ISS Service Innovation Leadership Seminar, 28 March - Mrs Chew Kwee Tiang

Innovation in Healthcare- Our Journey Thus Far

Mrs Chew Kwee TiangChief Executive Officer, Khoo Teck Puat Hospital

Alexandra Health System

KTPH

Yishun Community

Hospital

Community Based Care

Villa Francis Nursing Home

& Others

Old Folks’ Homes

Yishun Polyclinic &

Others

Woodlands MedicalCentre

GPs

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Regional Health Systems in Singapore

We are Alexandra Health System!

Regional Health Systems in Singapore

We are Alexandra Health System!

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Alexandra Health

Vision“Help our people live a long and healthy life and support them with thoughtful and dignified care to the end.”

Mission“Provide good quality, affordable and hassle-free healthcare with science, love and wisdom.”

Tagline“Touching lives, Pioneering Care, Making a Difference”

TransformingHealthcare Delivery

Design Challenge:

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Insight Into Healthcare Needs of Patients

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Pre-illness Illness Post-illness

Health Maintenance• Vaccination• Public Health Education• Health Screening• Workplace Health promotion

Illness Care• Cost effective, efficient care

- systems processes - clinical pathways

Health Recovery• Skills-for-life• Homecare support• Follow-up support

Head-to-Toe Lifelong AnticipatoryHealthcare of Whole Person

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Fast Medicine

Slow Medicine

Cruise Medicine

(Assembly Line)

Khoo Teck Puat Hospital Woodlands Medical Centre (2017)

Yishun Community Hospital (2016)

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PopulationClassification

Managing The Population In The North

Well Healthy

Well UnhealthyUnwell

Unhealthy(Early Stage)

Unwell Unhealthy(Late Stage) Frail and Dying

Population Health Programmes Ageing In PlaceCare Model

Pre-illness

Illness

Post-illness

KTPH YCH WMC

Acute care &Chronic Disease Management

Wellness Centre/ Community

GPs, Polyclinic, KTPH Nursing HomesSetting of Care

Yishun Community Hospital

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4 Design Concepts

1. Health Promoting

2. Improve community health

3. Enable ageing in place

4. Design hassle-free experience

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Health Promoting Hospital

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Design Concept 1

The Thinking Behind The Design

Be The

CHOICE

ARCHITECT

RELATEREPEATREFRAME

Shape

The

PATH

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Innovation : Create a Living Lab at KTPH

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Workplace Health

Health for Life System

Personal Health Record Risk Stratification Corporate Health Report

Lifestyle Maintenance(Low Risk)

Lifestyle Modification(High Risk)

Disease Modification(Chronic Disease)

1. Overview of employees’ health status

2. Determine target Interventions

3. Focused resources on relevant staff

Measure outcomes, progress report, etc

inputs

outputs

Health Risk Assessment

Biometric Parameters/Lab Inx

Clinical Practice Guidelines

Current Evidence

HR inputs

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Determinants : Philosophy, Value, Attitude, Knowledge, Discipline

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PARTICIPATION

2380 staff

77%

PARTICIPATION3088 staff

85%

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Annual Staff Health Screening

Individual Health Screening Reports

• Patient Portal• View all your health screening results• Visualize your health status over the years

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Improve Community Health

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Design Concept 2

Health Education in the Community

• Mini Medical School

• Workplace health programmes

• Community health programmes

Mini Medical School 1st Run Jan 2013LIVE! Programme in workplace and community

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Sharing Best Practices With Workplaces

190 WHP

Practitioners

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Sembawang Shipyard Onsite Diabetes/HBa1C & Eye Screening & Tele-consultation

Service Innovation: Facilitated Network @ Sembawang Shipyard

Foot Screening & Skills for Life

Global Healthy Workplace Award 2013

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Piloting Population Health: A Transformation @ Sembawang & Choa Chu Kang

IN SHORT, TO CHANGE SOME 140,000 PEOPLE IN 3 YEARS

In three years, we target to support at least 50% of screened residents age 40 years and above to take greater personal

responsibility for their health.

