More than 30 new "patient navigators" have been appointed by the SingHealth group to steer patients through the complex health-care system - from admission to discharge and beyond.
They serve as a bridge between patients with complex conditions and other health-care staff, such as doctors, therapists and medical social workers.
They also keep tabs on patients after they are discharged, and will make home visits if necessary.
"Our health-care system is complex, and we need someone to actually hand-hold (patients) through the journey," said Dr Tracy Carol Ayre, group director of nursing for SingHealth.
She estimates that 20 per cent of patients have conditions in need of this service.
The 33 patient navigators, who started their new full-time roles in June, are mostly nurses with about 10 years of experience.
They identify the patients who they feel may need more help - such as those who have multiple chronic conditions or get poor support at home.
The navigators will then guide these patients through the various aspects of their health-care journey, from sorting out their medication to putting together referrals for step-down care facilities.
The new role was officially launched yesterday in conjunction with SingHealth's Nurses' Day celebrations.
SingHealth hopes to have 400 patient navigators by 2018, with each one of them looking after around 100 patients.
They will be based at Singapore General Hospital (SGH), KK Women's and Children's Hospital, and the National Heart Centre Singapore.
The group hopes that the navigators will be able to prevent "frequent fliers" from being constantly readmitted, which can happen when a patient's conditions are not optimally managed.
Group chief executive Ivy Ng said: "With the introduction of the patient navigator role, it is expected that there will be a reduction of readmission rates and average length of stay for patients with complex chronic conditions."
One of the new patient navigators is nurse clinician Xu Yi, who works in SGH's medical oncology department.
Formerly, the 34-year-old played a more supervisory role, helping to manage other nurses in the hospital ward.
"This is more patient-focused," she said of her new role. "We follow up with patients very frequently."
At yesterday's event, Health Minister Gan Kim Yong presented awards to outstanding nurses, and congratulated all nurses on their hard work.
He said: "With your commitment, your compassion, as well as your clear sense of mission, you have touched the lives of many."