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Agenda
•  Introduction
Service From The Heart - •  Lessons on service and quality (70s - 90s)
Back to Basic •  In pursue of service excellence at Alexandra
24 June 2010
Hospital (2000 -2010)
•  Our dream for Khoo Teck Puat Hospital,
Yishun
•  Conclusion

1 2

Work Experience Other Appointment – Service & Quality

Chief Executive Officer Council Member, Institute of Service Excellence at SMU

Alexandra Hospital / Khoo Teck Puat Hospital (ISES) Governing Council
(2000 till to-date) Singapore Management University

Member, Lifelong Learning Endowment Fund

Pharmacist, SGH Advisory Council, Ministry of Manpower
(1978 – 1984) (2006 – 2009)

Director of Pharmacy & Materials Member, Incentives & Grants Committee,

Management, NUH (1985 – 1989) Singapore Workforce Development Agency
(2006 – 2009)

Operations Manager, KKH Member, People Developer Council

(1989 – 1991) (2000 – 2002)
Member, Standards Council, SPRING Singapore
Chief Operating Officer, SGH (2001 – 2007)
(1991 – 1992)
Member, Singapore Tourism Board (2004-2007)
Chief Executive Officer, TPH/CGH
(1992 - 1999)

1970s 1980s
•  Quality Control Circle (QCC)
•  Instruction manual
•  Total Quality Management (TQM)
•  Courtesy campaign
•  Lessons from MUIII, •  Business Process Re-engineering
(BPR)
SGH
•  On-The-Job Training (OJT)
•  Work Study
Singapore General Hospital
•  Lessons from Dr Kwa Soon Bee

5 National University Hospital

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1990s In Pursue of Service Excellence

•  Balanced Scorecard (BSC)
Alexandra Hospital
2000 - 2010
•  ISO Certification

Kandang Kerbau Hospital

•  SQ Centre
•  Lessons from CPF
•  Lessons from Shangri-La Hotel

Toa Payoh Hospital

7 Changi General Hospital 8

Before Restructuring (2000)

A Brief History of AH
•  British Military Hospital
•  Thriving hospital in 70s
•  Declining fortunes from 80s
•  One-star hospital, historical site in 90s

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Before Restructuring : Our Reputation AH Culture 2000

•  One-star hospital •  AH is a victim of ……

•  AH is a cheap, one-star hospital for the old and
•  A historical site
poor
•  Underground tunnel •  Everything must be done through proper channel
•  Hospital for the old and poor •  Incremental, evolutionary change

•  Cheap
•  39% would not recommend hospital to others

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First get the right people on

the bus (and the wrong
people off the bus) and then
figure out where to go.

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Leadership Team Role of Leader

•  Diversity •  Visualise
•  Shared values, Trust •  Simplify
•  Deep understanding of business •  Prioritise – operationalise

Vision is nothing without execution

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Visualisation The Bureaucrat’s Approach

•  What will patients see, feel, smell … when they
Prove to me that you are dying then I will give you
enter the hospital 5 years from now ?
what you need to barely stay alive because we
•  What services, facilities will we offer?
didn’t want you to develop a dependency mindset.
•  Who are the 5 key leaders?
We don’t really have to do this for you, you know?
You would better appreciate it.

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3

We are ladies and gentlemen serving
ladies and gentlemen
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The Desired AH Culture Post 2000
•  We control our own destiny (Pro-active)
•  We put our patients’ interest before our own
•  We aim for excellence but we accept failures
•  We will out learn, out innovate, out run and out
perform all comers
•  Every individual is expected to think and to add value
•  We care for our patients, our community, our
environment and our people
“Culture eats strategy for lunch everyday”
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Alexandra Hospital Post 2000
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Setting The Tone From The Top
Our Priority
Our patients are the most important people in this
hospital. We put the well-being, interests and
convenience of our patients before our own in
everything that we do.
No reserve car parks for bosses
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Caring For Our Patients
•  Immaculate physical environment (Raffles Hotel)
•  Clean, well maintained
•  Tranquil, restful environment
•  WOW level of service (Ritz-Carlton)
•  Patient friendly process and system
•  Friendly helpful service
•  Well groomed, professional staff
•  Highly competent, professional care
•  Highly competent, caring staff
•  People & technical capability to provide quality care
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Patients’ Definition of A Good Hospital
•  Respect patient’s dignity
•  Provide Information
•  Facilitate access to integrated care and services
•  Deliver consistent, good quality care and services
•  Provide cost effective care
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Bringing Services To Patients

