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Service From The Heart - Back to Basic

24 June 2010

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Agenda

•  Introduction

•  Lessons on service and quality (70s - 90s)

•  In pursue of service excellence at Alexandra Hospital (2000 -2010)

•  Our dream for Khoo Teck Puat Hospital, Yishun

•  Conclusion

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Work Experience

Chief Executive Officer Alexandra Hospital / Khoo Teck Puat Hospital (2000 till to-date)

Pharmacist, SGH (1978 – 1984)

Director of Pharmacy & Materials Management, NUH (1985 – 1989)

Operations Manager, KKH (1989 – 1991)

Chief Operating Officer, SGH (1991 – 1992)

Chief Executive Officer, TPH/CGH (1992 - 1999)

Other Appointment – Service & Quality

Council Member, Institute of Service Excellence at SMU (ISES) Governing Council Singapore Management University

Member, People Developer Council (2000 – 2002) Member, Standards Council, SPRING Singapore (2001 – 2007)

Member, Lifelong Learning Endowment Fund Advisory Council, Ministry of Manpower (2006 – 2009)

Member, Incentives & Grants Committee, Singapore Workforce Development Agency (2006 – 2009)

Member, Singapore Tourism Board (2004-2007)

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•  Instruction manual

•  Courtesy campaign

•  Lessons from MUIII, SGH

•  Work Study

1970s

Singapore General Hospital

National University Hospital

•  Quality Control Circle (QCC)

•  Total Quality Management (TQM)

•  Business Process Re-engineering (BPR)

•  On-The-Job Training (OJT)

•  Lessons from Dr Kwa Soon Bee

1980s

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Kandang Kerbau Hospital

Toa Payoh Hospital

Changi General Hospital

•  Balanced Scorecard (BSC)

•  ISO Certification

•  SQ Centre

•  Lessons from CPF

•  Lessons from Shangri-La Hotel

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1990s

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In Pursue of Service Excellence Alexandra Hospital

2000 - 2010

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

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A Brief History of AH

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Before Restructuring (2000)

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Before Restructuring : Our Reputation

•  One-star hospital

•  A historical site

•  Underground tunnel

•  Hospital for the old and poor

•  Cheap

•  39% would not recommend hospital to others

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AH Culture 2000

•  AH is a victim of …… •  AH is a cheap, one-star hospital for the old and

poor •  Everything must be done through proper channel •  Incremental, evolutionary change

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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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•  Diversity

•  Shared values, Trust

•  Deep understanding of business

Leadership Team

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•  Visualise

•  Simplify

•  Prioritise – operationalise

Role of Leader

Vision is nothing without execution

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•  What will patients see, feel, smell … when they enter the hospital 5 years from now ?

•  What services, facilities will we offer? •  Who are the 5 key leaders?

Visualisation

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The Bureaucrat’s Approach

Prove to me that you are dying then I will give you what you need to barely stay alive because we didn’t want you to develop a dependency mindset.

We don’t really have to do this for you, you know? You would better appreciate it.

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We are ladies and gentlemen serving ladies and gentlemen

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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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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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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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Alexandra Hospital Post 2000 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�

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Diabetes Centre Health for Life Centre Dental

Ophthalmology & Visual Sciences ENT Cardiology

Endoscopy Centre General Medicine Orthopaedic Surgery

Geriatric Medicine General Surgery Sports Medicine

1.5T MRI 64 Slice CT Scan Interventional Radiology Suite

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•  To provide quality patient care and services at reasonable cost

•  To meet and exceed expectations of our patients

•  To be amongst the very best in whatever we do

Organisational Philosophy

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To provide a level of patient care and service good enough for our own mothers, without the need for special arrangements.

