​Have you hesitated to change your approach at work or towards patients but feared judgement or ridicule? Imagine a new model of care emerging simply because someone dared to speak up. 

Switching the narrative

In 2020, amid the pandemic, Medical Social Services (MSS) piloted LACE (Local Area Coordination and Empowerment) - a person- and goal-centric approach to empower patients with heart failure and their community in their care journey. During conversations with patients, the MSS team delved into their vision of a ‘Good Life’ to help them reframe their perspectives and discover their own life goals. Additionally, the MSS team fostered close connections between patients and community partners to facilitate holistic care to delay the progression of heart disease. You can read more about LACE here

The MSS team dressed in white and red NHCS t-shirts, together with their patient who has benefited from LACE. (L-R): Lim Jing Kai, Jasmine Ku, Sim Yu Xuan, Dr Goh Soon Noi, Master Medical Social Worker from CGH, Anuradha, patient, Ong Shi Hui, and Tan Boon Cheng. 

This was this first time that such a relationship-driven approach was used in the outpatient setting with heart failure patients in Singapore. It may have seemed like a wild idea with no guaranteed odds of success, but triumph it did. The pilot, which ended in 2023, saw more than 90% of healthcare partners increasing their capability in cardiac care management in the community, and close to 96% of patients feeling more empowered and in control of their lives. These results had a positive downstream effect: 58% of patients had reduced readmissions, and the average length of hospital decreased by two days.   

Embracing discomfort

Medical Social Workers, Sim Yu Xuan and Lim Jing Kai from MSS, who have been working closely with their patients using the LACE approach, shared with CardioConnect how a deep culture of trust and respect in their department have boosted their confidence to voice their thoughts. 

What is the culture like at MSS?

Yuxuan: It is a place where I can take relational risks with my superiors and yet have a mutual understanding that we can agree and disagree respectfully. I see what we have as a work in progress – we must constantly build and maintain psychological safety within the team. It cannot be taken for granted and it takes effort to build this dynamic. 

Jing Kai: Our team values communication, where we seek to understand everyone’s perspectives and appreciate the insights from each other. There is mutual respect for each staff member regardless of the positions held, and I feel comfortable speaking up and voicing my thoughts authentically without fear of being judged.  

What prompted you to speak up?

Yuxuan: It bothered me that we always responded in a similar way to the recurrent issues that patients faced, knowing that the outcome would not be different. I felt that if we were to approach a problem differently, there might opportunities for different outcomes. Therefore, whenever I feel that things can be improved, I will speak up to suggest how we can co-create a different approach, such as in the case of LACE.

Jing Kai: I had a discussion with my supervisor to explore opportunities to collaborate with my peers in the department, and that open conversation led to my involvement in LACE. 

How did you feel at that time?

Yuxuan: I am glad that our team listened to one another, embraced the discomfort to face the differences, and spoke openly to resolve areas of contention and disagreements. I am proud of the team in making intentional efforts to understand one another's perspectives and discussing what was feasible and realistic whilst withholding assumptions.

Jing Kai: My supervisor provided a safe space for me to verbalise my thoughts and invited me to co-create opportunities with my colleagues. The feeling of being heard and being valued deepened the trust in our working relationship. 

How can we work towards improving the level of trust, respect and empowerment among staff in NHCS?

Yuxuan: We must first have respect for one another as human beings. To do this, we must set aside the concept of hierarchy and perception of power dynamics. If there are assumptions that I am better than you or I am more senior than you, it gives a sense of entitlement and limits openness to constructive feedback that is not helpful in building a psychologically safe environment. It is important to recognise that everyone brings contribution to the table, and that individuals can grow with the right environment and support. 

Jing Kai: I believe that leadership can greatly influence and shape the culture of NHCS by setting forth an example in their day-to-day interactions and clinical care – one that demonstrates trust, respect and empowerment. At the same time, I hope that fellow colleagues can also be activated to bring up new ideas, feedback and create opportunities for collaboration. 

Admittedly, swimming against the tide is not easy, especially with all the questions and challenges that come up. That is why it is so encouraging to see more staff members stepping forward to question old practices and try new ways of doing things. For example, Jing Kai shared ICU care rounds were started to let multidisciplinary care team leaders and members openly talk about their experiences and feelings in caring for seriously ill patients. In the last two years since it began, the initiative has strengthened the camaraderie amongst colleagues.

Indeed, team psychological safety – a safe space to express ideas and concerns without fear of negative consequences is essential in building successful teams. So, the next time someone has an idea or feedback, let us embrace it, respect the diversity in views, and applaud their courage to speak up!

Psst: SingHealth has launched our symbol for psychological safety – Sora, the SingHealth Orangutan! 

Unlike an 800-pound gorilla that is often associated with being intimidating and acting without regard for others, let our endearing Orangutan remind us not to be like the gorilla, but to embrace and be respectful of diversity in views and have the courage to speak up.