AHA magazine Nov-Dec 2018: Striving for constant improvement

aha

MCI (P) 101/04/2018

Issue 6: November-December 2018

STRIVING FOR CONSTANT IMPROVEMENT Tracing the roots of Yishun Health’s Kaizen culture

EYE FOR EXCELLENCE AND INNOVATION

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A DIFFERENT SIDE OF NURSING

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SMART HOLIDAY EATING

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ontents

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COVER STORY Striving for constant improvement This first story in our Kaizen series traces the roots of Yishun Health’s culture of constant improvement

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THE KAIZEN SERIES 2 |

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HEALTH HIGHLIGHTS Healthcare news and updates

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

13 SPOTLIGHT Eye for excellence and innovation A look at the innovative healthcare models and processes undertaken

by Yishun Health’s Ophthalmology and Visual Sciences (OVS) department 16 EVERYDAY HEROES A different side of nursing Senior Staff Nurse Tham Juncheng shares how his hobbies and volunteer work add colour to the nursing role

24 5 THINGS ABOUT… Coping with end-of-year stress Manage the highs and lows of the festive season and enhance your personal well-being 26 LIVE WELL The heart of long service Principal Physiotherapists Ms Marguerita Bee Bee and Mdm Lim Chai Ming on keeping healthy, active and young-at-heart 28 MAKAN TIME Chicken breast with Thai asparagus and cranberry sauce Healthy, delicious and full of the flavours of the festive season

We explore what it means to imbue an organisation with the spirit of Kaizen — a culture of constant improvement, and how continuous small refinements in the way we work form the building blocks of innovation in our healthcare delivery model. In this first of three cover stories, we trace the roots of our Kaizen culture and how it has been nurtured into our DNA.

PUBLISHER

30 30 DAILY DOSE Smart holiday eating Focus on quality, quantity and frequency

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EDITORIAL TEAM Hannah Wong Sabrina Ng Sharon Ng Albert Foo

EDITORIAL COMMITTEE

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31 MIND & HEALTH A numbers game Have a few minutes? Work out your brain with a little Sudoku.

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

The editorial committee — made up of clinical, nursing, allied health, population health & community transformation, and administrative heads of department — advises aha’s direction.

A/Prof Tan Kok Yang Angeline Tang Bastari Irwan Chia Kwee Lee Fatimah Moideen Kutty Shirley Heng

ktph.com.sg/aha

H

ow might we make things better?

This is the question that we ask ourselves every day at Yishun Health. Thinking about how to make improvements — big and small — is so much a part of our mindset that it has become part of our DNA. We explore this idea of everyday, continuous improvement in this three-part Kaizen series. This first instalment (page 18) looks at how this culture was seeded, and what was done for it to take root to become part of our foundation.

This theme of improvement and innovative thought is also reflected in our story on the Department of Ophthalmology and Visual Sciences (OVS) on page 13, and in some of our achievements (highlighted in What’s Up on page 6). For more inspiration, turn to page 16 and page 26 for stories on self-improvement and professional dedication respectively.

For a lighter read, we cover some tips on staying healthy for the holiday season — from emotional wellness (page 24) and smart seasonal eating (page 30) to a flavourful, festive dish (page 28).

Happy reading!

The Editorial Team

aha@ktph.com.sg

PUBLISHING AGENT THINKFARM PTE LTD www.thinkfarm.sg M A N AG I N G D I R E C TO R

Christopher Tay

E D I TO R I A L D I R E C TO R

Chua Kim Beng

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

Sheralyn Tay E D I TO R

Dang Hui Ling A R T D I R E C TO R

Regina Wong DESIGNER

Melissa Poon S E N I O R M A N AG E R , C L I E N T R E L AT I O N S H I P

Jessie Kek

C O N T R I B U TO R S

Justin Loh

aha is the official bi-monthly publication of Khoo Teck Puat Hospital (Co. Reg. No. 200717564H) and is produced by ThinkFarm Pte Ltd. All rights to this publication are reserved and no part may be reproduced without the expressed written consent of the publishers. While every effort has been made to ensure that the information in this newsletter is accurate and up to date, the editorial team will not be responsible for errors due to information received. Opinions expressed are that of the writers and do not necessarily represent the views and opinions of the publishers. Printed by Mainland Press Pte Ltd. MCI (P) 101/04/2018

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ealth Highlights

Unusual Type of

Diabetes

With diabetes in the spotlight in recent months, you are probably familiar with type 1 and type 2 diabetes; some of you are also likely to have heard of gestational diabetes. But what about monogenic diabetes?

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he most common types of diabetes include type 1 and type 2, which are caused by multiple influences, including genetic (usually involving multiple genes), as well as lifestyle and environmental factors. In contrast, an uncommon type of diabetes, monogenic diabetes, results from having mutations (changes) in a single gene, which are usually inherited.

Monogenic diabetes appears in several forms, and most often affects adolescents and young adults. In most forms of the disease, the body is less able to produce insulin, a hormone that helps the body use glucose (sugar) for energy. The two main forms of monogenic diabetes are maturity-onset diabetes of the young (MODY), and neonatal diabetes in newborns, which usually occurs in the first six months after birth.

A study conducted by the Clinical Research Unit (CRU) in KTPH shows

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that, in our local population, about 12% of young-onset diabetes patients (age of onset less than or equal to 35 years) have monogenic diabetes — this number is significant. The study also concluded that patients are often misdiagnosed because monogenic diabetes shares similar characteristics with other forms of diabetes.

Accurate genetic diagnosis of monogenic diabetes means that the right treatments can be prescribed,

leading to better care for the patient.

For instance, someone who has monogenic diabetes could be easily mistaken to have type 1 diabetes.

For some patients, correct diagnoses may even mean doing away with insulin injections, as diabetes pills or a healthy diet alone is enough to control their glucose levels. Correct diagnoses will in turn benefit family members, who may have monogenic diabetes themselves and are not aware of it.

Take part in KTPH’s research studies to help us better understand the prevalence and physiology of monogenic diabetes and young-onset diabetes in our local population. For more information, reach us at:

9755 2352 ktph.mody.registry@ktph.com.sg ktph.com/sg/cru/section_page/516

Do you have any of the following?

