Innovation in Healthcare
- Our Journey Thus Far
Mrs Chew Kwee Tiang
Chief Executive Officer, Khoo Teck Puat Hospital
Alexandra Health System
KTPH
Yishun
Community
Hospital
Community
Based Care
Villa Francis
Nursing Home
& Others
Old Folks’...
Regional Health
Systems in Singapore
We are Alexandra Health
System!
3
Alexandra Health
Vision
“Help our people live a long and healthy life and support them with
thoughtful and dignified care ...
Transforming
Healthcare Delivery
Design Challenge:
5
Insight Into Healthcare Needs of Patients
6
Pre-illness Illness Post-illness
Health Maintenance
• Vaccination
• Public Health Education
• Health Screening
• Workplace...
Fast
Medicine
Slow
Medicine
Cruise
Medicine
(Assembly
Line)
Khoo Teck Puat Hospital Woodlands Medical Centre
(2017)
Yishun...
Population
Classification
Managing The Population In The North
Well
Healthy
Well Unhealthy
Unwell
Unhealthy
(Early Stage)
...
4 Design Concepts
1. Health Promoting
2. Improve community health
3. Enable ageing in place
4. Design hassle-free experien...
Health Promoting Hospital
11
Design Concept 1
The Thinking Behind The Design
Be The
CHOICE
ARCHITECT
RELATE
REPEAT
REFRAME
Shape
The
PATH
12
Innovation : Create a Living Lab at KTPH
13
Workplace Health
Health for Life System
Personal Health Record Risk Stratification Corporate Health Report
Lifestyle Maint...
Determinants : Philosophy, Value, Attitude, Knowledge, Discipline
15
16
26.91
23.26
59.89
29.51
3.07
30.43
7.67
14.86
2.47 1.94
0
10
20
30
40
50
60
70
2011 2012
Very Poor
Poor
Fit
Good
Excell...
PARTICIPATION
3088 staff
85%
17
Annual Staff Health Screening
Individual Health Screening Reports
• Patient Portal
• View all your health screening results
• Visualize your health stat...
Improve Community Health
19
Design Concept 2
Health Education in the Community
• Mini Medical School
• Workplace health programmes
• Community health programmes
Mini M...
Sharing Best Practices With Workplaces
21
Sembawang Shipyard Onsite Diabetes/HBa1C &
Eye Screening & Tele-consultation
Service Innovation: Facilitated Network @ Sem...
Global Healthy Workplace Award 2013
23
Piloting Population Health:
A Transformation @ Sembawang & Choa Chu Kang
IN SHORT, TO CHANGE SOME 140,000 PEOPLE IN 3 YEAR...
Ageing In Place
Design Concept 3
25
Subsidised
Private
Fiscal year 2010 Fiscal year 2011
The Impetus To Innovate
A Local Challenge – High Bed Occupancy at KTP...
70% of health determinants can be
changed or modified
Socio-economic pressures
Unsafe homes
Self-medication
PolypharmacyUn...
Service Innovation: Setting Up Community Wellness
Centre And Nursing Post
28
29
Discharge triage
Transitional Care Programme
Patients that requires continued medical
support at home after discharge
C...
Home
modificationEnhancement for
Active SEniors
(EASE)
Collaboration with
grassroots &
community agencies
Home
help
Commun...
Before home visits-- After home visits
Average no. of
admission for a
single FF
Average length
of stay for a
single FF
Pil...
Design Hassle-free Experience
Design Concept 3
32
Know What The Patients Value
Treat/AdviseDiagnose
Respect for patients‟ dignity
Clear and accessible information
Integr...
Provide a level of patient care
and service good enough for
our own mothers, without the
need for special arrangements.
34
Define Hassle-free Hospital
Doing things right for the patients, and
delivering value safely, from the time he
enters, til...
Innovation is for improving our patients‟ experience and it is
everyone‟s responsibility.
Share a
Common
Understanding
of ...
Patients Flow Fast & Yet Safe
Enhanced Allied Health Services such as Radiology, Lab, Pharmacy etc
37
Patient Value Stream (SOC, DEM)
We Know
You
Know me
Diagnose
me
Treat me Advise
me
Patient Flow
Patient Education
Head-to-...
39
Pt Info
Transport
Investigations
(Outpatient)
Medications
TCU
Portering
Transport
Investigations
Treatment
Diet
Pt Info...
Visual Management At The Emergency Department
Consult
Info Board
Triage
40
Current Way of Admitting A Patient In DEM
Front counter staff needs to use
6 different softwares to admit one
patient to t...
World view: top part
Bed Management: Overview of Bed Status
42
Bed Management
43
Bed Census
44
Dr orders
test in SCM
Phlebo
takes &
dispatches
blood
Lab
receives &
processes
blood
Blood
result
available
in SCM
Problem...
Problems
• CT/MRI orders with Patient Consent not easily tracked
• Nurses unable to chase doctors to obtain consent
• Nume...
Nursing AndonRadiology Andon Pharmacy Andon
SCM
47
13 Andon „Eco-Systems‟
Lab Order
status
Lab Result
status
Rad Order
status
Consent
status
ECG
order
Discharge
tracking
Nursing Andon
49
Andon Board for Pharmacy
49
C-IVOC2012
Handling Patients
Quick Links
Appointments
Planned Appointment
Currently Warded
Regular Patient
C41 PSA Jamilah...
