Major Processes Of Khoo Teck Puat Hospital

Published Date: 02 Nov 2017

Introduction

Outline

Khoo Teck Puat Hospital (KTPH) was first officially opened to the community on 2012 15th of November. It is a public hospital consisting of 550 beds with a broad range of medical specialties and clinical support from rehabilitation to Pharmacy. The 3.4 hectares hospital is located in Yishun and this construction is part of the healthcare hub in our very future planned by the government.

Managed by Alexandra Health, KTPH focus their attention on more than 700,000 people living in mainly the northern part of Singapore such as Woodlands, Sembawang, Ang Mo Kio and Yishun. This comparatively young residential area will be expected to enter the aging population phrase in the upcoming years. To prepare from the up rise of healthcare needs in this particular area, KTPH will be functional to reduce the workload of other healthcare provider such as Tan Tock Seng and General hospital. (Khoo Teck Puat Hospital, n.d.)

KTPH cost a total of $555m for the buildings and over $119m merely for the medical and relevant equipment and furniture. This amount is entirely financed by the Government in support of this project to improve the efficiency of the overall healthcare services in Singapore. Those medical equipment and facilities are advance and up-to-date to empower quicker treatments and precise diagnoses. By enabling automation, it simplifies the entire operation of KTPH and enhances the productivity of all departments. (Khoo Teck Puat Hospital, n.d.)

Presently, KTPH is the newest generation of general hospital of its kind in Singapore with more than 38 comprehensive types of medical specialties. Some of the services and medical support they provide are neurology, oral and dental surgery, oncology, plastic surgery, weight management, general surgery, cardiology and diabetes care. Apart from those listed, geriatric clinic is one major medical specialty they are offering. This clinic provides a full suite of healthcare services that cater entirely to senior citizens. Their main focus is to ensure stability in the social, mental and physical wellness of elderly.

Organization Structure

KTPH is the first and only public hospital in Singapore with a board of directors of its own. This unique organization structure in their board of directors was created to support strong corporational governance for the purpose of innovation, stability in financial aspect and most importantly service excellence. This board of directors consists of local corporation leaders from numerous industries and companies. (Meiyu, 2011)

Since KTPH is under the management of Alexandra Health Board, the board of directors is made up of top managerial level of Alexandra Health Board with Ms Jennie Chua taking the lead as the chairperson of this board of directors. Under Ms Jennie Chua, consist of 8 other members of the board of directors with Ms Irene Png as their Company Secretary. Under this structure, we could see that KTPH has a high formalization with the need to follow regulations and rules set by Alexandra Health Board and the Government of Singapore.

Beside the external management members, the organization structure of KTPH is mainly in authority of the Mr Liak Teng Lit the chief Executive Officer (CEO) of KTPH where he is the main decision making point of the hospital. The CEO of KTPH is primarily managing 2 very large groups of KTPH. One of it is the medical board where they are in-charge of the healthcare of the patient in KTPH whereas the other is the is the managerial group that manage the entire hospital regarding the human resource, operation, financial, nursing, IT and aesthetics & patient relationship. Therefore it shows a rather broad span of control in KTPH organization structure.

Under Associate Prof Pang Weng Sun, the Chairman Medical Board, are 4 deputies Chairman Medical Board assisting him in the handling of all medical departments and specialists. Due to the fact that KTPH have been providing a wide range of medical services, there are a total of 14 different departments under the medical board to meet all the healthcare needs of KTPH patients. Hence this shows a strong basis of departmentalization based on what they are specialized in. Therefore, doctors will be grouped under each department depending on their medical knowledge and experiences.

Other than the Medical Board, the CEO is also supervision 6 other non-medical departments. With Mr Alvin Ong as the Chief Information Officer (CIO), Mr Lau Wing Chew as the Chief Transformation Officer (CTO), Ms Lynn Gan as the Chief Human Resource Office, Mrs Chew Kwee Tiang as the Chief Operation Officer (COO), Ms Irene Png as the Chief Financial Officer (CFO) and lastly Ms Low Beng Hoi as the directory of Nursing.