Get yourself checked for monogenic diabetes.

Diabetes when you were pregnant Age of diabetes onset ≤35 years

Type 2 diabetes but not overweight (BMI ≤ 32.5)

Family history of diabetes

Type 2 diabetes well controlled by diet

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hat’s Up

Recognition for Yishun Health at NHG Quality Day O

n 19 September 2018, more than 450 staff and partners of National Healthcare Group (NHG), including Yishun Health, gathered to celebrate achievements in quality improvement at NHG’s annual Quality Day. Themed ‘Empowering Staff, Celebrating Joy in Improvement’, this year’s Quality Day recognised the importance of keeping all involved in the care transformation journey engaged and productive by improving their wellness at work.

Keynote speaker Mr Göran Hendriks, Chief Executive of Learning and Innovation, Qulturum, County Council of Jönköping, Sweden, spoke on the use of quality improvement approaches to increase joy at work and strategically improve population health in the process. NHG Group

QUALITY IMPROVEMENT AWARDS Improving and Sustaining Quality and Safety Category 1. Forging Optimal Mobility for the Critically Ill — Is It Possible and Safe?

Team Leads: Ms Kylie Siu, Senior Physiotherapist, KTPH, and Dr Kumaresh Venkatesan, Senior Consultant, Anaesthesia, KTPH In this project, the team optimised mobilisation of patients admitted to a local intensive care unit (ICU).

Critically ill patients are at risk of deconditioning and developing functional impairments, and early mobilisation improved functional outcomes, and reduced ICU length of stay (LOS) to 0.7 day.

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Some of our Yishun Health recipients with NHG GCEO Prof Philip Choo (fifth from left).

Chief Quality Officer A/Prof Tai Hwei Yee encouraged staff to always be curious and continuously seek new approaches to better their work.

2. STOP-Catheter Associated Urinary Tract Infection (CAUTI) in a Sub-acute Ward at a Community Hospital Team Leads: Ms Priscilla Chng, Senior Staff Nurse, Infection Control, YCH, and Ms Ho Foong Nun, Nurse Manager, Ward D98, YCH In this project, the team reduced the rate of CAUTI in the pilot sub-acute ward by 30% within 12 months through various implementations and workflow process improvements. Preventing CAUTI will potentially save cost for patients from extended LOS, antibiotics usage, and laboratory tests.

In addition to these meaningful messages, NHG presented a range of awards, eight of which were won by Yishun Health.

EXCELLENCE IN ACTION AWARDS Team Category 1. Community and Home Eye Screening Service (CHESS) Team Leads: A/Prof Yip Chee Chew, Head and Senior Consultant, Ophthalmology and Visual Sciences, KTPH CHESS is a novel, low-cost, population-based community eye care project. It detects eye diseases early, increases medical access for elderly and homebound residents, and reduces hospital referrals. The team was recognised for leading this initiative and for ensuring sustainability in their implementation by training staff and partners, and spreading this beyond Yishun Health [see page 14 for more on CHESS].

2. Wellness Kampung Team Lead: Ms Evon Chua, Manager, Population Health & Community Transformation, KTPH Wellness Kampungs are community spaces transformed through active listening to community needs to become relevant gathering spaces.

The team was recognised for designing programmes that build strong and engaged communities in the North through social interactions that influence selfcare among residents instead of direct hospital interventions.

3. Holistic Patient Evaluation through Communal Activities and Rehabilitative Engagement (HOPE and CARE) Team Leads: Mr Clement Liew, Physiotherapist, and Ms Choo Wan Ling, Speech Therapist, Rehab Services, YCH This project provides patient-centric care that improves the quality of lives of our patients through

a cohesive and productive multidisciplinary team (MDT).

This is done through communal group exercise, eating and table games sessions, where the MDT interacts with and learns more about their patients and their family members away from their beds, in a non-stressful setting.

This also allows co-consultations, and filling in multidisciplinary reports on the spot.

The Palliative Care Team was recognised for their innovative problem-solving methods.

Through the programme, the team built trust and friendships with palliative patients, improved dynamics within the MDT, and workflow processes in the ward.

HOPE and CARE also won an award in the Service Redesign and Delivery Category at the Quality Improvement Awards.

INDIVIDUAL CATEGORY 1. Mr Yeo Boon Kiak, Senior Podiatrist, Podiatry, KTPH

Boon Kiak was recognised for his high clinical competence, as he contributed significantly in the development of new services, as well as improving standards and processes within the department. He consistently provides excellent service to his patients and is highly regarded by his colleagues.

EXEMPLARY CAREGIVER AWARD 1. Mr Daniel Ho, Caregiver Nominated by the Cardiology Department, KTPH Mr Ho was recognised for his dedication in caring for his mother, who had suffered a massive heart attack and severe brain damage. Although he was also working and looking after his young daughter, he continued to be actively involved in his mother’s stay at the hospital, and went the extra mile in her recovery process back home.

In the Spirit of Caring Y

ishun Health received the Charity Gold Award at the annual Community Chest Awards Ceremony on 9 October 2018. This award recognises organisations with a high rate of participation in Community Chest’s SHARE programme, which enables individuals to make small but regular donations on a sustained basis. Yishun Health has a participation rate between 80% and 89% as a majority of staff contribute generously to the SHARE programme monthly.

Ms Magdalene Chai, Chief Human Resource Officer, KTPH and Yishun Health, receiving the Charity Gold Award on behalf of Yishun Health from Mr Sam Tan, Minister of State, Ministry of Foreign Affairs and Ministry of Social and Family Development

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hat’s Up

Ensuring Safety, Security and Sustainability in Yishun Health K Top: Ms Eileen Koh, Manager, Operations Support, represented KTPH to receive a prestigious award from Mr Masagos Zulkifli, Minister for the Environment and Water Resources Above: Mr Gan Pei Soon, Assistant Manager, Security, represented KTPH to receive the SSWG Award

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TPH recently won two awards that strongly affirmed our long-standing efforts in safety, security and environmental programmes. For our environmental stewardship and green initiatives, the Singapore Environment Council (SEC) presented the Singapore Environmental Achievement Award (Public Sector) 2018 to KTPH on 30 August 2018, making it the first restructured hospital to be recognised in this area. This is a nod to our achievements in successful energy management, water

conservation, and our 4Rs: Refuse, Reduce, Reuse and Recycle.