Quality

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•  Match and exceed the best performers •  Standards set by other industries •  Lowest infection rate •  Shortest length of stay •  Lowest average bill size

Benchmarking

Kameda Medical Center, Japan

Mayo Clinic, Rochester, USA

Aravind Eye Hospital, India

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•  Botanic Gardens •  Citibank •  City Cab •  CPF •  General Electric •  IKEA •  McDonald •  National Library Board •  Raffles Hotel •  Ritz-Carlton Millenia •  SIA •  Singapore Zoological Gardens •  Toyota �

Benchmarking

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“Learning from the Best”

Raffles Hotel

National Library Board

Singapore Telecoms

General Electric

Ritz Carlton Hotel

Bernard Harrison & Friends

Glaxo SmithKline

Agilent Technologies

Victoria Junior College

Ikea Chris Lowney Singapore

Prisons 32

People Participation Programmes -Quality Circles -Staff Suggestion Scheme -Support Group

Organisational Management Systems (Tools & Initiatives)

FOUNDATION INTERMEDIATE ADVANCED

6 Sigma Programme Balanced Scorecard Toyota Production System

Management & Planning -Strategic Planning -Leadership Development Programme

Customer Loyalty Programme

Process Management Statistical Tool

Innovation & Creativity Programmes -WOW @ AH -Fun @ AH -Kaizens/CPIP

Strategic HR Planning -Talent Scouting/Growing/ Retaining

Continuing Business Excellence

Voice of Customer

Process Mapping

Customer Feedback System

Process Measurement

5S House-keeping

ISO 9001:2000 Integrated QEMS ISO 9001/ISO 14001

Singapore Quality Class People Developer Standards ISO 14001

JCI

Singapore Quality Award

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Continuous Quality Improvement

•  Individual’s initiative (I see, I do)

•  Group Initiative (We see, we do)

•  Staff Suggestion Scheme (I see, I recommend)

•  Quality Circles (Plan, do, check, act)

•  Six Sigma (Define, measure, analyse, improve, control)

•  Task Forces (Conceptualise new ways of adding values)

•  Wow Initiatives

•  Fun @ AH

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•  Closing quality gaps: •  What we are providing what is good enough

for our families

•  Improvement through: •  Elimination of redundancy •  Simplification •  Functional integration •  Automation

Quality Circle (QC)

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Toyota Production System

•  Define value precisely

•  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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Better, Faster, Cheaper & Safer

Diagnose, Treat, Advise

Customer’s Needs :

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1. Define 2. Measure

3. Analyse

4. Improve

5. Control

Six Sigma

Process Design/Re-Design

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Grab a bite!

Paging Service

Home Sweet Home

Pre-Appointment Reminder

via SMS/Letter

Appointment Day Registration

Blood Test

Consultation

Post Consult Services Appointment & Payment

Pharmacy

“WOW @ Specialist Outpatient Clinic ”

Preparing you for Hospital Admission

Height & Weight Chaperon

Your experience starts here

Waiting for Consultation

Meal Voucher

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Simplicity

•  Good quality … affordable… to many

•  Find the simplest way to get work done

•  Achieve BIG results with small means

- IKEA

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•  Performance Indicators

•  Clear performance targets

•  Graphic presentation for impact

Measurement (What you cannot measure, you cannot manage)

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•  Infection rates •  Unplanned returns to A&E •  Unplanned returns to operating theatres

Clinical Indicators

•  Telephone service •  Total turnaround time •  Patient satisfaction

Service Indicators

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Balanced Scorecard

Financial

Internal Process

Learning and Growth

Customer MISSION AND STRATEGY

OUTCOMES

DRIVERS

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Balanced Scorecard Charts

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Paradox of Measurement It is important to measure. But the most

important cannot be measured. 会认人 会用人 会做人�

Talent Building

Recognise talent

Deploy talent

- - - - - -

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•  Some people make the world go round; •  Some watch the world go round; •  Some are not aware that the world is going round; •  Some are simply enjoying the opportunity to

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

Making The World Go Round

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Recruitment

•  Selecting the right staff for the right job •  Matching “natural talent” to job •  The “best” person may not be the “right” person

Michael Schumacher

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•  Hire for Attitude

•  Train for Skill

Human Resource Management

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Wanted : Happy, positive people

Career Sweet Spot

Talent

Value to Others

Passion

Thinking style : Visual, auditory or kinesthetic

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The High Performance Team •  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