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Ageing In Place

Design Concept 3

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Subsidised

Private

Fiscal year 2010 Fiscal year 2011

The Impetus To InnovateA Local Challenge – High Bed Occupancy at KTPH

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70% of health determinants can be changed or modified

Socio-economic pressures

Unsafe homes

Self-medication

PolypharmacyUntrained caregiver

Things we would never see until we made home visits – and those we can change

Determinants Of Health Can Be Modified

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Service Innovation: Setting Up Community Wellness Centre And Nursing Post

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Discharge triage Transitional Care Programme

Patients that requires continued medical support at home after discharge

Community Nurse Programme

Care plan

Allied Health support

TherapistsDietitian

Pharmacist

Clinical supportGP

PalliativeEarly Review

Clinic

Social supportFinancial

VolunteersDomestic support

Community Nurse Post1. Community engagement2. Early disease detection &

management

An Integrated Discharge Plan In The Community

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Home modificationEnhancement for

Active SEniors (EASE)

Collaboration with grassroots &

community agencies

Home help

Community Case

Management Service

Home medical & nursing

Temporary domestic help upon

early discharge

Integrated Single Point of Contact

AIP Partners

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Before home visits-- After home visits

Average no. of admission for a single FF

Average length of stay for a single FF

Pilot Study: Early Results400 patients completing 6 months of care

6.17 days

3.5 admissions

1.2 admissions

5.94 days

47%

No Readmission

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Design Hassle-free Experience

Design Concept 3

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Know What The Patients Value

Treat/Advise Treat/Advise DiagnoseDiagnose

Respect for patients’ dignity

Clear and accessible information

Integrated care and services

Consistent, good quality care and services

Cost effective care

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Provide a level of patient care

and service good enough for

our own mothers, without the

need for special arrangements.

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Define Hassle-free Hospital

Doing things right for the patients, and delivering value safely, from the time he enters, till he gets out of the hospital.

-wait -delay- reworks

luevalue

Wow!

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Innovation is for improving our patients’ experience and it is everyone’s responsibility.

Share a Common Understanding of Innovation

Patients Flow Fast & Yet Safe

Enhanced Allied Health Services such as Radiology, Lab, Pharmacy etc

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Patient Value Stream (SOC, DEM)

We Know You

Know meDiagnose

meTreat me Advise

me

Patient Flow

Patient Education

Head-to-Toe Diagnosis/Treatment

Anticipatory Care

20mins 20mins 20mins0 mins

0 mins 0 mins 0 mins

60mins

Information / Material Flow

Know me Recognise me

Direct meDiagnose me

Track meTreat me

Advise meClose encounter with

me

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39Pt Info

Transport

Investigations(Outpatient)

Medications

TCU

Portering

Transport

Investigations

Treatment

Diet

Pt Info

Nursing care

Portering

Diet

Pt Info

Nursing care

Surgery

Portering

Preparation

Transport

Nursing care

Investigations

Treatment

OT Listing

Pt Info

Diet

Pt Info

Investigations

Treatment

Clerking

Nursing care

Pt Info

Orientation

Portering

BMU

Financial Counselling

Dressing

Lab test

Investigations

Pt InfoAssessment

Pt Info

Clerking

A & E Triage Registration Wait for Consult ConsultationPost Consult Treatment

Discharge

Inpatient Admission

Nursing Assessment

MedicalAssessment

Pre-Operation Operation Day Post Operation Recovery

Discharge

Admission for Acute Illness

1. Medicine consists of systems, processes and interdependencies

2. Patients’ requests are not requests of parts of us, but requests of the whole

3. To make any significant impact, the change must include all

Why Is Change So Difficult In Healthcare?

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Visual Management At The Emergency Department

Consult

Info Board

Triage

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Current Way of Admitting A Patient In DEM

Front counter staff needs to use 6 different softwares to admit one patient to the ward

Financial Counselling

Hospital Patient Management & Billing

System

Checking Insurance

A&E Careline System

Bed Management System

Medisave 41

World view: top part

Bed Management: Overview of Bed Status

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Bed Management

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Bed Census

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Dr orders test in SCM

Phlebo takes & dispatches blood

Lab receives & processes blood

Blood result available in SCM

Problem:“Nurse disintermediation” syndrome.

