ISS Service Innovation Leadership Seminar, 28 March - "Design Thinking and Service Innovation - The Khoo Teck Puat Hospital's Journey" by Mrs Chew Kwee Tiang, CEO, Khoo Tech Puat Hospital

1. Innovation in Healthcare
- Our Journey Thus Far
Mrs Chew Kwee Tiang
Chief Executive Officer, Khoo Teck Puat Hospital

2. Alexandra Health System
KTPH
Yishun
Community
Hospital
Community
Based Care
Villa Francis
Nursing Home
& Others
Old Folks’
Homes
Yishun
Polyclinic &
Others
Woodlands
Medical
Centre
GPs
2

3. Regional Health
Systems in Singapore
We are Alexandra Health
System!
3

4. Alexandra Health
Vision
“Help our people live a long and healthy life and support them with
thoughtful and dignified care to the end.”
Mission
“Provide good quality, affordable and hassle-free healthcare with science,
love and wisdom.”
Tagline
“Touching lives, Pioneering Care, Making a Difference”

5. Transforming
Healthcare Delivery
Design Challenge:
5

6. Insight Into Healthcare Needs of Patients
6

7. Pre-illness Illness Post-illness
Health Maintenance
• Vaccination
• Public Health Education
• Health Screening
• Workplace Health promotion
Illness Care
• Cost effective, efficient
care
- systems processes
- clinical pathways
Health Recovery
• Skills-for-life
• Homecare support
• Follow-up support
Head-to-Toe Lifelong Anticipatory
Healthcare of Whole Person
7

8. Fast
Medicine
Slow
Medicine
Cruise
Medicine
(Assembly
Line)
Khoo Teck Puat Hospital Woodlands Medical Centre
(2017)
Yishun Community Hospital
(2016)
8

9. Population
Classification
Managing The Population In The North
Well
Healthy
Well Unhealthy
Unwell
Unhealthy
(Early Stage)
Unwell Unhealthy
(Late Stage)
Frail and Dying
Population Health Programmes Ageing In PlaceCare Model
Pre-illness
Illness
Post-illness
KTPH YCHWMC
Acute care &
Chronic Disease Management
Wellness Centre/
Community
GPs, Polyclinic, KTPH Nursing HomesSetting of
Care
Yishun Community Hospital
9

10. 4 Design Concepts
1. Health Promoting
2. Improve community health
3. Enable ageing in place
4. Design hassle-free experience
10

11. Health Promoting Hospital
11
Design Concept 1

12. The Thinking Behind The Design
Be The
CHOICE
ARCHITECT
RELATE
REPEAT
REFRAME
Shape
The
PATH
12

13. Innovation : Create a Living Lab at KTPH
13

14. Workplace Health
Health for Life System
Personal Health Record Risk Stratification Corporate Health Report
Lifestyle Maintenance
(Low Risk)
Lifestyle Modification
(High Risk)
Disease Modification
(Chronic Disease)
1. Overview of employees’ health status
2. Determine target Interventions
3. Focused resources on relevant staff
Measure outcomes, progress report, etc
inputs
outputs
Health Risk
Assessment
Biometric
Parameters/Lab Inx
Clinical Practice
Guidelines
Current
Evidence
HR
inputs
14

15. Determinants : Philosophy, Value, Attitude, Knowledge, Discipline
15

16. 16
26.91
23.26
59.89
29.51
3.07
30.43
7.67
14.86
2.47 1.94
0
10
20
30
40
50
60
70
2011 2012
Very Poor
Poor
Fit
Good
Excellent
PARTICIPATION
2380 staff
77%

17. PARTICIPATION
3088 staff
85%
17
Annual Staff Health Screening

18. Individual Health Screening Reports
• Patient Portal
• View all your health screening results
• Visualize your health status over the years
18

19. Improve Community Health
19
Design Concept 2

20. Health Education in the Community
• Mini Medical School
• Workplace health programmes
• Community health programmes
Mini Medical School 1st Run Jan 2013
LIVE! Programme in workplace and community
20

21. Sharing Best Practices With Workplaces
21

22. Sembawang Shipyard Onsite Diabetes/HBa1C &
Eye Screening & Tele-consultation
Service Innovation: Facilitated Network @ Sembawang Shipyard
Foot Screening &
Skills for Life

