Patient Safety rounds at Alexandra Hospital by JGH Management

Head A&E, Head Anesthesia/ Patient Safety Officer, Director Medical Affairs, Chairman Medical Board and Director Nursing chatting with staff at the Eye Clinic at Alexandra Hospital during Management Patient Safety Walkabout

Transition management between the Jurong General Hospital (JGH) and the KTPH team at Alexandra Hospital (AH) has started since 28 March 2010.  

The JGH team now runs the Eye Clinic, the Dental Clinics, the Day Surgery Ward, the Dietetics services and other clinical and operations support services such as CSSD, Materials management and security at AH.  In the meantime, our doctors and nurses have started to work alongside our colleagues in AH in other wards, clinics and operating theatres.  The transition has been smooth and staff are generally in high spirit.

There are 2 key priorities for the JGH team taking over operations at AH - maintain the high level of service that patients have come to expect at AH, and ensure that patients are safe in our care.

To ensure that staff can do their work well, we've started a Management Patient Safety Walkabout, the first of which was conducted on 14 April 2010.  The leadership team visited the areas that JGH have assumed management to chat with staff and find out if they have all the necessary resources and support to do their job well and ensure that care to patients is safe.  It was very heartening to see and hear that staff are putting in their best and are very open with their feedback and suggestions for improvement.  My promise to our staff, we will listen to your suggestions and we will act on them.

Since then, our Patient Safety Officer Dr Ng Huey Ping has been working hard to ensure that good suggestions are quickly implemented and study suggestions that will require more effort to work through.

These official patient safety walkabout will continue monthly.  But, if you observe carefully, it is not hard to catch members of the JGH management and clinical leadership making their rounds daily to spot our staff doing the right thing, and be a resource to our ground staff to do a better job.

We have a great bunch from JGH at AH who will put our best foot forward for our patients!  Thank you folks!

The "lost" waiting to be found?

It is the school holidays.  The kids are out.  They are hanging out, perhaps taking a well deserved break from the routine of school.

My kids are also spending some time away from school routines of homework, assessment books, tuition.  There are with my wife at Aranda Country Club, leaving behind this father who is too busy with work to join them.  However, I did join my family for dinner last night.  We took a short walk from Aranda to the nearby Downtown east to do so.

I was appalled by the behavior of our youths there. While queuing up at the ATM, I noticed that the line was not moving.  I realised that 3 youths were taking their time with their transactions.  No money came out of the machine for more than 15 minutes and they were giggling away occasionally looking back almost as if to see how frustrated others were as they whiled away time.  One of the boys was heavily tattooed from his neck down to his ankle.  The other two carried MOE student cards in their wallets.  Obviously, there were in bad company and I wondered how would their lives turned out in future?  I did not have high hope.  They finally moved away from the ATM after about 20 minutes smiling and perhaps happy that they messed up the lives of others even for a while.  I stayed in line all this while mainly because I was curious if they would be up to any good.  But "good" was not a quality that even came close from these boys.

Soon, my family were at the foodcourt. There were many youths there.  I spotted many girls with boys/ boyfriends with hairstyle that would hardly be allowed in schools - or could they be hair extenders that I have come to be aware of?  Though young, the public affection that they showed to each other with hands in all the "wrong" places could put many B grade actors to shame.  

After dinner, we passed by many youths smoking.  Others were using vulgarities loudly. A few others have their noses, lips pierced and one carried a ear loop the size of a 50cents coin!  It became quite obvious to me that there were no parents in the midst of this youthful crowd. Are these expressions of pent up behavior from strict parenting or is the result of lack of parental guidance and supervision?  Or am I too old fashion and I should just "loosen up" because this is the new generation?

I worry about our youths.  In particular, I worry about my kids.  I pray that they will not be led astray.  I used the experience to tell them that those behavior that we saw was not right and that they should not feel that they have to conform to bad behavior.  Most of all, they should know that they are loved deeply, and they should measure their action against the love that they can come to expect.

Views anyone?

It has been a long time since I appreciate a poem...

Who do you think wrote this poem?