• Nurse totally out of the loop!• Because NO more paper trail & visual cues.• Lab orders and results no longer visible unless

nurses watch SCM all the time.

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Electronic Lab Order Workflow

Problems

• CT/MRI orders with Patient Consent not easily tracked

• Nurses unable to chase doctors to obtain consent

• Numerous calls (at least 2-3 calls) needed between ward nurses and Radio dept to check consent/IV plug/fasting status, fix appt and arrange patient transport.

Dr orders MRI in SCM

Dr explains procedure & takes consent from patient

Nurse faxes completed consent to Radiology Dept

Radiology calls back to give MRI appt

Radiology calls at appt time to send patient down

MRI result in SCM

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Electronic CT/MRI Order Workflow

Nursing AndonRadiology Andon Pharmacy Andon

SCM47

13 Andon ‘Eco-Systems’

Lab Order status

Lab Result status

Rad Order status

Consent status

ECG order

Discharge tracking

Nursing Andon

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Andon Board for Pharmacy

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C-I

VO

C 2

01

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Handling PatientsHandling Patients

Quick LinksQuick Links

AppointmentsAppointments

Planned Appointment

Currently Warded

Regular Patient

C41 PSA JamilahPreviously AttendedHealth Screening

Building Patient Journey through C-IVOCC

-IV

OC

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Medical Care Me

Recognize and

Direct Me

Know Me

Discharge Me

Keep in-touch with

Me

SAP

FICO

SCM

PFS

SAPISH

iHFL

SCMSA

PISH

iHFL

SCM

SCM

SAPISH

SAPISH

Phase 1

Data from Multiple SourcesSAP, SCM and iHFLData from Multiple SourcesSAP, SCM and iHFL

iPharm

MRMS

MRMS

PFS

ELPIS

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Computerised, Integrated View of Customer (C-IVOC)

• Know me

• Identify me

• Direct me

• Track me

• Clear the way for me

• Close the encounter with me

• Stay in touch with me

Thomas*

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Use Of Technology To Improve Service At Multiple Touch Points

Experimentation in teletriage and teleconsult

Queue ViewerBed Management System

MMS – Wound Care

Self Registration

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Grab a bite!

Paging Service

Home Sweet Home

Pre-Appointment

Remindervia SMS/Letter

Appointment Day Registration

Blood Test

Consultation

Post Consult ServicesAppointme

nt & Payment

Pharmacy

“WOW @ Specialist

Outpatient Clinic ”

Preparing you for Hospital

Admission

Height & WeightChaperon

Your Your experience experience starts here starts here

Waiting for

Consultation

Meal Voucher

Touching Lives, Pioneering Care, Making A Difference,

Designing Touchpoints

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Design Approach

FOCUS ON PATIENT EXPERIENCE

Patient Value Met

• Quality • Respect • Information• Care integrated• Effective

Outcome Achieved

•Diagnose, treat, advice•Better, Faster, cheaper,•safer

Value stream

•Identify Value•Value Stream•Flow•Pull•Pursue Perfection

workplace

•Location•Layout•Automation•Human factor•Health promoting

Service/Care Processes

•Model of care•Care standards•Service standards

Customer Experience

•AH Service Ways•Touchpoint •Care point

Design

Line of visibility

DESIGN THINKING

WHAT THEY WENT THROUGH

HOW THEY FELT DURING THEIR EXPERIENCE

IDENTIFY PROCESSES THAT NEEDS TO SUPPORT THESE PATIENT SERVICES

LINE OF VISIBILITY

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Our Approach

1. Agree on what is patient Value.

2. Articulate patient value streams.

3. Identify service touch points (WOW)

4. Act on functional, mechanic and humanic clues

5. Take small steps in rapid succession.

6. Do what you can with what you have.

7. Learn, teach, design and do.

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•Do what you can with what you have

•Little touch points count

Teaching & training aid for patient and staff

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Silent clock Anti-slam device Night light

Message boardFloral headboard

Electronic patient locator

Ideas From Staff & Patients

Ergonomic food tray

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Apples and Blankets

Ideas thatSave lives

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| Design Thinking in AHS|Eye Clinic

Patient Waiting Experience

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INTRODUCTIONBACKGROUND: TO SOLVE WAITING TIME ISSUES

OUR FINDINGS: THE WAIT HAS TO BE JUSTIFIED“Patients do not mind waiting, as long as they know what, why and how

long they are waiting for.”

