1st KKH Formal Lecture and Dinner

10 Jul 2005

By Mr Khaw Boon Wan, Minister For Health

Venue: THE Ritz-Carlton, Millenia

"FROM GUINNESS TO BRIGHAM"

My first encounter with the KK Hospital was in 1984. I was then given the task to start up the newly built NUH.

From KKH to NUH

I went to the KKH to consult the late Prof SS Ratnam. His reputation was awesome and as a young officer, I went to the meeting with some anxiety. But he quickly put me at ease; in fact we hit it off very well. Our first positive encounter eventually led to a long and productive working relationship in NUH.

It helped ensure a smooth transfer of the University O&G Department from the old KKH to the new NUH.

From NUH to KKH

Later, when the government decided to restructure the other public hospitals, my involvement in this assignment eventually led me to KKH as its CEO in 1990.

During that posting, I became involved in the planning of the new KKH and chaired its Hospital Planning Committee. One basic issue which we had to address was whether it was still appropriate to build a maternity hospital in Singapore.

From Mother to Child

It was divisive, with many holding different and strong views. Many were against a hospital solely devoted to O&G, as some patients might have other medical problems and would require multiple specialists for joint management. The positive experience of the new O&G Department in SGH led by Prof Charles Ng lent considerable weight to this school of thought.

But the past reputation of KKH as a maternity hospital tilted the debate somewhat. The KKH brand name was considered too valuable to be diluted by other medical specialties if it were to become a general hospital. After all, which other Singapore hospital has the honour of a place in the Guinness Book of World Records? More significantly, the KKH name was associated with the first IVF baby and many other breakthroughs in O&G. Prof Ratnam's Unit was a mecca for doctors and clinician scientists. KKH was on the world stage, synonymous with excellence in O&G.

The paediatricians joined in the debate. Unlike the obstetricians, they were unanimous in arguing for a Children's Hospital in Singapore. They advanced a clever argument that adding a Children's Wing to an O&G hospital would help realise their dream, besides bringing other medical specialties to the women patients who might need them. That settled the debate. Hence, the KK Women's & Children's Hospital was born.

Keeping Our Roots

But we made a conscious decision to retain "KK" in the naming of the new hospital. Through these initials, we keep the historical linkage to our roots.

I played a part in planning the new KKH. It is a beautiful hospital with an efficient layout. But we made our share of mistakes. We had not fully anticipated the significant drop in birth rates. In particular, we failed to anticipate that Medisave would lead to more births in private than in public hospitals. Unlike the past when practically every Singaporean was born in a public hospital, Medisave made it affordable for many mothers to deliver their babies in private hospitals.

Losing Business

The combined effects of these two structural trends have resulted in the new KKH being under-utilised. Bed occupancy is about 65%, below average. Number of babies born is one-third what it used to do.

The question is where do we go from here? One obvious response is to fight and win back our obstetric market share. This means fighting with the private hospitals for a share of a shrinking pie.

What for? As a government, we should be pleased that Singaporeans are finding private obstetric care affordable. Then our limited resources can be re-deployed to serve more pressing needs, like oncology and geriatrics, where patients may not be able to afford private hospital care. Time to Change

At the same time, when we look beyond O&G, we see women living longer and presenting with many conditions which require our care: osteoporosis, oncology, geriatrics, strokes, etc. Their needs beyond O&G are growing and contribute to the crowding in the general hospitals. See the long waiting in TTSH Emergency Department as an example.

So I suggested to Dr Ivy Ng that we rewrite the mission of KKH to go beyond O&G. Besides the Children's Hospital which should continue to benchmark against the likes of the Boston's Children's, let's also aim to be the best hospital in Asia for women's health, serving all the healthcare needs of women as well. A good model for this development is Boston's Brigham & Women's Hospital. Let's be the Brigham's of the East. In Asia, there isn't quite such an entity yet and we have the potential to fill this gap.

