October 2019
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TD Magazine

A Systems Approach to Success

Tan Tock Seng Hospital: 2019 BEST Award Winner, #5


Talent development is central to this hospital's campaign toward better people, better care, and better community.

The numbers tell the story of the daily challenges Singapore's Tan Tock Seng Hospital confronts: a staff of 9,500 dedicated professionals to serve the public facility's patient base; a projected 50 percent increase in local residents over age 65 by 2030; and a shrinking labor pool that reflects this aging trend as the fertility rate dips below the 2.1 replacement rate.

Add to that a pronounced increase in lifestyle diseases such as diabetes and heart disease that once were uncommon.

Serious problems abound. But it is the decreasing supply of healthcare providers that most concerns David Dhevarajulu, the executive who heads the hospital's transformation division. "We need an army, because 9,500 people alone cannot care for the population we look after," he contends.

The hospital has launched a variety of initiatives to bolster that army in numbers, proficiency, and productivity. Dhevarajulu and colleague Lillian Yeo, HR director for talent management, also are members of a leadership team of hospital executives that oversee all such initiatives, including those from the 215-person talent development department.

Along with professional education units within the hospital, the TD team spearheads efforts ranging from HR partnering to developing professional team-based community programs. Its mission is to transform the hospital in multiple ways that are encompassed within the facility's succinctly worded strategy: "Better People. Better Care. Better Community."

A strategy in action

The Better People Strategy, as it's collectively known, seeks to empower each employee to own the processes and actions required to do their jobs well, better, and differently through various TD efforts. Better People can then provide the best possible care for patients and build a sustainable, better community to support increased healthcare demands.

The Better Community strategy taps into the critical informal resource of community partners, part-time staff, and outside volunteers, explains Dhevarajulu. It stresses relationship-building with the hospital's community partners so care can be integrated among the hospital, community care providers, and social services. The TD team promotes this effort by equipping staff and community partners with engagement tools and skills to foster stronger partnerships.

Talent management functions support the strategy by ensuring that everyone becomes an expert in their assigned areas. Employees are expected to adopt mindsets of continuous learning so they are future-ready. They also ensure a culture of leadership in change and innovation through care and job redesign and better use of technology.

An annual learning needs analysis ensures that all employees identify at least two learning programs to help them perform their jobs well, better, or differently. The TD team develops individual learning plans for each employee following a screening to ensure alignment with the Better People strategy.

Supporting this strategy is a systems approach to TD that includes planning, implementing, and improving innovation initiatives. Called the "innovation cycle," this approach seeks to redesign systems-level care processes to optimize their value for patients and reduce waste. It also leverages automation and technology to take over simple, repetitive but necessary jobs to free up staff resources.

"Before you can look at people development, you must examine the end-to-end processes that are key to delivering care in the hospital," explains Dhevarajulu. "You must optimize these end-to-end processes so that care is delivered in a safe and efficient manner."

Putting innovation to work

Here's an example of the strategy at work. Together with the operations team, the TD team focused on the critical role of patient service assistants, who are the frontline staffers who assist doctors in their patient consults, interface with the public, handle registration in the clinic, and perform other tasks.

Beyond the patient service training programs, the team redesigned the patient service assistants' job and expanded their roles with additional value-added responsibilities. These include clinical support such as venipuncture and administration functions—jobs that nurses typically perform—in clinics and wards. Other tasks include patient financial counseling and even training. The TD team modified the unit's development program to upskill each patient service assistant. Results include improved efficiency within units, better use of skilled nurses, and improved patient care.


But hospital employees normally don't work alone; they work in teams. With the shift toward patient-centric care to support the hospital's aging population, the focus has been to redesign care so that a multidisciplinary team of doctors, nurses, and allied health professionals can better deliver it. The TD team initiated and developed ways to more effectively recognize care that is delivered through teams and seeks to "foster interprofessional collaboration within the hospital and obtain greater clarity of team goals and their specific contributions to the organization," says Yeo.

One such job redesign exercise targeted the hospital's pharmacy. The TD team applied the innovation cycle through interviews with all pharmacy employees about their roles. "We then took a particular mental model to the pharmacy and asked them to restructure the work they do through process redesign," says Dhevarajulu. "That led to a conversation about automation."

The outcome was a revised process that featured the use of robotics for the tedious job of packing medications for the inpatient area. It has had an impact on productivity, staff morale, and career development, Dhevarajulu notes.

The hospital's shift toward a team-based care model has included transdisciplinary job redesign exercises to transform patient care. As the hospital redefined and expanded job roles and skill sets, it also redesigned how it trained and developed talent. The result is a new emphasis on cross-disciplinary and interprofessional training through team-based work and projects.

Dhevarajulu reports that results from a recent national healthcare patient experience survey reveal the combined impact of the hospital's efforts. Regarding specialist outpatient clinics, the hospital's team-based care scored an impressive rating of 92.6 percent, which is 10 percent higher than regional and national rating scores, he says. Scores for waiting time reached 95.7 percent, a full 10 percent higher than regional and national ratings.

As for employee satisfaction, the survey produced a dramatic increase in all categories since its previous survey three years earlier. Those categories included job satisfaction, engagement, empowerment, and L&D. But most important, the results underscore why Tan Tock Seng Hospital has enjoyed a 92 percent staff retention rate for the past three fiscal years, 7 percent higher than the industry norm.

View the entire list of 2019 BEST Award winners.

About the Author

Paul Harris is a freelance writer in Alexandria, Virginia.

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