KTPH was also conferred the honourable Safety and Security Watch Group Award (SSWG) in the individual category for the fifth consecutive year. Jointly organised by the Singapore Police Force and Singapore Civil Defence Force, the award ceremony was held on 28 September 2018. The SSWG recognises members for their exceptional efforts in taking ownership and practising a proactive approach towards premises safety and security.

Delivering Value for Patients, One Improvement at a Time L

eaders and practitioners in the community care sector gathered on 19 September 2018 for the Agency for Integrated Care’s (AIC’s) Quality & Productivity Festival, during which the Community Care Excellence Awards were given.

Among the 400 individuals and teams recognised was Yishun Community Hospital’s Senior Nurse Manager Ms Pauline Tan, who has served in the profession for 25

years. She was conferred the Gold Award in the Individual Awards Category. Also winning an award for Clinical Quality Improvement in the Community Hospital Category was YCH for its infection control project, STOP-Catheter Associated Urinary Tract Infection (CAUTI). The initiative is aimed at reducing CAUTI in the pilot sub-acute ward by 30% within 12 months. In the Productivity and Innovation Awards Category, YCH’s Food Services team won for their

project, Label Innovation to Improve Food Traceability and Food Safety in a Community Hospital. The clear labels, with production and expiry dates, have led to an annual savings of around $5,000.

YCH picked up a total of 29 Community Care Excellence Awards (Individual Category), six Clinical Quality Improvement Awards (Community Hospital Category), and two Productivity and Innovation Awards.

Guest-of-Honour Dr Amy Khor, Senior Minister of State, Ministry of the Environment and Water Resources and Ministry of Health, gave out the awards Left: Ms Pauline Tan, Senior Nurse Manager, YCH Ward D107, accepting her Gold Award for her tireless service, dedication and passion Middle: Ms Priscilla Chng, Senior Staff Nurse, YCH Infection Control, receiving the Clinical Quality Improvement Award for YCH’s STOPCAUTI project Right: Mr Francis Lim, Sous Chef, YCH Food Services, representing his team, which efficiently prepares more than 800 patient meals with new clear labels every day

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hat’s Up

World Mental Health Week I

n conjunction with World Mental Health Day, observed annually on 10 October, Yishun Health’s Psychological Medicine Department set up a Wheel Of Wellness (WOW) exhibition at KTPH’s Main Lobby. Through educational posters, activities and talks, the exhibition highlighted the importance of nurturing mindful self-compassion as a way to enhance emotional well-being and mental resilience.

Both staff and members of the public stopped by the booths at KTPH’s Main Lobby

No Pressure!

O

n 6 October 2018, the Pressure Injury Workgroup and Population Health & Community Transformation team held a Pressure Injury Awareness Day at Kampung Admiralty. The event aimed to educate and empower the public — especially caregivers — on how to spot signs of pressure injury and the ways to prevent them. More than 200 participants turned up for the event, which included informative health booths and live demonstrations on how to use a sliding sheet and a wedge pillow.

Left: Participants tried their newly acquired skills on a real person Right: Staff addressing a query from a member of the public

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Left: Er. Dr Lee Bee Wah (centre), Adviser to Nee Soon South GROs and MP for Nee Soon GRC at the Both Sides, Now exhibition with Ms Evon Chua (right), Manager, Population Health & Community Transformation, and a resident Top Right: Ms Grace Fu (centre), Minister for Culture, Community and Youth, sharing her thoughts at the Last Dance performance Bottom Right: Mr K Shanmugam (sixth from left), Adviser to Chong Pang GROs and MP for Nee Soon GRC, also paid a visit to the exhibition

Residents get to the Heart of End-of-Life Matters F

or the past two years, arts engagement festival Both Sides, Now has made a home in Chong Pang. It is co-presented

by Lien Foundation, Ang Chin Moh Foundation, Drama Box and ArtsWok Collaborative, in collaboration with community partners Yishun Health and Montfort Care Goodlife! As a platform to highlight the taboo topic of death and end-oflife issues, Both Sides, Now seeks to enable people to have conversations with their loved ones on their last wishes and plans.

One of its initiatives is ‘Closer’, its sixth and final engagement with the Chong Pang residents.

Senior residents had the chance to work with artists to create trails

for the community to examine and understand their ideas of death and dying. Since 2017, it has culminated in artworks that express the experiences, values and relationships close to the hearts of the residents. The public installation ran from 19 September to 7 October 2018 between Blocks 108 and 115 along Yishun Ring Road.

Through workshops and other creative approaches, the residents were given opportunities to venture, discuss and unearth personal connections with death and dying, and what it means to live and die well. Besides these activities, there was a participatory performance entitled ‘Last Dance’ to address grief, bereavement and the idea of legacy.

Ms Evon Chua and a participant showing their moves in the Last Dance performance

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hat’s Up

Staying in the Pink of Health O

n 29 September 2018, more than 300 participants turned up for the Breast Cancer Awareness Public Forum, ‘Stay in the Pink of Health’, at the KTPH Auditorium. Catering to both English- and Mandarin-speaking residents, the forum engaged them through educational talks on preventive measures, early detection, and healthy eating.

Top: Breast cancer survivor Ms Pauline Leow (middle) inspired the audience that morning with her story Bottom: Dr Pek Chong Han, Associate Consultant, General Surgery, speaking with a participant on the topic of breast reconstruction

Ever Ready!

Fire Preparedness Exercise O

n 26 September 2018, KTPH collaborated with the National Fire and Civil Emergency Preparedness Council and Singapore Civil Defence Force (SCDF) to conduct a Mass Fire Evacuation Drill.

Held annually, this drill was part of a month-long national campaign to promote fire safety and emergency preparedness in public premises. This was also the first time a hospital participated, and it served as a good opportunity to highlight the importance of fire safety awareness in healthcare institutions. The exercise involved more than 1,000 people and comprised Yishun Health staff, Company Emergency Response Team members, and SCDF volunteers. The drill also tested the reaction of emergency responders, and the evacuation procedures for patients, staff and visitors.

