities had to cater to the interests of staff. The decision was then made to centralize all the activities under the common umbrella of LIFEWORKS!. This measure helped with the alignment of activities throughout KTPH by tying activities to the Five Pillars of Health.
Fostering community bonding with color-coded T-shirts A year into the launch of LIFEWORKS!, color-coded Five Pillars T-shirts were introduced on Active Day. In the past, all T-shirts were yellow. To reinforce the â&#x20AC;&#x2DC;brandingâ&#x20AC;&#x2122; of the Five Pillars of Health, a third-generation of T-shirts were printed in the color code of the pillars.
Possession of the T-shirts had to be earned. Only role model participants who lived by any of the Five Pillars would earn themselves a brand new Five Pillars T-shirt to celebrate their achievement.
Staff wear their color-coded Five Pillars T-shirts with pride. 62
Signature events offered by LIFEWORKS! Signature events are unique to KTPH and are held yearly to encourage widespread participation by KTPH staff. Home Run The Home Run was started to make it fun to exercise and at the same time raise funds for KTPHâ&#x20AC;&#x2122;s adopted charity. The event aims to cultivate a love for exercise and make it a habit, create an environment and culture of health and wellness within the hospital and set a good example as a health promoting hospital to the community.
CEO Mrs Chew Kwee Tiang kicking off the Home Run event. The Five Pillars of Health
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An email encouraging staff to take part in the Home Run. 64
Staff of all levels join the Home Run as part of their commitment to exercise regularly.
KTPH staff enjoying a brisk walk round Yishun Pond.
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Fitness Challenge The annual Fitness Challenge is another Signature event held to encourage people to step forward and show the outcome of their exercise efforts. Individuals are rewarded based on their scores gained in tackling the challenges. These are: • Sit and Reach • Sit Ups • Push Ups • 2.4km Run or 1.6km Brisk Walk
Staff doing as many sit-ups as they can in one minute during the Fitness Challenge.
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On-going LIFEWORKS! activities Sports Interest Groups (SIG) To bring together like-minded people with similar interests, SIG was launched by LIFEWORKS!. Participants come together weekly to play and have fun. All these activities are initiated from the ground up by individuals passionate about sharing their interests and bringing like minded staff together. It also brings in people who are curious or have heard about an activity and want to give it a try. These events have expanded over time and are sustainable because they were initiated by individuals rather than imposed from the top down by management. In addition, the Human Resources Department (HRD) and the Healthcare Services Employees’ Union (HSEU) are very much in touch with the current trends and keep the interest level high by being early adopters.
Pillar of the week: Be Happy "There is nothing either good or bad that thinking makes it so."- William Shakespeare. Letting go of unhappy thoughts and memories is an act of self-care. Stay cheerful and optimistic, and have a great week ahead!
Piloxing – new! Blending the agility of boxing, the flexibility of pilates and incorporating funky dance moves, Piloxing is a new cardio workout that will help you burn calories, build lean muscles and increase your stamina!
Bolly Zumba – new! An interesting combination of Bollywood dance and exercise routines choreographed to Bollywood songs. Let Instructor Lavania bring you through rhythms to tone your body.
Date: Mon (Starts 30 May) Time: 6.30pm Venue: YCH Level 5 Staff Lounge
Date: Wed (Starts 16 Mar 2016) Time: 6.30pm Venue: YCH Level 5 Staff Lounge
Home Run mass workout - Piloxing – new! Didn’t manage to attend the Home Run launch? Join us in our new monthly mass workout at the promenade! Experience a new workout each month and get fit together with your colleagues. To kickstart this programme, we will be introducing Piloxing, which is a fusion of Pilates and boxing. It’s free, so come on down and join the fun!
The current SIGs at KTPH include line dancing, tai chi, table tennis, Zumba, badminton, futsal, brisk walking. Different age groups gravitate to these activities. For example, line dancing and tai chi see more participation from older staff while Piloxing and kickboxing are favored by the younger ones.
Sports Interest Groups Activity
Time
Line Dancing
Mon // 1.00pm - 2.00pm
Table Tennis
Mon // 6.15pm - 7.15pm
Badminton
Tue // 6.30pm - 10.00pm
Running
Tue // 6.00pm - 7.00pm
Bowling
Wed // 6.15pm - 7.15pm
Basketball
Wed // 6.30pm - 8.30pm
Brisk Walking
Thu // 6.00pm - 8.00pm
Zumba
Thu // 6.00pm - 7.00pm
Soccer (Futsal)
Thu // 6.00pm - 7.00pm
Badminton
Thu // 6.30pm - 8.00pm
Tai Chi
Fri // 5.30pm - 6.30pm
Schedule of on-going LIFEWORKS! activities at KTPH which caters to all age groups . The Five Pillars of Health
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Top and bottom: Staff and the community of all ages taking part in Piloxing exercises, led by a trainer.
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Active Day During this event, the hospital management and staff come together for various health and fitness-related activities. This event is organized annually and held towards the end of the year.
16 THU 3 N ov 20
y a D E V I ACT Morning Yoga
ster for Click to regi in ic g talk Lunch time ju
ut Evening worko
itne ss fun He alth an d f he day to suit throu ghout tere sts and rosters! d ifferen t int ACTIVE DAY BAZAAR
YOGA JUICING TALK
EXERCISE MEDLEY 7:30am – 8:15am Promenade
12:00pm – 1:00pm KTPH Learning Centre
PRIZE PRESENTATION 11:00am – 4:00pm KTPH Main Lobby
Kpopx Fitness, Kickboxing, Zumba 4:30pm – 6:00pm Promenade
Fitness Challenge, AHS League 2016 6:00pm Promenade
Other LIFEWORKS! activities In addition to the annual Signature and Corporate events, LIFEWORKS! organizes a wide range of ad-hoc and weekly in-house activities and ongoing interest group activities. Weekly in-house activities Many of these weekly in-house activities are either one-off or recurrent activities. The HR Department of KTPH broadcasts the schedule weekly to all staff to encourage them to take part. These event schedules are also posted on notice boards which are updated weekly. The events include classes for cycling, yoga, Piloxing, Zumba, self-defence, lunchtime talks, mass workouts and many more.
SIG (Cycling) announcement. The Five Pillars of Health
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Inter-department leagues Inter-department leagues are an important part of SIG and bring staff together for friendly competitions. These games were organized by the HR Department, dating from KTPH’s past as Alexandra Hospital, and serve as a platform to build friendships and camaraderie among staff. Many of these are conducted in community sport arenas and they model exercise activities for the local community. The competitions involve KTPH departments competing against each other. They are also held with external organizations.