Diabetes Centre Health for Life Centre Dental

Ophthalmology & Visual Sciences ENT Cardiology

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Endoscopy Centre General Medicine Orthopaedic Surgery

Organisational Philosophy
•  To provide quality patient care and services
at reasonable cost
•  To meet and exceed expectations of our
patients
Geriatric Medicine General Surgery Sports Medicine
•  To be amongst the very best in whatever
we do

1.5T MRI 64 Slice CT Scan Interventional Radiology Suite

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Benchmarking
Quality
•  Match and exceed the best performers
To provide a level of patient care and service •  Standards set by other industries
good enough for our own mothers, without the •  Lowest infection rate
need for special arrangements. •  Shortest length of stay
•  Lowest average bill size

Kameda Medical Center, Mayo Clinic, Rochester, Aravind Eye Hospital,

Japan USA India

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Benchmarking “Learning from the Best”

•  Botanic Gardens
•  Citibank
•  City Cab
Victoria Junior
•  CPF National Library College
Board
•  General Electric
Ritz Carlton Hotel
•  IKEA
General Electric
•  McDonald
Raffles Hotel
•  National Library Board Singapore Telecoms

•  Raffles Hotel
•  Ritz-Carlton Millenia
Agilent
•  SIA Technologies

•  Singapore Zoological Gardens Glaxo SmithKline

Bernard Harrison
•  Toyota & Friends
Ikea
31 32 Singapore Chris Lowney
Prisons

Organisational Management Systems (Tools & Initiatives)

Continuous Quality Improvement
ISO 9001:2000 Integrated QEMS JCI
ISO 9001/ISO 14001 6 Sigma Programme
Balanced Scorecard •  Individual’s initiative (I see, I do)
ISO 14001 People Developer Standards
Toyota Production System
Singapore Quality Class •  Group Initiative (We see, we do)
Singapore Quality Award
Continuing •  Staff Suggestion Scheme (I see, I recommend)
FOUNDATION INTERMEDIATE ADVANCED Business
•  Quality Circles (Plan, do, check, act)
Excellence
Customer Feedback
System Voice of Customer Customer •  Six Sigma (Define, measure, analyse, improve, control)
Loyalty Programme
Process Mapping
Process Management
•  Task Forces (Conceptualise new ways of adding values)
Process Measurement
Management & Planning Statistical Tool
-Strategic Planning •  Wow Initiatives
5S House-keeping -Leadership Development Innovation & Creativity
Programme Programmes •  Fun @ AH
People Participation -WOW @ AH
Programmes -Fun @ AH
-Quality Circles -Kaizens/CPIP
-Staff Suggestion
Strategic HR Planning
Scheme
-Talent Scouting/Growing/ Retaining
-Support Group
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Quality Circle (QC) Toyota Production System

•  Closing quality gaps:
•  What we are providing
for our families
•  Improvement through:
•  Elimination of redundancy
•  Simplification
•  Functional integration
•  Automation
•  Define value precisely
what is good enough
•  Remove muda (waste)
•  Continuous flow process
•  Kaizen (continuous incremental
improvement) and Kaikaku (radical
improvement)
•  Pull (rather than push) production
•  Aim for perfection

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Six Sigma
Customer’s Needs :
Process Design/Re-Design

