KKH's 3rd Annual Scientific Meeting & Opening of Paediatric Simulation Training Centre

06 Jul 2007

By Prof K Satku

Venue: KK Women's and Children's Hospital

Mr Bernard Chen

Chairman, SingHealth

Professor Ivy Ng

Chief Executive Officer, KK Women’s and Children’s Hospital

Professor Tay Eng Hseon

Chairman Medical Board, KK Women’s and Children’s Hospital

Dr Vincent Yeow

Chairman, Organising Committee

Distinguished Guests, Colleagues

Ladies and gentlemen

Good morning

It gives me great pleasure to join all of you here today, at the KK Women’s and Children’s Hospital 3rd Annual Scientific Meeting and opening of the Paediatric Simulation Training Centre.

SETTING THE STANDARD

The theme of this year’s scientific meeting is “Setting the Standard – Leadership in Clinical Outcomes and Training Excellence.”

The theme reflects KK’s determination to be a leader in setting the standards for service delivery, clinical care and training excellence.

KK has a rich history of medical excellence and world-class achievements. I am confident that with strong leadership and unwavering commitment, KK will continue to soar to greater heights.

What does setting the standard mean? I interpret it as being in the forefront of excellence, creating excellence itself, or in other words, setting an example for others to follow.

In KK’s context, that would mean striving to be the premier women’s and children’s hospital, not only in the region, but also worldwide.

In achieving medical excellence and setting the standards, I would suggest a three-prong approach, namely,

Teaching Excellence

Service and Clinical Care Standards, and

Scholarship

Teaching excellence is one of the pillars of a premier hospital.

All of us have benefited from the selfless devotion of many quiet heroes who have taken time to teach and mentor us.

Mentorship not only serves to transmit the necessary clinical skills, but also to pass on the right attitudes and professional values.

With a heavy caseload and multiple responsibilities, it seems increasingly difficult to find time to teach the next generation of colleagues.

Let me convince you that time spent teaching is time well spent.

Firstly, more than mere transmission of knowledge, teaching leaves a legacy. Generations will benefit from your teaching - what you teach your juniors will be passed on to their juniors and for many generations to come.

Secondly, teaching results in innovation. The teacher’s interaction with inquisitive minds often throws up new perspectives. It is precisely because our juniors are fresh that they can see things from a fresh perspective.

Through answering questions such as “why” or “why not”, we often discover new ways of doing things better.

Thirdly, teaching promotes a collegial atmosphere.

Although it is important to compete, it is just as important to share ideas and learn from each other. Exchanging ideas and learning from each other builds synergy.

Not only does the individual benefit, the organisation as a whole benefits. Moreover, collegiality amongst healthcare professionals provides for a friendly and productive working environment.

Health care professionals desire to work in an institution where there is goodwill because there, they have opportunities to grow and contribute at the same time.

Last but not least, teaching ultimately benefits the patient. Having an environment in which teaching is emphasised will raise the standards of care. Patients are the ones who will ultimately benefit from it.

My Ministry supports your efforts by providing the resources to ensure that trainees have protected time to engage in learning, but it takes strong leadership at all levels of the organisation to transform the hospital into one that promotes nurturing of the next generation of health professionals.

Next, I shall touch on service and clinical care standards.  

I commend KK for setting the standards and benchmarking itself against reputable centres overseas.

I note from your hospital website that your Neonatology Department has done very well in an outcomes study with the Vermont Oxford Network.

Your hospital was in the best quartiles for bronchopulmonary dysplasia, severe intraventricular haemorrhage and coagulase negative staphylococcal infection. Your hospital had lower rates of these complications compared to the overall average in the Vermont Oxford Network. 

I trust you will continue to excel.

As healthcare becomes increasingly complex, one of the more powerful tools to emerge to ensure consistency of standards are protocols.

These protocols come with different names, depending on how you define them.