Staff taking part in inter-department league competitions in badminton (top right) and bowling (bottom).
KEEPING WITH TRENDS TO ENCOURAGE EXERCISE The HR Department at KTPH monitors current exercise trends and incorporates them in creative ways to encourage staff to lead a healthy lifestyle. During the Pokémon craze, HRD organized an amazing race to hunt for Pokémon.
Strategic use of latest trends (Pokémon GO) and adopting it as an activity to encourage KTPH staff to exercise.
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HEALTH ADVOCACY COURSE (HAC) The Health Advocacy Course (HAC) was initiated to promote the Five Pillars of Health. It aims to equip all hospital staff with the knowledge and skills to live healthily and to enable them to become â&#x20AC;&#x153;Health Ambassadorsâ&#x20AC;?. At the end of this one-day course, which is compulsory for staff, they learn the key messages of the Five Pillars
of Health and are able to provide health information to patients, caregivers, their families and friends. The guiding philosophy behind the HAC is that when staff walk the talk by living healthily, they also acquire the knowledge and moral authority to advise others. This adds value to their professional and social interactions with others.
AWARD WINNER The little hospital that could KTPH, then under Alexandra Health System, stood among giants in 2013 when it won a global award for the healthiest workplaces in the world. The hospital was named as a winner, along with Royal Dutch Shell and Toyal America, in the inaugural Global Healthy Workplace Awards and Summit 2013. In so doing, it beat Johnson & Johnson and P&G China among others to the winning post. The global search for organizations which have invested in structured workplace promotion programs to build a healthy workforce was sponsored by the Cigna Foundation and hosted by International Health Consulting and iGenius, organizations whose common goal is to promote awareness of emerging better practices in health promotion and wellness in the workplace. Dr Michael Wong, then the Deputy Chairman Medical Board and Director of Health for Life Centre, received the award on behalf of KTPH in London in April 2013.
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CONCLUSION KTPH has successfully created an environment that promotes exercise as one of its core healthy lifestyle practices. Many of these strategies were developed at KTPH to encourage participation in exercise-related activities and can be models for other organizations for their workplaces.
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CHAPTER 3: BE HAPPY
INTRODUCTION The driving force behind positive psychology in the workplace is the notion that happier employees are more productive, more innovative and create a more attractive working environment. The benefits of positive thinking go beyond merely feeling good. Studies have shown that positive emotions can help ease the adverse physical effects of negative emotions on heart rate and blood pressure. Inculcating positive thinking is by no means an easy undertaking. KTPH benefits from having clinical psychologists to incorporate and encourage the concept in the hospital. Working in a hospital, unlike in most other professions, is often emotionally charged as staff encounter people who, when dealing with their own illness or that of loved ones, are worried or anxious.
It can be emotionally and physically taxing for staff to maintain a cheerful disposition during the work day while performing their duties. Maintaining such positive attitudes requires continued commitment and a high degree of personal energy. It also requires leadership from hospital management to provide strategies and avenues for creating a positive work environment which inculcates positive thinking, general cheerfulness and overall wellbeing among the staff. The senior management of the hospital keeps close tabs on staff emotional wellbeing and actively supports a wide range of activities and events planned to encourage staff to channel their interests and energies beyond work.
Service champion Sockalingam S/O Ramalingam is often the first happy face patients see on arrival at the hospital lobby. Patient greeters like him often set the tone for a patientâ&#x20AC;&#x2122;s visit.
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PROMOTING THE BE HAPPY PILLAR AT KTPH The senior management at KTPH invest time and effort to engage staff regularly at the work level to provide emotional and psychological support. To create this positive culture, they routinely do walk-rounds to various departments, listening and talking to staff to better understand the issues they face.
Planned activities and events for promoting staff health In addition to facetime with senior management, the emotional and physical wellbeing of staff are at the core of a variety of activities and events carefully chosen to
cater to the broad spectrum of interests to be expected among a staff population of some 4,300 people. These programs provide variety to the work day and cater to personal interests and hobbies or build skills and instil confidence that further empower staff in their work.
Positive messaging Use of light-hearted positive messages infused with humour have been observed to bring smiles to the faces of patients, visitors and staff. These messages are used in various locations throughout KTPH e.g. in consultation and waiting rooms, walkways and even the restrooms.
Light-hearted â&#x20AC;&#x153;Be Happyâ&#x20AC;? messages in the Health for Life Clinic. 74
The â&#x20AC;&#x153;Be Happyâ&#x20AC;? pillar of health infuses messages and guides on proper toilet etiquette. A touch of humour makes the signs less pedantic and more acceptable.
Encouragement to preserve toilet cleanliness goes down better with a touch of humour in the male restrooms.
Amusing messages in the female restrooms encourage proper toilet etiquette without sounding pedantic.
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Relaxation Therapy The Health for Life Clinic conducts a “Relaxation Therapy” program to introduce various self-help techniques to overcome stress and anxiety.
Relaxation Therapy
Take Time to RELAX : Learn some simple, soothing methods What is Relaxation Therapy? Relaxation Therapy includes a variety of methods that effectively reduce stress and help the body to enter into a relaxed state. The methods can be used by anyone to help manage stress and anxiety. It is also helpful for those who are recovering from illness. )LULÄts of Relaxation Therapy • Reduces anxiety • Reduces pain • Reduces blood pressure • Relieves muscle tension • Promotes better sleep • Promotes state of calmness and positive well-being • Promotes healing from injuries or illnesses Relaxation Techniques The relaxation techniques that you will learn in the session include: • Deep Breathing • Progressive Muscle Relaxation • Guided Imagery/ Visualisation Learn all 3 relaxation techniques in ONE session. Trainer: Clinical Psychologist Duration: One hour per session Scheduling an appointment Should you or your loved ones be interested in this programme, please contact us at (65) 6555 8828.
A flyer promoting “Relaxation Therapy” sessions. 76
LIFEWORKS! activities LIFEWORKS! encourages staff to be actively engaged The weekly LIFEWORKS! events and activities chart circulated to staff is color-coded to correspond to the pillar of health that the activity or event relates to. Physical activity has long been known as a stress reducer and KTPH has effectively incorporated this through the LIFEWORKS! Be Happy activities and events which are coded in yellow.
LIFEWORKS! creates connections with the KTPH community Connecting and building friendships with fellow staff beyond workplace interaction is an important part of building a healthy staff community. Positive interactions from informal and community events carry benefits which flow into the workplace and results in positive interactions among co-workers and supervisors. Many events organized at KTPH by LIFEWORKS! allow for these positive interactions through physical and community activities.