Diagnose, Treat, Advise 1. Define 2. Measure

Better, Faster, Cheaper & Safer

3. Analyse
5. Control

4. Improve

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Your
experience Blood Test

starts here Simplicity

Pre-Appointment Appointment Day
Reminder Chaperon Height & Weight
Registration
via SMS/Letter
•  Good quality … affordable… to
Waiting for
many
Consultation
Home Sweet Home •  Find the simplest way to get
“WOW @ Specialist
Meal Voucher
Grab a bite! work done
Pharmacy Outpatient Clinic ”
•  Achieve BIG results with small
means
Paging
Service
- IKEA

Consultation
Preparing you for
Hospital Admission

Appointment & Payment Post Consult Services

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Measurement Clinical Indicators

(What you cannot measure, you cannot manage)
•  Infection rates
•  Performance Indicators •  Unplanned returns to A&E

•  Clear performance targets •  Unplanned returns to operating theatres

•  Graphic presentation for impact

Service Indicators
•  Telephone service
•  Total turnaround time
•  Patient satisfaction

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Balanced Scorecard Balanced Scorecard Charts

Financial

OUTCOMES

MISSION AND
Internal
Customer Process
STRATEGY

DRIVERS

Learning and Growth

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Paradox of Measurement Talent Building

It is important to measure. But the most
important cannot be measured.
会认人 Recognise talent

会用人 Deploy talent

会做人 ------

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Making The World Go Round Recruitment

•  Some people make the world go round; •  Selecting the right staff for the right job

•  Some watch the world go round; •  Matching “natural talent” to job

•  Some are not aware that the world is going round; •  The “best” person may not be the “right” person

•  Some are simply enjoying the opportunity to

complain about the way the world is going round,
too slow, too fast …..

Michael Schumacher

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Career Sweet Spot

Human Resource Management

•  Hire for Attitude

Passion Talent
•  Train for Skill

Wanted : Happy, positive people

Value to
Others

Thinking style : Visual, auditory or kinesthetic

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The High Performance Team Staff Training

•  The ambitious General Manager
•  The spare-no-expense Designer
•  The perfectionist, take forever R&D Director
•  The efficiency-above-all else Production Manager
•  The stingy Finance Director
•  The obliging Marketing Manager
•  The give-away-for-nothing Salesman

CANNOT STAND ONE ANOTHER

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7-Habits of Highly Effective People

•  Be Proactive
•  Begin with the end in mind
•  Put first thing first
•  Think win-win
•  Seek first to understand, then be
understood
•  Synergize
•  Sharpen the saw

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Jesuits’ Leadership Built To Last

•  Self awareness : strengths, •  Core values
weaknesses, values, worldview •  Big hairy audacious goals
•  Ingenuity : innovate, adapt to •  Just do it
and embrace a changing world •  Competition with self
•  Love : engage others with a •  Power of “And”
positive, loving attitude
•  Heroism : energize themselves
and others through heroic
ambitions

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Power of “And” A Bias For Action

•  Cheap and Good “Take small steps in rapid succession.”
- Mr Khaw Boon Wan
•  Fast and Accurate Minister for Health
•  Competent and Caring Think, think, do, think, do, think, do …..
•  High Tech and High Touch (not paralysis through analysis)
•  Short and Long Term Focused Fast, temperamental horses, not slow docile mule

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Execution Is Everything
•  Can do
Ideas (including those from CEOs) are a dime a
•  Sure
dozen. Ability to execute, making the idea work is
•  Certainly worth millions.
•  Happy to help ~ Mr Koh Boon Hwee
•  Let me find a way to help Chairman, DBS

•  Consider it done

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Rewards
The capable gets more
responsibility but also more
authority, freedom and
rewards.

Equality is unfair.

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Human Resource Management “Vitality Curve”

Staff Turnover Management

•  Priority is to meet and exceed expectation of

the 90% of staff who are doing their best.
•  Poor performers receive counselling, training
and finally, advice on alternative career.
•  No surprises at annual performance
appraisal.

