Anxiety over impending changes made Chelvi consider leaving but her team at the Pre-Admissions Centre needed her. 

“It can’t be done.”

“We are Patient Service Associates, admin staff. We don’t know medicine or surgery, unlike the nurses. How can we do listing for surgery? What if we make a mistake and patients are harmed?”

“And we’ve experimented before, for us to do surgery listing. They were disasters. We couldn’t read the surgeons’ handwriting so how to key in the correct surgery?”

“There are so many terms to learn and understand – names of surgeries, types of implants, which theatre is suitable for which type of patients…”

“Every specialty had different steps. Some doctors do things their own unique ways, which only their nurses know, the knowledge is inside their heads, not written down anywhere.”

High anxiety and fear struck the team of about 20 front counter staff from the Pre-Admissions Centre when they were told nearly three years ago that they had to relieve the nurses of the administrative task of listing (or scheduling) surgeries. Until then, they were liaising with patients on non-clinical matters such as financial counselling, or scheduling of tests prior to surgery.

Fight or flight?

Executive Chelvi (Thirvchelvi Palaniappan) was a Senior Associate Executive at the PAC at that time. Stressed out by the fear that she may not be able to do the new work of listing, she was tempted to take up a job offer from one of the newer hospitals. “Since they want me, why not? Why stay and take on this burden of doing something I’m not confident of doing?”

But her husband and 3 children thought otherwise. “What makes you think you don’t have to learn to do things differently in the new hospital? At least in SGH, you know the place and people so well.” That proved so true. 

Taking control 

“My nursing friends in the SOC told me, ‘You can do it. It’s possible now, with the surgeons filling in Electronic Admission Forms.’ This meant doctors’ handwriting is not a problem anymore,” said Chelvi. 

When the managers asked for suggestions, the PAC staff had one very firm request. “We must have training, structured training, with teaching materials and dedicated training hours.” 

In the previous unsuccessful attempt about 10 years ago, training was on the job. “10 of us were crowding around the computer at the counter to watch how the nurses did it. We only learnt that it was very difficult and became even more demoralised,” recalled Chelvi.

So Deputy Director Cass Chay and her management team at Pre-Op & Admitting Services got to work. With inputs painstakingly gathered from surgeons and nurses from various specialties, they designed standardized processes and digital forms. The executives developed step-by-step manuals for listing, and Senior Manager Linda Lim became the master trainer. 

The Patient Service Associates, many of whom are mothers and wives in their 50s who are used to rushing home to prepare dinner, stayed behind over two nights till 9pm, for classes.

For Chelvi, “I studied and even asked my teenage children to test me, to make sure I remembered and understood. Sometimes they stumped me with questions that I couldn’t answer, like “Why do you have to do it this way?” I’d bring those questions back to work, and the executives would revise the materials to be clearer or get answers. We also made sure to share with all the staff. In this way, we refined the instructions together,” said Chelvi.

Manager Zewei relished the experience of going through the journey together. “We are new to surgery listing too. So we went through the same training together, step by step.”  

Ze Wei (left) and Chelvi trained and overcame challenges together.

In addition to the classes, the PAC staff were sent in pairs to train with SOC nurses in the clinics. “The nurses are very supportive. We are able to call them for help whenever we’re not sure,” said Chelvi.

Confidence was further boosted when new colleagues fresh from the polytechnics were able to do the listing without major difficulties, after training. 

The biggest fear

The biggest fear that the staff had, was talking to surgeons. “We have to clarify their instructions when there are missing or unclear information, as these may impact patient safety. Or there could be a duplicate booking or erroneous booking into another surgeon’s slot,” explained Chelvi.

“Some of us had experienced the surgeons coming across as very aggressive, especially over the phone. They also like to ask rhetorical questions, which we are not expected to answer but leave us confused and feeling inadequate,” said Chelvi.

“However, I’ve come to understand that doctors are pre-occupied with many other matters, and they respond better to face-to-face queries. As such, I try to reassure my colleagues and help them empathize with the doctors.”

“And we get smarter about how the surgeons work as we go along,” said Manager Zewei . “Once we see a pattern emerging, we verify with the HOD to establish a standard procedure and don’t have to trouble the surgeons again. As the PAC staff learn to use more IT systems, they are also discovering that they can access some of the documents (such as CPOE order forms) online, without having to ask the doctors for them.” 

More valuable work

For her leadership in helping the team navigate the changes, Chelvi was promoted to be an Executive last year to oversee operations in PAC, which completed its expansion late 2017. The team of about 20 Patient Service Associates will take over, in phases, centralized listing of surgeries from the SOCs and wards. They also co-ordinate and schedule pre-admission evaluation and tests, carry out financial counselling and attend to patient queries.

Chelvi’s new role as Executive also requires her to learn even more new things, such as attending meetings and recently, making a presentation to COO.

“Zewei and the other executives guided me to prepare the slides, and I rehearsed at home with my children as the audience. My children had questions but I brushed them aside, because I was so nervous. At the meeting, COO asked me the same questions. I should have listened to my kids,” confessed Chelvi.

Gearing up for the future SGH

There’s more learning to come, as the PAC team gets ready for the upgraded Operating Theatre Management System to be rolled out in the coming months. On the horizon is the new Elective Care Centre to be built in 6 years’ time, and PAC is already testing out better processes and new ideas that can be scaled up there. In navigating the changes today, Chelvi and her team at the PAC are one step ahead in gearing up for the future.

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