Self-Enrichment Activities
Ground-Up Events
Competitions
Chinese New Year Celebration
Enrichment classes Inter-department and workshops games like: captainâ&#x20AC;&#x2122;s ball, bowling, badminton, basketball, Lunchtime talks futsal, etc. Sports Interest Groups (SIG)
Deepavali Celebration Hari Raya Celebration
Staff bazaars
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Annual Events: World Happiness Day and World Mental Health Day
3-13 MAY
Gratitude Walkabouts • Look out for Gratitude Ambassadors who will be coming to spread happiness and kindness in your department. Get ideas on how to “Pass It On”!
World Happiness Day and World Mental Health Day events are celebrated annually in the hospital by the KTPH Psychological Medicine Department. During these events, staff can practice incorporating positive psychology into their daily lives. Posters containing practical tips are also displayed in various parts of the hospital.
9 MAY
Happiness Day • Check out activities at our booth at the KTPH Main Lobby from 9am to 3pm • A surprise is happening at night!
Khoo Teck Puat Hospital Alexandra Health
Happiness Day 2016 In conjunction with World Kindness Day
PASS IT ON HAPPINESS VIA GRATITUDE AND KINDNESS
Pick up a ‘Pass It On’ card. Do a kind act or write a message of gratitude for someone. Pass on the card to the person who has received your kindness.
Event
Date 9 May
Encourage him/her to do the same. Let’s get this ‘PASS ‘PA P SS IT ON’ wave going! Bro the m fro
AN ct DE . na d a one ITU ive me AT ece m so else! GR er IA av e fro eone S V d uh yo atitu r som ES ists e d, IN r log dicin car of g me fo PP ho syc l Me HA this age sa al P gica ive ess the lo nic Cli cho ece r a m oing sy ur the yo ess o by d by t of P en n n you en Wh kind s it o t to artm s ugh Dep of Pa
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Brought to you by the Clinical Psychologists Psychologists, Departmentt of Psychological Medicine
Posters and events announce World Happiness Day and World Mental Health Day at KTPH.
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Information cards promoting “Be Happy” messages are placed at the LIFEWORKS! wall for KTPH staff to take and share with others.
CORPORATE SOCIAL RESPONSIBILITY Beyond providing medical care, the CSR program connects hospital staff, beyond their professional roles as doctors, nurses and administrators, to the larger community of people they serve.
Volunteering makes a difference to the lives of the volunteers by stoking positive feelings and helps them reduce stress, find friends, reach out to the community and even learn new skills.
Unlike private organizations which often have capability to fund social programs, KTPH, as a public hospital, is able to offer the skills and energy of its staff. Volunteering is an integral part of CSR initiatives. The program is designed for a two-way flow of volunteers – from the hospital to the community and vice versa. Engaging volunteers from the community fosters closer ties and mutual understanding to promote healthy lifestyles.
It helps people in need and promotes worthwhile causes in the community. Volunteers benefit too as the positive feelings it fosters reduces stress, combats depression, keeps the volunteer mentally stimulated and provides a sense of purpose.
Guided by the Healthropolis philosophy and the Five Pillars of Health, CSR programs integrate community volunteering and exercise into a wholesome combination of efficient use of time, skills and healthy habits.
• Volunteering helps counteract the effects of stress, anger, and anxiety • Volunteering combats depression • Volunteering makes one happy • Volunteering increases one’s self-confidence • Volunteering provides a sense of purpose • Volunteering helps one to stay physically healthy
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Calling volunteers at a paired event Requests for volunteers from nursing homes are broadcast to the entire nursing staff. Nursing volunteers are paired with nursing home residents e.g. for inhouse exercise activities and healthy eating discussions, playing a dual role as volunteer and influencer in encouraging home residents to adopt healthy eating habits, exercise regularly and practise the tenets of the Five Pillars of Health. KTPH has adopted five nursing homes near the hospital where staff can volunteer their time. These are: • All Saints Home (ASH) • HCA Hospice Care • Singapore Christian Home (SCH) • Sree Narayana Mission • Villa Francis Home for the Aged
Top: A heartfelt moment at HCA Hospice Care. Middle: Students from neighbouring Hua Min Primary School put up a performance for residents of our partner homes. Bottom: Staff bring cheer and ice cream to the residents of the Singapore Christian Home at Christmas.
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Volunteering in the KTPH Gardening Club The KTPH Gardening Club is a hugely popular volunteering activity at KTPH, drawing in residents from the community to tend to the rooftop gardens in the hospital. In Singaporeâ&#x20AC;&#x2122;s urban environment, land is at a premium and very few opportunities for gardening exist. The Gardening Club allows KTPH staff and local residents to indulge in a healthy hobby, producing copious quantities of organically grown produce for sale to the public three times a week. Sales of fresh organically grown produce and potted plants are a hit with residents and staff alike. The general consensus is that in addition to providing a healthy physical activity, gardening also promotes a sense of accomplishment, fosters camaraderie with fellow gardeners and an overall sense of wellbeing and happiness.
Top left and bottom: KTPH Gardening Club volunteers happily sweat it out in the gardens and get their hands dirty. Top right: A winter melon on its way to growing even bigger. Second from top: A healthy custard apple. The Five Pillars of Health
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Chief gardener Rosalind Tan with a prize-winning winter melon.
The rooftop gardens and those in the rest of the hospital grounds are also adopted by various KTPH departments. Gardening sessions are regularly organized among staff, often doubling up as light exercise sessions.
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STAFF APPRECIATION Bringing staff together regularly and recognizing their effort through awards and tokens of appreciation serve to boost morale and help reinforce team spirit in KTPH.
Top: Happy staff at the annual Long Service Awards. Center: An inhouse celebration for staff who received KTPH and national awards. Bottom: Senior management turn waiters for the hospital-wide STARS Day, an event to appreciate the yearlong contribution of all staff.
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CONCLUSION The mental health of staff is a critical component of a positive workplace environment. In a hospital setting where staff work with patients daily, it is important that a positive attitude and general cheerfulness are part of the hospital culture and DNA. KTPH has been successful in planning and organizing numerous inhouse events and programs that have addressed this need and promote a general sense of wellbeing in the workplace.
