Singapore scaling up many healthcare pilot projects to provide better care

Changi General Hospital staff demonstrating the use of a bed transporter.
Changi General Hospital staff demonstrating the use of a bed transporter.ST PHOTO: SEAH KWANG PENG

Singapore - The past few years has seen so many pilot projects being rolled out at healthcare institutions that the standard joke is the sector has more pilots than Singapore Airlines.

The good news is that some pilots have proven to be successful and will be scaled up nationwide.

Innovations in healthcare, while not new, had taken on a life of its own around 2012 to 2013, backed by more support and funding from the Government.

As healthcare agencies sought better ways of doing things, the number of pilot projects boomed, partly fuelled by the need to deliver good and sustainable care in the face of higher demand from an ageing population.

Said Senior Minister of State for Health Chee Hong Tat in an exclusive interview with The Straits Times: "Certainly, it's an exercise where we must be willing to accept some successes and some failures."

He added that no one should be penalised should a pilot not turn out as expected. There are lessons to be learnt even in failures.

BED TRANSPORTER

One project that will find its way into several public hospitals by the middle of next year is bed transporters.

The Health Ministry will buy 595 transporters for use in four public hospitals. They are projected to reduce manpower by 34 porters and 19 nurses in total.

Other public hospitals, including those coming on board in the next few years, will have the option to buy them at the same negotiated price.

Piloted at Changi General Hospital last year, the transporter is like an engine attached to a bed. It enables one person to easily move the bed, instead of two as is the case now.

Even with two people, the task in strenuous, said Mr Wong Kok Cheong, the hospital's deputy director of nursing. "It is back-breaking work with the potential of injury."

That's because bed, patient and any equipment like a ventilator or drip, would weigh between 260kg and 360kg.

Typically, Changi General needs to move about 120 patients and beds daily, such as sending patients for scans, or moving them to a different ward, said Mr Wong.

It is better to move a patient with the bed than to take him off the bed, transport him separately, then put him back onto the bed, he added.

Mr Chee said the transporters are useful as health care workers are getting older and the Health Ministry wants older workers to continue working, given the shortage of experienced manpower.

GP FIRST

Another pilot that will be scaled up nationally is Changi General's "GP first" initiative, which encourages patients to see a general practitioner instead of heading straight to the hospital's emergency department.

At least several hundred of the more than 2,000 people who show up daily at public hospital emergency departments are not so seriously ill that they need hospital treatment.

But many patients ignore to call to see a GP first because if they needed hospital care, it would mean paying twice and delaying the care they needed.

So Changi General worked with GPs in the vicinity and gave priority to a patient sent there by a GP.

Their bills at emergency would also be $50 less to help offset the amount paid to the GP.

Ms Daphne Chan, 42, an interior designer, fell and injured her leg in February. She went to her family doctor who referred her to emergency at Changi General. "I was glad for the referral as I was not aware of the seriousness of the fall."

Her family doctor charged her $20 for assessment and consultation and at the emergency, she was attended to in 30 minutes. She also received a $50 waiver at the hospital.

She now tells her friends to do it her way when they face non-life threatening problems.

Dr Lee Chien Earn, who heads Changi General, said the scheme has resulted in a 10.5 per cent drop in walk-in patients since it began in 2013.

The hospital incurs some cost, said Mr Chee, but the results are worth it as, among other things, it frees up hospital staff for more serious cases.

PREDICTING NO-SHOWS

Roughly one in four patients with appointments at public-sector clinics fail to show up.

These no-shows also do not inform the clinic which could have given the slot to another patient.

This is especially critical in places like the National Dental Centre Singapore (NDCS) where patients can wait a year or more for treatment.

Ms Lee Chen Ee, NDCS' chief operating officer, also noted the waste of resources as the dentist would wait for the patient.

Integrated Health Information Systems, the government's health IT company, had piloted a predictive analytics software to try and identify patients who are likely to be no-shows.

For example, patients who are less than 30 minutes late for their previous appointment are more likely to show up for their next appointment.

The predictive model, which went on trial at NDCS, was found to have a 77 per cent accuracy in identifying the likely no-shows.

The dental clinics would call and remind them of their appointments. "Some would then inform us they would like to postpone the appointment," said Ms Lee. The slot would be given to another patient.

This predictive analytics model has been rolled out to all clinics at the NDCS since August, and will be adopted at other SingHealth institutes, such as its polyclinics and hospitals like Singapore General Hospital.