SGH Quality Convention 2013- ‘Radical Improvement’

I was the guest speaker at the Quality Convention earlier today. It was good to catch up with so many old friends but at the same time a little disheartening to hear of the challenges faced.

My topic was “Radical Improvement” in Singapore healthcare- Desperately Needed (Slides used attached SGH20130327 SGH Quality Convention JL ). Hope I got my main points across:

  1. Quality of care for individual patients who have managed to get into the system has likely improved tremendously; however we need to be concerned about those who are kept out due to capacity constraints
  2. The situation is not likely to improve infrastructure-wise as our bed and manpower situation are lagging significantly and even with the new hospitals announced, we will still be far behind the OECD average
  3. The intra-institution optimization is essential but insufficient; there is little choice but to embrace seemingly radical options. Status quo is the worst option.
  4. As a country and as a system, we need to reframe our role as being health instead of healthcare. This would mean even specialist centers and hospitals utilizing every patient encounter to offer preventive health services and plugging care gaps such as missed screening, poor control of chronic conditions etc. The American healthcare group Kaiser Permanente through its ‘Proactive Office Encounter’ does this very well.
  5. Another major effort could be focused on re-designing healthcare provision and I framed this as:
    1. Self-care: Do we really need a medical consultation and certification for every minor ailment? Singapore’s kidney dialysis population is made up of 80% hemodialysis (care delivered in dialysis centers by nurses) and 20% peritoneal dialysis (largely home-based and self-service). This is the reverse of Hong Kong despite us both being city-states and predominantly Chinese. Imagine how many nurses could be re-deployed to other roles in the health system, how many dialysis centers could be used for other purposes if more kidney patients were on peritoneal dialysis.
    2. Supported care: Patients with chronic conditions could be managed more and more with technology augmentation. Tele-health add-ons could reduce the number of in-person consultations needed and also provide more attention to at-risk patients so that complications or deterioration could be detected earlier.
    3. Substituted care: Doctors, dentists and nurses don’t need to do everything. My son had his dental care provided by a technician in his school based on an earlier evaluation by a dentist. She was very good and more to the point, good enough and at an appropriate cost, for his dental needs. There would be further examples throughout healthcare.
  6. Take home message: To continue to offer the same and higher quality of care, SGH needs to simultaneously improve existing care AND reduce need for SGH expertise. This is the only way to conserve precious SGH expertise for patients who really need you and to free up time for SGH staff to define tomorrow’s medicine.

SGH is the largest acute hospital in Singapore. Any healthcare transformation must necessarily involve her. I hope SGH staff look beyond the confines of the hospital and see thier role as staff of the ‘flagship hospital’ also as contributing to the improvement and enhanced quality of the system as a whole.

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