As I came to explore

I began to know more

How our forefathers laboured as they can

With their very own bare hands

So I stepped back to the past

The environment was loud

With chitter-chatter

And the smoke reaches the air

As the coolies shed their sweat

Their load got even worse

Just a pat on the back

Will overcome their fear

As the four sins continue

The secret societies find a venue

To create trouble

Maybe to make it double

Opium smoking becomes a habit

For those not weary

Health may deteriate

But never the will to create

Death houses banned in 1960’s

Then became hospices

The dying slept in coffins

To give space to the sick

The Samsui’s and Ah Ma’s

Work as they must

To take care of construction

And of course the master’s reunion

As the Samsui’s wake up at dawn

They let out a tired yawn

Rice, fish and veggie

Is all their breakfast will be

Due to extreme poverty

They celebrate once a year

With a special steamed chicken dish

They can smile ear to ear

But now times have changed

Technology is improved

Skyscrapers are everywhere

With Singapore in good care

New Kois for the New Year!!

It has been a tough but challenging week at work.  I ended the week with flu but with rest and sleep that my family has so lovingly given me, I am well on my way to recovery!

After tea break today, I brought my family to the Summer Koi farm at Jalan Kayu.  My children wanted to get some outdoors and were naturally excited when I told them that we will see some big and lovely kois at the farm.

I ended up buying 2 beautiful kois, one a hiutsuri and the other a red/ black Kumonryu from Japan.  These fishes costs me the equivalent of many packets of chicken rice but looking at their beauty and grace bring great calmness to my soul.  If that is the case, it is worth every cents (more like dollars).

My daughters named the Kumonryu "Disco" and my 3-year old son named the Hiutsuri "Tango".

Enjoy the photos that I took at the Summer Koi!

Releasing the Kois into my pond

My father watching from the living room

Children can't wait to release the kois!

Packing the Kois

Kois trying to swim away

Almost bought these golden kois but their body shape was in question

Netting in the kois for viewing

My hiutsuro

Mega Koi (Chagoi) about 1m in size!!

My daughter Brittney, shocked by the size of the fish!!

Goodbye 2009, welcome 2010

Ten years ago, the world was preparing herself for the new millennium with trepidation because of the Y2K bug that never was.  It was a non-event, far removed from the gloom and doom that was predicted.

A year later, the world's attention was gripped in horror as many of us watched the terrorist attack of September 11.  I remember receiving an sms asking me to tune in to the TV as "war has started in America".  The scene on TV was surreal - could it be real that big commercial planes were crashing into the World Trade Centre building at New York?  It was.  That day changed the way we travelled forever.

Two years later in March 2003, an enemy we could not see again gripped the world and this time Singapore in particular.  SARS (Severe Acute Respiratory Syndrome) struck Singapore after it quickly spread from the index case in Hong Kong.  Hospitals in Singapore was put on full alert and we geared up rapidly.  There was significant fear as the nature of the disease and how it spread was unclear initially.  Schools were closed, Singapore companies quickly came up with thermal scanners to help with mass temperature screening, there was shortage of N95 masks and other personal protective equipment.  At some point, healthcare workers were discriminated against due to fears of contamination.  Visitor limitations were imposed... SARS changed the face of healthcare but we came through stronger and better prepared for future epidemic/ pandemic situations.

One year later, on boxing day, the tsunami of 2004 "crept" onto the shores of many countries and destroyed many coastal homes and families.  The devastation was shocking and till today the rebuilding is still taking place.  As much as the tsunami destroyed, it also united the world.  The outpouring of aids and the direct assistance rendered by many countries and their people were heartwarming.  At that time I was in SGH and I recall the number of hospital staff volunteering themselves.  Teams were sent, supplies were packed and lives of many who volunteered were changed as they saw how every humble effort of one person could make a difference to another facing calamity.

Thereafter, the world "kind of hum along" with smaller aberrations every once in a while until the "virus of the Pigs" provided yet another scare in April 2008.  It started in Mexico but quickly spread to the US and with global travel, the virus found its way to Singapore.  Many of us now know of it as the H1N1 virus.  Fortunately, mankind is spared of major devastation as the virus turned out to be less virulent than originally thought.