Major processes of Khoo Teck Puat Hospital

Register as outpatient in the clinic

This process is to allow patient with illnesses or sickness to register them at the clinic in Khoo Teck Puat hospital and to get their queue number before proceeding to visit the doctor. The parties involved in this process are the patient, the nurse, the print system and the registration system used by the hospital. The major key functions performed by this process consist of registering patient through their identification number, assign doctor in terms of the type of illnesses and to distribute queue number for easy references purpose as a clear instruction on when to proceed for consultation.

The patient will enter the clinic and proceed to the outpatient clinic counter where the nurses are for enquiry and registration purposes.

The nurse will then request for identification card (IC) for registration purpose to look for your profile in their database.

If the patient has brought his/her IC:

The patient will pass his/her IC to the nurse.

If the patient has not brought his/her IC:

The nurse will then ask for other form of identification to verify his/her identity.

The patient will present other form of identification such as driving license or personalised EZ-link card.

The nurse will then scan barcode on the identification documents provided as an input data into the registration system.

The registration system will search for patient in the hospital database for identical identification number.

When the searching is done, it will retrieve personal information of the patient.

After retrieving, the registration system will straight away prompt for the information of the illnesses of the patient (reason for the visit to the clinic).

The nurse will then first read out some parts of his/her personal information to ensure that the patient is the one mentioned in the database.

The patient will verify personal information by confirming his/her personal information.

After that, the nurse will ask for the patient illnesses.

The patient will provide description of his/her illnesses.

The nurse will enter the relevant description and information provided by the patient into the registration system.

The registration system will begin searching for doctors and it will then check for doctor’s patient queue.

If the queue length is just right for that patient in conjunction to the seriousness of his/her illnesses:

Proceed to the next step.

If the queue length is too long for that patient due to the seriousness of his/her illnesses:

Proceed to step 12 for the registration system to repeat the search.

The registration system will assign and add the patient to that particular doctor’s queue list.

Then the registration system will generate queue number.

The print system will then print the queue number.

Finally, the patient will take the queue number and this will end the activity flow diagram of registration in the clinic as outpatient.

Receiving Medication with Payment from Pharmacy

This process is to allow patient with get their medication prescribed by the doctor after the consultation and to pay for fees owning for the medical services. The parties involved in this process are the patient, the pharmacist, the payment system, the print system, numbering display system and the medication system used the Khoo Teck Puat hospital. The major key functions performed by this process consist of processing and preparing of prescription, calling through numbering display system and payment through choices of payment methods.

The patient will enter the pharmacy and proceed to the enquiry counter in the pharmacy where the pharmacists are for preparing medication following the prescription.

The pharmacist will then ask for prescription from the patient.

The patient will pass the prescription given by the doctor previously during his/her consultation to the pharmacist.

The pharmacist will scan the barcode located on the prescription as an input into the medication system.

The medication system will add the prescription to the prepare list of the pharmacist.

The medication system will then starts to generate queue number while the pharmacist prepare for the medication.

Next, the print system will print the queue number for the patient.

The patient will then take the queue number and wait for his number to be called.

After the pharmacist has done preparing the patient medication and after the patient has received the queue number, the pharmacist will request for the patient’s queue number to be displayed.

The numbering display system will then display the queue number on the public monitor screen to alert the patient.

Upon seeing the queue alert, the patient will proceed to the pharmacy counter.

The pharmacist will request for the queue number.

The patient will provide the queue number given to him previously.

Then the pharmacist will assign the medication and tell him the amount owning.

The pharmacist will then request for payment methods to be chosen by patient.

If cash:

The patient will provide a sufficient amount of cash

If nets / credit card:

The pharmacist will request for bank issued card.

The patient will provide the card to the pharmacist.

The pharmacist will then swipe the card on the payment system.

The payment system will prompt for password from the patient.

The patient will then enter the password and the payment system will start to validate the password entered.

If invalid password:

Proceed to step 15)b)iv).

If valid password:

The payment system will approve payment.