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potlight

F Eye for Excellence and Innovation Yishun Health’s Department of Ophthalmology and Visual Sciences (OVS) tackles a wide range of eye diseases. Beyond episodic treatments, the department has set its sights on the holistic and sustained management of eye conditions by focusing on innovative ways to drive prevention, promote self-care, and address underlying risk factors.

rom age-related conditions such as cataracts and macular degeneration to diabetic retinopathy, Yishun Health’s OVS department provides comprehensive screening, diagnostic, and medical and surgical treatments.

According to A/Prof Yip Chee Chew, Head & Senior Consultant, OVS, the ageing population and rise in chronic diseases is increasing the importance of eye health and ophthalmology as a medical specialty. “The eye is the only place in the body where you can see the blood vessels without any invasive methods,” he points out. “Studies show that what we see in the eye also reflects the status of the blood vessels in other parts of the body, such as the kidney, brain and heart.” The eye is truly a window to your health, he adds.

“The health of the eye and its vessels can act as an important surrogate marker for other diseases such as stroke and heart attack.”

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potlight This underscores the commitment of the OVS department to deliver innovative initiatives that take a more holistic and preventive approach to eye conditions. One of the ways the department does so is through their community eye health programmes, enhancing early detection, and improving the public’s access to affordable care. The department regularly organises community outreach programmes to educate the public on the importance of proper eye care, notes A/Prof Yip. “This helps us to manage eye and general health holistically in the community where they live.”

BRINGING EYE CARE TO THE COMMUNITY One of these is the multiple awardwinning Community Home and Eye Screening Service (CHESS).

Launched in February 2017, CHESS drives early detection of eye problems in people aged 50 and older, and people with diabetes of any age who do not have follow-up appointments with an eye doctor and have not seen one in more than a year. The goal of CHESS is to improve access to eye care and to identify eye diseases early through

To ensure sustainability and better reach, volunteers from NTUC Health Active Ageing Hub have also been actively involved in SeLECT, helping in eye check-ups and administrative tasks

screenings and consultations. It does this through empowering nurses and optometrists to be physician extenders.

CHESS is rolled out across two levels: First-level Community Eye Screening (FiLCES) and a Secondlevel Eye Consultation (SeLEC).

SeLEC has since evolved to Secondlevel Eye Consultation Teams (SeLECT), as it has included the volunteers at the NTUC Health Active Ageing Hub since October 2018.

FiLCES is conducted by community nurses, healthcare assistants, and nurses from Yishun Health’s Ageingin-Place Community Care Team. If problems are picked up, residents are referred to the next level of care under SeLECT, which comprise KTPH and Admiralty Medical Centre (AdMC) optometrists, ophthalmologists and NTUC Heatlh Active Ageing Hub volunteers (see box story).

This model of care is efficient as it keeps the cost of screening and

COMMON CONDITIONS OF THE EYE The OVS team of trained specialists offers consultation and treatment for: • Cataract and comprehensive ophthalmology • Medical and surgical retina • Oculoplastic and cosmetic eye conditions • Paediatric ophthalmology • Squint (misaligned eyes) • Glaucoma • Cornea • Uveitis (eye inflammation) A/Prof Yip demonstrating to community nurses how to do the Torchlight Eye Screening Test (T.E.S.T.)

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managing eye conditions low without compromising on the quality of care. A/Prof Yip, who is also Medical Director, AdMC, notes that these community screening platforms will increase healthcare access for the elderly and homebound, and alleviate the heavy demand on eye specialists in acute hospitals.

MATA: SELFMANAGEMENT MATTERS In a related push to bring preventive eye care, screening and monitoring to people, the department also developed a Macular Amsler Testing App (MATA) that motivates those with diabetes to comply better with monitoring their eye health.

A/Prof Yip says the app builds a sense of autonomy and ownership of care in patients. “It is well known that patients who are more involved in decision-making regarding their care are more motivated; this translates to better self-care and fewer complications.” The app uses facial recognition technology to replace the traditional use of paper charts, improving the accuracy of the test.

It also functions as a screening tool to detect vision abnormalities, and monitors the progression of eye disease. A/Prof Yip notes that patients can use the app as part of their own self-management, thus cutting down on the number of visits to the hospital for vision checks. Patients can also access the app for patient education resources.

A FOCUS ON QUALITY IMPROVEMENT Apart from prevention and screening in the community, the department drives a number of significant quality improvement projects to enhance care.

Its LEAN cataract surgery care path, which uses topical anaesthesia, has cut down on the time and cost of surgery. The streamlined process

increases efficiencies so that it is faster, better, cheaper and safer. “Nurses are trained to be physician extenders and able to do pre- and postoperative procedures and assessments for non-complicated cases,” A/Prof Yip explains. “This means patients need not make separate appointments for the anaesthesia clinic.” Instead of separate drops, nurses use combination drops that both numb and dilate the eye prior to surgery, saving time. This has resulted in an improved surgery lead time for patients, from four weeks to two weeks; and shorter surgery preparation time for the nurse, with time savings of about 472 hours per year. This process has had the added benefit of broadening the skill sets of the nurses and increasing their capabilities in dispensing anaesthetics for non-complicated eye surgeries.

“This means we do not need to impose on anaesthetists, whose time can be reserved for more complex cases, such as general surgery for patients with multiple illnesses,” advises A/Prof Yip.

A PARTNERSHIP TO BOOST EYE SCREENING

During the Awareness of Macular Disease Week 2018, AdMC signed a Memorandum of Understanding (MOU) with NTUC Health’s Active Ageing Hub (AAH) to drive better collaboration in bringing eye care to the community. This event was also in conjunction with Functional Screenings organised by Woodlands Galaxy CC and the Silver Generation Office. Under the MOU, AAH’s volunteers will play an important role in the SeLECT programme by doing simple vision testing and undertaking administrative tasks.

This is the first free eye-care programme in a community setting, and it aims to screen between 400 and 500 people over a period of 12 months.

The signing was witnessed by Dr Amy Khor (right), Senior Minister of State, Ministry of Health and Ministry of the Environment and Water Resources

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veryday Heroes

A different side of nursing For Yishun Community Hospital (YCH) Senior Staff Nurse Tham Juncheng, the world of nursing is one where he can grow and give back in more ways than one, such as through his hobbies and voluntary work.