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CHAPTER 4: STOP SMOKING
INTRODUCTION Lung disease accounts for one-fifth of deaths in Singapore, according to the Ministry of Health. It ranks as the third most common killer disease, behind cancer and heart disease, and kills up to half of all users. Most of tobacco’s damage to health is not evident until years or even decades after the onset of use. In addition to eating wisely and exercising regularly, the World Health Organization (WHO) has identified avoiding tobacco smoke as the three behaviors that can prevent chronic illness. Adopting these three behaviors can prevent 80 per cent of premature heart attacks, stroke and Type 2 diabetes and 40 per cent of cancers.
with COPD, a disease that narrows the air pipes, restricting air supply to the body. Ninety-nine per cent of COPD patients have a smoking history. Statistics provided by the Health Promotion Board on its website show that the social cost of smoking in 1997 ranged from S$673 to S$839 million. This includes the direct costs (payments for hospitalization and healthcare due to smoking), morbidity costs (lost production due to smoking-related illnesses) and mortality costs (lost production from people who died early due to smoking).
In Singapore, the National Health Survey 2010 found that one in seven Singaporeans smoked. According to the Health Promotion Board (HPB), 40 per cent of deaths due to heart disease before the age of 65 are caused by smoking. About seven Singaporeans die prematurely from smoking-related diseases each day.
The Singapore Cancer Society’s website states that tobacco smoke contains at least 69 carcinogens (cancer causing agents) and increases the risk of getting certain kinds of cancer such as lung and oral cancer, cancers of the stomach, kidney and bladder. Any form of tobacco is considered harmful and studies have shown that smoking just one to four cigarettes a day can lead to health problems.
Smoking-related diseases, including cancer, heart disease, stroke and chronic obstructive pulmonary disease (COPD) – also known as chronic obstructive lung disease (COLD) – are the nation’s top killers. Twenty per cent of Singapore’s total population smoke and one in five smokers is diagnosed
In addition, second-hand smoke is just as damaging to health. Ninety per cent of cigarette smoke is released into the air when a cigarette is lit, becoming second-hand smoke. Even if one does not smoke, the smoke from other smokers can increase one’s risk of lung cancer.
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STOP SMOKING – THE STURDY FOURTH PILLAR OF HEALTH Stop Smoking is the key fourth pillar of health in KTPH. To reinforce KTPH’s policy of being a ‘No Smoking’ hospital, highly visible signs throughout the hospital state the message clearly and uncompromisingly. These are complemented by programs to help smokers kick the habit and adopt healthy lifestyle practices. KTPH staff are encouraged to lead by example – by being non-smokers themselves and encouraging smokers whom they see lighting up within the hospital perimeters to stub out or to smoke outside the hospital boundaries.
The charts below testify to the healthy attitude towards not smoking among KTPH staff. Only 3.7 per cent of staff in the 2016 health screening exercise smoked. This is 10.6 percentage points lower than the national average of 14.3 per cent. Among staff, 87.5 per cent have never smoked before and 8.9 per cent have stopped smoking completely. Of the remainder, only 1.5 per cent smoked one cigarette or equivalent per day on average.
Proportion of Smokers (%)
Smoking Habits of KTPH Staff (%)
16
100
14 80
10
% Participants
% Participants
12
8 6 4
60
40
20
2 0
86
0 3.7
14.3
87.5
8.9
2.2
1.5
KTPH (Health Screening 2016)
Public (National Health Survey 2010)
Never smoked before
Stopped smoking completely
Ocassionally (less than 1 cigarette per day)
At least 1 cigarette per day
CLEAR SIGNS SEND A STRONG POSITIVE MESSAGE KTPH actively encourages patients, the public and its staff not to smoke. Colorful and attractive signs declare the hospital’s status as a Smoke Free Hospital. Messages are
clearly visible even before one enters the premises. They serve to remind and to encourage patients, visitors and staff to maintain a clean smoke-free environment.
Around Yishun Pond The grounds around the Yishun Pond are a prime exercise area for all comers and is an important location for messages that appeal to the public not to smoke. The tagline “Our patients need fresh air” reminds visitors that their civic-mindedness can aid patients on the road to recovery, providing greater impetus for them to refrain from smoking.
At the common walkways No smoking signage is prominently displayed along the common walkways around the buildings and the promenade.
Upon entering the hospital
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Indoors in the hospital At the link bridges
Top left: No smoking signs are prominently displayed at main thoroughfares like the link bridge at Tower C Level 3. Top right: No smoking signs prominently displayed at all door entrances.
At the Health For Life Clinic
Messages at the HFL Clinic are uncompromisingly clear â&#x20AC;&#x201C; smoking kills. 88
At staircases
EDUCATIONAL MATERIALS AND EVENTS Events help to remind and educate staff and the public about the importance of healthy lifestyle habits. Educational materials are disseminated at these events.
Quit Smoking Educational Books
World No Tobacco Day World No Tobacco Day and Quit Smoking Day are important annual events promoted by the KTPH Retail Pharmacy. They help to create awareness, educate and promote a healthy lifestyle.
In an effort to caution the young before they start, books for children on the harmful effects of smoking are sold at the KTPH Retail Pharmacy.
Educational books for children on sale at the KTPH Retail Pharmacy. They teach children about the harmful effects of smoking using age appropriate language.
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SMOKING CESSATION PROGRAM The Smoking Cessation program is jointly run by the Health For Life Clinic and the Pharmacy Department. It comprises of three sessions where the pharmacist will discuss and tailor individualized plans to help smokers kick their habit.
Legends:
Teaching method codes (TMC) E – Explanation W - Written instruction
D –Demonstration V - Visual presentation
Learners performance codes (LPC): 1 - Cannot perform skill /cannot understand
3 - Independently demonstrates skill /indicates understanding
2 - Needs reinforcement/return demonstration
EXPECTED OUTCOMES Patient verbalized / demonstrate understanding / skill
TMC
LPC
Pamphlet given (Y/NA)
Remarks
4. Pain Management NA
Type yp / Nature of pain p Pain scale Medication: o Simple painkillers e.g. Paracetamol
o COX-2 inhibitors and/or nonsteroidal anti-inflammatory drugs (NSAIDS)
o Opioids p Call for nurse when in pain
5. Infection Control
For patients at admission When a patient is admitted into the ward, the ward nurse will help complete the Patient and Family Education Record with the patient and his next-of-kin. One of the sections focuses on smoking. If the patient is a smoker, the nurse will advise the patient to enroll in the Health For Life Clinic’s smoking cessation program.
