Opening Address by Mr Chee Hong Tat, Minister of State for Health, at the Singapore Healthcare Management Congress, 16 August 2016

Prof Ivy Ng, Group CEO, SingHealth

Prof Ang Chong Lye, Deputy Group CEO, SingHealth

Mr Tan Jack Thian, Group COO and Group CPO, SingHealth

Friends and colleagues

A very good morning.

Introduction

1.    A very warm welcome to our friends overseas – welcome to Singapore, and welcome to this congress. I am happy to be here today at the Singapore Healthcare Management Congress.

2.    Now in its sixth year, this event continues to be a platform for healthcare administrators in the region to exchange insights and share best practices on hospital administration, supply chain and risk management.

Turning challenges into opportunities

3.    I think many of you are aware that Singapore, similar to many of the countries and cities in Asia, faces an ageing population. In the next 15 years, by 2030, we will see a doubling in terms of the number of seniors that we have. Today, we have about one in eight Singaporeans aged 65 and above. By 2030, we expect this ratio to increase to one in four. With an ageing population, there are increasingly complex healthcare needs and higher healthcare demands. The Government has put in place measures to expand the capacity of our healthcare system, such as building new acute hospitals, community hospitals, polyclinics and nursing homes.

4.    We are also ramping up our healthcare workforce by hiring more doctors, nurses and allied health professionals. To improve healthcare affordability, we introduced the Pioneer Generation Package and universal healthcare insurance through Medishield Life since November last year.

5.    However, doing more of the same cannot be the sustainable solution. With an ageing population and a shrinking local workforce, if we continue with the same model, the current trend is not sustainable. Today, I want to talk to you as healthcare administrators, about what we can do. You know the ageing population trend, you know the increasing demand for healthcare, you know the challenges, you know the need to continue to provide quality healthcare in a sustainable way. As healthcare administrators, you are in a good position to initiate change, streamline processes and implement better ways to deliver quality care, and to support and work with your colleagues in healthcare institutions to achieve this for our population.

Scaling up pilots and implementing innovative ideas to increase productivity

6.    Allow me to share a few commendable examples of positive change led by healthcare administrators. To enhance convenience to patients while boosting operational efficiency, Marine Parade Polyclinic launched the Prescription in a Locker Box (PILBOX for short) this year. The locker system allows patients to pick up their medication at any time of the day, at their convenience. You can schedule a date with the clinic and ask for your regular medication, which will then be put into the locker. Payment can be made at the kiosk when you collect your medication from the PILBOX. This is a win-win situation as it is both convenient for the patient, and also efficient for the polyclinic. The average time spent collecting medication is reduced from 30 minutes to just five minutes.

7.    SingHealth Polyclinics, which Marine Parade Polyclinic comes under, intends to roll out PILBOX to its other polyclinics progressively. I hope the implementation and scaling up can be done quickly, so that we can benefit more patients in different parts of Singapore. I also urge other healthcare institutions, including NHG Polyclinics, to consider implementing this idea. My request is this – since it has already been tested and proven to work, there is no need to spend more time doing further pilots. Instead, focus our resources on implementing this idea and scaling it up. I hope this can be done at different polyclinics to benefit more patients, including Toa Payoh Polyclinic, which my constituency comes under.

8.    If an idea has already been proven to work, whether overseas or in Singapore, the emphasis should be to see how we can implement and scale it up so that it becomes part and parcel of core operations. The performance measurement should not be how many pilots are conducted each year, because simply doing more pilots alone will not benefit our patients. Only when we incorporate the good ideas and practices into our core operations, will we start to make a real difference to the outcomes we want to achieve.

9.    We need to work together on this. I have asked my colleagues in MOH to get feedback from healthcare institutions and hospitals to see how we can adjust our financing schemes and policies so that we are aligned, and we are able to not just support the implementation of pilots, but also to support the scaling up and implementation of good ideas, which is equally important after the pilots have been done. This requires the policy and financing to be aligned with what is on the ground. I welcome your feedback on what we need to fix. I have formed a taskforce comprising hospital CEOs and other colleagues from the healthcare sector to work together with us. I am keen to see how we can move this in a way that will be meaningful and sustainable for our healthcare system.

Tapping on technology as an enabler and tool for higher productivity

10.    We have also seen how technology can bring about significant improvements in efficiency. For example, Changi General Hospital (CGH) has been working with global electronics company, Panasonic, to test the use of robots to deliver medicine, medical specimens and case notes ‘24-7’. This started since February last year. Equipped with sensors and programmed with the hospital's map, these robotic ‘porters’ are able to take the lift independently, navigate around the hospital and avoid obstacles. CGH uses four of these robots presently. They have helped CGH boost the productivity of its portering staff, and more importantly, they have enabled porters to be redeployed to critical services, such as the transfer of patients, which the robots cannot do. This use of technology allows us to deploy our people to do things which technology today cannot do. It takes away some of the tasks which are more routine and standardised, which robots or automation can help us with, because we are short on manpower.