D

iscipline, respect, and a focus on mentorship and self-development. As a black belt and registered coach in taekwondo, Juncheng not only applies these traits in his hobbies, but also in his daily work as a nurse and preceptor*. In the last two years, Juncheng has expanded his martial arts training, picking up ju-jitsu in 2016 and historical European martial arts in 2017.

“It goes towards my own personal and professional development, and helps me be a better mentor to my juniors,” he says.

His interest in martial art aside, the 28-year-old also takes time to be a medical volunteer. This work allows him to experience other aspects of nursing — such as primary care as well as pre-hospitalisation. It puts his work in the community arena in perspective. In addition to volunteering at a migrant worker clinic at least one Sunday a month, he goes on ambulance calls with the SCDF Civil Defence Auxiliary Unit 16 |

about twice a month. “Sometimes, the same patients I see from my ambulance calls end up in YCH, and they are always surprised to see me,” he says.

His extracurricular activities do not end there. Juncheng is also

on the editorial board of Connect, a magazine published by the Singapore Nurses Association.

This offers him the chance to meet nurses of all levels of experience and backgrounds, as well as learn about Singapore’s nursing landscape.

I am aware that I am still very junior and have a lot to learn, so I am grateful to be given a chance to specialise in an important area of healthcare.

“It allows me to grow my medical knowledge as well as give back,” offers the keen young man. “It all

differently, depending on which part of the brain is affected,” he explains.

“I try to find out what makes each

builds back into my development as a nurse.”

type different and how it affects patients.” This helps him understand and care for them better.

In 2016, Juncheng received an Advanced Diploma in Nursing (Gerontology), which has aided him in understanding aged care issues better. In 2017, under the Healthcare Manpower Development Plan, he went on a team learning journey to London, where he learnt about stroke programmes. He is now part of a transdisciplinary team at YCH that is developing a specialised stroke rehabilitation unit.

FINDING HIS PLACE IN NURSING Being a nurse in a community setting was not something he ever saw himself doing. He admits that, growing up, his impression of nursing was gleaned from TV shows that glamourised emergency rooms and operating theatres. It was only natural that, as a student, he aspired to work in the accident and emergency department. However, when the opportunity to join YCH in 2015 arose, he jumped at the chance to do something new to expand his horizon. “We shouldn’t be narrowminded when it comes to learning,” he reflects. “If we are too focused on what we think we want, then we become blind to other opportunities that come our way.”

Beyond professional development, he greatly enjoys how he is able to connect with his patients in the community hospital setting.

As patients stay an average of 21 days, he is able to build stronger relationships, he shares. “I learn about their daily habits and preferences, as well as their personalities and quirks. This allows me to provide care for my patients on a more personal level.”

These aspects of the job give him a deep sense of satisfaction. “I am aware that I am still very junior and have a lot to learn, so I am grateful to be given a chance to specialise in an important area of healthcare.”

*A preceptor is an experienced and/or senior staff nurse who serves as a role model. He/she acts as a mentor and point person to newly employed nurses, student nurses, or graduate nurses.

Left: Beyond his nursing duties, Juncheng goes on ambulance calls with the SCDF Civil Defence Auxiliary Unit Below: Juncheng (far right) with his taekwondo classmates

THE ROAD LESS TAKEN Juncheng has been rewarded by taking this leap of faith. Working in YCH Ward D97, which is dedicated to stroke patients, he has not only built his skills as a nurse, but also gained experience in stroke management and care. This is an area that is becoming increasingly relevant and important with an ageing population.

Juncheng works hard to expand his knowledge on stroke, frequently researching and reading up on each type. “Stroke affects each person | 17

Cover Story

STRIVING FOR

CONSTANT IMPROVEMENT Turning challenges into opportunities for transformation, and problems into pivot points for improvement: this mindset, seeded since our early days, has become a driving ethos for Yishun Health’s culture of Kaizen.

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THE KAIZEN SERIES PART 1 OF 3

The annual Kaizen Festival is led by Bong Ai Wei and Joanna Tang (2nd and 4th from left), and a team of representatives from across the hospital

HOW GOOD IDEAS COME TO LIFE

Kaizen is the Japanese term for a culture of making things better than yesterday, everyday. It is a core principle of the Toyota Production System.

I

nnovation plays an important role in the development of the healthcare sector. Whether it is advancements in medical technologies, breakthroughs in drug discoveries, or designing new models of care, innovations in these areas have not only increased our life spans, but also improved our quality of life.

But real innovation often comes about as a result of a tireless spirit to make daily improvements in the small things, rather than on

random moments of ingenuity.

An improvement mindset is one that thinks different, constantly strives to improve the status quo, identifies gaps, and turns them into springboards for change.

At Yishun Health, Kaizen has long been a way of life and built into our organisational DNA as a building block of innovation. Bong Ai Wei, Assistant Director, Operations, credits the genesis of this culture to the many “unconventional” things then Chief Executive Officer (CEO)

The annual Kaizen Festival celebrates the many ways that staff across our campus bring the innovation mindset to life. Started six years ago as The Good Ideas Forum (T.G.I.F), the festival represents the continuous improvement mindset that has been part of the DNA of Yishun Health since the days of Alexandra Hospital.

The event recognises and rewards not only for projects, but for being Nurturers, Champions, and more! Each year, some 150 submissions are received and 70 to 80 improvement projects are shortlisted for display.

Mr Liak Teng Lit implemented when the Alexandra Hospital was first restructured in 2000. The humble Alexandra Hospital had to set itself apart from the bigger, more established hospitals by thinking differently, she recalls. “We worked hard as a healthcare institution to get our certifications within a very short time,” she reveals. These included those from International Organisation for Standardisation (ISO) and People Developer. “It was important for us to show the | 19

Cover Story public that we had met all the basic standards.” She adds that they also adapted approaches from the hospitality sector, and even visited Toyota plants and workshops in Singapore and Japan to explore how the Toyota Way could be applied to healthcare. All these laid the foundation to elevate care standards from a different tack, Ai Wei reflects.

