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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
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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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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.
We are ladies and gentlemen serving
ladies and gentlemen
No reserve car parks for bosses
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The Desired AH Culture Post 2000 Caring For Our Patients
• We control our own destiny (Pro-active) • Immaculate physical environment (Raffles Hotel)
• We put our patients’ interest before our own • Clean, well maintained
• We aim for excellence but we accept failures • Tranquil, restful environment
• We will out learn, out innovate, out run and out • WOW level of service (Ritz-Carlton)
perform all comers • Patient friendly process and system
• Every individual is expected to think and to add value • Friendly helpful service
• We care for our patients, our community, our • Well groomed, professional staff
environment and our people
• Highly competent, professional care
“Culture eats strategy for lunch everyday” • 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
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:
• Define value precisely
• What we are providing what is good enough
for our families • Remove muda (waste)
• Continuous flow process
• Improvement through:
• Kaizen (continuous incremental
• Elimination of redundancy
improvement) and Kaikaku (radical
• Simplification
improvement)
• Functional integration
• Automation • 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.
Recognise talent
Deploy talent
------
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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
• Hospital within a garden, garden within a hospital
• Tranquil, restful, healing environment
• Warm, “cuddling” feeling
• Calming and cheerful 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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