11.    However, we should not encourage institutions to chase the most sexy and expensive technology as their end objective. Instead we should see technology as a tool and enabler to help us improve productivity, to enable our staff to work more efficiently and to enhance the quality of care for our patients. It is a tool to help us. We should use the tool effectively to serve our purpose, and not end up where the pursuit of technology becomes the end in mind – that will become the tail wagging the dog.

12.    In addition, the most expensive technology or drug is not necessarily the best solution in all situations. There is a need for rigorous scientific and medical assessment of the outcomes to ensure sustainability and affordability for our patients. We are moving to increase standardisation in the way we deliver care, so as to achieve better overall outcomes and value. When the relative benefits and system costs of new technologies are fully understood, clinicians, patients and administrators can then make better-informed choices. MOH will facilitate this through the provision of evidence-based guidance to healthcare institutions.

13.    Managing costs is important because eventually, whether we fund through subsidies, insurance premiums or medical fees, the money will come from all of us. Keeping healthcare costs affordable is an important priority for all of us to keep the healthcare system sustainable for all Singaporeans. To manage rising costs, SingHealth’s Group Procurement Office has streamlined and centralised the purchase of lab supplies across participating institutions. Through collaboration and active engagement of end users, the initiative achieved close to $2 million in savings. This is a good start. I believe we can do more when stakeholders cross boundaries and work together towards a common goal, so that more savings can be achieved, which we can then pass on to our patients.

14.    Beyond these, productivity improvement and innovation must be supported by the right organisational culture to ensure longer-term sustainability. An example of facilitating ground-up ideas is the Tan Tock Seng Hospital’s Nursing Innovation Fund which was implemented in 2013. The Fund provides awards of up to $1,000 to support the prototyping or implementation of good nursing innovation ideas. Since the inception of the Fund, a total of 79 ideas have been supported. One of the ideas that have been implemented is the reconfiguration of trolleys used for peritoneal dialysis to facilitate draining of fluids from 15-Litre fluid bags several times daily. Now, the bags are positioned to drain at an incline from a casement retrofitted onto the trolley, eliminating the need to lift and drain the bag manually. This reduces the physical strain on nurses and frees up time for nurses to focus on patient care. These ideas can also help us to reduce work-related injury to our staff and enable our older healthcare workers to continue working for a longer time. This is not only good for the older healthcare workers individually, it also benefits the system as we are able to continue to tap on their experience and contributions.

15.    I am pleased to know that the above project did not just stop at the pilot stage. TTSH has taken it and incorporated it as part of the hospital’s core operations. This is what we need to encourage and support. While implementation may not be as glamorous as starting new pilot projects, it is critical in achieving our strategic objective of enhancing value and improving healthcare sustainability.

Reviewing workflows to enable healthcare professionals to practise at top of licence

16.    We want to review our workflows to enable all groups of healthcare professionals to practise at the top of their licence. From the feedback I have received, many of our schemes today require doctors to certify the patients before subsidies can be extended.

17.    We are reviewing this arrangement to see how we can allow our doctors to focus on handling the more medically complex cases, and empower our nurses and allied health professionals to perform some of the roles of assessing the most appropriate care for patients. This can help us to maximise the way we deploy our scarce healthcare manpower resources, so that each group of healthcare professionals can practise at top of licence. This is something which MOH cannot do without your inputs. We need your feedback to know where are the policy and process pain points, so that our policies can support what you do on the ground.

Providing a supportive, safe and conducive environment for our healthcare workers

18.    Finally, it is important for us to provide a safe, supportive and conducive environment for our healthcare workers to care for patients.  I watched the video by NUH called “Everyone Matters”.  It is a good video, I encourage you to watch it.  One trend that we are quite concerned with is the rise in abusive behaviours towards our healthcare workers, although it involves only a small minority of patients and family members at this point. Such abuse could be verbal or physical. I have discussed with the Union and our healthcare leaders, we agree on the need to take a common and united stand against such abusive behaviours. It is not right to abuse healthcare workers who are putting in their best effort to care for our patients. This will affect the way they work, their morale, and the care for other patients. We need to put in place safeguards to protect our healthcare workers, to support them, and provide a safe and conducive environment for them to provide good quality care for patients.

19.    We welcome constructive feedback and suggestions for improvement. But there is a difference between raising complaints and providing feedback for improvement, versus abusing healthcare workers. We welcome feedback on where we can do better, but please treat our staff with respect and allow them to do their work professionally. This is important because if we create a negative environment for our healthcare workers, not only does it compromise their productivity and quality of care for patients, it also discourages young Singaporeans from entering the sector.

Conclusion

20.    Through this congress, I hope you will pick up new ideas and forge new partnerships in the journey to transform our care models and achieve better outcomes for our patients. That is the end in mind. Whatever we do, we focus on the care for our patients. The road ahead will be tough as we need to regularly question existing assumptions, review our policies and processes, and be willing to take bold steps to try new ideas and very importantly, integrate them into our core operations, to scale them up and make them part and parcel of our system. To succeed, I think it is important for all of us to work together and help one another. We need to pull together our collective efforts to achieve this Herculean task.

21.    Thank you everyone, and I wish you a fruitful Congress.