Co-Creation and Co-Learning for Stronger Future Healthcare

​Project: Smart Geofencing System (SGS) for Residents' Safety

Ren Ci Hospital encourages its Nursing Home residents to move freely within designated areas as part of communal living and active empowerment. However, some residents, especially those with dementia, may abscond or unknowingly wander out of their households (i.e. living area) or facility. To keep residents safe, the team implemented the Smart Geofencing System (SGS), which uses RFID technology to track and record movement. Residents' clothes are RFID-tagged, and RFID readers are installed in each monitored area. Monitoring tablets are available at staff stations and security posts. SGS would immediately trigger warning alerts to the tablets if residents entered non-designated areas such as lift lobbies/ staircases. Care staff and security personnel will then be able to quickly stop residents from wandering off the premises and safely return them to the household.

​Project: Community Management of Dementia by a Community Hospital (Community Response Team)

The multidisciplinary Community Response Team (CRT) at St Luke's Hospital assesses, diagnoses, and manages dementia in the community to address the gaps in management and access to mental health services identified by the National Dementia Strategy. The CRT provides quick assessment, rapid care coordination and service linkages to Persons Living with Dementia (PLWDs) with Behavioural and Psychological Symptoms of Dementia (BPSD) and Seniors with suspected dementia, as well as supports the caregivers. CRT served 114 clients and avoided hospital admissions for dementia-related behavioural issues from FY19 to FY21, providing relief to families and cost savings to the healthcare system.

​Project: Diabetic Foot in Primary and Tertiary (DEFINITE) Care: A Health Services Innovation in Coordination of Diabetic Foot Ulcer (DFU) Care within a Healthcare Cluster

The National Healthcare Group (NHG) 's Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter-institutional and multidisciplinary team health systems innovation programme. It aims to achieve coordinated care across primary and tertiary care for diabetic foot ulcer (DFU) patients across the NHG cluster. At 18 months after the implementation of DEFINITE Care, amongst 3,475 patients with DFU, there was a significant 76% relative risk (RR) reduction in minor Lower-extremity amputation (LEA), from 36.4% to 8.7% and a 22% RR reduction in major LEA, from 6.5% to 5.1%. There was also a significant improvement in cardiovascular profile: diabetes and hyperlipidaemia control, with improved average blood sugar level from 8.4% to 7.9%.

​Project: Placing Sustainability at the Core of Everything We Do at Juronghealth Campus

Environmental footprints like electricity, CO2 emissions, and waste production have the potential to harm people's health and the environment. Jurong Health Campus Green Committee (JHCGC) embarked on a "Go Green Journey" since 2020, incorporating sustainable practices into daily business to improve energy and water efficiency to mitigate climate change and improve people's and the planet's health. The JHCGC ensures sustainability strategies are fully executed across Ng Teng Fong General Hospital (NTFGH) and Jurong Community Hospital (JCH), manages and tightens goal-setting and reporting processes, and strengthens relationships with external stakeholders and overall accountability. NTFGH and JCH emitted at least 20,000,000kg of CO2 yearly for electricity consumption. Working with the users and specialist vendors to identify and explore the potential for energy efficiency improvement, JHCGC leveraged technology and implemented intervention strategies to achieve at least 2,464,061kWh energy savings and reduced 1,005,337kg CO2 emission as of 2021.

​Project: NUHS Group Facility Management Strategic Transformation – From Preventive to Predictive Maintenance

NUHS Group Facility Management (NUHS-GFM) keeps the NUHS hospitals operating smoothly whilst maintaining a safe and healthy environment that is conducive to meet the needs of patients, staff and the public. With Hospital Facilities Management (FM) operations growing fast and an ageing workforce, continuing with the traditional manual operations approach is no longer sustainable and effective. FM is manpower-intensive and has inherent inefficiencies as the processes rely heavily on hard copies and manual workflows, which are prone to errors and lapses, if not safety risks. NUHS-GFM embarked on a "Go Digital Journey" and moved from Preventive to Predictive Maintenance. Preventive maintenance is typically scheduled based on our operational experience and time-based. With Predictive Maintenance, NUHS-GMF can leverage technology to improve workplace safety, efficiency, and productivity and develop a future-ready engineering workforce.

​Project: The Clinical Diabetics Educator Programme: A Novel Transdisciplinary Model for Diabetes Care

A person with diabetes is often thrust into a complex system of care delivered by a large team of healthcare professionals (HCPs) of doctors, nurse clinicians, pharmacists, dietitians, podiatrists, social workers, and others deliver various aspects of therapy and preventive care. With so many HCPs caring for a patient, healthcare delivery can become fragmented. Duplicated services and uncoordinated visits may result in patient dissatisfaction, high default rates, and poor treatment outcomes. The Clinical Diabetes Educator (CDE) programme was conceptualised to reduce care fragmentation, with the central idea to systematically cross-train and elevate the capabilities of the diabetes Allied Health Professional (AHP) workforce. For example, a pharmacist could teach glucose self-monitoring skills through the programme; a nurse could perform foot screening; a dietitian could adjust insulin doses–collectively streamlining diabetes care. With these transdisciplinary innovations in workforce capability, the team achieved greater cost-effectiveness while improving patient compliance and maintaining outcomes.

​Project: Enhancing Workforce Productivity through Digital Workers – SGH's RPA Journey

Manpower cost accounts for at least 60% of healthcare costs in Singapore. Yet, traditional business processes in a hospital, especially in operations, comprised of huge amounts of rule-based, repetitive and manual tasks that do not necessarily need to be performed by a human. Robotic Process Automation (RPA) can be the solution to cut costs, save time, create sustainable processes and maximise the use of resources. SGH started using RPA in late 2020, and the gains were substantial – ranging from headcount savings to be able to do more with the same amount of resources, reduced turnaround time, increased quality time with patients, and increased staff satisfaction, as they are relieved of doing repetitive tasks. As of July 2022, SGH reaps S$646,780 in productivity gains each year (and counting) through RPA alone.

​Project: Improving Mobility Via Exoskeletons (iMOVE) - Implementing wearable robotic exoskeleton use across the continuum of rehabilitation care, from hospital to community

Rehabilitation of mobility after acquired neurological injuries such as strokes is labour-intensive. Robotic Exoskeleton Training (RET) is more effective than conventional physiotherapy (CP) in achieving independent mobility and improving walking speed. RET is implemented across the continuum of rehabilitation care (hospital to the community).

Of 441 patients who underwent 12 sessions of RET to the CP across settings, 81.6% were from inpatient and outpatient rehabilitation facilities. Patients were stratified by Functional Ambulatory Category (FAC). For dependent patients (FAC 0-1), RET resulted in 3 times more step count and distance walked compared to controls. Clinical Outcomes Variable Scale (COVS) gain was 34% better in RET than in controls. Although Functional Independence Measure (FIM) motor sub score gain was not significantly different between groups (i.e., RET patients required 1.9-person assistance for walking outside the device, controls required 1.6-person assistance), RET can be undertaken with 1 trained therapist and represents significant cost savings. For stroke patients FAC≥2, there were no differences in walking speed gains between RET and controls. Acritical operational size is needed to cater holistically to the complex rehabilitation care needs of RET patients. Most of their centres have successfully implemented the programme and will be incorporating the use of exoskeletons into clinical care.