23. Global Healthy Workplace Award 2013
23

24. Piloting Population Health:
A Transformation @ Sembawang & Choa Chu Kang
IN SHORT, TO CHANGE SOME 140,000 PEOPLE IN 3 YEARS
Better Health
Awareness
Better Health
Management
A Healthier
Environment
In three years, we target to support at least 50% of screened
residents age 40 years and above to take greater personal
responsibility for their health.
24

25. Ageing In Place
Design Concept 3
25

26. Subsidised
Private
Fiscal year 2010 Fiscal year 2011
The Impetus To Innovate
A Local Challenge – High Bed Occupancy at KTPH
26

27. 70% of health determinants can be
changed or modified
Socio-economic pressures
Unsafe homes
Self-medication
PolypharmacyUntrained caregiver
Things we would never see until we made
home visits – and those we can change
Determinants Of Health Can Be Modified
27

28. Service Innovation: Setting Up Community Wellness
Centre And Nursing Post
28

29. 29
Discharge triage
Transitional Care Programme
Patients that requires continued medical
support at home after discharge
Community Nurse Programme
Care plan
Allied Health
support
Therapists
Dietitian
Pharmacist
Clinical support
GP
Palliative
Early Review Clinic
Social support
Financial
Volunteers
Domestic support
Community Nurse Post
1. Community engagement
2. Early disease detection & management
An Integrated Discharge Plan In The Community
29

30. Home
modificationEnhancement for
Active SEniors
(EASE)
Collaboration with
grassroots &
community agencies
Home
help
Community
Case
Management
Service
Home medical & nursing
Temporary
domestic
help upon
early
discharge
Integrated
Single Point
of Contact
AIP
Partners
30

31. Before home visits-- After home visits
Average no. of
admission for a
single FF
Average length
of stay for a
single FF
Pilot Study: Early Results
400 patients completing 6 months of care
6.17 days
3.5
admissions
1.2
admissions
5.94 days
47%
No Readmission
31

32. Design Hassle-free Experience
Design Concept 3
32

33. Know What The Patients Value
Treat/AdviseDiagnose
Respect for patients‟ dignity
Clear and accessible information
Integrated care and services
Consistent, good quality care and services
Cost effective care
33

34. Provide a level of patient care
and service good enough for
our own mothers, without the
need for special arrangements.
34

35. Define Hassle-free Hospital
Doing things right for the patients, and
delivering value safely, from the time he
enters, till he gets out of the hospital.
-wait -delay
- reworks
luevalue
Wow!
35

36. Innovation is for improving our patients‟ experience and it is
everyone‟s responsibility.
Share a
Common
Understanding
of Innovation

37. Patients Flow Fast & Yet Safe
Enhanced Allied Health Services such as Radiology, Lab, Pharmacy etc
37

38. Patient Value Stream (SOC, DEM)
We Know
You
Know me
Diagnose
me
Treat me Advise
me
Patient Flow
Patient Education
Head-to-Toe
Diagnosis/Treatment
Anticipatory
Care
20mins 20mins 20mins0 mins
0 mins 0 mins 0 mins
60mins
Information / Material Flow
Know me
Recognise me
Direct me
Diagnose me
Track me
Treat me
Advise me
Close encounter with me
38

39. 39
Pt Info
Transport
Investigations
(Outpatient)
Medications
TCU
Portering
Transport
Investigations
Treatment
Diet
Pt Info
Nursing care
Portering
Diet
Pt Info
Nursing care
Surgery
Portering
Preparation
Transport
Nursing care
Investigations
Treatment
OT Listing
Pt Info
Diet
Pt Info
Investigations
Treatment
Clerking
Nursing care
Pt Info
Orientation
Portering
BMU
Financial
Counselling
Dressing
Lab test
Investigations
Pt Info
Assessment
Pt Info
Clerking
A & E Triage Registration Wait for Consult Consultation
Post Consult
Treatment
Discharge
Inpatient
Admission
Nursing
Assessment
Medical
Assessment
Pre-Operation Operation Day Post Operation Recovery
Discharge
Admission for Acute Illness
1. Medicine consists of systems, processes and interdependencies
2. Patients‟ requests are not requests of parts of us, but requests
of the whole
3. To make any significant impact, the change must include all
Why Is Change So Difficult In Healthcare?
39

40. Visual Management At The Emergency Department
Consult
Info Board
Triage
40

41. Current Way of Admitting A Patient In DEM
Front counter staff needs to use
6 different softwares to admit one
patient to the ward
Financial Counselling
Hospital Patient
Management & Billing
System
Checking Insurance
A&E Careline System
Bed Management System
Medisave 41