“Top 20” “The Vital 70” “Bottom 10”

General Electric

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Recognition & Celebration

•  Just-Do-It awards
•  SQ awards

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Communication
•  Hearing
•  Listening
•  Knowing
•  Understanding
•  Believing
•  Doing

Every time we fail to be the best that we can be, we hurt

our patients and waste their money, sometimes we kill
them.

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Customer Feedback Staff Feedback

•  Management walk about •  Orientation
•  Feedback forms •  Management walk about
•  Toll-free telephone •  Training Programmes
•  Telephone survey •  Small group meetings with Senior Management
•  Focus group discussions •  QC activities
•  Formal staff suggestion scheme
•  Employee satisfaction survey

“If your failure rate is one in a million,

what do you tell that one customer?”
- IBM

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Staff Meeting with CEO Results

1. What can we do to further improve the quality of Patient Satisfaction Rate rose from 69% (1999) to 98.8% (2009)
patient care and services?

2. What can we do to improve your life in AH ?

3. Who are the 3 doctors, 3 colleagues you respect the

most in this hospital?

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The New Millennium Running Faster and Going Nowhere

•  Globalisation,
internet & genomics
change everything

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The Next S Curve

“Only the paranoid survive.” Business

goes on
- Andrew S Grove to new
heights

Business
Inflection Point Declines
The Strategic Inflection Curve

“Only the paranoid survive.”

- Andrew S Grove

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“Hassle-Free Hospital”

Khoo Teck Puat “I posed the challenge to the AH rebuilding team: build a
Hospital hospital… designed with patients unambiguously at the centre of
the focus, with technology fully exploited for the benefit and
convenience of patients…. It will be a hospital which is well
linked… and to which the patients can be transferred
seamlessly… It will be a hassle-free hospital.”

- Mr Khaw Boon Wan

Minister for Health
Parliamentary Debate
17 March 2004
AH

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Transforming Healthcare Trailblazing Hospital of The Future

Touching Lives, Pioneering Care, Making A Difference
Do to healthcare what NLB has done for library - Dr James Low, Head, Geriatric Medicine

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Patient Centric Technology As An Enabler

•  Hassle-free processes designed for patients’ convenience •  Wireless technology
•  Engaging patients and their families as partners •  Digitalized hospital
•  Safety of patients are of paramount importance •  Sensing devices
•  Intuitive, easy movement for patients and visitors •  Robotics
•  Minimal movement for patients
•  Clustering of services and facilities

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High Touch Healing Environment

•  Warm, “cuddling” feeling
•  Calming and cheerful environment
•  Hospital within a garden, garden within a hospital
•  Tranquil, restful, healing environment
•  Sight, scent and sound of nature
•  Surrounding patients with nature

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El Camino Hospital
Finding The New Breakthrough

Learn from everyone

Follow no one
Look for pattern
Work like hell

Sutter Health Latter-Day Saints (LDS) Hospital

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Sacramento

Designing The Patient Flow Focal Group Discussion

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Make Visual the Patient Process Flow

Engaging URA,
PUB, NParks, LTA
and Sembawang
Town Council in
developing Yishun
Pond and
integrating with
Yishun Park

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Khoo Teck Puat Hospital

Subsidized Ward Tower

Private Ward Tower

Medical Centre

A&E
Entry & Lobby

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Fast Cruise Medicine Slow

Medicine (Assembly Line) Medicine

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Design Thinking

•  Human-centred approach
•  Deep dive
•  Extreme user
•  Divergent convergent
•  Visual thinking
•  Rapid prototyping
•  Fail early, fail often
•  Enough is enough (dateline)

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Selling a product ≠ Addressing customer’s needs

Conclusion Eg. Seller : Selling a T-shirt
Customer : Buying a “cool” image

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There is no
All about the customers not us
secret recipe

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Service Is More Than Just A Smile

•  People
•  Business model
•  Systems and process
liaktl@gmail.com
•  Technology
•  Aesthetics and ambience
•  Culture
•  Leadership setting the tone

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