Speech by Dr Koh Poh Koon, Senior Minister of State, Ministry of Health, at the 12th Singapore-International Physiotherapy Congress

Ms Lee Sin Yi, President of the Singapore Physiotherapy Association (SPA)

Dr Shamala Thilarajah, Chairperson and Associate Professor Kwah Li Khim, Vice-chairperson of the Organising Committee for the Singapore-International Physiotherapy Congress 2021

Distinguished speakers and guests

Ladies and Gentleman

     Good morning. I am delighted to join you at the 12th Singapore-International Physiotherapy Congress today. The theme this year, “Integrate”, highlights the vision of the physiotherapy profession to work with all stakeholders and create a future-ready healthcare system.

2     I would like to express my appreciation to all healthcare colleagues for your dedication and commitment to your patients as we all press on with the fight against COVID-19. My thanks to the organising committee too, for putting together this online event to continue collaborations and knowledge exchange despite some of the challenges that we face in the past year or so. Such efforts stand us all in good stead, as we create the future of patient care in a new norm arising from this pandemic.

TOWARDS CARE TRANSFORMATION

3     Indeed, care transformation often requires healthcare team members to collaborate and push boundaries using patients’ needs as an important compass. And if done right, we produce a whole system that functions greater than the sum of its parts.

4     The potential for physiotherapists to drive such transformation efforts is undeniable. Let’s think beyond how things have traditionally been done, and create new ground for “Integration” in Physiotherapy. Let me take this chance to share with you some possible areas where we could push the envelope.

5     The first area is systems thinking. In the words of Peter Senge who wrote the book “The Fifth Discipline: The Art and Practice of the Learning Organization”, systems thinking is a way of seeing connections, links, or relationships between things.

6     One example of systems thinking and partnership is the Stroke Community of Practice (or COP) formed by SingHealth in collaboration with the Singapore Institute of Technology. The platform gathers stroke champions from SingHealth acute and community hospitals, as well as community partners, to share best international practices and help them work with like-minded professionals beyond their organisations. Through a needs analysis, the COP has identified priority areas for clinical improvement, such as helping stroke survivors return to work. They plan to develop protocols to address these priority areas, and will also support their partners to drive change in their respective organisations. With this consolidation of knowledge, members can also access a network of organisations which provide stroke support services.

7     The second area is on value-based care. Healthcare professionals have long strived towards evidence-based research and practice. Having said that, evidence-based practice should also include the evidence of creating value, such as the recent report commissioned by the Australian Physiotherapy Association to demonstrate both health and economic value of physiotherapy[1]. While not every research project may study economic benefits as comprehensively, we should consider two additional perspectives that would help to better present the value in physiotherapy. These are patient-reported outcomes and resource utilisation. Developments in care do not always have to be cheaper, but we should be confident, they should create greater value overall.

8     One example is in musculoskeletal care. Countries such as the United Kingdom and Australia have developed physiotherapy-led models of care where musculoskeletal physiotherapists triage and provide early intervention to patients. The models were established because they were shown to create additional value through better patient outcomes and satisfaction, faster access to care, lower overall costs and better quality of life.

9     In Singapore, we are also working to make sure that those who need rehab receive the right level of timely care. Earlier this year, we announced the National One-Rehab framework. We will expand the capacity and capability of polyclinics and community providers, so that patients with stable musculoskeletal conditions such as lower back pain who do not require surgery or complex interventions can receive rehabilitation in the community, instead of doing so at our hospitals.

10     This leads me to the third area of today’s speech – seamless care for our patients or clients. Through One-Rehab, we also support therapists and patients to track their progress towards care goals using defined outcomes throughout their entire rehab journey. This will enable therapists from different care settings to have access to their patients' care progress information, and work together to support patients as they transit across the various care settings.

11     Here’s an example driven by the Amputee care team at Tan Tock Seng Hospital. They realised that their patients received a total of 15 different clinical outcome assessments by different healthcare team members. To improve the patient journey, the team set up a committee led by a physiotherapist, and comprising doctors, multiple allied health disciplines and a case manager. They mapped out the care journey of a patient with amputation and interviewed patients as well as clinicians. This helped them to identify areas which needed to be addressed along the patient’s care journey, such as patients needing more psychological support at the start of their journey. The learning points then guided the team towards skills sharing between healthcare professionals. Psychologists taught the others how to identify such patients at risk, and podiatrists trained the team to identify wounds ready for weight bearing. All in all, the team analysed their patients’ needs holistically, remained open to skill-sharing and in doing so, were able to reduce the number of clinical outcomes and streamline care for the patient.

CLOSING

12     Physiotherapists have been a mainstay of allied healthcare since its advent in Singapore 80 years ago. Looking ahead, I am sure you will all continue to play a critical role in our healthcare system. I believe our system holds immense potential for innovative models of care to be piloted. But whatever the model being studied, it should be based on systems thinking, support integrated care, and show greater overall value. I urge you to approach your future endeavours with these principles in mind. And last but not least, I wish you all a fruitful congress. Thank you.

[1] Value of Physiotherapy in Australia (2020). Report by Nous group commissioned by the Australia Physiotherapy Association. https://australian.physio/sites/default/files/Report_FA_WEB.pdf