Proceed to next step.

The pharmacist will request for receipt from the payment system.

The payment system will generate receipt.

Then the print system will print out the receipt.

Lastly, the patient will received the receipt and this will end the activity flow diagram of receiving medication with payment from pharmacy.

Request for Booking of Dental Consultation Online

This process is to allow patient to request for a booking of an appointment for dental consultation using the online system on Khoo Teck Puat Hospital website. The parties involved in this process are the patient, the nurse, the web system and the booking system used by Khoo Teck Puat hospital. The key functions performed by this process consist of requesting for dental appointment, contacting of patient and updating of doctor schedule.

The patient will access the online dental booking page on Khoo Teck Puat Hospital website.

The web system will prompt user to enter name and IC number to know your basic particular.

The patient will enter name and IC number and submit by clicking on the submit button located at the bottom of the page.

Next, the web system will prompt for further personal information while prompting for contact information.

The patient will enter both personal information and contact information.

After, the patient will then be able to submit his/her full particular.

The nurse will receive the booking request sent by the patient through the webpage.

The nurse will then contact the patient with the contact information provided by the patient.

The nurse will then identify and verify patient by asking question related to his/her particular.

The patient will then his/her confirm particular and be identified as the patient that submit the dental appointment booking request.

The nurse will then request for doctors’ schedule from the booking system.

The booking system will then retrieve the doctors’ schedule for the nurse.

The nurse will select a particular date and time and provide the date and time to the patient.

Then, the patient will confirm the appointment.

If Yes:

The nurse will book that slot for the patient’s dental appointment.

If no:

Proceed to step 13 to reselect a date and time for the patient.

Lastly, the booking system will update that particular doctor’s schedule after the nurse booked the slot and this will end the activity flow diagram of request for booking of dental consultation online.

Information system that can be or have been used by Khoo Teck Puat Hospital

E-Commerce applications (e.g. B2C, B2B, C2C, B2E, or e-Government)

Wireless applications (e.g. RFID, GPS)

Today, with new and advance wireless applications that is becoming more and more affordable, many industries and companies have start to exploit the benefits in using those technology to enhance and increase their quality and efficient in any way possible. In organizations with large perimeter like KTPH, the transferring of patient medical data will be laborious without the introduction of wireless applications. Imagine how hospitals in the past spend hefty amount of time just on the process of getting information across multiple platforms. The wireless technology has also opened up to many new innovations that change and mould the how KTPH treat their patients. This integration of healthcare and wireless technology has set out new services and treatment methods that ventures out in KTPH.

Wireless applications have been used throughout KTPH with the setting up of a wireless fidelity (Wi-Fi) that covers the whole hospital. With, this many portable devices with network interface card can now access to any patient or management data with a touch of a button. This make sharing of patients data easier become most patients have to proceed to different department in the hospital during their treatment in KTPH. Moreover, wireless applications can changed how data has been inputted in KTPH with the use of RFID to replace their existing barcode system. Even though barcode are cheaper and are more cost efficient then RFID, the prices of RFID are becoming more affordable and the ease of using RFID by just swiping it across the RFID reader shorten the time taken as compare to locating and scanning the barcode. Below contains specific use of wireless applications and their benefits.

Specific use of wireless applications and their benefits

Tele-Geriatrics through Wi-Fi

Tele-geriatrics is a type of wireless telemedicine. KTPH has been using tele-geriatrics even since the opening of its clinics and specialists. The use of tele-geriatrics is through communicating by transferring information through video conferencing via Wi-Fi where doctors from KTPH were conduct a remote consultation for patient. With telemedicine, doctors could even listen to the heartbeats of the patient and have their blood pressure (BP) measurement in an instant. Those patients are mainly elderly with difficulty traveling. This allows doctors to provide regular scheduled follow-ups and checks even without having elderly to visit the hospital frequently due to their needs in the meticulous care from long-term diseases. A particular community where KTPH used this application on is the nursing homes in Singapore. (Integrated Health Information System, 2011)

With telemedicine, early detection of illnesses will be allowed due to the fact that many elderly have a stereotypical view about visiting the hospital for check-up. The benefit to KTPH is that it will significantly decrease the number of outpatient whether it is in the specialist or generalist department. This will decrease the waiting time for each patient as part of the patients from outpatient is being managed through telemedicine. This way, KTPH could focus more on patients that requires more attention from the doctors while still have a balance in managing follow-up through video conferencing. Therefore on the whole, it will improve the service standard and efficiency of KTPH by ensuring a short waiting time which is a concern in the healthcare system in Singapore.