Hand washing
Type of precautions: ____________________________________
Specific p Education (if applicable): pp ) o Minimize bringing g g items into patient’s p room / cubicle o Keep p door closed o Educate on donning, g, removal and discard of surgical g mask o Unwell visitors are advised not to enter patient’s room
6. Fall Prevention Interventions
Key Risk factors ______________________________________________________ _ ___ ______________ ______________ ________________ __________ ______________________________________________________
Effects of fall e.g. g fracture,, head injury, j y, etc
Importance to comply with fall preventive measures and to stay in p the ward for care under supervision Interventions [tick the appropriate pp p interventions,, dash (-) ( ) if NA]]
Advise to call for assistance
Explain p on having g call bell and belongings g g within reach ((arm length) g )
Explain to keep bed in low position and keep bed rails up for safety ((if applicable) pp )
Explain p ensure trousers/ sarong g above ankles
Call for nurses’ assistance for toileting needs and wait to be assisted
Explain p about the green g wrist tag g
Explain about the medication effects anesthesia can cause weakness/ anesthetic effects
Orientate the p patient /caregiver g on safety y measures and surrounding g
Explain that physical restrainers will be applied for safety if required
7. Medical Equipment NA
PCA Pump p Others:________________________________________________ ______________________________________________________
8. Smoking : No Yes
If yes, advise to attend smoking cessation clinic
Education given to: ________________ Signature
___________________________________ Nam of Learner / Caregiver Name
________________________ Date & Time
8. Smoking : No Yes
If yes, advise to attend smoking Education cessation clinic given by: _______________________________________________________ _____ __ ___ ____ _____ ___ ___ ______ ___ ___ Signature
FORM-PFE-071 REV03 (30Jun2015)
Designation & Staff Name (In Full) Des sign
2
________________________ Date & Time
Records for SWI-NURS/INPT-01-01-01
Patient and Family Education Record form.
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For staff The three-session program is open to all KTPH staff to enourage smokers to quit. As healthcare employees, staff are expected to lead by example. The smoking cessation program helps motivate the smokers among them to quit, with goals set at each session and incentives offered to staff who quit successfully. Such measures ensure that the staff population of KTPH is largely smoke-free.
KTPHâ&#x20AC;&#x2122;s Smoking Cessation Program The three-session program is made more accessible to staff through a cost structure that incentivizes them to quit smoking. If the employee successfully quits smoking within three months, 90 per cent of the programâ&#x20AC;&#x2122;s cost will be subsidized by HR.
Smoking cessation program incentives offered to KTPH staff to quit smoking.
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CONCLUSION The negative effects of smoking are well documented and quitting is the only effective way to step towards adopting a healthy lifestyle. KTPH stands firmly by its Stop Smoking pillar of health. Its clear and uncompromising message that smoking is harmful to health is complemented by active steps to encourage and help individuals to stop.
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CHAPTER 5: PRACTISE PERSONAL HYGIENE
INTRODUCTION Good hospital hygiene is critical for preventing healthcare associated infections in hospitals. Transmission of microorganisms from the environment to patients may occur through direct contact with contaminated equipment or indirectly as a result of touching with hands. In order to minimize infection, good personal hygiene is a fundamental tenet of hospital culture. In the hospital environment where the sick and the healthy interact at multiple levels, strict personal hygiene becomes second nature to all hospital staff as it can literally be a matter of life or death.
This nexus between the resident and hospital communities creates potential for infection; and contagions can potentially flow in both directions â&#x20AC;&#x201C; from the hospital into the community and vice versa. Healthcare associated infections, if not prevented, can be very expensive and impose financial cost to the healthcare system and the community through loss of time and productivity. The strict practice of good personal hygiene enables healthcare workers in KTPH to model these practices for the community at large in which they live and work.
The importance of practising and maintaining a culture of strict personal hygiene is heightened by KTPHâ&#x20AC;&#x2122;s location among residential Housing Development Board (HDB) flats. The natural greenery and breezy hospital grounds, in close proximity to residential flats and exercise facilities around Yishun Pond, attract a constant stream of residents from the surrounding community.
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SELF-CLEANING CULTURE AT KTPH This is an important core concept of the Practise Personal Hygiene pillar and drives the many health promoting initiatives at KTPH. “Self-cleaning” is a portmanteau word combining the idea of cleaning up after oneself with keeping amenities clean for the next user. It is aimed at making the responsibility for cleaning up after oneself a part of everyday culture and life for staff. Their considerate actions in ensuring cleanliness e.g. in picking up litter whenever they see it, models such behavior for the general public. KTPH has been a leader in Singapore in championing selfcleaning within its food court and throughout the hospital
premises by patrons and staff alike. This self-cleaning culture is promoted by: • Providing the necessary infrastructure • Providing encouragement through positive messaging • Providing easy access and guidance for proper use of the facilities • Providing peer support to spur the desired change in behavior
Creation and placement of attractive signage Cheerful colors, motifs and clear messages are used to remind users of the facilities to clean up after themselves.
The butterfly is an important motif in sending the self-cleaning message to everyone, wherever it is seen.
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Placement and display of signage in communal table areas Colorful and attractive stickers are placed on outdoor furniture to remind users that amenities are shared and to leave them clean for others.
Self-cleaning signage on a communal table to encourage and promote the self-cleaning culture.
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Colorful, humourous signs on trash bins The artwork on the trash bins was designed by the KTPH Environmental Services Department. These designs make creative use of the local flora and fauna to capture the essence of KTPH’s “hospital in a garden” concept, with positive cheerful messaging to encourage use of the bins.
The KTPH management and staff lead by example, demonstrating personal responsibility in helping to maintain a clean and hygienic environment in and around the hospital premises by picking up litter wherever they spot it.
Colorful signs on the bins encourage users to dispose of their rubbish properly.
Self-cleaning and sorting culture in the food court In addition to public areas, the food court is well patronized by the public and staff. The self-cleaning culture is modeled here by KTPH staff. As ambassadors to advocate for the maintenance of a clean, green environment, they return their food trays to the self-sorting stations and deposit the utensils correctly into the bins provided. Self-sorting stations are conveniently located to facilitate the return of trays and utensils. The objectives are: • Helps cultivate positive hygienic habits and the selfcleaning culture
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• Lightens the load for cleaners and enables them to attend to other tasks, thus raising productivity • Messages are placed at strategic locations to nudge patrons into positive action and to encourage them to return their trays and utensils to the right bins
Left and bottom left: Messaging on tables to encourage customers to return their trays and utensils after their meals. Below: Built-in tissue paper holders are available on tables to encourage and allow customers to clean the table for the next user.
Self-sorting stations strategically located on Level 1 of the food court at KTPH. The Five Pillars of Health
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Self-sorting stations strategically located on the mezzanine floor of the food court at KTPH.
