Chapter Five: Looking Ahead
Part Two
NUHS nurses (in dark blue polo shirts) took over from Sengkang Health nurses (in white, orange, and yellow tri-colour polo shirts) at the stroke of midnight on 1 June 2018.
Ultimately, the command centre’s priority was to take care of the safety and preferences of patients before it stood down at the end of a week. A key area of focus, according to chief nurse Ms. Margaret Lee, was to facilitate the reassignment of patients in Sengkang Health wards to those run by AH.
“I will always remember the image of the few of us in our ‘war room’ staring at a whiteboard with the patient census,” she recounted. “The transfer of patients began after dinner but our work continued into the night. We wanted to ensure that the system cutover was smooth and also make sure that nurses on night duty—it being their first night at AH under NUHS—were supported and able to deliver care effectively. We held nurse-led multi-disciplinary teams round twice a week with nurse-led care for our patients.”
Shedding light on the mammoth task of moving, Ms. Chiang, whooversaw the entire handover, said this process needed a year of preparatory work. This involved assembling teams from scratch.
For instance, she had to hire biomedical engineers to assess all medical equipment handed over and ensure their safe operability. In addition, new systems and departments to manage procurement needs and patient records had to be established.
Based on AH’s qualities such as its size and successful track record as a test-bed for new medical initiatives and processes, the NUHS team was charged by MOH to rethink healthcare “to spur innovative solutions on a larger scale.”
The core team, comprising Dr. Phua, Ms. Chiang, Ms. Lee, and Dr. Khoo See Meng, spared no effort in working to inculcate proper work culture mindsets, designing new service and operation standards and models of care, and giving AH a new personality.
AH moved towards a one-stop care system, such that outpatients with multiple co-morbidities would be cared for by one principal doctor instead of a variety of specialists. Underpinning the rethink, said Ms. Chiang, is the concept of “rendering care good enough for our loved ones.”
This meant rolling out changes as simple as extending the operating hours of the hospital’s appointment hotline, enabling members of the public to dial in any time they needed to seek assistance. To further facilitate seamless patient experiences, every service counter in AH was equipped to assist patients and family members with their bills and medical reports.
With innovation taking place on so many fronts, Dr. Phua jumped at the opportunity to forge an innovative work culture. At AH, staff were encouraged to learn and innovate. He said: “We’re very much about work-life harmony because we spend so much time at work. So work should preferably be fun and fulfilling, where we can count on our friends and colleagues. It’s more wholesome for staff members to like what they are doing and to be supported in their work passions. This way, they can give their best to patients.”
A New Chapter
If you were at AH on 31 May 2018, you might have been surprised to see healthcare workers in two distinct sets of uniforms.
It was the eve of the big move. Staff from the National University Health System (NUHS) were onsite to prepare to take over the campus from Sengkang Health. It was a momentous occasion, noted Dr. Phua. NUHS was to be AH’s final operator after four handovers since 1972.
It marked the end of an era of transitions and various nesting incubations. The NUHS team had a tight handle on the massive operation. Among other fail-safe measures, it established a 24/7 command centre to ensure a smooth transition from Sengkang Health’s services.
At the heart of this endeavour was then chief operating officer, Ms. Grace Chiang (2017-2021). One aspect of the handover was setting up the new IT systems. The IT team stayed overnight on 31 May, migrating 66 applications in the process, to ensure key infrastructure such as patient systems, surgeon-rostering systems, and critical security protocols were in place.
What was crucial, Ms. Chiang noted, was making sure that patient records were transferred fully and accurately, and the right types of medication and therapeutic diets could be served safely to patients.
Additionally, the Intensive Care Unit and the Urgent Care Centre needed their equipment to be properly linked and information captured correctly. Some staff in the facilities management team were new and had to familiarise themselves with their roles and responsibilities, as the previous team had moved out of AH.
While Queenstown has evolved over the years to include a good mix of new and younger families, it still remains home to one of the largest senior populations within the western region, many of whom have multiple co-morbidities. As part of AH’s mission to be one with the community, AH launched geriatric service hubs in Clementi and Ghim Moh to improve pre-frailty access to the management of geriatric conditions.
AH set up a Parkinson’s Disease (PD) Hub where a person with PD is seen by a geriatrician and a neurologist, and cared for by a multidisciplinary team that includes a geriatric nurse, pharmacist, physiotherapist, and neuropsychiatrist.
On the Clinical Services front, AH also launched five signature programmes. The Well, FAST, Chronic, Healthy Ageing, and Supportive and Palliative Care programmes are a move towards seamless patient-centric care, guided by multidisciplinary expertise with the personal touch of a single professional. AH practises a novel patient-centric care model where care can be adjusted between three different intensity levels according to the patient’s needs, while they remain in the same bed.
This model aims to maximise timely responses to patient needs and optimise the use of hospital resources as the presiding doctor may adjust these levels when making their rounds. The patient’s nursing and rehabilitation intensity can also be dynamically regulated depending on patient progression.
Since the big move, the biggest challenge confronting staff has been the COVID-19 pandemic. Its arrival on Singapore’s shores took everyone by surprise, noted Dr. Phua. Healthcare workers had been on guard for the next worrisome disease “X” since the SARS outbreak of 2003. However, few expected it to come in the form of the highly virulent COVID-19.
Staff members of the AH Parkinson’s Disease Hub with a patient.
“SARS was severe. But it came and went, dying with its hosts,” said Dr. Phua. “COVID has been far trickier. It doesn’t kill its hosts and spreads like wildfire. Our healthcare system has been taxed and our staff are fatigued,” he said.
Dr. Phua said he was proud of his team, which has been contributing to the nation’s fight against the virus. They could take pride in having established various systems to manage the outbreak. For instance, AH staff were the first to respond to the 2020 outbreak in migrant worker dormitories by setting up care sites.
From there, protocols and procedures to care for the ill and to mass test occupants were rolled out at other dormitory-based healthcare operations islandwide. Nurses were deployed to vaccination operations, to beef up manpower shortfalls at other institutions, and to set up the Big Box Community Care Facility in 2020 and the F1 COVID-19 Treatment Facility in 2021.
Like other public acute hospitals, AH was required to convert general wards into COVID-19 cohorting wards. At the onset of the outbreak, AH promptly refitted its negative pressure rooms to meet COVID-proof standards. AH also set up an extended screening tent outside its 24-hour Urgent Care Centre to assess visitors and manage suspected COVID-19 cases.
This concerted effort by the AH team primed them to ultimately care for thousands of COVID-19 patients. At the peak of the COVID-19 pandemic, AH was one of the first public health institutions to roll out a Virtual Care Centre and see more than 50 percent of its clinic consultations conducted virtually, so that patients and caregivers need not turn up in person for their clinic appointments.