Accurate medication processes

In KTPH, the traditional method of passing prescription to the pharmacy from patient is still in place even though the digitalized version of the prescription is available in the database of KTPH for the pharmacy straight after the consultation of the doctors. Then, the pharmacy will scan the barcode. However, this dependency of physical prescription by the pharmacy reduces the automation of data entry because with the large amount of patient they are dealing with, pharmacy might miss out some of the prescription as they scan through the barcode. To prevent garbage in, garbage out, data entry must be as automated as possible this way it will minimise the amount of error in the input of data. Hence, to solve this issue, NFC tags could be embedded in the prescription. Therefore when patient wants to retrieve their medication, they could just swipe the prescription against the NFC readers located in the pharmacy.

This also could be further implemented by adding the NFC tags in to the medication. At times, pharmacist could miss out some medication for that particular patient or even worse there are cases where wrong type of medication is being given out due to the similar packaging of those medications. Hence, pharmacist could swipe each of those medications along the NFC readers and the system will produce a medication checklist which will then automatically update and more importantly it will prompt user if a wrong type of medication is given out.

Even though barcode is used, by allowing patient to swipe their prescription by themselves, pharmacist could concentrate on preparing the medication rather than having their attention spread out as they will need to attend to patient. Furthermore, this will also reduce the error made when scanning many prescriptions at once. With the implementation of NFC, it will significantly increase the speed and effectiveness of the pharmacy as compared to finding and scanning the barcode which requires line of sight with the barcode and the barcode scanner.

Moreover, accurate preparation of medical could be done more efficiently and effective because pharmacists now do not have to read and match the medicine on the prescription since the NFC will do the matching automatically. Hence error will be reduced to the minimum and double checking will not be required anymore. Therefore, the pharmacy could prepare more prescriptions and reduce the waiting time needed which will increase the patient satisfactory level towards KTPH.

Fast and efficient patient information sharing

KTPH equipped every doctor with a wireless computer so that they could tap on the Wi-Fi around KTPH to gain access the entire database of patients’ information such as their symptoms and x-ray records. With this, specialist could look at medical information keyed in from other specialist regarding that particular patient. This form of collaboration is only allowed at the conveniences of the doctors in KTPH with wireless applications. In addition, doctors could enter their prescription directly in to electronic sheets of patients profile with diagnosis.

With that implementation, information of patient could be shared in an instant. This fast and efficient process could never be done without the use of wireless application. In hospital without wireless application, large amount of x-ray records must be distributed around the large perimeter with only the help of nurse. This is increase the possibility of medical records being mixed up and this is a tedious process too. Now, with just a click of a button, x-ray taken in the x-ray room will be transferred to the doctor’s room and this is an example of how wireless application have shown the increase in speed and efficient in the sharing of patient information across multiple platforms and department in KTPH.

Enterprise Resource Planning Systems

Due to the characteristic of some of KTPH organization processes where they are only located and used within one or fewer functional areas, the need for ERP comes in. With ERP, KTPH could integrate and merge management, planning and usage of KTPH’s resources together by means of a shared database and software platform. This allows information from one functional area of KTPH to flow smoothly and flawlessly to other functional area that requires and function with the same information. Hence it will be an automatic process using ERP rather than manually duplicating those information which will lead to loss of data integrity and quality.

