Alexandra Hospital garners Health Care Asia Awards trophy for Patient Care Initiative of the Year - Singapore

Its Care Consolidation programme reduces the patient's need to transfer to various healthcare institutions for their appointments.

Caring for a population of 1.1 million across 26 precincts in the Western region of Singapore has always been the driving force that motivates Alexandra Hospital (AH). AH, which has been under the National University Health System (NUHS) since 2018, serves as a 326-bedder facility that provides seamless, one-stop comprehensive care by one care team to some 100,000 residents in Queenstown precinct (the oldest housing estate) and Southwest and the rest of Singapore.

Intending to redesign healthcare with and for humanity, AH brings seamless integrated care beyond discharge and enables continuity of care anchored in the safety and comfort of the home and community, AH is driven to redesign healthcare with and for humanity. It aims to develop technologically-enabled, innovative healthcare as well as person-centric solutions that enable best practices to be scoped, shared and scaled. 

AH’s patients are predominantly elderly and with multiple co-morbidities. Many patients have appointments at different institutions. This leads to care fragmentation, frustrations in navigating the system(s), duplicative tests, unnecessary costs and inconvenience for patients and their caregivers. Care needs to become holistic again and re-centred around the patient and caregiver. 

This led AH to be the first integrated general hospital in Singapore that provides holistic and seamless care from acute, sub-acute to rehabilitative settings. Through its Care Consolidation programme, the patient's need to transfer from one healthcare institution to the next is significantly reduced. 

To start the project, the hospital's team decided to start to consolidate the outpatient appointments of inpatients at AH. This entailed two things: i) identifying a Principal Doctor and ii) eliminating unnecessary appointments. To create a user-centric process that integrates the needs of the care team, patients and caregivers, the project team adopted a Design Thinking approach. 

The team also aimed to create impact and deliver value as early as possible. They adopted Scrum, an Agile framework whereby work was broken into Sprints (time-boxes of 2 to 4 weeks), and planning, development and rapid experimentation of prototypical workflows in the ward are done iteratively. 

Since Care Consolidation is a new concept in Singapore, the team had to create a brand-new process from scratch. Their two objectives were to assign a principal doctor who works with other AH healthcare professionals as a care team to each AH patient and minimise their patients’ number of appointments.

Over a span of six months, the monthly percentage of AH inpatients that were care consolidated was between 13% and 26%. 

The majority of patients who had their number of appointments reduced had one to three fewer appointments, across different institutions, on different days. After care consolidation, they are now seen at AH’s Integrated Care clinic. 

The cost savings over a year for consultation fees alone equate to at least a few hundred dollars per patient on average. Time and costs incurred for travel and consultation are greatly reduced. Patients also don’t get frustrated from getting asked the same questions by different doctors. 

Apart from the benefits mentioned in earlier sections, Care Consolidation reduces the patient load at the outpatient clinics as each principal doctor manages multiple conditions for each patient. This means more clinic slots were available for patients who need them and waiting time for appointments could potentially reduce. 

Dr Neeta Kesu Belani, who has been leading care consolidation for more than two years now, credits the good effort to a multi-disciplinary and close-knitted team here at AH, which comprises those working in the hospital and in the community. Through design processes such as field research, role-playing and prototyping, the team has come up with solutions it hopes can help plug the gaps, especially amid Singapore’s changing social landscape. She said, “We were looking at how we might encourage patients to keep up with their appointments, how we can make it easier for them, which is how the one principal doctor concept came in. This involves building rapport with the patient, so that the patient doesn’t need to repeat the story, to a different doctor each time. One care team who had known the patient as an inpatient when admitted, and then following the patient up as an outpatient, also makes for a safer and better experience for the patient. With one stop care, the patient can get to multiple health points here, but with only one trip here to AH.”  

As the first in Singapore to adopt agile principles and methodologies in redesigning a care process, Care Consolidation is a concept that makes a patient’s health journey much more manageable for the patient and the caregiver. AH hopes to inspire other hospitals and healthcare institutions to shift to a more patient-centric paradigm in care planning and delivery care.

Hear from the hospital's resident physician, Dr. Neeta Kesu Belani as she discusses how the team came up with a brand-new process of consolidating their patient's appointments that made a huge impact on their lives.