Today, with Yishun Health serving more than 800,000 residents in the north of Singapore with a strength of about 5,000 staff, cultivating a Kaizen mindset continues in three broad ways: • Enabling people through management support, learning and training, as well as dedicated test-bedding platforms • Understanding patients so as to develop meaningful, effective and relevant care initiatives • Challenging established models to shift away from a traditional, illness-centric model of care

THE SUPPORT TO DO BETTER

We adopt a thinking-doing-learning mindset in all that we do — from the small to the big — to make healthcare better, faster, cheaper and safer for all.

MRS CHEW KWEE TIANG, CEO, KTPH & YISHUN HEALTH 20 |

Applying novel approaches to improve care is a hallmark of Yishun Health. This is because of the strong and visible leadership across a multitude of platforms.

Apart from conventional events such as townhalls, Yishun Health’s leadership holds weekly administrative meetings, organises book reviews, and even facilitates workshops for staff. Ai Wei emphasises that this support is bolstered by current CEO Mrs Chew Kwee Tiang, whose oft-reminded motto is, “Do your job and improve what you do.” All staff are encouraged to embrace a ‘see something, say something, and do something’ attitude and make improvements. “We adopt a thinking-doing-learning mindset in all that we do — from the small to the big — to make healthcare better,

THE KAIZEN SERIES

PART 1 OF 3 faster, cheaper and safer for all,” Mrs Chew shares.

There are a range of options with a structured and purposeful curriculum for everyone to equip themselves with the skills to innovate and improve what they do. For LIVING CRISIS AND instance, all staff are required to WITH COMPLEX attend Problem Solving, Decision ILLNESS CARE Making, and Value Stream Mapping workshops, says Joanna Tang, Senior Manager, Operations. On top of this, Joanna and Ai Wei run Kaizen Facilitation Project Workshops.

“We train managers LIVING WITH and supervisors to LIVING FRAILTY WELL identify feasible Dojo is the Japanese term for project scopes a hall or space for and facilitate learning and meditation.

Kaizens in their LEAVING It has close association departments, with the martial arts, but WELL as well as the concept has been adapted by inspire and FIGURE 1 other sectors. motivate staff to embrace the spirit of continuous improvement,” she explains. Another JUST DO IT: GOING BEYOND THE CALL OF DUTY initiative is the Alexandra Health The Just Do It award illustrates the tacit permission given to staff to Fund Rapid Prototyping Grant, make time-sensitive decisions that are beyond their job scope without which staff can tap on to protype the need to seek clearance — as long as there is a justifiable benefit. inventions, products, projects and Inspired by the Nike tag line, this award inculcates a sense of autonomy, other ideas. empowering staff and recognising them as agents of positive change within Yishun Health. These are some of the often retold ‘war stories’ Beyond capability building, staff that continue to galvanise and inspire Yishun Health staff. have been allocated space to think about new ideas and try them out.

COMPASSION IN THE DARK During a middle-of-the-night power trip at Drawing concepts from design the old Alexandra Hospital, security officers, nurses and support officers thinking, the Yishun Health Idea Lab took the initiative to carry patients from the emergency department in stretchers up four flights of stairs to the wards. In another part of the is set aside as an area devoted to hospital, nurses and patient relations associates took it upon themselves prototyping, where teams develop to transfer the corpse of a Muslim patient to the mortuary so that family their ideas in dojos. There, they can could complete funeral arrangements within the timeframe required by scribble on walls, make flow charts, their faith. map out thoughts, and even use a DO IT YOURSELF As the hospital was about to be audited for the multifunction maker’s room. This Singapore Quality Award in 2001, a small group of managers and room also acts as a training space, executives put together a room for the auditors. With little funds and tool shed, and workshop for them less time, they used DIY project display panels to showcase the quality to do 3D-printing, build and refine improvement work. As the door to that room was particularly drab and prototypes or road-test designs. uninspiring, a spur-of-the-moment decision was made to paint it the day before the auditors were due. Opting for a grid pattern akin to Piet Mondrian’s signature artistic style, the team painted late into the night PUTTING PEOPLE to finish it. That colourful door would come to symbolise ownership, IN THE EQUATION innovative thought, and team spirit.

Central to this Kaizen mindset is understanding the needs of people.

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Cover Story Says Dr Wong Sweet Fun, Deputy Chairman, Medical Board (Population Health), and Chief Transformation Officer, KTPH and Yishun Health, “This means putting patients at the centre of what we do so we can truly develop processes that make a difference to their care.”

Segmenting the population in the north has been a foundational way to understand user needs.

These five segments of care (see Figure 1), now aligned with the National Healthcare Group — Living Well, Living with Illness, Crisis and Complex Care, Living with Frailty, and Leaving Well — take into consideration the health status, lifestyles and health needs of the community. “This understanding aids Yishun Health in better targeting appropriate programmes for our unified patient-centric model of care,” says Dr Wong.

Another interesting way to ensure that programmes are truly relevant is to simply leave them incomplete.

“This gives patients, caregivers and even residents the space to step up — be it to take a more active role to do self-care, act as a volunteer, or adapt programmes to their own needs. Allowing people to fill in the blanks encourages ownership and

sustainability, and creates space for further improvements,” Dr Wong emphasises.

CHALLENGING THE STATUS QUO The third critical component of nurturing innovative thinking is to be unafraid of challenging established processes and ways of doing things.

In its early days, rather than chasing specialties that had been ‘claimed’ by other healthcare institutions, the

organisation built up other strengths, focusing on outpatient services, geriatrics, diabetes care, and uniquely, service quality.

“We were always told not to be satisfied with the status quo, but challenge traditions and make things better,” states Ms Velusamy Poomkothammal, Deputy Director, Nursing, KTPH, who saw Yishun Health through its restructuring days. She cites the WOW patient experience initiative — which is

Essentially, the unifying objective in all our innovations is to find solutions for a better world.

