When paperwork threatened to take nurses away from their patients' bedsides, the National University Hospital (NUH) decided it was time to take a long hard look at how things were run.
Five years on, its complete overhaul of work processes has had an impact. Nurses in the general wards there now spend at least half their time directly caring for patients, up from 30 per cent in 2010.
Part of the impetus for change, according to Ms Ng Sow Chun, the hospital's deputy director of nursing (nursing quality), was that patients felt things could be done better.
"We saw that the nurses were very busy, and we also received feedback from patients about our care and services," she said. "So we thought we could relook our operations."
Her team spoke to nurses to find out what was stopping them from doing the best job, and timing how long it took them to go about each of their daily tasks.
They even counted the number of steps nurses took each day to see if they could eliminate unnecessary walking.
Nurse clinician Veronica Loh recalled that she and her colleagues used to walk at least 84 steps in order to prepare a dose of antibiotics for one patient.
Syringes, for instance, were kept in a different place from where the medication was prepared.
"In the past, things were placed in different locations," Ms Loh said. "Now, they are in the same place and we sort them out by colours, with specific labels."
With everything within arm's reach, the new system is so much more efficient that her step count is now effectively zero.
Cutting down the amount of paperwork, however, is the change that has made the biggest impact to her working day.
"There was a lot of documentation - I could easily take up to 30 minutes or more filling it in," Ms Loh said.
From having to fill in 20 pages each time someone was admitted, she now has to fill in only seven pages of the most vital information.
BUILDING RAPPORT WITH PATIENTS
It has made quite a lot of difference when patients are assured, and the rapport is a lot better when there are fewer changes.
MS NG SOW CHUN, NUH's deputy director of nursing, on the move to ensure the same few nurses care for the same patient over his stay.
The changes have freed up an extra 11/2 hours for each nurse per shift. This means that they have more time to build relationships with their patients or follow doctors on their ward rounds.
For example, said Ms Ng, the hospital now tries to make sure the same few nurses care for the same patient over his stay. "It has made quite a lot of difference when patients are assured, and the rapport is a lot better when there are fewer changes."
While she considers the overhaul a success, she is not planning to stop there and hopes to use technology to help make work even more efficient.
For instance, patients with a high risk of falling down need to be supervised at all times, which can be very draining on manpower.
"We could look at gadgets to replace that pair of eyes, alerting nurses early if the patients try to get out of bed," she said.