42. World view: top part
Bed Management: Overview of Bed Status
42

43. Bed Management
43

44. Bed Census
44

45. Dr orders
test in SCM
Phlebo
takes &
dispatches
blood
Lab
receives &
processes
blood
Blood
result
available
in SCM
Problem:
“Nurse disintermediation” syndrome.
• Nurse totally out of the loop!
• Because NO more paper trail & visual cues.
• Lab orders and results no longer visible unless
nurses watch SCM all the time.
45
Electronic Lab Order Workflow

46. Problems
• CT/MRI orders with Patient Consent not easily tracked
• Nurses unable to chase doctors to obtain consent
• Numerous calls (at least 2-3 calls) needed between ward
nurses and Radio dept to check consent/IV plug/fasting
status, fix appt and arrange patient transport.
Dr orders
MRI in
SCM
Dr
explains
procedure
& takes
consent
from
patient
Nurse
faxes
completed
consent to
Radiology
Dept
Radiology
calls back
to give
MRI appt
Radiology
calls at
appt time
to send
patient
down
MRI result
in SCM
46
Electronic CT/MRI Order Workflow

47. Nursing AndonRadiology Andon Pharmacy Andon
SCM
47
13 Andon „Eco-Systems‟

48. Lab Order
status
Lab Result
status
Rad Order
status
Consent
status
ECG
order
Discharge
tracking
Nursing Andon

49. 49
Andon Board for Pharmacy
49

50. C-IVOC2012
Handling Patients
Quick Links
Appointments
Planned Appointment
Currently Warded
Regular Patient
C41 PSA Jamilah
Previously Attended
Health Screening

51. Building Patient Journey through C-IVOC
C-IVOC2012
Medical
Care Me
Recognize
and
Direct Me
Know Me
Discharge
Me
Keep in-
touch with
Me
SA
P
FIC
O
SC
M
PF
S
SA
P
IS
H
iHF
L
SC
MSA
P
IS
H
iHF
L
SC
M
SC
M
SA
P
IS
H
SA
P
IS
H
Phase 1
Data from Multiple Sources
SAP, SCM and iHFL
iPharm
MRMS
MRMS
PF
S
EL
PIS
51

52. Computerised, Integrated View of Customer
(C-IVOC)
• Know me
• Identify me
• Direct me
• Track me
• Clear the way for me
• Close the encounter with me
• Stay in touch with me
Thomas*
52

53. Use Of Technology To Improve Service At
Multiple Touch Points
Experimentation in teletriage and teleconsult
Queue ViewerBed Management System
MMS – Wound
Care
Self Registration
53

54. Grab a bite!
Paging
Service
Home Sweet Home
Pre-Appointment
Reminder
via SMS/Letter
Appointment
Day Registration
Blood Test
Consultation
Post Consult Services
Appointment
& Payment
Pharmacy
“WOW @
Specialist
Outpatient Clinic ”
Preparing you
for Hospital
Admission
Height & Weight
Chaperon
Your
experience
starts here
Waiting for
Consultation
Meal Voucher
Touching Lives, Pioneering Care, Making A Difference,
Designing Touchpoints
54

55. Design Approach
FOCUS ON PATIENT EXPERIENCE
Patient Value Met
• Quality
• Respect
• Information
• Care integrated
• Effective
Outcome Achieved
•Diagnose, treat, advice
•Better, Faster, cheaper,
•safer
Value stream
•Identify Value
•Value Stream
•Flow
•Pull
•Pursue Perfection
workplace
•Location
•Layout
•Automation
•Human factor
•Health promoting
Service/Care Processes
•Model of care
•Care standards
•Service standards
Customer Experience
•AH Service Ways
•Touchpoint
•Care point
Design
Line of visibility
DESIGN
THINKING
 WHAT THEY WENT THROUGH
 HOW THEY FELT DURING THEIR EXPERIENCE
 IDENTIFY PROCESSES THAT NEEDS TO SUPPORT
THESE PATIENT SERVICES
LINE OF VISIBILITY
55

56. Our Approach
1. Agree on what is patient Value.
2. Articulate patient value streams.
3. Identify service touch points (WOW)
4. Act on functional, mechanic and humanic clues
5. Take small steps in rapid succession.
6. Do what you can with what you have.
7. Learn, teach, design and do.
56