It struck an immediate chord among the clinicians there. They were seized with it and were ready to charge ahead. I was infected by their enthusiasm. I advised them to work out a practical strategy that allows us to pursue this incrementally and opportunistically. My side interest is also to help relieve over-crowding elsewhere, in TTSH and SGH.

After extensive discussions, we now have a plan to work towards this new goal. KKH will progressively expand its existing services, adding medical specialties that will complement its existing O&G services. It will also include specialties that have the potential to draw international patients.

Over the next few months, the following specialty services for women will be added or expanded: the Breast Service, ENT Service, Orthopaedic Surgery and Plastic, Reconstructive and Aesthetic Services. Once these have stabilized, new services such as Ophthalmology, Psychological/Psychiatric Services, and Adolescent Medicine will be considered. With this full suite of services, KKH will be able to cater to all the special healthcare needs of women, just as it is already a comprehensive general hospital for children.

Used to Remaking

I am optimistic that the new goal can be achieved. KKH is used to re-making itself and thrive. When it started off nearly 150 years ago, it was a general hospital for both locals and foreigners. Over the years, it was at various stages, a hospital for seamen, a police hospital, a pauper hospital, a war-time emergency general hospital, a women's hospital, and now a women and children's hospital. But for most of its long history, it served the needs of women and was hugely successful.

And neonates too. During my term in KKH, I was particularly struck by the dedication and devotion to excellence by our neonatologists, led by Dr Tan Keng Wee and Dr Ho Nai Kiong. Both were some of the most competent, and yet pleasant, clinical heads I have the privilege of working with. With falling birth rates, the bureaucratic response would have been a merger of both neonatal units. But this would have been a disaster.

I kept the two units apart, so that both could continue to compete, not in a silly destructive way, but compete to produce the best results for their patients. They pushed the frontier of neonatal care and as a result, I believe KKH is now among the best in neonatology in this region.

At the same time, our paediatricians are diligently converting their dream of a hospital for sick children, to reality: advanced care that matches some of the best elsewhere, yet very caring and holistic. Singaporeans should be very proud of our Children's Hospital which has an expanding international patient base.

Leader in the East

KKH has strong and deep roots. It has good genes to be able to grow into a mighty institution. It can be a world leader, for example, not only in conjoined-twin separation surgeries, but also to help the patients lead as normal a life as possible, through proper rehabilitative care. It can be a world leader in all aspects of women's and child health.

Besides medical excellence, we must particularly up-hold our high ethical standards. Prof Ratnam used to lament at unnecessary caesarean sections. He suggested to me that we should equalise the consultation fee for delivery, whether it was vaginal or caesarean. I thought it was a sensible idea and NUH became the first public hospital to do so. I hope this is now the standard model for charging deliveries, at least in public hospitals.

Prof Ratnam also taught me the importance of peer review and transparency in both clinical and research activities.

But we were not perfect. Once, a colleague in the mortuary made a mistake. He released the wrong dead baby to a couple. The baby was duly buried. Soon after burial, we discovered that the baby actually belonged to another couple who had earlier decided not to claim the body. The second baby was still in the mortuary.

It was a devastating discovery for us! But we did not take long to decide that we should come clean, admit the mistake, make amends and change work procedures to ensure that such mistakes will never recur.

For those of us who went through the trauma, it was an enduring lesson in the importance of living by our high ethical standards. I hope that over time, more of these little anecdotes will emerge and join the KKH institutional memory. That is how values get transmitted; that is how great institutions are built.

With rapid advancement in medicine that allows us to do ever more for our patients, healthcare professionals will face ever greater ethical, philosophical and even religious challenges. Just because we can, does not always mean that we want to. It takes considerable wisdom to know when to intervene and when to let go. There will be many questions that past generations of healthcare professionals never had to confront, but you will have to answer. Having strong and deep ethical roots will help you resolve the many dilemmas you will surely encounter.

The Best Is Yet to Be

KKH was one of the great institutions before. It has what it will take to be among the very best in the future. Adapt to the changing needs of the patients here and in the region. Serve them well. Be guided by strong principles and ethical standards.

Work at it and good luck.