Assoc Prof Tay Sook Muay, Associate Dean for NUS Yong Loo Lin School of Medicine, shares the importance of instilling a culture of quality and safety in future clinicians and the roles that faculty must play in quality improvement.

Assoc Prof Tay Sook Muay
Associate Dean for NUS Yong Loo Lin School of Medicine
Senior Consultant, Anaesthesiology Department, SGH

I have always thought the Cheshire Cat from Alice in Wonderland is very wise. When Alice asked which way she should go, the Cheshire Cat replied, “That depends a good deal on where you want to get to.” Likewise, if we know our destination, we will know the way to go.

We want to deliver best quality care. However, the definition of quality can be complex because of the different needs of stakeholders involved in delivery of care, such as patients, the employing hospital and government agencies.

We can start with the basics and define quality in healthcare as patient safety, i.e. the prevention of errors and adverse events such as injuries to patients, and use it as a common reference point to work towards.

Studies have consistently shown that adverse events happen to about 10 per cent of patient admissions. This result has been duplicated in studies around the world and for more than 20 years. How can this figure be improved upon in our institutions?

We can do this through quality improvement – and our faculty has multiple roles to play in it:  Role models, drivers, supporters, perpetuators and practitioners. When we develop our faculty to perform these roles well, we can improve quality of patient care.

I define faculty as anyone who is empowered to teach in our care settings.

They can be someone appointed formally as instructor, or a senior staff teaching a newcomer the ropes. They are healthcare workers at the epicentre of patient care, and in the best position to build a strong safety culture. 

Tools for process improvement such as Six Sigma and Total Quality Management (TQM) are widely used in different industries. While training faculty in these methodologies are important, they need to be real-life role models in quality improvement.

For example, the research project, “Falls in a Psychiatric Unit” led by Assoc Prof Ng Beng Yeong was conducted by a research team involving SGH medical staff and Yong Loo Lin students. For students, such hands-on practice on improving patient care is very important.

Aside from this, faculty can support a safety culture by challenging the “blame and shame” culture, normalising respectful, assertive communications across hierarchies, and openly report and learn from incidents and near-misses.

Other educational strategies to instil a safety culture in future clinicians include teaching them mindful practice, self and situational awareness, and having empathy as a habit of care.

To sum up, beginning with the end in mind helps us focus on how we can effect quality improvement right at the beginning, with our students learning from educators how to work towards better patient care.

By starting students early on to have an awareness of patient safety, we can build it into a consistent behaviour and, from there, it will become a habit.