57. •Do what you
can with what
you have
•Little touch
points count
Teaching & training aid for
patient and staff
57

58. Silent clock Anti-slam device Night light
Message boardFloral headboard
Electronic patient locator
Ideas From Staff & Patients
Ergonomic food tray
58
Apples and Blankets

59. Ideas that
Save lives
59

60. | Design Thinking in AHS|
Eye Clinic
Patient Waiting Experience
60

61. INTRODUCTION
BACKGROUND: TO SOLVE WAITING TIME ISSUES
OUR FINDINGS: THE WAIT HAS TO BE JUSTIFIED
“Patients do not mind waiting, as long as they know what, why and how
long they are waiting for.”
61

62. INTRODUCTION
BACKGROUND: TO SOLVE WAITING TIME ISSUES
OUR FINDINGS: PATIENT’S VALUE HAS TO BE MET
“I felt very shiok after the doctor did such a thorough check on me, no
wonder I had to wait so long! It was worth it!”
62

63. INTRODUCTION
REFRAME THE PROBLEM STATEMENT
IT‟S ABOUT ENHANCING THE
EXPERIENCE OF THE WAIT
AND DELIVERING VALUE TO
THE PATIENT
WAITING
TIME/TURN
AROUND TIME IN
THE CLINIC
ORIGINAL PROBLEM REFRAMED PROBLEM
63

64. RESEARCH FINDINGS
WHAT DO PATIENTS VALUE?
KTPH HEALTHCARE INNOVATION AND RESEARCH
COMPETENCYCONCERNCLARITY
To help patients feel
more empowered in
their experience.
To help patients feel
like they are being
cared for.
To assure patients
that they are in good
hands.
(e.g. providing a suitable
waiting room
environment, testing
environment, the human
touch)
(e.g. eliminating
inconsistencies, informatio
n communicated to the
patients)
(e.g. seamless
processes, communication
within staff and healthcare
system, well-equipped
machines)
64

65. OBSERVATION FINDINGS
CLUES TO PATIENTS‟ ANXIETY AND NEED FOR SIMPLICITY
NEED TO KNOW THE NECESSARY
“ She was telling me so many things inside, I
don’t think I can remember all of them, so I
wrote the important details on my hand so that I
won’t forget.”
PATIENT‟S PERSPECTIVE
PATIENT‟S PERSPECTIVE
“I don’t like the feeling of missing out on things I
should have told the doctor after I leave the consult
room, that is why I am writing down all my
problems while I wait for my turn.”
AFRAID TO LEAVE OUT INFORMATION
65

66. RESEARCH FINDINGS
“I was trying to cooperate, but he was just dripping
until the drops keep rolling down my face. He
asked me to look up, but I wasn’t sure how up is
up.”
HAVING THE RIGHT ENVIRONMENT
PATIENT‟S PERSPECTIVE
STAFF‟S PERSPECTIVE
“From my past experience working in other eye
clinics, it is a common problem to get elderly to
do the dilation drops as it is harder for them to lift
up their heads.”
DIFFICULT FOR ELDERLY PATIENTS
NOT GUIDED IN THEIR EXPERIENCE TO COOPERATE WITH US
66

67. PROTOTYPE
BUTTERFLY ON CEILING AS VISUAL CUE
1st Prototype 2nd Prototype
Without Target
With Target
67

68. OTHER PROTOTYPING
EXPERIMENTS IN THE EYE CLINIC
DILATION TROLLEY ORIENTATION GUIDE
68

69. Job Shadowing Training Nursing Home NursesTelemedicine Exposure
Telemedicine at Nursing Homes
Care Delivery Innovation

70. Dream Ward
Service Innovation in the Wards
Mood lighting
One click
control
Flexible
security
One-click
room service
KTPH
Navigator
Ward
notifications
Visual Nurse
call
Personal
Calendar
Patient
Message
Board
Upcoming features Health Services

71. Keeps track of patient‟s weight
without getting them out of the bed
71
In-bed Patient Weighing System
Improving Nursing Work Efficiency

72. Hopscotch How to Play InstructionsFitness Drive-through Stations
Health Promoting Innovations

73. • Match and exceed the best performers
• Standards set by other industries
• Lowest infection rate
• Shortest length of stay
• Lowest average bill size
Learn From Everyone
Kameda Medical
Center, Japan
Mayo
Clinic, Rochester, USA
Aravind Eye
Hospital, India
73

74. Learn From Everyone
74