Staff Training

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•  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

7-Habits of Highly Effective People

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Jesuits’ Leadership

•  Self awareness : strengths, weaknesses, values, worldview

•  Ingenuity : innovate, adapt to and embrace a changing world

•  Love : engage others with a positive, loving attitude

•  Heroism : energize themselves and others through heroic ambitions

•  Core values •  Big hairy audacious goals •  Just do it •  Competition with self •  Power of “And”

Built To Last

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•  Cheap and Good

•  Fast and Accurate

•  Competent and Caring

•  High Tech and High Touch

•  Short and Long Term Focused

Power of “And”

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A Bias For Action “Take small steps in rapid succession.”

- Mr Khaw Boon Wan Minister for Health

Think, think, do, think, do, think, do ….. (not paralysis through analysis)�

Fast, temperamental horses, not slow docile mule

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•  Can do

•  Sure

•  Certainly

•  Happy to help

•  Let me find a way to help

•  Consider it done

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Execution Is Everything

Ideas (including those from CEOs) are a dime a dozen. Ability to execute, making the idea work is worth millions.

~ Mr Koh Boon Hwee Chairman, DBS

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

Equality is unfair.

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•  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.

Human Resource Management Staff Turnover Management

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“Vitality Curve”

“Top 20” “Bottom 10” “The Vital 70” General Electric

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•  Just-Do-It awards •  SQ awards

Recognition & Celebration

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

Communication

Every time we fail to be the best that we can be, we hurt our patients and waste their money, sometimes we kill them.

•  Management walk about •  Feedback forms •  Toll-free telephone •  Telephone survey •  Focus group discussions

Customer Feedback

“If your failure rate is one in a million, what do you tell that one customer?”

- IBM

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•  Orientation •  Management walk about •  Training Programmes •  Small group meetings with Senior Management •  QC activities •  Formal staff suggestion scheme •  Employee satisfaction survey

Staff Feedback

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1. What can we do to further improve the quality of 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?

Staff Meeting with CEO Results Patient Satisfaction Rate rose from 69% (1999) to 98.8% (2009)

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The New Millennium

•  Globalisation, internet & genomics change everything

Running Faster and Going Nowhere

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“Only the paranoid survive.”

- Andrew S Grove

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“Only the paranoid survive.” - Andrew S Grove

Business goes on to new heights

Business Declines Inflection Point

The Strategic Inflection Curve

The Next S Curve

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AH

Khoo Teck Puat Hospital

“I posed the challenge to the AH rebuilding team: build a 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

“Hassle-Free Hospital”

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Do to healthcare what NLB has done for library

Transforming Healthcare

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Trailblazing Hospital of The Future Touching Lives, Pioneering Care, Making A Difference

- Dr James Low, Head, Geriatric Medicine

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

Patient Centric

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•  Wireless technology •  Digitalized hospital •  Sensing devices •  Robotics

Technology As An Enabler

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•  Warm, “cuddling” feeling •  Calming and cheerful environment

High Touch

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•  Hospital within a garden, garden within a hospital

•  Tranquil, restful, healing environment

•  Sight, scent and sound of nature

•  Surrounding patients with nature

Healing Environment

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Finding The New Breakthrough

Learn from everyone

Follow no one

Look for pattern

Work like hell

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El Camino Hospital

Sutter Health Sacramento

Latter-Day Saints (LDS) Hospital

Make Visual the Patient Process Flow

Designing The Patient Flow

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Focal Group Discussion

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

Entry & Lobby A&E

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Fast Medicine

Slow Medicine

Cruise Medicine (Assembly Line)

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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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Conclusion

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Selling a product ≠ Addressing customer’s needs

Eg. Seller : Selling a T-shirt

Customer : Buying a “cool” image

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All about the customers not us

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There is no secret recipe

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Service Is More Than Just A Smile

•  People

•  Business model

•  Systems and process

•  Technology

•  Aesthetics and ambience

•  Culture

•  Leadership setting the tone

liaktl@gmail.com

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