As the world's attention was diverted to the H1N1 virus, the "Mega" financial smeltdown started some time in Sep 2008.  I remember thinking to myself at that time that "there is something about the month of September!" AIG bailout, Lehman Brothers collapsed and then the stock market crashed.  Companies that were seen to be "too big to fail" fell.  It was quite unexpected as the economy was booming just shortly before and oil price saw its peak at US$145/ barrel a few months before that.  Fortunately, the economies of the world took concerted measures to shore up the financial markets and today consumer confidence have returned and the market is picking up steam again.  The Singapore market has now recovered some 65% from the lows last year.

It is with this brighter horizon that we are preparing to enter 2010 - the beginning of yet another decade.

For me, this past decade has been one where I have experienced growth both personally and professionally.  I count my blessings amidst the many things that have happened.

(1)  My lovely daughter Melody was born in 2003 and my cheeky son Zachary arrived on 20/07/2007 (auspicious date right?)

(2)  We moved into our new home in 2003 albeit shortly after that SARS struck

(3)  Had a fulfilling 6-year stint starting from April fools day of 2004 at SGH and SingHealth playing the roles of COO SGH, Group Chief Procurement Officer and later on as Group Chief COO SingHealth

(4)  Celebrated my 16th wedding anniversary with my wife - the woman of my life and my source of inspiration!

(5) Living up my dream to lead in the starting up of the new Jurong General Hospital and the opportunity to see it come to fruition in 2014.

2010 looks set to be an exciting year already!  Many Singaporeans will be counting down to 2010 tonight.  My hope for all of us:

(1) we will have good health so that we can live a life that we desire,

(2) we will truly treasure, love and spend time with our family

(3) we will learn not to live a life as if everything depend on us - rest!

(4) we will experience love, peace and joy even as we work hard for a little more wealth so that we enjoy it with the health that we have

Happy new year everyone!! Talk to you next year :-)

An excellent Singapore product for the elderly

This Christmas, I picked up a Black iNO CP09 big button phone designed by a Singapore company for my father-in-law.

It is an excellent phone - big button numeric pads that is extremely comfortable both to use and to the eyes, comes with attached touch light, FM radio, and external keylock function.  The clincher for me is that one-button "SOS" function in bright orange at the back of the phone.  When an elderly person falls at home or is suddenly disabled from illness, all he/ she has to do is to depress the SOS button.  Doing so will activate automatic messaging to 4 predetermined mobile phones with the message "This is an emergency. Call me now".  Concurrently, the iNO will automatically dial the 4 emergency numbers in quick succession until someone picks up the phone.  When that happens, the iNO automatically goes into speaker mode so that the elderly may be able to communicate without the need to hold the phone close to the mouth. At $88 for the phone, I thought it was a great buy and a very useful one too.  As Singapore ages, innovation such as this will be in greater demand.

The main problem with this phone is actually not about the phone, but how it is poorly marketed.  The instruction manual that comes with the phone was written in poor english with many typos.  When the phone was being charged, a message "Charging" appears on  the screen.  At the end of the charge cycle, the message on the screen was "Charging FULL"!

Singapore companies need to pay attention to details if they want to make it to the global market.  It would be such a waste if they have a great product - as the case may be for the iNO CP09, but are confined only to the Singapore market because they have failed to take the product through the last mile!

Life without a domestic helper

I have been without a domestic helper for the last 2 weeks.

This is the first time that we do not have an overlapping period between change over of domestic helpers - coping without a maid in our busy lifestyle is certainly challenging.

Part of this challenge is due to my expectations.  My colleagues would know that I reiterate the maxim of "a place for everything and everything has its place" countless times as we plan transition to Alexandra Hospital and the new JGH.  Basically, I am quite neat with my things at home.  Little did I find out that my wife, having a led a life with me for more than 15 years has become even more demanding in the area of cleanliness and keeping things neat.  So, the rest is history...