There are clinical pathways, critical pathways, care paths, clinical protocols, clinical guidelines, decision support tools and a myriad of others of a similar nature.

To varying extents, protocols ensure consistency of standards of care, reduce unnecessary variation, improve quality of care and reduce utilisation of resources.

Recognising their importance in ensuring standards, healthcare institutions have embraced the use of these clinical protocols and pathways, and quite rightly so.

I too will commend protocols to you but I must also caution that protocols have limitations and cannot be the panacea for our shortcomings, be they inadequately trained healthcare workers or overworked staff.

Recently I was asked to approve the transference of function from one group of healthcare workers to another and was assured that protocols were in place to ensure patient safety.

When I asked whether the health care workers who were taking on the job had been trained to do the task, I was met with silence.

More recently I came across an interesting article in the May issue of Casebook, a journal published by the Medical Protection Society.

It describes a phenomenon known as involuntary automaticity, somewhat akin to total autopilot mode, leading to serious errors despite the application of a protocol.

An example cited was a patient in UK who received the wrong dose of radiotherapy 14 times, despite having a protocol in which the parameters were double checked by different staff at different times.

While automaticity is usually discussed in terms of bringing about benefits such as increased efficiency, it could also result in persons involved becoming oblivious to glaring errors.

The point I want to make is that whilst clinical protocols and pathways which promote consistency of care are invaluable to ensuring standards we should recognise their limitations. We should never fall into a checkbox mentality and believe that when all boxes are checked, the patient is well.

We must also guard against the use of protocols as “mental crutches”, which has the effect of limiting our natural inclination to constantly innovate and find ever better ways to solve a problem or to treat a condition.

We should train our staff well, design our protocols so that it always engages the thinking faculties of health professionals and allow room for clinical judgment based on the individual circumstances of the patient.

Next, I shall touch on scholarship. The Royal College of Physicians and Surgeons of Canada formulated the CanMED framework which identified seven core competencies for medical education and practice.

These core competencies reflect the abilities required to provide the highest quality medical care.

The seven competencies identified are Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Professional and Scholar.

This morning, I shall focus on the role of the Scholar. The core competence of a scholar as defined by CanMEDS is the ability to “demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.”

In brief scholarship allows the creation of knowledge through research and reflective learning.

Research provides your institution with an edge over others. I note that KK has had many impressive breakthroughs that have contributed to the creation of new knowledge and excellence.

Asia’s first In-Vitro Fertilisation baby was delivered in KK in 1983, and Asia’s first GIFT (Gamete Intra-Fallopian Transfer) baby was born at KKH in 1986. I note that KK is currently involved in research in many aspects of women’s and child health.

I applaud your efforts and encourage you to continue to expand the scope of research.

Contrary to what many want us to believe, scholarship should be part and parcel of clinical care.

It should not just be the domain of a selected few, but should be an intrinsic part of every health professional.

Whether it is the humblest review of literature for a case report or a ground-breaking discovery, every time you engage in scholarship, you emerge for the better.

That’s why CanMED identified scholarship as one of the core competencies of health professionals.

INCREASING NATIONAL FERTILITY RATE

While I leave you to ponder on ways to achieve medical excellence and set standards, I shall now move on to some other pressing challenges.

At your hospital’s first Annual Scientific Meeting just two years ago, I had encouraged you to take on two challenges:

One, adolescent health where much is now being done and I shall touch on in a moment, and the other, on helping to improve the national fertility rate, where more work can probably be done.

Medical evidence has shown that a woman’s fertility decreases with age. Even though pregnancies are delayed for a whole host of different reasons - career, financial, social or personal reasons – many women make this trade-off incognizant of the fact that their chances of conceiving a baby declines even as their other priorities take centre stage.

This under-appreciated fact may translate to higher rates of Singaporean women seeking assisted reproduction, but given that these techniques are not foolproof, the more important implication is that affected couples may miss out on their chance to have babies, the chance to enjoy a happy and rewarding family experience.