The ERP system used by KTPH is called Integrated Electronic Medical Records (EMR). The main purpose of EMR is to merge all the data of patients onto a common platform so that staffs, nurses, pharmacists and doctors could have instant and easy access to those information. The need of EMR comes in when KTPH have uses so many kinds of information system and most of them are in paper form. Thus, this makes KTPH difficult to manage and to provide efficient services to reach the expectation of their patients. As compared to other ERP systems, EMR contains healthcare automation tools that are specifically used by healthcare institute like KTPH. Those tools are usually found all over different information system and now with EMR, easy access to those tools will definitely increase the pace of how KTPH will work in. (Integrated Health Information System, 2011)

Specific use of ERP systems and their benefits

Efficiency in managing patients’ appointments

Some patients have many different appointments in different department of KTPH. Those appointments are usually spread across different dates and patients have to visit KTPH frequently to fulfil those appointments. However, with EMR, appointments will be organized in a way that patients could fulfil those appointments within one or few visits. This could be done because the EMR helps to collect appointments data from different departments of KTPH so that nurses could analyst those appointments date organized by EMR to provide a combined appointment date for almost all the patient treatments and check-up if possible. (Healthcare Information and Management Systems Society, 2012)

This efficiency in managing of patients’ appointments allows KTPH to better manage their capacity of the facilities because there will be less patients in the facilities as those patients have multiple appointments rather than having many patients visiting just to fulfil one their many appointments. This will also increase the customer relationship with KTPH because KTPH understands the trouble of patients by having to visit the hospital often when this could actually be done in one or even fewer visits.

Higher quality and accuracy in doctors analyst and consultation

With EMR, it seamlessly connects doctors all over KTPH along with the patients’ medical profiles. When dealing with complex illnesses that deal with many different specialists from different departments, knowledge from different doctors will be needed to accurately determine the real illnesses behind a patient. This could not be done with just the analysis from one doctor because it might not be accurate and true because one doctor might not have the right knowledge and information. Hence, to ensure quality in doctors’ diagnostics, the EMR helps to combine all healthcare professionals’ knowledge and information about a single patient into that particular patient medical profile. Moreover, allergies known from the patient could be identified across all the doctors’ in-charge of that patient with the use of EMR so that prescription from any doctors will never contains medication that is not suitable for that patient. With every mistake, comes a chance of a life-threatening possibility and therefore it is essential to have the EMR to provide an accuracy and of high quality diagnostic and analysis from the doctors in KTPH.

Decreasing costs and expense across KTPH

With EMR, information from all information systems could be gathered to form reports so that management of KTPH could look at the overall critical data to identify places of possible improvement. For example, knowing that a certain medication have been used up fast due to changing of season that cause the wide spread of disease like H5N1, KTPH could use the EMR to look at the usage of all department and compare it with their supply chain through report generated using the information of EMR. This way, KTPH could know when to increase their supply of medication while minimizing the ordering cost and holding cost of those medications. Hence this will reduce the cost and expense of KTPH in term of their supply chain.

Since the EMR system used by KTPH is integrated, only a small IT support team is needed to support it to get it up online as compared to information systems that are not integrated. Furthermore, with the EMR system, most operation becomes centralized and hence KTPH could decrease their spending on employing supporting stuffs as a small number of supporting stuffs is sufficient to cope with the operation of KTPH.

Customer Relationship Management Systems

Customer Relationship Management (CRM) is used by organization as a strategy that focuses on increasing the level of satisfaction of their customers by considering their preferences and opinions on services and products. Resource has shown that the majority of the revenue earned by any organization is through loyal and frequent customers as compared to other type of customers like new customers. Thus, many organizations have now recognized their customers as the core towards a successful business. Therefore, how much profit and growth the organization will have proportionally depends on how successful the organization manages of the customer relationship. Hence, KTPH has introduced customer relationship management even before the building of their infrastructure.

Operational CRM is used by KTPH to receive valuable and beneficial patients’ data so that KTPH could have a better understanding of their customer by getting their feedback. With this, KTPH has started to gather feedbacks and comments largely from the public regarding any relevant information about their services and facilities with customer interaction centers (CIC). Knowing the benefits and the wide spread of online platforms, KTPH has further reach out to their patients through social media as one of their customer interaction center such as Facebook to target mainly on the younger generation of patients that visit KTPH. This is one new customer touch point that hospital in the past do not used due to the limitation of IT.