There are a few great things that have come about as a result of the unforeseen departure of my maid.  First, my children are now even closer to me.  I bathe them, change them, bring them to the toilet, play with them, read to them, go shopping with them, bring them to the library and bookstores, write them notes, tuck them into bed, pray for them.  Not that I do not do these things with them when my maid was around but the regularity and significant increase in frequency helped solidify our bond further.

Second, I am now better equipped to know where are the various things kept throughout the house.  Although the system used to store the stuff may be questionable, the most important quick fix for me is to know where to find things.  I am resolved to create a better inventory system when this "crisis" is over.

Third, I have developed better empathy regarding what my wife has to go through daily taking care of kids as a stay home mom.  It is really not easy - practically no time-out unless she consciously carve out some time for herself to recharge.  Sometimes when I am asked if my wife is working, my reply would be "only one person need to suffer...", and I was really referring to my wife.  Taking a job out there could well be "easier" than a stay home mom - at least one can apply for leave, take a lunch break, etc at the office! I really treasure her for taking on this "harder" job.

Despite these, life without a maid is still a "crisis" that my family is trying to manage.

My plans for the rest of the year have been turned upside down.  There are many readings and planning for next year that I would have loved to spend more time in my quiet reflection.  But, where is that time for "quiet reflection" with kids demanding my attention all the time with their many needs!  My maid used to help to manage the kids when I need some time of my own at home.  Interruptions are now rampant.  I would read the first line on a paper and my 3 year old would yell out "...cannot hold..." and I would hurriedly leave my desk to bring him to toilet.  As I settled back, skimmed the next few lines and I would hear a scream - gosh my kids are fighting for the same game again. I would settle the commotion, finished the first page and my daughter would come in and ask if I can read to her. I said I would do so after I am finished with the paper and the next thing I know, my son spilled his food...  In quiet contemplative kind of environment, that paper would have taken 15 minutes to read but in my "new life", I would be lucky to finish reading a paper in 3 hours.

The key is to keep the peace at home as our hearts, mind and plans are ruffled.  "Sacrifices" will have to be made.  I accept it that during this period, not everything will be in its place.  Some things may not be done to perfection in order to maintain some sanity.  All of us will have to step outside our comfort zone and self-perceived roles and chip in as we should as a family.

I am so glad that my new maid will start work in my home this coming wednesday.  There will be a period of "ramping up" for her and during the same period I hope my wife and I can "ramp down" somewhat.  I am indeed looking forward to catching some personal time and time with my wife in the near future!

In the meantime, I am just a tad grouchy.  I hope that you will find it in your heart to forgive me.

"I prefer to keep them healthy than treat them when they are sick"

It is strange that I should be doing this on Christmas Day, but I am catching up on my readings.  Tasked with the charge to be the healthcare architect for the population in the west with the building of the new Jurong General Hospital, I have been populating and inspiring my mind with ideas others are thinking and implementing.

I picked up an email containing an article from one of the online issue of the NYTimes, "If all doctors had more time to listen".  Dr Batlle, a primary care doctor in the US was quoted in the article saying "I prefer to keep them (patients) healthy than  treat them when they are sick".  I thought to myself, this is indeed what Jurong Health Services - the health system comprising Jurong General Hospital, aspires to do for the population in the west.

The article started with a visit by Dr Batlle to the home of a 93-year old patient.  She had 15 types of medications from a range of healthcare providers including a cardiologist, gerontologist, a pulmonologist and upon checking, found that "...some of the medications have expired, some unnecessary and some dangerous if taken together".  Dr Batlle was able to cut her medication to 4 and gave the family her personal mobile phone number.  According to Dr Batlle, she was able to save the patients from several visits to the accident & emergency and hospital stays because she was able to attend to the needs of the patient in a timely manner.

I asked myself, "Is this a far-fetch example of badly coordinated care, or is this the real world out there where patients may unwittingly be left floundering?" Based on the experiences of my family members, feedback from patients that I have heard over the years, and some recent feedback from colleagues whose loved ones have taken ill (both locally and overseas) - this example represents a real need out there for better care coordination, better access to patient-centred care that will enable patients to manage their medical conditions or to just stay healthy.