KTPH ambassadors in action â&#x20AC;˘ KTPH staff and volunteers help to promote the self-cleaning culture and urge patrons to embrace and practise it â&#x20AC;˘ KTPH staff and volunteers lead by example by doing their part and offer guidance to other patrons and visitors 98
Simplified sorting process at the self-sorting stations KTPH Food Court has simplified the self-sorting process by reducing the bowls and plates choices to two types each, making it easier and faster for patrons to deposit them into the right bins, clearly labelled with prominent visuals for the halal and non-halal stations. Self-sorting ensures the table are always neat and tidy and cleared of used utensils and trays, contributing to the pleasant ambience of the Food Court.
Reduced types of crockery for easy sorting The KTPH food court has simplified the self-sorting process by reducing the types of bowls and plates to two each, making it easier and faster for patrons to deposit them into the right bins. These bins are clearly labelled with prominent
visuals for the halal and non-halal stations. Self-sorting ensures the tables are cleared of used utensils and trays, contributing to the pleasant ambience of the food court.
Sorting of utensils and crockery into the right bins made simple and fast through limiting the types of crockery used and visual prompts. The Five Pillars of Health
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INTEGRATION OF GREEN INITIATIVES IN THE FOOD COURT AND HOSPITAL PREMISES The green messaging of the hospital is effectively conveyed through the easy-to-recall 4Rs mnemonic:
Refuse: Disposables, water bottles, plastic bags and extra packaging
Reduce: Paper, electricity and water consumption
Encouraging the use of re-usable lunch boxes and tumblers in the food court To reduce the use of disposables for takeaways, thereby reducing the rubbish load, incentives are given for patrons who bring their own reusable containers.
Incentives offered in the food court for patrons who bring their own lunch boxes and tumblers.
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Reuse: Paper and takeaway containers
Recycle: Paper, plastics, cans and batteries
• Prominent signs state that “take-away” paper containers will cost an extra $0.30 to discourage their use and encourage patrons to bring their own re-usable lunch boxes • Patrons who bring their own lunch boxes and tumblers will get a discount of $0.20 and $0.10 respectively
Go paperless Even the small touches matter. Touchscreens at the food court cashier stations allow customers to decline paper receipts.
Discouraging the use of plastic bags within the hospital The scourge of plastic bags which end up in landfills and in the oceans is a global concern. KTPH actively discourages the use of plastic bags by charging for them. By the same token, it also encourages the use of recyclable bags. Staff are encouraged to contribute their clean shopping bags to the Retail Pharmacy and these are given free to customers. â&#x20AC;˘ Posters are put up at the retail shops and the Pharmacy indicating that plastic bags cost $0.10 for a small bag and $0.20 for a big bag, aimed at discouraging their use â&#x20AC;˘ The charge is aimed at sending a green message and nudging people towards a green choice of either bringing their own bag or accepting a recycled shopping bag
Posters displayed at retail stores and the Pharmacy discourage the use of plastic bags.
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PROMOTION OF GOOD PERSONAL HYGIENE PRACTICES AT KTPH As an acute care hospital, KTPH employs various strategies to encourage and help staff and visitors to practise good personal hygiene in all public areas and in patient wards and clinics. Its location, nestled in the Yishun community, makes it imperative to educate and encourage the public and visitors to observe good personal hygiene practices when entering the hospital premises.
Around the hospital Visitors and staff alike are encouraged to help keep the environment clean. This helps KTPH keep its surroundings clean without incurring extra costs. Glove stations are strategically placed around the hospital to encourage everyone to use them while helping to pick litter in the grounds.
Glove stations placed strategically around Yishun Pond.
Inside the hospital premises and the wards Germ stopper stations are strategically placed along common walkways in the hospital and before the entrance
A germ stopper station at the link bridge on level 1, stocked with face masks and handrub. 102
to wards. These stations are stocked with face masks and hand sanitizers and are freely available to staff and the public, accompanied by helpful messages and reminders to encourage their use.
INFECTION PREVENTION STRATEGIES AT KTPH
Transmission of diseases and infections can be prevented by effective control of pathogens. KTPH deploys strategies to encourage people to adopt good personal hygiene and infection control practices. Use of humor and light-hearted messages in public areas Humorous and light-hearted messages are displayed inside the lifts to nudge patients and visitors to practise good personal hygiene for the benefit and safety of all whom they come in contact with.
Messages inside the public access lifts encourage good infection control practices.
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Hand-washing Hand-washing is fundamentally critical in healthcare as it is a simple and effective way to prevent infections. Cleaning of hands can prevent the spread of germs, including those that are resistant to antibiotics and are becoming difficult, if not impossible, to treat. At KTPH, hand-washing is taken very seriously and proper hygiene standards are strictly adhered to in order to keep patients, visitors and staff safe from needless infections.
Center: Hand-washing messages are placed conspicuously in wards to remind staff to wash their hands before and after patient contact.
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There are numerous reminders placed at strategic points to constantly remind staff to wash their hands frequently and keep the sink areas clean after hand-washing. Hand hygiene forms the bedrock of safety in the hospital setting and every healthcare professional performs an average of eight to 30 hand washes or rubs during an hour of patient care. The correct hand-washing technique is as important as frequency.
Left: Messages are strategically placed next to sinks to remind users to dry splashes around sinks inside the washroom.
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INFECTION CONTROL AUDITS The internal infection control audit is an important feedback mechanism to gauge the effectiveness of the practices adopted in any hospital. The results of handwashing and other practices have been very encouraging in KTPH. With the key principle of “prevention is better
than cure” as a guide, KTPH’s team of Infection Control nurses diligently performs sweeps and audits to ensure staff and patient safety. They follow strict measures to prevent contact transmission by staff and visitors, earning them the nickname the ‘Bug Police’.
