Medical technology and workforce transformation identified as key enablers to tackle Singapore’s healthcare challenges at inaugural FutureHealth conference

The National University Health System (NUHS) Regional Health System (RHS) rolled out its Patient Appointment Consolidation (PAC) programme in 2014, to deliver more person-centric and seamless care to patients with multiple chronic diseases.
 

Preliminary analysis of the NUHS PAC programme has shown that patients with multiple chronic conditions enrolled in the PAC programme had 33% fewer visits to Specialist Outpatient Clinics (SOC) at the National University Hospital (NUH). For this group of patients, their hospital admissions and length of stay have also dropped by 53% each, and they also saved an estimated average of $492 each per year.

NUHS attributes these positive outcomes to one primary physician model supported by a holistic team-based approach. In this model of care, a primary physician will manage the patient's various chronic conditions, with inputs from specialists when needed. The programme employs primary care coordinators who assess each patient's case carefully to determine if the patient's conditions can be cared for in the community by a family physician from one of NUHS' primary care partners. Patients with more complex conditions will be cared for by a doctor from NUH one-stop Internal Medicine (IM) clinic. The primary physician is supported by a multi-disciplinary team who coordinates and delivers the care needed by the patient in the hospital, community and home. Patients enjoy the convenience of seeing one primary care physician. This means shorter waiting time and cost savings to patients as the number of appointments for each patient is reduced.

The Nursing Home Value Stream Mapping (NH VSM) project started due to the long turnaround time (TAT) for Nursing Home (NH) placement which saw a significant number of medically-fit patients waiting for NH in the acute hospital. The application process was also complicated and tedious.

To tackle this, the NH VSM workgroup was set up comprising representatives from 4 TTSH Departments, the Agency of Integrated Care and Ren Ci Nursing Home, St Theresa's Home and Thye Hua Kwan Nursing Home.

Three key initiatives were rolled out:
1) A standardised and streamlined workflow for NH applications was co-created with inputs from all the project team members during the future state mapping phase.
2) A standardized set of information required for NH application was formalized and communicated both upstream and downstream of the NH application process.
3) Lastly, the AIC NH Referral Team was relocated to work on-site in TTSH to facilitate the direct processing of NH applications. 

The results achieved were highly encouraging. The TAT for NH applications fell by 70% from Jan 2015 (71 days) to Aug 2017 (21 days). There was also a drop in the number of NH applications requiring re-work from 95% to 2% (data from 1 Jun 16 – 10 Oct 16). This translated to a shorter waiting time for NH placement for patients and a shorter length of stay in the acute hospital, hence faster access to acute care for new emergency cases with higher acuity needs.

The Outpatient Pharmacy at Singapore General Hospital (SGH) Bowyer Block fills about 6,000 prescriptions of over 20,000 drug items per month. With a drug volume this high, the packing process will inevitably be susceptible to human errors such as wrong drug pick. 

 The Smart Bin offers a novel approach to handling high drug volume safely and at the same time, increasing drug picking accuracy and traceability. A simple scan of the barcode on the drug label lights up the LED and unlocks the drug bin, and guides the Pharmacy staff to the correct drug bin, for picking or drug loading and returns.

 Data analysis from Apr 2016 to Nov 2016 showed that the picking accuracy of the system was nearly 100 per cent, eliminating possible near misses due to human error. 

 With the implementation of the Smart Bin, patient safety has been enhanced, in line with our hospital safety goal of "Target Zero Harm". Pharmacy staff have now be re-deployed to spend more face-to-face time with patients and improve service levels at the Outpatient Pharmacy.  

The Transformation of Financial Assistance Workforce in the Medical Social Work department of IMH sought to provide timely assistance to patients and caregivers by redesigning the job scope of Social Work Assistants (SWAs) for more efficient allocation of manpower, and also greater job satisfaction for staff. 

Financial assistance cases were previously processed and administered by Medical Social Workers (MSWs). The large number of such cases meant that MSW resources were channelled to these, instead of to complex psychosocial cases that required in-depth MSW intervention. 

As 40% of financial assistance cases were identified to be straightforward cases that did not require an MSW to manage, the SWAs underwent training by the MSWs so that they could be empowered to attend to these cases. As part of their upskilling, the SWAs learned to use a social care screening tool to enhance their assessment of patients' and caregivers' psychosocial needs, and to highlight potential risk cases to MSWs. This in turn freed up the MSWs to address the 60% of medium and high complex psychosocial cases that required their in-depth intervention.

With the reduction in the financial assistance administration workload, the department has managed to save one MSW full-time equivalent, which has been redeployed to attend to patients and caregivers in more urgent and complex cases seen at IMH's Emergency Services. 

• Workplace by Facebook
• Philips Electronics Singapore Pte Ltd
• NEC Laboratories Singapore Pte Ltd
• PricewaterhouseCoopers Consulting (Singapore) Pte. Ltd
• Johnson & Johnson Pte Ltd

• Salford Royal NHS Foundation Trust (as represented by Haelo), United Kingdom

• South West Academic Health Science Network, United Kingdom

• SkillsFuture Singapore (as represented by Institute for Adult Learning Singapore)