KK being the premier hospital caring for our women and children should see this as an opportunity to extend their duty of care in a holistic way.

You can play a leading role in educating and providing young Singaporean couples with the necessary knowledge to make the informed choices for themselves.

Your actions can make a big difference to their lives, and will hopefully reverse our falling fertility rates.

ADOLESCENT HEALTH

As for adolescent health I cheer you on in your efforts.

Around the world, it is increasingly recognized that the adolescent population, youths aged 10 to 19, has special and specific health needs.

A period marked by physiological changes coupled with mental and psychological maturation of individuals, the adolescence phase is distinctive from childhood and adulthood.

While the discipline of Adolescent Medicine is relatively new and that there are relatively few physicians trained in Adolescent Medicine worldwide, it is timely for Singapore to develop expertise in this area and to devote sufficient resources for the provision of medical services for this segment of the population.

I am most happy to hear that KK is looking into the development of adolescent health and has submitted a HSDP application for a pilot programme targeted at improving the health of adolescents through focussed interventions for at risk individuals, such as 1) adolescents with chronic illness, 2) adolescents with pregnancies and victims of sexual assault and 3) adolescents with obesity.

This Adolescent Health Initiative aims to show that adolescents with an identified health issue will benefit from a multi-disciplinary approach to their needs, along with key input from the specialist for the primary problem.

I understand that my colleagues at MOH are currently evaluating this proposal.

Personally, I am more than delighted with this initiative.

CHILD & ADOLESCENT MENTAL HEALTH

I am also pleased to learn that KK has started to develop its Child and Adolescent Mental Wellness Service.

For now, I understand that this is an ambulatory and a collaborative consultative service to cater only for internal referrals. But to me it is a critical development.

As a nation, we have done very well in terms of eradicating debilitating infectious illnesses through national programmes such as the Childhood Immunisation Programme.

But what about the mental health and mental well-being of our youths?

It is widely accepted that healthy young minds and bodies form the cornerstone of a healthy nation.

A community study estimated the prevalence of emotional and behavioural problems in Singaporean children 6 to 12 years old to be 12.5%. Another local study has found that 7.4% of young girls are at risk of eating disorders.

More startling perhaps - is the knowledge that 100 kids in the 10 to 19 age group attempt suicide and out of this 100, 10 succeed.

For me, even one suicide is one too many.

But what has KKWCH to do with mental health?

Children who are victims of accidents, violence or, abuse or who are exposed repeatedly to invasive medical procedures due to chronic illnesses such as cancer or cardiac conditions, live with great emotional stress.

This can result in post-traumatic stress disorders and other psychiatric conditions such as anxiety, depression, panic attack, borderline personality and substance abuse.

Indeed, research has found that early exposure to stress and trauma impedes neurodevelopment, increasing an individual's risk of psychiatric disorders, and can have a negative effect on the individual's core identity and ability to relate to others.

Despite their long-term impact, the effects of emotional stress are generally under-appreciated and seldom treated.

It is therefore important for KKH to adopt a holistic approach in managing child and adolescent medical conditions by incorporating mental health services into the overall framework of service delivery.  

The Ministry recognises KK’s difficulties in building a strong unit for child and adolescent psychology medicine, and is willing to support you in developing this initiative.

In view of the tight constraints at present, in terms of specialised manpower at the national level, I strongly urge all relevant professionals and other stakeholders across our institutions, both public and private, to collaborate and lend their expertise to aid in establishing a strong adolescent and child psychology medicine unit at KK.

Wherever necessary, we can also consider recruiting from abroad. I am sure that the Specialists Accreditation Board will be happy to recognize the appropriate specialists to help us in this endeavour.

I look forward to KK becoming a one-stop holistic preventive and treatment centre for all aspects of paediatric and women’s health.

CONCLUSION

On this note I would like to wish you all a very stimulating learning and sharing experience at this year’s ASM.

Thank you and have a pleasant day.