INFECTION CONTROL EDUCATION FOR PATIENTS AND FAMILY MEMBERS Patient Family Education (PFE) The Patient Family Education protocol plays a significant role in reaching out to the patients and their families to keep infection control at bay in the home. When a patient is admitted into the ward, the ward nurse will go through Legends:
the PFE Checklist with each patient and explain the necessary steps he or she can take to control infection, including proper hand-washing. Such information is also shared with family members. Teaching method codes (TMC) E – Explanation W - Written instruction
D –Demonstration V - Visual presentation
Learners performance codes (LPC): 1 - Cannot perform skill /cannot understand
3 - Independently demonstrates skill /indicates understanding
2 - Needs reinforcement/return demonstration
EXPECTED OUTCOMES Patient verbalized / demonstrate understanding / skill
TMC
LPC
Pamphlet given (Y/NA)
Remarks
4. Pain Management NA
Type yp / Nature of p pain Pain scale Medication: o Simple painkillers e.g. Paracetamol
o COX-2 inhibitors and/or nonsteroidal anti-inflammatory drugs (NSAIDS)
o Opioids p Call for nurse when in pain
5. Infection Control
Hand washing
Type of precautions: ____________________________________ __
Specific p Education (if applicable): pp ) o Minimize bringing g g items into patient’s p room / cubicle o Keep p door closed o Educate on donning, g, removal and discard of surgical urg mask o Unwell visitors are advised not to enter patient’s en room
6. Fall Prevention Interventions
Key Risk factors ______________________________________________________ _ __ _ __ ______________________________________________________ _ ___ ______________ ______________ ________________ __________
Effects of fall e.g. g fracture,, head ea injury, j y, etc
Importance to comply with h fa fall preventive measures and to stay in s p the ward for care under supervision Interventions [tick the appropriate pp prop interventions,, dash (-) ( ) if NA]]
5. Infection Control
Hand washing
Type of precautions: ____________________________________
Advise to call for ass assistance
Explain p on having ng g call bell and belongings g g within n rreach ((arm length) g )
Explain to keep ee bed in low position and keep be bed rails up for safety ((if applicable) pp ble)
Explain p n ensure e trousers/ sarong g above ankles kl
Call for fo nurses’ assistance for toileting needs ne and wait to be assisted ssi
E Explain p about the green g wrist tag g
E Explain about the medication effects ect anesthesia can cause w weakness/ anesthetic effects
O Orientate the p patient /caregiver g e on safety y measures and surrounding g
E Explain that physical restrainers ain will be applied for safety if required
7.. Medical Me Equipment N NA
Specific Education (if applicable): o Minimize bringing items into patient’s room / cubicle o Keep door closed o Educate on donning, removal and discard of surgical mask o Unwell visitors are advised not to enter patient’s room
A PFE checklist used in the inpatient wards.
P PCA Pump p Others:________________________________________________ O _ _ _ ______________________________________________________
8.. Sm Smoking : No No Yes
IIff yes, advise vi to attend smoking cessation clinic
Education Ed du uc c given to: ________________ Signature
Education given by: _______________________________________________________ Signature Designation & Staff Name (In Full)
FORM-PFE-071 REV03 (30Jun2015)
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___________________________________ Name of Learner / Caregiver
2
________________________ Date & Time
________________________ Date & Time
Records for SWI-NURS/INPT-01-01-01
THE “BUG” POLICE
MAKING INFECTION CONTROL OUR PRIORITY FOR PATIENTS’ SAFETY As the saying goes, ‘Prevention is Better than Cure’. Patients who are already very ill are especially vulnerable to infections. KTPH’s team of Infection Control nurses means serious business when it come to ensuring patients and staff are safe by following strict measures. Contact transmission is the most frequent mode of transmission of hospital acquired infections. Hand washing is the single most important measure to reduce the risk of transmitting microorganisms from one person or site to another. As such, high standards of hand hygiene are critical in preventing infections. Visitors to the hospital also need to play their part to help us keep infections at bay by washing their hands before and after visiting their loved ones.
A clean working environment halts the spread of germs. SN Benjamin Tan inspects the wards almost everyday. Clean utility rooms housing urinals, bed pans and bed sponging trolleys must be kept clean with no sign of used consumables such as plasters and bandages. Cabinets under sinks are prone to contamination and should also not contain items used for patient care such as towels and blankets. He also checks each handwashing station to ensure there is enough soap and paper towels and the soap pumps are not malfunctioning which are deterrents to washing hands.
SSN Foo Meow Ling conducts regular handwashing audits in the wards and clinics to ensure doctors, nurses and allied healthcare professionals comply. She also trains and audits staff from the housekeeping department on the proper ways to dispose of waste and cleaning up after spills.
With the emergence of new infectious diseases and multi-drug resistant organisms (MDRO), a collaborative effort must be made to combat such risks. Patient and staff safety is our utmost priority in infection control. Our ultimate goal is zero infections. – Ms. Foo Meow Ling, Nurse Clinician, Infection Control Department
When a patient is suspected of having an infection, a “Contact Precaution” sign is displayed prominently. Before checking on the patient, SSN Li Dunli washes her hands, puts on a disposable apron and gloves. She ensures that the patient’s cannula insertion is properly done and there are no signs of infection. She also briefs the nursing team in the ward so that they, too, pay extra attention when caring for these patients.
*AN: Assistant Nurse, SN: Staff Nurse, SSN: Senior Staff Nurse, NM: Nurse Manager
A feature on the Infection Control team in the AHA! newsletter. The Five Pillars of Health
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EVENTS TO CREATE AWARENESS OF GOOD HYGIENE PRACTICES Global Hand Hygiene Day The Annual World Hygiene Day held at KTPH highlights the importance of good personal hygiene, to raise awareness and to promote personal hygiene among staff and visitors. In commemoration of the World Health Organization (WHO)’s “Save Lives: Clean Your Hands” campaign, KTPH holds a hand hygiene relay annually.
Hand-washing mascot and staff show off their clean hands at a World Hygiene Day event in KTPH.
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Infection Control Fair KTPH holds an annual Infection Control Fair during which exhibits are set up in the main lobby to raise awareness and to promote good personal hygiene among staff and visitors.
An exhibit put up by the Food Services Department on food hygiene at an Infection Control Fair.
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Monthly litter picking This is a monthly event to encourage staff to volunteer their time on Sundays to pick litter in the neighborhood. It is a highly visible effort to reinforce the message for a clean and hygienic environment where the hospital partners the community to keep germs at bay and reduce the risk and spread of infections. By encouraging residents to keep their community spaces clean, the hospital hopes residentsâ&#x20AC;&#x2122; appreciation for hygiene and cleanliness will extend to their visits to KTPH.
A Sunday morning well spent. KTPH management, staff and volunteers show off their haul of litter during a monthly litter picking exercise in the neighbourhood. 110
CONCLUSION Health education measures focus on both individuals and on contextual factors to shape the actions of individuals, with the aim to prevent and reduce ill-health and improve wellbeing. Inculcating responsible personal hygiene habits is an important public duty that hospitals can assume, given the public trust in the skills, knowledge and professionalism of healthcare workers.
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IN CLOSING KTPH draws on existing human and material resources to enhance self-help and social support and develop flexible systems to strengthen public participation. KTPH expands the goals of health promotion to develop a health promoting culture by creating active, participatory roles for patients, visitors and staff. Continuous development, involvement, measurement, monitoring and assessment are key and must incorporate the fundamentals of health promotion into the organizational structure and culture. This health promoting operations manual has documented in detail the various health promoting principles, strategies and operational setup employed, while at the same time reinforcing the message, by tying it to the Five Pillars of Health namely: Eat Wisely, Exercise Regularly, Be Happy, Stop Smoking and Practise Personal Hygiene.