Analytical CRM is also used by KTPH to gather and store those patients’ data from the operational CRM to analyse and come out with conclusion that will be advantageous to KTPH. Those data will be used by KTPH to unwrap deeply into the behaviour of patients to look at the trends and relationship that KTPH could focus on. Therefore, with this, it will bring about a strong support and development in decision making that will increase the level of satisfaction and that is the main function of the CRM.

Specific use of customer relationship management systems and their benefits

Attracting new customer to increase profitability

KTPH have noticed that many patients in the ward felt discomfort during hourly body check-up like taking body temperature and blood pressure especially when patients are having their deep sleep or when they have uneasiness moving their body due to external or internal injuries. Those discomfort could be not be prevented if those checks must be done so KTPH introduced "Dream Ward". Under the Dream Ward, a machine will be placed on the bedside and this will continuously take the patient’s body status over now and then. (Mohandas, 2011) This differentiation in their ward services as compare to any other hospital in Singapore is a strategy used in their CRM to attract new customers. Therefore patients who are particular and are in deep pain will choose KTPH over the others, knowing that their rest over there will be undisturbed. This is one method KTPH used to increase their profitability by responding to comments of patients. Retaining and maintaining of customers through better customer experience

Preventing loss of existing patients

Like many other hospitals, patients from KTPH experience long waiting time is this is one of the most common feedback gotten from customers. Therefore, KTPH and many other hospitals in Singapore have started an app called "Health Buddy". This Health Buddy contains a queue watch function which allows patients to use this function through their smartphones to view KTPH and other hospitals in Singapore. It will take a photo of the outpatients and other department like the acute and emergency (A&E) in KTPH and then it will be updated to the app every 5 minute. (Integrated Health Information System, 2012)

This way, patients could estimate the timing where they feel comfortable enough for them to go down rather than then waiting uncomfortably while they are sick in the outpatients department for example. Hence, patients will feel that the waiting time will be shorter as compared to visiting KTPH aimlessly without knowing when they will be able to consult the doctor. This some cases, patients will get extremely irate and tired when waiting and this is will cause dissatisfaction which will lead to loss of patients. Hence, this is one of the methods used by KTPH to maintain their relation with existing patients.

Decreasing of patient management expenses and costs

By implementing CRM, KTPH will then be able to put in solutions and implementation that focus directly on the patient needs rather than what KTPH thinks they should provide. This way, KTPH will spend money investing on those solutions to improve on ways to raise the customer experiences in KTPH as compared to wasting money on expenses that they think will be constructive to the company. Thus, the money KTPH spent will be based on what the customer will want and this will decrease on expenses and costs on solutions that KTPH thinks will help in customer management.

Business Intelligence

"Business intelligence will be one of the components integrated with the new systems from the start, to help clinicians analyse records and make decisions", says Lim.

Finding new revenue opportunities

Aiding patients in their recovery

Determining rate and charge

Allocation of resource

Conclusion

KTPH has always been finding new ways to improve on their service whether it is in term of their effectively, efficiency or quality to provide the best they could to serve their patients from all over Singapore. On a whole they aim to develop into a more community based hospital by working together with citizens in the North to create a self-conscious healthy environment by bringing integrated and seamless healthcare closer than any hospital could even done. They are also focusing on aging in place which is the dominant current issue in elderly by delivering a holistic medical centre that welcomes any patient regardless of their social status. Information technology is one of the major parts of KTPH that could never be excluded once they have tap on it. Over the years, through the use of information technology, KTPH have benefited through simplifying and speeding up of process in their work, innovation and medical exploration. Everything have truly change how a hospital operations by placing those technology that are primitively used in a business over to the medial industries and institutions. Using those technology in KTPH and other hospitals have led to the creation of a healthcare hub in Singapore, making Singapore one of the most advance country in the world in term of their healthcare system.