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INTRODUCTIONBACKGROUND: TO SOLVE WAITING TIME ISSUES

OUR FINDINGS: PATIENT’S VALUE HAS TO BE MET“I felt very shiok after the doctor did such a thorough check on me, no

wonder I had to wait so long! It was worth it!”

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INTRODUCTIONREFRAME THE PROBLEM STATEMENT

IT’S ABOUT ENHANCING THE

EXPERIENCE OF THE WAIT

AND DELIVERING VALUE TO

THE PATIENT

WAITING

TIME/TURN

AROUND TIME IN

THE CLINIC

ORIGINAL PROBLEM REFRAMED PROBLEM

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RESEARCH FINDINGSWHAT DO PATIENTS VALUE?

KTPH HEALTHCARE INNOVATION AND RESEARCH

COMPETENCYCONCERNCLARITY

To help patients feel more empowered in their experience.

To help patients feel like they are being cared for.

To assure patients that they are in good hands.

(e.g. providing a suitable waiting room environment, testing environment, the human touch)

(e.g. eliminating inconsistencies, information communicated to the patients)

(e.g. seamless processes, communication within staff and healthcare system, well-equipped machines)

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OBSERVATION FINDINGSCLUES TO PATIENTS’ ANXIETY AND NEED FOR SIMPLICITY

NEED TO KNOW THE NECESSARY“ She was telling me so many things inside, I don’t think I can remember all of them, so I

wrote the important details on my hand so that I won’t forget.”

PATIENT’S PERSPECTIVE

PATIENT’S PERSPECTIVE

“I don’t like the feeling of missing out on things I should have told the doctor after I leave the

consult room, that is why I am writing down all my problems while I wait for my turn.”

AFRAID TO LEAVE OUT INFORMATION

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RESEARCH FINDINGS

“I was trying to cooperate, but he was just dripping until the drops keep rolling down my face. He

asked me to look up, but I wasn’t sure how up is up.”

HAVING THE RIGHT ENVIRONMENT

PATIENT’S PERSPECTIVE

STAFF’S PERSPECTIVE

“From my past experience working in other eye clinics, it is a common problem to get elderly to

do the dilation drops as it is harder for them to lift up their heads.”

DIFFICULT FOR ELDERLY PATIENTS

NOT GUIDED IN THEIR EXPERIENCE TO COOPERATE WITH US

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PROTOTYPEBUTTERFLY ON CEILING AS VISUAL CUE

1st Prototype 2nd Prototype

Without Target

With Target67

OTHER PROTOTYPINGEXPERIMENTS IN THE EYE CLINIC

DILATION TROLLEY ORIENTATION GUIDE

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Job Shadowing Training Nursing Home NursesTelemedicine Exposure

Telemedicine at Nursing HomesCare Delivery Innovation

Dream Ward Service Innovation in the Wards

Mood lightingOne click

control

Flexible security

One-click room service

KTPH Navigator

Ward notifications

Visual Nurse call

Personal Calendar

Patient Message

Board

Upcoming features Health Services

Keeps track of patient’s weight without getting them out of the bed

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In-bed Patient Weighing System Improving Nursing Work Efficiency

Hopscotch How to Play InstructionsFitness Drive-through Stations

Health Promoting Innovations

• Match and exceed the best performers• Standards set by other industries• Lowest infection rate• Shortest length of stay• Lowest average bill size

Learn From Everyone

Kameda Medical Center, Japan

Mayo Clinic, Rochester, USA

Aravind Eye Hospital, India

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Learn From Everyone

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