Navigating healthcare for our own health can be quite daunting.  We lack knowledge of medicine and hence depend heavily on healthcare providers to guide us through the "healthcare maze" of:

- when should I go to the GP,
- when do we need specialist care,
- is this serious enough for us to head straight to the the accident and emergency department,
- is there a particular type of specialist I should see,
- if there are few specialists looking after me is there one overall in-charge who will know everything about my medical condition,
- my doctors who are seeing me for various conditions are giving me different medication - should I take all or discontinue some,
- when I am discharged from the hospital will I be able to take care of myself,
- how will I know if I have fully recovered,
- if I am referred to the community hospital will they know how to continue my care,
- which nursing home should I choose - are they all the same,
- how do I take care of my wound when I am discharged,
- why is the instruction from the discharge nurse different from the doctor - who should I follow,
- if I need help to manage my condition who should I ask,
- this medication makes me dizzy should I stop
...the list goes on.

It has become quite obvious that we need a better way to integrate care for our patients, hopefully even before they become a "patient".  The population will benefit when we are able to "stitch together" the various components of our healthcare system and make it easy for the man-in-the-street to be able to better access the right care.  In the first instance, we should make it easy for people to stay healthy or at least have the information so that they can be motivated to do so.

My dream is that we will be able to ultimately integrate healthcare in a manner so simple that we can literally "bring health to every home" - much like the simple but powerful Microsoft vision of "putting a PC on every desk running Microsoft".

IT will be a key enabler and work to put in place a national health record for Singapore has already started.  Healthcare capacities and capabilities will need to be enhanced, and the plan to build JGH is a testimony to that commitment.

Singaporeans can be proud of our healthcare system.  When compared to the healthcare systems of even many of the advanced countries in the world, ours continue to stand out in terms of quality, access and cost.  As our population continue to age and with the growing incidence of chronic illnesses, this transformation of our healthcare system that is currently taking place, from the current episodic acute care based approach to one that is integrated, seamless and population based will indeed be the change that we need.

Let's see how we can co-create a healthcare system that will truly put "Health" at the centre and NOT just "illness" care.

Strong when we are weak...

This week, faith and trust took a beating.  It is in my nature to be trusting and believe the best in people as the default mode. Most times, this has been the right approach.  I have seen people blossom right before my eyes as I did so, the rewards unimaginable and satisfying!

However, my domestic helper (maid) who has been with my household for the last 3 years betrayed that trust a few days ago.  Many of us might say, no problem, move on - she is just a maid.  True, she is just a maid but she saw my boy grow up for the last 3 years and actually did her job well.  My kids are quite fond of her, my parents have grown to trust her and she is a welcome help to my family.

Last saturday, when we returned from our trip from Hainan (she went on trip with us), I received a call for her from Indonesia.  I called her to the phone - she took some time as she was helping to unpack and clean, but after she had spoken for about only 15 secs, she dropped the phone and broke down crying. I asked her what was wrong and amidst her tears, she told me that her husband had died in a bus accident in Indonesia and her son who was traveling with her hubby was in hospital.  I called my wife and she comforted my maid and held her hands to give her strength.  We told our maid that we would do everything within our means to help her.  I went on the Internet, checked out the earliest flight back to Jarkata (turned out to be SQ and not Tiger Airways) and with her agreement booked that SQ flight for her to go back in time to be with her family.  My kids were at the airport on Sunday to see her home - there was tears but then she had to be back with her family.

To cut the long story short, all this was all a hoax!  The husband did not die and the son is well.  In fact, when I called her home in Indonesia and asked her family member "how was her husband?", her husband came mistakenly to the phone and spoke to me. While I was disappointed and felt betrayed, my wife was devastated this has turned up to be one of the biggest hoax. She could have told us that she wanted to go home and we would have still let her.  Why did she lie?

Suddenly left without a domestic help and with my wife, parents and kids taken ill, it was really hard for the whole family.  Naturally, I chipped in doing the bathing of the kids, preparing their milk, packing the bags before we go out, making the beds, folding the clothes, cleaning up the vomit, etc etc etc.  I do not begrudge doing these tasks, in fact I think I do them quite well.  But, with everything that went on, the priority was keeping the peace at home.