DR WONG SWEET FUN, DEPUTY CHAIRMAN, MEDICAL BOARD (POPULATION HEALTH), AND CHIEF TRANSFORMATION OFFICER, KTPH & YISHUN HEALTH 22 |

A WOW patient experience can be as simple as celebrating a patient’s birthday

THE KAIZEN SERIES PART 1 OF 3

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still running today — as one of many long-standing examples that illustrates this culture of continuous improvement and patient-centred care. Likewise, Mdm Yiap Pok Ling, Deputy Director, Nursing, KTPH, remembers the start of this mindset. “Mr Liak encouraged our nurses to be more than protocolbased, but to also be patientfocused,” she recalls.

The WOW initiative thus empowered staff to make small changes at various touch points, from giving patients mugs on their birthdays and fresh apples at registration counters to providing warm blankets and medicated oil in the Emergency Department.

This approach of being unafraid to break with tradition has been

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lived out in numerous ways since.

Yishun Health has now embarked on stitching up the patients’ care journey end-to-end, including their transitions from community to hospital and then back to the community, and commit to delivering that care to the last under a unified patient-centric care model. While these moves may not be strictly defined as innovation processes, or fall under specific change management concepts, the spirit of Kaizen nevertheless drives the engine of improvement.

Technicalities and concepts aside, Dr Wong suggests that these definitions do not matter as much.

“Essentially, the unifying objective in all our innovations is to find solutions for a better world.”

1. & 2. At the Kaizen Festival, staff learn valuable process improvement methods through unconventional activities such as cooking and taking care of a baby 3. Kaizen posters showcase the tangible improvements achieved by teams over a few months 4. Senior management regularly conducts Town Halls, where they dialogue with staff

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Things About...

5 Things About COPING WITH END-OF-YEAR STRESS

The end of the year brings with it vacations, holidays and parties.

For some, it can be a period of deadlines, hectic schedules, and increased responsibilities. Here are some ways to manage the highs and lows of the festive season, and enhance your personal well-being.

In consultation with Dr Lim Wei Shyan, Associate Consultant, Psychological Medicine, KTPH

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WATCH FOR EXCESSES

Coping with the increased demands of the year-end festive season can take a toll on your physical health. Studying for exams, covering for colleagues, the festive peak period, or simply catching up before your own break are some, to name a few. Coupled with this are the excesses of feasting, drinking and late-night partying. Even as you juggle all your responsibilities, be sure to take good care of yourself. Sleep well, eat well, and exercise often, as you have done all year long.

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’TIS THE SEASON FOR GIVING

It is often said that giving is twice blessed: it blesses the giver as well as the receiver.

Boost your own sense of well-being and that of others by doing something meaningful. Give to charity, volunteer in an activity to help the community, or simply look out for one another as you go about your day.

For friends and family, give the gift of time. These acts of kindness and love are gifts in themselves. Research has demonstrated that performing acts of kindness enhances psychological well-being and boosts happiness.

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GIVE TO YOURSELF, TOO

Don’t forget to take time and be kind to yourself, even as you go about your busy day.

Schedule some moments for yourself. A quiet walk, a long shower, or a nice pot of tea can go a long way in restoring your mental clarity and giving you a physical boost. Treat yourself — it’s a reward for having made it through 2018!

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TAKE TIME TO TAKE STOCK

Every year has its peaks and troughs. The end of the year is a good time to take stock and reflect on your successes and disappointments of the past 12 months. Of course, it’s also helpful to think about your hopes and aspirations for the new year, and how you plan to achieve them. This exercise in reflection and goal-setting can help you focus on what matters in the new year.

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DECLUTTER PHYSICALLY AND PSYCHOLOGICALLY As you clear out unwanted items and emails during this time of the year, free up mental space by letting go of unpleasant memories and emotions of 2018. Move on from the past and ‘spring clean’ your heart and mind to prepare for a brand new year.

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ive Well

The heart of long service Together, they clock almost a century of experience and have served countless patients with empathy, compassion and tenacity in their work as physiotherapists. Ms Marguerita Bee Bee (also known as Mrs Dass) and Mdm Lim Chai Ming share what’s kept them active in body and mind — and young-at-heart.

AGEING GRACEFULLY IN AN ENERGETIC PROFESSION

Mrs Dass, Principal Physiotherapist, KTPH

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Dynamic and vibrant. That’s how Mrs Dass describes her profession.

The same can be said for the active and spirited Principal Physiotherapist, who has spent 40 years on the job.

Just like her life’s work, she keeps evolving, growing and rising to new challenges. It is perhaps one of the reasons for her youthful attitude and positive outlook on life. Though a veteran in many aspects of the

work, Mrs Dass never fails to keep up with changes. “I believe that physiotherapy is a dynamic and vibrant profession that is currently growing in the healthcare sector,” she says.

She notes that, with new research, technologies and robotics, physiotherapy is evolving into different areas of specialisation and treatment strategies. “My determination to continue in this profession grew as I gained more experience through practising,” she

shares. “I feel satisfied and motivated when I see my patients improve optimally with my treatments, and empowered to self-manage their condition outside the hospital.”

Mrs Dass’ passion for physiotherapy was first sparked when she saw children with cerebral palsy being taught how to swim.

“Their adaptation to mobility in water was so different compared to the difficulties faced when walking on land due to their impairments,” she remembers observing. What stuck with her the most was the gentle encouragement of their physiotherapists. Seeing how rehabilitation also helped her grandfather walk again after a hip fracture further inspired her to join the profession. “Physiotherapy has always been a true calling for me; it’s where compassion, patience and understanding are needed to provide the highest standard of care to patients,” she reflects.

And when she’s not at work, she attaches the same devotion to her family and hobbies, such as listening to music, playing the piano, and creating art.

the therapy aspect of the work meaningful and interesting. Her father’s support not only led to her present career — which has lasted 50 years — but her outlook on life and ageing well. It’s one of the reasons she continues to work.

“My father lived till he was 93 and worked till the end, so why not I?” she questions with a laugh.

This dedication and passion has seen Mdm Lim through all her different postings, from tending to sick children to treating leprosy patients. This wealth of novel experiences has added to her own professional development.

She recalls that training was more on-the-job in the past. Today, there is more structure and a stronger focus on evidence-based research, case documentation, as well as patient education and engagement.

However, the goals of the job remain the same: help patients regain their functions and live their lives to the fullest — in spite of disability or limitations.

