The Opening of the Inaugural Joint Commission International Practicum

26 Jun 2006

By Ms Yong Ying-I, Permanent Secretary

Venue: Swissotel, The Stamford

Good morning ladies and gentlemen,

It gives me great pleasure to welcome you to the opening of the first Joint Commission International Practicum in Singapore, which brings together 82 participants for an intensive, stimulating interaction with the JCI faculty.  I would particularly like to welcome the international participants who come from all over Asia, and as far away as Saudi Arabia and Angola.  I am delighted by the overwhelming support that you have given for the Practicum. 

I would like to thank JCI for accepting my Ministry's suggestion to host the international practicum in Singapore, the first time a Practicum is being held outside the Americas.  I hope that the very strong demonstration of interest has further encouraged you to consider holding future events in Singpaore.  My thanks also to our three public hospitals - Changi General Hospital, National University Hospital, and Tan Tock Seng Hospital - for voluntarily submitting their facilities and resources for the two-day accreditation survey simulation.

The International Demand For Accreditation

The strong international interest in accreditation is a good thing.  IT shows that healthcare organizations in different countries may differ in their philosophies and structures, but they share a common goal, which is to provide safe and high quality care to their patients.  I am certain that the fact participants from 12 countries in this room today all share this common dedication and obligation to the customers you serve.

I believe that the strong international interest in accreditation is founded on 2 key factors.  First, the rising middle class in developing countries around the world, and their rising expectations of the quality of care they want to receive.  Second, the globalization of healthcare as an industry, where it is now quite common for patients to travel halfway round the world in search of affordable care with the best treatment outcomes.  This includes well-informed patients from the west seeking medical treatment in Asian hospitals whereas it was the other way round not that long ago.  In general, patients will only venture outside of their own countries if they can be assured that the safety and quality of care they receive out there is at least as good as, if not better than, what they get at home.  This creates both strong incentives and strong pressures for healthcare organizations in every continent to create safe environments that emphasize quality, safety and continuous improvement.

This is where healthcare accreditation can play a critical role.  Accreditation measures a hospital's performance against the best international standards, and, in the process stimulates continuous systematic improvements that lead to better outcomes of patient care.  Receiving international accreditation helps assure patients from home and overseas of standards. Hospitals have recognized this -- today, there are accredited hospitals in the Middle East, Europe and in the Asia-Pacific region.  The Joint Commission has emerged as the leading international standard, based on JCAHO's successful track record of accreditation in the US that spans half a century.

Singapore's Accreditation Journey

Singapore was keen to host this Practicum because we are deeply committed to our quality journey.  My Ministry facilitated this effort because we believe that the quest for good quality patient care must begin with an intrinsic desire in every individual healthcare professional and within each organization.  Regulation alone will not be able to achieve this.  Hence we encourage accreditation but we have not mandated it.  I am proud to note that we are the only country in the world where all our public sector hospitals are JCI accredited.  Our private hospitals are currently also preparing themselves for accreditation and I look forward to their achieving this recognition as well.

Indeed, I was delighted to hear that the 3 hospitals that have volunteered themselves for the simulation have received special commendation from JCI in the areas of clinical pathways, leadership, infrastructure, and systems and processes. Tan Tock Seng Hospital was recognised for their use of multi-disciplinary pathways to reduce unnecessary and undesirable variation in clinical care.  National University Hospital was noted for its leadership in promoting quality and safety in patient care.  And Changi General Hospital's multiple clinical pathways had have the highest compliance rate among physicians to deliver safe patient care.  I applaud your dedication and commitment, and hope you will keep you the good effort.  I'm confident that participants at the Practicum will benefit from the learning journeys to your facilities.

The Customer - A Force For Quality Improvement

Now, I would like to touch on an aspect of care which, I sense, will resonate with many of you.  That is the role of the customer in pushing for quality.  Rising costs, an educated population, greater availability of information from the internet, and the ability to compare data, have made customers a more powerful force in healthcare provision.

It has been known for some time that clinical outcomes can vary widely across institutions.  For instance, let me cite a statistic from "HealthGrades", which is a leading independent healthcare ratings company in the US.  A 2006 HealthGrades study of 5,122 non-federal hospitals in the United States showed that the top 5 percent of hospitals have, on average, a mortality rate 27 percent lower, and a complication rate 14 percent lower, than the average hospital.  But as many of you know, measurement of performance is a controversial subject for clinicians.  Performance measures are not necessarily welcomed by everyone in the profession. 

Now, market trends suggest that customers are increasingly willing and able to make choices based on quality.  Each month this year, the HealthGrades websites have attracted more than 2 million users, and the numbers are rising.  The US Center for Medicare and Medicaid Services has a Hospital Compare website with a growing bank of patient safety statistics  available to viewers.  In the UK, the NHS which has been desperate to show that patients are getting value for money in the face of rapidly rising costs, has gone to the extent of inspecting doctor's surgery and giving them star ratings.  This is supposed to enable patients to tell the quality of care by General Practitioners at one glance.  Wow! This is like Michelin-style rosette ratings for restaurants.    I am sure that participants here, who are all from the supply side, will find this shift in customer behaviour thought-provoking.

Singapore's Approach Towards Engaging The Customer For Quality Improvement

What have we done in Singapore in terms of engaging customers?  You might find it interesting to know that our focus has been on price transparency.  Patients are routinely given financial counseling before admission into a hospital, both in the public and private sectors.  Not too long ago, my Ministry started publishing the average bill sizes of the top 70 disease conditions and surgical procedures.  The intent was to create an awareness among providers in similar clinical disciplines that there was room for greater efficiency and productivity gains.  We invited the private sector institutions to join in, starting with pricing data for a smaller range of conditions and procedures which they can gradually expand on.  Not surprisingly, customers greatly welcomed this.  As for results achieved, we believe that the decrease over time in bill sizes for some surgical procedures and treatments, has been a direct result of pricing transparency. 

We have recently started publishing occasional papers highlighting the outcomes of selected clinical procedures.  Again, the media and public have expressed strong support for the publication of such information.  Our next challenge will be to push for greater transparency in outcomes of care.  One of the ideas my ministry is exploring is how we can adapt models such as the Center for Medicare and Medicaid Services' Hospital Compare site for local use.   But for a small country like Singapore, we will benefit from benchmarking not just locally, but with comparable institutions in the rest of the world.  In this regard, we would greatly welcome opportunities to tap into the network of Joint Commission accredited hospitals to benchmark ourselves and share and learn from each other.

Conclusion

Let me conclude by observing that accreditation plays a significant role in facilitating the process of transparency and in assuring customers of the quality care that they can expect.  I do hope that it will be possible to take transparency further by benchmarking outcome and cost information across accredited institutions, as this would raise the overall value of accreditation. 

On that note, let me wish all of you a very enriching and stimulating learning experience, and every success in your efforts to transform your institutional practices in pursuit of the goal of delivering effective, safe, timely and efficient patient-centered care.

Thank you.