Faith and trust in people took a beating.  I was mentally tired out. At times I thought to myself, I should be less trusting and perhaps even be "nasty" but realises deep down that to do so would be wrong.  Even so, I was not able to really rise beyond what I had experienced - the betrayal and lie.

I was on facebook this evening, when I spotted one of my friend Josephine Xu posting a Youtube video of Whitney Houston singing her new song "I look to you".  Whitney was my favourite singer until she was lost to drugs.  The song was beautiful and brought me to remember again that when we are weak - as I was, we can "look up" and draw strength.  I listened to this song 3 times and at the last time, my eldest daughter stepped into my room and I shared the song with lyrics with her.  As I listened to the song with her, I know I have the answer to the question that she asked me in the afternoon, "how should I feel towards auntie? I know she did not do a nice thing but she did take care of us..."

I am no longer disappointed, I am no longer angry with my maid.  In doing so, I have experienced rest and closure.  My faith is back and I can be more trusting again.  I Look to You...

Here are the lyrics of the song "I look to you" so that you can enjoy as well

As I lay me down
Heaven hear me now
After giving it my all
I’m lost without a cause
After giving it my all

Winter’s storm has come
And darkened my sun
After all that I’ve been through
Who on earth can I turn to

I look to you
I look to you

After all my strength is gone
In you I can be strong

I look to you
I look to you

And when melodies are gone
In you I hear a song
I look to you

About to lose my breathe
There’s no more fighting left
Sinking to rise no more
Searching for that open door
www.musicloversgroup.com
And every road that I’ve taken
Lead my regret
And I don’t know if I’m going to make it
Nothing to do but lift my head

I look to you
I look to you

And when my strength is gone
In you I can be strong

I look to you
I look to you

And when melodies are gone
In you I hear a song
I look to you

My levees are broken
My walls have come
Tumbling down on me
The rain is falling
Defeat is calling
I need you to set me free
Take me far away from the battle
I need you
Shine on me

I look to you
I look to you

After all my strength is gone
In you I can be strong

I look to you
I look to you

And when melodies are gone
In you I hear a song
I look to you
I look to you
I look to you

What can we learn from the Tiger Wood?

The front page of the Straits Times today carried a feature about Tiger Wood taking time off golf to heal his family relationship.  I had been away from Singapore for the last 10 days visiting my ancestral home in Hainan Island and have not kept up with news.  Before leaving on my trip, I remembered the news about his driving incident and the world was buzzing about why it happened.

I read the news with a tinge of disappointment.  I asked myself why would a man with such success come to possible ruin due to such foolish judgement and actions?  I remembered too that when the news broke, he vehemently denied any marital problems and extra-marital relationships.  But, now he confirmed the problems.

Tiger Wood is a brand name - some may even say an "organisation" unto itself, with "revenues" of over US$100 per year in terms of sports endorsement.  Fans, perhaps expected him to be more transparent when the news broke, and through their loyalty, forgive him.  Because he denied and later confirmed the problems, his following may take a beating and could take time for him to recover.

On the same day, Salma Khalik wrote an article asking healthcare institutions to be more transparent about their mistakes so that individually and collectively as a system we can improve.  I agree.  Taking reference from the Tiger Wood "fiasco" (even though direct comparison is incompatible), transparency and sincerity about the mistakes we make would be key to patient (or fan) confidence.  Particularly in healthcare where there is information asymmetry, transparency becomes even more important.  Patients rely on healthcare professionals to "do the right thing for them" because many times they don't know better.  Healthcare institutions should honour that trust by being forthright when things go wrong, apologise with sincerity, and do their best to "make it right" to the patient.  The recent chemotherapy incident at KKH provided an excellent example in this regard.  Not surprisingly, the patients and families involved in the incident have been forgiving.

To err is human, to forgive divine.  For forgiveness to take place when mistakes happen, transparency and sincerity seems to be 2 key ingredients for individuals and organisations to put into action quickly.  Doing the right thing will always be the right thing to do.