KTPH is the first health promoting hospital in Singapore and South East Asia, having signed up as a member of the International Network of Health Promoting Hospitals & Health Services in May 2009. The commitment to promote health (including environmental health) to patients, staff and the public is validated by the international healthcare community. The hospital has won global and national awards for its many innovative health promoting programs. These include awards for corporate physical activity, nutrition and mental wellbeing. Some of them are: • First Health Promoting Hospital in Singapore and South-East Asia by the International Network of Health Promoting Hospitals & Health Services, 2009 • Singapore Health Award – Platinum Health Award, 2012
This manual provides guidance and is a toolkit for implementation of well thought-out, streamlined strategies which can be applied in existing hospitals and other organizations. It provides a way forward to address the critical need of delivering pre-emptive strategies to improve health for individuals and for communities to contribute to improved wellbeing of the overall population.
• Global Healthy Workplace Award (International), 2013
The hospital is an active proponent of the national values of promoting health instead of healthcare, adding value to the quality of care it provides and promoting active ageing to the community it serves in the north of Singapore.
• Manpower Resourcing & Planning (SM) by The Singapore HR Awards, 2015
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• Singapore Book of Records – Longest Duration Zumba Dance, 2014 • Quality Work Life, Physical & Mental Wellbeing (Leading) by The Singapore HR Awards, 2015
• Lifelong Learning (SM) by The Singapore HR Awards, 2015
REFERENCES Introduction
Chapter 3
http://www.diet-studies.com/open/Sackett2002-open.pdf
http://www.forbes.com/sites/ womensmedia/2012/08/08/5-quick-ways-you-can-bringpositive-psychology-to-your-workplace-without-earninga-degree/#29ac06564023
Chapter 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114340/ Detels, Roger, Sheena Sullivan, and Chorh Chuan Tan. Public Health in East and Southeast Asia. Univ Of California, 2012. (http://escholarship.org/uc/item/6354g2xv#page-2) http://www.who.int/nutrition/publications/public_health_ nut1.pdf http://www.fao.org/3/a-y5736e.pdf http://www.straitstimes.com/singapore/health/ singapore-has-2nd-highest-proportion-of-diabetics https://www.moh.gov.sg/content/dam/moh_web/ PressRoom/Highlights/2016/cos/factsheets/COS_ Factsheet%20-%20Diabetes.pdf
Chapter 4 https://www.hpb.gov.sg/HOPPortal/health-article/432 https://www.ktph.com.sg//uploads/report/ documents/11524_AHS_Annual_Report_2015-16.pdf https://www.moh.gov.sg/content/moh_web/home/ Publications/Reports/2011/national_health_survey2010.html https://www.hpb.gov.sg/HOPPortal/health-article/432 http://www.singaporecancersociety.org.sg/learn-aboutcancer/cancer-basics/what-causes-cancer.html
http://www.ncbi.nlm.nih.gov/pubmed/26706957
Chapter 5
Chapter 2
http://www.straitstimes.com/singapore/environment/liakteng-lit-5-million-people-70000-cleanersthats-ridiculous
http://www.nhcs.com.sg/aboutnhc/Newsroom/ NewsArticles/Pages/heart-failure-hits-sporeans-early.aspx
http://news.asiaone.com/news/singapore/pick-afteryourself-create-more-bright-spots
http://www.nhcs.com.sg/aboutnhc/Newsroom/ NewsArticles/Pages/heart-failure-hits-sporeans-early.aspx
https://www.facebook.com/notes/reachsingapore/sporea-clean-city-dont-joke/10151143418208795/
https://www.healthhub.sg/sites/assets/Assets/PDFs/HPB/ PhysicalActivityPDFs/ActiveForLifebooklet_20110415_ final.pdf
https://www.cdc.gov/handhygiene/
http://www.heart.org/HEARTORG/HealthyLiving/ PhysicalActivity/FitnessBasics/American-HeartAssociation-Recommendations-forPhysical-Activity-in-Adults_UCM_307976_Article.jsp#. V6qfQJN958c http://nyti.ms/28Iv194 https://www.healthhub.sg/sites/assets/Assets/PDFs/HPB/ PhysicalActivityPDFs/NPAG_Summary_Guide.pdf
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IN APPRECIATION It is people who energize organizations and make programs come to life. KTPH staff embrace the corporate values and mission with conviction and passion. It is through their wholehearted effort that KTPH succeeds as a health promoting hospital. We would like to thank the following individuals, departments and companies for their contributions in making KTPH a Health Promoting Hospital and for their contributions to this book. Chapter 1: Eat Wisely NTUC Foodfare Co-operative Ltd Cheers Holdings (2004) Pte Ltd Shirley Goh, Executive, Operations Department Ho Shok Fong, Assistant Manager, Operations Department Jolia Low, Manager, Operations Department Food Services Department Nutrition & Dietetics Department Operations Department Tenancy Department Chapter 2: Exercise Regularly Lisa Choo, Principal Clinical Psychologist, Psychology Service Stanley Oh, Senior Manager, Human Resources Department Healthcare Services Employeesâ&#x20AC;&#x2122; Union (HSEU) Health for Life Clinic Human Resources Department LIFEWORKS! Committee Rehabilitation Department Chapter 3: Be Happy Lisa Choo, Principal Clinical Psychologist, Psychology Service Psychological Medicine Department Chapter 4: Stop Smoking Facilities Management Department Operations Department Pharmacy Department Chapter 5: Practise Personal Hygiene Environmental Services Department Infection Control Unit Nursing Department
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ACKNOWLEDGEMENTS Sponsors This book is made possible by the generous contributions of: NTUC Foodfare Co-operative Ltd Cheers Holdings (2004) Pte Ltd Advisors Dr Michael Wong, Director, Health for Life Clinic, KTPH Yen Tan, Chief Operating Officer, KTPH Gladys Wong, Chief Dietitian, Nutrition & Dietetics Department, KTPH Editor Tong Yoke Tho, Deputy Director, Quality Service Management, KTPH Writers Shirley Goh Shini, Executive, Operations Department, KTPH Jack Lau Quan Feng, Executive, Operations Department, KTPH Dr Vidya Schalk, Ph.D Photographer the fat farmer Designer Barking Dogs Design Pte Ltd Printer Print Dynamics (S) Pte Ltd
Khoo Teck Puat Hospital August 2017 ISBN: 978-981-11-4491-2
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NOTES
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