Making polyclinics hassle-free

28 Sep 2008

By Khaw Boon Wan

1. SPS Hawazi, PS Maliki and I welcome all of you to our constituency.

Getting better

2. As this polyclinic serves our constituents, we get direct feedback on its service level. Dr Jason Cheah and his polyclinic staff are hence under some pressure! But they have done well. There are some complaints, but many residents have told me that services have improved.  And it is not just here at the Woodlands Polyclinic. Some residents have visited other polyclinics such as the Toa Payoh Polyclinic, and said that there have also been improvements there. 

3. The problem of long waiting for walk-in cases remains, but those who come for chronic disease management under the Family Physician (FP) Clinic are pleased with what they get. There is not much waiting as their attendances are through prior appointments. They get to see the same doctor. They also get to spend more time with the doctor. FP Clinic charges a few dollars more than walk-in clinic, but the patients find it good value for money. I congratulate Dr Jason Cheah and his team for such a service innovation.

But let’s raise the bar

4. Last week, I commended the public healthcare sector for achieving a higher patient satisfaction level than before. But I also challenged them to raise the bar and go for further improvement. The renovated Woodlands Polyclinic will enable it to further improve on its service level. Its physical facilities are now elderly friendly. Access is barrier-free and older patients will find it easier to move around. Waiting areas through re-layout are bigger, with more seats. More importantly, it is leveraging on IT to change its processes so that patients receive better, faster and safer care. There are self-registration kiosks and there will soon be machines to enable automated blood pressure, height and weight measurements.

Let’s make polyclinics hassle-free

5. Dr Jason Cheah told me that his team have not yet completed their mission. Their mission is to transform the way polyclinics are run to benefit the patients in significant ways.

6 They want to eliminate unnecessary visits to the polyclinic. This will save patients’ time and money. Quite often, clinics make patients come back just to review the results of their blood tests or X-rays. This can be avoided. With teleradiology, X-ray scans can be reported on the same clinic visit, even though the polyclinic does not have a resident radiologist. Blood test results can be conveyed to patients via telephone or email or sms. These changes are already happening, but we must make them routine, rather than exceptions.  

7. Dr Jason Cheah’s team also want to better coordinate the care for their patients. Lack of care coordination is a big problem faced by many patients not just at polyclinics but also at hospitals. They receive care from multiple healthcare providers, but the schedule of care and services rendered are seldom well-coordinated. This problem will grow as our population ages, as elderly patients tend to present with multiple illnesses and disabilities, requiring services from many healthcare players, including doctors, nurses, physiotherapists, pharmacists and dieticians. Good care coordination is a very difficult challenge, but when well executed, saves the patients tremendous time, cost and inconvenience. We must try to address this and do it well. We must make polyclinic care hassle-free for the patients and their family members.

And hospitals too

8. Meanwhile, over in Yishun, another team is working to make the new Khoo Teck Puat Hospital hassle-free. When open in 2010, it will serve the 700,000 residents in the north. I have entrusted this mission to Jennie Chua and Liak Teng Lit. They are passionate about this mission. I know they will not disappoint. They have promised a new experience for patients in their new hospital; something that will distinguish their care from existing hospitals: more one-stop services, better coordinated care, less waiting, less unnecessary pushing from pillar to post.

9.       The team at the Changi General Hospital, led by Mr Udairam, is also trying to raise the bar of service level, to benefit the residents in the east. 

10.     We will see which team does better. This is the sort of competition that we welcome. Each hospital, each polyclinic tries to out-do the others to make their services more satisfying to their patients, with less fuss and unnecessary wastages. Healthcare services should really be hassle-free. Patients are already sick with anxiety and pain, we should not add to their misery by our bureaucracy and inefficiency. Healthcare services are already costly to provide, we should not add to the cost with unnecessary care and irrelevant frills.  

11.  Some service improvements are happening. For example, TTSH Rheumatology Department works closely with Ang Mo Kio Polyclinic to reduce unnecessary referrals. This saves patients cost. Some polyclinics have special arrangement to refer specific patients to certain allied health services in the hospitals, without the need for the patient to see a specialist. This cuts down an unnecessary visit to the specialist and also reduces the cost to the patient.

Seamless, integrated care

12. Inherent in this transformation journey is the need for all healthcare providers, i.e. hospitals, polyclinics, nursing homes, GPs and home-nursing staff, to work together in a coordinated, integrated and seamless manner. Patients will need to move from one care setting to another as their illnesses progress. We must be able to refer and hand them over from one professional to another smoothly, without losing valuable information or time.   

13. We should get inspiration from F1 and strive to achieve the high level of coordination, integration and seamless transfer among the professionals at the F1 pit-stops. In 5 seconds, the pit crew of 20 professionals jack up the car, change 4 wheels, fill 65 litres of fuel, adjust the front wing, clean the radiator ducts, lower the jacks and send the car back out onto the track. While the drivers receive most of the attention, the pit crew often represents the difference between winning and losing. While we are seldom in such every-second-counts scenarios, except at the Emergency Room when a life-threatening casualty arrives or when Code Red is declared, we are far from such a high-performance level. Some medical records are still missing in transit, resulting in patients and doctors having to wait at clinics. Some test results are still not available, resulting in tests having to be repeated, adding to the cost for the patients. Transfer between hospitals and nursing homes is seldom smooth. Even within a hospital or a polyclinic, the movement of many patients from clinic to pharmacy is still marked by long waiting, when e-prescription should theoretically have removed such bottlenecks. We have much more work to do.

14. Emergencies and walk-ins are unpredictable and some waiting is inevitable. But most of our patients are non-emergencies and repeat patients with their chronic diseases well-known to us. There are standard protocols to manage their chronic diseases, not unlike motor workshops’ regular maintenance schedules for motor cars.  We ought to see how we can emulate the engineers and mechanics. 

Let’s keep Singaporeans healthy

15. We have nevertheless done well but let’s not be satisfied with incremental improvements. Let’s go for a transformation. In so doing, we have to confront old habits and ground rules. Not all ground rules are wrong and have to be ditched. But some old habits may have to be dropped.

16. In any transformation, there will be some downside risk, but we now have strong teams in place. They are out-of-the-box thinkers but are also prudent doers. I will champion their cause, to help them achieve this challenging but rewarding mission.

17. The result will be a new model of delivering healthcare to Singaporeans, sharply focused on the patients, with strong emphasis on prevention and health promotion and not just treatment in times of illness. In engineering term, we will still need excellent car repair workshops, but most of the activities are focused on scheduled preventive maintenance, with car owners playing an important part. It will be a model where all providers work together and in partnership with patients to help Singaporeans lead healthy lives. To succeed, our staff, whether in hospitals or in polyclinics, will have to often get outside of their workplaces, to get involved with community and grassroots health-related events and activities.  Such events are good opportunities to offer health tips, promote healthy lifestyle, and simply make friends.  My Sembawang grassroots leaders and residents stand ready to welcome you, with open arms.

18. On this note, let me congratulate the management and staff of NHGP on the re-opening of Woodlands Polyclinic.