Little innovations go a long way in Tan Tock Seng Hospital’s Covid-19 fight
Ms Laura Ho, deputy director of nursing at Tan Tock Seng Hospital.
SINGAPORE — It may not be apparent, but the true lifesavers at Tan Tock Seng Hospital (TTSH) for its nurses during the fight against Covid-19 are several simple innovations that had changed how they work.
For instance, nurses used to have to wait about 10 minutes for an available porter to help them wheel each patient, but they can now do it on their own as new hospital beds are fitted with a motorised fifth wheel.
The bed also has a weighing scale built in, so that the nurses will not need to expend extra energy to carry an immobile patient off the bed to be weighed.
There is also a one-piece patient gown with buttons on the side being used. This has cut down the number of nurses and time needed to put on new garments for a patient at the intensive care unit (ICU), when the norm is still for patients to put on a two-piece pyjama set.
These solutions introduced over the past decade may not amount to much on their own, but they have saved the nurses much agony during this period.
And they were made possible because the hospital has empowered its nurses to eliminate unnecessary work processes daily so that they can focus on patient care.
This was what Ms Laura Ho, TTSH’s deputy director of nursing, said was a major reason why the hospital is able to cope at this time while facing a manpower crunch in its nursing department, which is its biggest workforce there with 3,600 nurses.
Elaborating on the labour shortage, the 48-year-old said: “Nurses are definitely stretched… When we opened the screening centre (at TTSH’s National Centre for Infectious Diseases, or NCID), we deployed prsonnel who are not just from ward operations.
“We deployed the case managers who do disease management, quality-team nurses who do data analysis, research nurses, nursing administrators, even our nursing directors had to be hands-on on the ground.”
Giving TODAY an insider look on Monday (June 1) at how work was streamlined for the hospital’s nurses, Ms Ho, who looks after inpatient operations efficiency, said that it often does not take a health emergency to cast the light on the work processes that need refining.
For more than a decade now, it had become part of the new-age nurses’ job to innovate, she said. The mantra had been: “Everybody is a problem solver, and each of us has two jobs to play: Doing our job well and doing our job better.”
For instance, nurses once had to walk an average of 8km each shift.
Their workstations used to be at a centralised location in the middle of a cluster of wards, and the nurses used to walk up to 200m to retrieve items from various places, Ms Ho said.
Following some swift changes in 2010, after taking in various feedback and ideas, nurses were made to work on a computer at the very ward where they deliver care. They have in their reach a set of items they usually require, such as kidney dishes, syringes and urine bottles, all at the same workstation.
They now walk an average of 5.2km during each shift, Ms Ho said.
100 IDEAS A YEAR
For smaller improvements, Ms Ho said that nurses had been tapping an innovation fund that has S$10,000 to S$30,000 parked away for them to test ideas that can be implemented for under S$1,000. Since it was introduced in 2013, the fund has attracted an average of 100 ideas a year, she added.
In the wake of the Covid-19 pandemic, one of the problems being worked on is finding a way to get hospital visitors to use the hand sanitiser provided before entering a ward.
Ideas being bandied about include using light triggers at entrances, on top of pre-recorded reminders for people to wash their hands.
Indeed, innovation has come a long way since Ms Ho was a junior nurse at the same hospital some 20 years ago, when she introduced ink chops to replace having to repeatedly write commonly used words in patients’ log books.
Today’s nurses are more “agile” in thinking up innovative ideas and putting them into action compared with decades ago. Still, they should accept failures as they come and be reminded that “yesterday’s change may be today’s norms”, Ms Ho said.
Using one of her ideas as an example — the hospital bed with a motorised fifth wheel — she said the first version that she and her team proposed in 2015, a forklift-looking motorised mover that can be attached to a traditional hospital bed, was not used in the end.
However, it helped others to imagine the possibility of having only one staff member manoeuvre the hospital bed independently, she said, adding that everyone thought a patient "must be pushed by two people”.
The unused innovation soon became a gamechanger in the market. Commercial vendors saw a future need and value for such powered beds in the hospitals and started manufacturing beds with these features.
Fast forward to today and all 330 beds used during the Covid-19 outbreak at NCID are beds with a fifth wheel that only need one person to manoeuvre. This inadvertently helped to minimise employees' exposure to infectious diseases as well.
In the next 10 months, nurses at the main hospital building will find more than half of its 1,600 hospital beds being replaced with those with a fifth wheel. At the moment, 227 of such beds are already in use at its geriatric wards.