Mdm Lim Chai Ming, Principal Physiotherapist, KTPH

As for Mdm Lim, she lives out these goals herself. Apart from early morning walks about five times a week, the avid cook and baker loves putting together big meals and sweet treats. She especially cherishes family time on the weekends, spending time with her children and seven grandchildren.

“It is all about work-life balance and building mental, physical, social and emotional wellness. Walk and be active for as long as you can — use it or lose it!”

A LIFELONG CAREER IN CARING FOR OTHERS When Mdm Lim Chai Ming, Principal Physiotherapist, KTPH, first joined the profession in 1968, physiotherapy work was very different from what it is today. “There were only two physiotherapists covering as many as four wards, including surgical, paediatrics and neurology. In the outpatient setting, we’d see as many as 30 patients a day,” she recounts.

Mdm Lim’s father, a forwardthinking man for his time, encouraged all his children to pursue their education, supporting most of them to do so overseas.

He particularly yearned for them to become doctors. Mdm Lim opted for physiotherapy as she found

(Previous page and right) Mdm Lim and Mrs Dass helping patients regain mobility from musculoskeletal and neurological rehabilitation respectively

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akan Time

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cut & keep

Chicken Breast with Thai Asparagus & Cranberry Sauce Served with mashed potato and chestnuts, this is a delicious yet healthy dish to have during the Yuletide season.

Recipe provided by Chef Muazzin Shah Bin Mohd Shah, Food Services, KTPH, and in consultation with Nutrition and Dietetics, KTPH.

INGREDIENTS

METHOD

Serves 10

1. Marinate chicken with salt and pepper.

2. Pan sear marinated chicken on a hot pan till brown, then bake in oven for 18 minutes at 180°C. 3. Sauté asparagus and chestnuts with olive oil, then season with salt and pepper.

4. For sauce: sauté 400g onions, add cranberries with 100ml water, then simmer for 10 minutes.

5. For mashed potato: sauté 100g onions with potatoes, add 500ml water, then simmer till soft and blend together.

6. Plate all together and serve.

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1.5kg chicken breast 700g Thai asparagus 500g cranberries, frozen 150g chestnuts, roasted 1kg potatoes 500g onions 20ml olive oil salt and pepper to taste

NUTRITIONAL INFORMATION (1 SERVING) Energy

312kcal

Carbohydrates

23g

Protein

39g

Fat

5g

• Saturated

1.1g

• Polyunsaturated

1g

• Monounsaturated

2.4g

Cholesterol

89mg

Fibre

8g

Sodium

136mg

For a healthier option, serve the dish with an assortment of steamed vegetables!

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aily Dose

Smart Holiday Eating

During the food-laden festive season, even the most disciplined people can fall off the healthy-eating wagon.

Feel free to have cake and turkey by applying three principles: quality, quantity and frequency.

In consultation with Ms Madeline Ng, Nutrition and Dietetics, KTPH

QUALITY Cut out the empty calories and artificial flavourings; instead, focus on high-quality, high-nutrition foods that are fresh or minimally processed. Select seasonal fruits and vegetables, wholegrains and lean cuts of meat over fatty and sugary foods and drinks. One way to fill up on quality foods is to load your plate with a rainbow of fresh fruits and vegetables. This increases your fibre and antioxidant intake. Wholegrains, fruits and vegetables also promote satiety without the extra calories.

Just remember to be mindful of the fat in salad dressings.

QUANTITY If you can’t control the quality of the meal, be conscious about portion control. Survey the spread along the buffet line before piling the food onto your plate. Start by filling half of 30 |

your plate with vegetables, followed by a quarter of lean protein and a quarter of wholegrains. If possible, use smaller plates. Studies show that simply halving the plate size can lead to a 30% reduction in the amount of food consumed. Also, take the time to savour every bite — you will eat less. This is because it takes 20 minutes for your brain to register that you are full. Chew well, pay attention to the taste, appearance, aroma and texture of what you are consuming, and stop eating when you feel satisfied.

FREQUENCY Mark out your parties and gatherings on a calendar and space them out to ensure that your calories are spread apart. Since you already know when

Want to eat healthier this festive season?

Cook it yourself!

Try our delicious baked chicken breast recipe on page 28.

those parties are going to take place, eat lightly a couple of days prior and add a little more activity to ‘earn’ yourself some extra calories. However, do not skip meals as you may end up eating more than you should!

Whatever the case, enjoy the festive feasting and cherish the time spent with your loved ones instead of feeling anxious around food. Ultimately, it is not what you eat during the holiday period that determines overall weight loss, but rather the consistency of healthy eating and exercise throughout the year.

ind & Health

a numbers game Just as your body needs exercise, so does your brain.

Research has shown that puzzles, such as the Sudoku challenge below, improve memory and increase concentration.

HOW TO PLAY Each digit from 1 to 9 must appear only once on • every row • every column • every nine-square block

9 2

8

4 5

2

7 4

1 5

5 9 8 4 5

3 9

2 7

1

Keep a lookout for the answers on the KTPH Facebook page!

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Community Nurse Post

Wellness Kampung

Wellness Kampung is an initiative comprising three wellness and care centres for residents in the north. They provide a suite of health and social programmes, creating a support network for residents to inspire each other to adopt healthier lifestyles in a close-knit 'kampung' setting.

Opening hours: Mondays to Fridays, 8.30am to 5.30pm (closed on Saturdays, Sundays and all Public Holidays)

115 Chong Pang

260 Nee Soon East

765 Nee Soon

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

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

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

6257 4702

6257 4802

6257 4842

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

Khoo Teck Puat Hospital (KTPH)

KTPH is a 659-bed general and acute care hospital serving more than 800,000 people living in the north of Singapore.

It combines medical expertise with high standards of personalised care in a healing environment, to provide care good enough for our own loved ones.

Yishun Community Hospital (YCH)

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

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

90 Yishun Central Singapore 768828

2 Yishun Central 2 Singapore 768024

6807 8000

6555 8000

6807 8800

www.admiraltymedicalcentre.com.sg

www.ktph.com.sg

www.yishuncommunityhospital.com.sg

www.fb.com/admiraltymedicalcentre

www.fb.com/khooteckpuathospital

www.fb.com/yishuncommunityhospital | 31