NUH redesigns workflows to reduce hospital bottlenecks

It has expanded nurse-led care and frontline decision-making.

Singapore’s National University Hospital (NUH) is restructuring workflows, staffing, and decision-making to reduce delays and duplicate work across its care system.

“Every handover, every referral, every duplicated note is a point where things can slow down — where intent gets lost, and outcomes start to drift,” Aymeric Lim, CEO at National University Hospital, told Healthcare Asia.

Lim said the hospital has identified organisational friction as a major obstacle to sustainable care delivery.

The state-owned facility has adopted what it calls a “mission command” model, shifting more decision-making to frontline teams instead of adding layers of process and oversight.

“The natural instinct is to respond with more control, more processes, more detail,” Lim said via Zoom. “But that usually makes things worse.”

National University Hospital estimates the healthcare system would need about 6,000 hires annually to maintain service levels, prompting the hospital to redesign roles and workflows instead of relying mainly on recruitment.

“We cannot recruit our way out of this,” Lim said.

The hospital has introduced a redeployment-before-recruitment policy, requiring managers to assess whether existing employees can be reassigned before opening roles.

It has also expanded nurse-led services. Nurses in the eye clinic now perform eye injections, whilst advanced practice nurses independently collect bone marrow samples. Midwives also run prenatal clinics without physician oversight.

The same approach has been extended to allied health teams, with speech therapists and dietitians jointly operating a paediatric feeding clinic.

Patient service associates previously assigned to administrative work have also been trained to perform triage and blood-taking.

Every January, the hospital conducts a “clean and clear month,” during which teams review workflows, remove redundant steps, and deploy automation or artificial intelligence tools where appropriate.

“It gives people the permission and the protected time to change things that daily pressures would otherwise keep in place,” Lim said.