Prof Fong Kok Yong, Deputy Group Chief Executive Officer, Regional Health & Medical, SingHealth

Dr Tracy Carol Ayre, Group Chief Nurse, SingHealth and Chief Nurse, SGH

Nurses

Staff and guests

Ladies and gentlemen

Introduction

A very good morning to all of you. It is my pleasure to join you today for the SingHealth Nursing Conference 2017. This is the second year that SingHealth has organised this conference, and I am heartened to see how the conference has grown in depth and scale since its inception.

2 This year's theme, "Rising Tides: A New Era in Nursing", is a timely one as our healthcare landscape continues to evolve to meet the changing needs of our population. With an ageing population and the rising burden of chronic diseases, the Ministry of Health has taken progressive steps to transform the way we deliver care. We are making three major shifts - beyond hospital to community, beyond quality to value, and beyond healthcare to health.

3 This morning, I would like to elaborate on the important role that nurses play in driving these shifts and what it holds for the nursing profession as we build a stronger healthcare system for Singaporeans.

Beyond hospital to community

4 First, moving beyond hospital-centric care to care in the community. Across the board, we are seeing more elderly with multiple and more complex chronic conditions. Among them, a sizeable number are at risk of multiple hospital re-admissions due to complex health problems and lack of proper support at home. They have both health and social care needs which need to be addressed holistically by different care providers. By working together, pooling resources and expertise to coordinate care, we can ensure that no one falls through the gaps as they transit from one setting to another, and that they are well-supported to stay in the community.

5 One group of SingHealth nurses has demonstrated how this works. Known as Patient Navigators, they identify patients with complex health and social issues and support them from the point of admission to discharge or end-of-life. They work closely with doctors and allied health professionals to assess patients' needs and plan their post-discharge care. Even after discharge, Patient Navigators monitor their condition closely via phone calls and home visits. They also connect patients and their caregivers with intermediate and long-term care agencies as well as voluntary welfare organisations to provide services such as home and day care, financial assistance and meals-on-wheels.

6 The outcome has been encouraging, as interventions by the Patient Navigators have resulted in better coordinated care. A&E attendance was reduced by 52 per cent for the 4,895 SGH patients enrolled on the programme from April 2015. To move care further upstream, SingHealth will be training more nurses for community care.

Beyond quality to value

7 While efforts to strengthen care delivery across the continuum are scaled up, we need to be mindful of the long-term implications on sustainability. This brings me to the second key shift for our healthcare system - moving beyond just ensuring good quality healthcare to achieving value-based care. Providing safe and quality care is the healthcare team's shared responsibility. But nurses are in a unique position to do this. They spend the most time with patients, acting as patient advocates to ensure that they receive care that is appropriate to their needs.

8 Nurses also play a vital role in driving and implementing quality improvement initiatives. Many of these have resulted in improved outcomes as well as considerable savings for patients. The nursing team at the National Heart Centre Singapore, for example, worked to reduce the incidence of hypoglycaemic events among heart bypass patients with diabetes. Hypoglycaemic events, if not managed well, can lead to longer lengths of stay in hospital and life-threatening complications.

9 The nurses employed a series of interventions which included serving night feeds to maintain patients' blood sugars at an optimal level, and increasing communication and education before and after surgery to help patients understand the need for night feeds. The Quality Improvement initiative resulted in increased compliance for night feeds, and hypoglycaemic events were halved from 20 to 10 per cent.

10 Another enabler of value-based care is the use of technology and automation to increase the efficiency of work processes. Previously, nurses had to do manual charting of patients' parameters such as vital signs and ventilator settings. With the Medical Device Interface (MDI), data can be transferred directly to the Electronic Medical Records (EMR) system. The automation reduces paper records and data entry errors, and frees up more time for nurses to spend on direct patient care.

Beyond healthcare to health

11 The third key shift is to go beyond providing healthcare services to nurturing a healthier nation and ramping up chronic disease management efforts. Last year, the Ministry of Health declared war on diabetes. It was a call to action against the disease which, if left unchecked, can affect nearly 1 million Singaporeans by 2050. Many of our public healthcare institutions have joined us in this fight. I am also pleased to note that today's conference includes a dedicated track on diabetes care and preventive management.

12 Diabetes not only affects the elderly but also children. Since the KK Women's and Children's Hospital introduced its paediatric endocrinology service in 1997, the Hospital has treated more than 1,000 children and adolescents with diabetes. Living with the chronic condition can be arduous for these young patients who need daily insulin injections to control their blood glucose levels.

13 With this in mind, nurses from KKH embarked on a research project to look at needle lengths to achieve optimal insulin efficacy. The team found that shorter needles were less painful and able to inject insulin more effectively into the fat layer under the skin. The findings have since led KKH to introduce 8mm needles instead of the standard 12mm needles in early 2016. KKH also plans to introduce even shorter 6mm needles this year, to further improve insulin delivery and patient experience.

Conclusion

14 It is clear that nurses have a significant role to play in the transformation of care. As we work together as one healthcare family to tackle future healthcare challenges, I urge all of you to continue learning and sharing best practices as you improve the care that our patients receive. With greater emphasis on continuing care in the community and at home, you are also the bridge that connects health and social care providers with patients and their loved ones. Stay true to your calling to comfort and heal and remember that you have a hand in defining the way care is delivered now and in the future.

15 With this, I declare the SingHealth Nursing Conference officially open. Thank you.

Source: Ministry of Health, Singapore