​Mercy Hospital in Oklahoma City, the Singapore healthcare system and SMRT Corporation have one thing in common: based on rankings, numbers and statistics, they are all one of the best in their fields. So why do they still feel the need to change? And how do they go about doing it?

Tomorrow’s Medicine brings you highlights from Singapore Healthcare Management 2015.

Improving Culture and Employee Engagement with Lean Tools

Mr Jim Gebhart, President of Mercy Hospital in Oklahoma City, USA, shared, “In healthcare we often try to be one notch better.   But the questions that need to be asked are: What is the ideal state? And what can be changed to achieve the ideal state?”

Mercy Hospital has applied Lean tools (management principles that starts by eliminating waste) to enhance their culture and improve care by taking bad experiences and not putting them to waste. In contrary, they use them to bring themselves closer to the ideal.   This involves a change in culture from leadership to the ground.

One of the changes is by going to Gemba (“the real place”) more often – in other words, beginning the transformation by observing the ground.   Leaders at Mercy Hospital set aside 2 hours to visit the ground daily and also consult people who are not healthcare workers before implementing new initiatives for patients.

Each department also puts up an “improvement board” where co-workers can write down existing problems, solve them together, and then moving the notes to the “solved” corner.   In their rehabilitation hospital, it has helped them cut down the number of falls from nine per month to zero in the past three months.

Mr Gebhart summarised the keys to transformation into four points: “Leadership, Humility and respect, Listening, and Discipline.”

Healthcare Operations – Continuation of the NHG Story

Singapore healthcare is ranked high by many organisations. “However, they only rank illness care,” said Prof Philip Choo, Group CEO of National Healthcare Group (NHG).   “The rankings are not meaningful, because illness care means we are taking care of people who are already sick.   Illness care is also expensive, unsustainable, and is a failing system.”

Moving away from illness care, Singapore is developing its Regional Health System (RHS) that is more sustainable.   In our healthcare system we only know a minority of the population – those who have visited our institutions.

Prof Choo added, “We should also see Regional Health System as relationship-based healthcare.”

He cited some examples of challenges in healthcare that can be addressed by the healthcare system outside the hospital setting.   For example, 90 per cent of Singaporeans die in a hospital setting, without a healing experience.

Some unhealthy behaviour has also become medicalised – the condition of diabetes patients in Singapore worsen faster compared to patients in some other countries due to over-reliance on medications and not change in lifestyle.

To bring about change, sometimes it is not just about the skills.   Lean and other Quality principles can be taught to all healthcare workers.   But often it is the mindset that needs to be changed.

Prof Choo called for leadership to make their people better and embed it in their everyday work.

Getting Us on Board and On Track

The public transport system and the healthcare system face similar challenges – for example in the areas of subsidies, congestion, infrastructure and affordability, and communications to the public.   They both also need to balance the needs of the public, staff, business partners and government. 

Mr Desmond Kwek, President and Group CEO of SMRT Corporation Ltd Singapore, is no stranger to public service.   During his stay with SMRT there has been very public incidents such as the recent line break down, and internally, low morale of staff – so much so that some employees refuse to wear their uniforms until they reach their workplace.

However, many improvements has taken place in the past few years with works going on in the train lines and the latest surveys revealing that their staff are now proud to work for SMRT.

But Mr Kwek warned, “Statistics does not mean anything to the customer. Managing public satisfaction is an emotive issue.”   He added, “Expectations are shaped by what customers experience.

Having 140 train stations does not mean anything to someone who has to walk two kilometres to the nearest one.   Having trains coming every few minutes does not mean anything to someone who is late for their job interview due to a delay.”

“Accolades and numbers don’t matter unless we can get mindshare and people on board.”