Building Patient Journey through C-IVOC
C-IVOC2012
Medical
Care Me
Recognize
and
Direct Me
Know Me
Discharge
Me
Keep in-
t...
Computerised, Integrated View of Customer
(C-IVOC)
• Know me
• Identify me
• Direct me
• Track me
• Clear the way for me
•...
Use Of Technology To Improve Service At
Multiple Touch Points
Experimentation in teletriage and teleconsult
Queue ViewerBe...
Grab a bite!
Paging
Service
Home Sweet Home
Pre-Appointment
Reminder
via SMS/Letter
Appointment
Day Registration
Blood Tes...
Design Approach
FOCUS ON PATIENT EXPERIENCE
Patient Value Met
• Quality
• Respect
• Information
• Care integrated
• Effect...
Our Approach
1. Agree on what is patient Value.
2. Articulate patient value streams.
3. Identify service touch points (WOW...
•Do what you
can with what
you have
•Little touch
points count
Teaching & training aid for
patient and staff
57
Silent clock Anti-slam device Night light
Message boardFloral headboard
Electronic patient locator
Ideas From Staff & Pati...
Ideas that
Save lives
59
| Design Thinking in AHS|
Eye Clinic
Patient Waiting Experience
60
INTRODUCTION
BACKGROUND: TO SOLVE WAITING TIME ISSUES
OUR FINDINGS: THE WAIT HAS TO BE JUSTIFIED
“Patients do not mind wai...
INTRODUCTION
BACKGROUND: TO SOLVE WAITING TIME ISSUES
OUR FINDINGS: PATIENT’S VALUE HAS TO BE MET
“I felt very shiok after...
INTRODUCTION
REFRAME THE PROBLEM STATEMENT
IT‟S ABOUT ENHANCING THE
EXPERIENCE OF THE WAIT
AND DELIVERING VALUE TO
THE PAT...
RESEARCH FINDINGS
WHAT DO PATIENTS VALUE?
KTPH HEALTHCARE INNOVATION AND RESEARCH
COMPETENCYCONCERNCLARITY
To help patient...
OBSERVATION FINDINGS
CLUES TO PATIENTS‟ ANXIETY AND NEED FOR SIMPLICITY
NEED TO KNOW THE NECESSARY
“ She was telling me so...
RESEARCH FINDINGS
“I was trying to cooperate, but he was just dripping
until the drops keep rolling down my face. He
asked...
PROTOTYPE
BUTTERFLY ON CEILING AS VISUAL CUE
1st Prototype 2nd Prototype
Without Target
With Target
67
OTHER PROTOTYPING
EXPERIMENTS IN THE EYE CLINIC
DILATION TROLLEY ORIENTATION GUIDE
68
Job Shadowing Training Nursing Home NursesTelemedicine Exposure
Telemedicine at Nursing Homes
Care Delivery Innovation
Dream Ward
Service Innovation in the Wards
Mood lighting
One click
control
Flexible
security
One-click
room service
KTPH
N...
Keeps track of patient‟s weight
without getting them out of the bed
71
In-bed Patient Weighing System
Improving Nursing Wo...
Hopscotch How to Play InstructionsFitness Drive-through Stations
Health Promoting Innovations
• Match and exceed the best performers
• Standards set by other industries
• Lowest infection rate
• Shortest length of st...
Learn From Everyone
74
ISS Service Innovation Leadership Seminar, 28 March - Mrs Chew Kwee Tiang
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ISS Service Innovation Leadership Seminar, 28 March - "Design Thinking and Service Innovation - The Khoo Teck Puat Hospital's Journey" by Mrs Chew Kwee Tiang, CEO, Khoo Tech Puat Hospital

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ISS Service Innovation Leadership Seminar, 28 March - Mrs Chew Kwee Tiang

  1. 1. Innovation in Healthcare - Our Journey Thus Far Mrs Chew Kwee Tiang Chief Executive Officer, Khoo Teck Puat Hospital
  2. 2. Alexandra Health System KTPH Yishun Community Hospital Community Based Care Villa Francis Nursing Home & Others Old Folks’ Homes Yishun Polyclinic & Others Woodlands Medical Centre GPs 2
  3. 3. Regional Health Systems in Singapore We are Alexandra Health System! 3
  4. 4. Alexandra Health Vision “Help our people live a long and healthy life and support them with thoughtful and dignified care to the end.” Mission “Provide good quality, affordable and hassle-free healthcare with science, love and wisdom.” Tagline “Touching lives, Pioneering Care, Making a Difference”
  5. 5. Transforming Healthcare Delivery Design Challenge: 5
  6. 6. Insight Into Healthcare Needs of Patients 6
  7. 7. Pre-illness Illness Post-illness Health Maintenance • Vaccination • Public Health Education • Health Screening • Workplace Health promotion Illness Care • Cost effective, efficient care - systems processes - clinical pathways Health Recovery • Skills-for-life • Homecare support • Follow-up support Head-to-Toe Lifelong Anticipatory Healthcare of Whole Person 7
  8. 8. Fast Medicine Slow Medicine Cruise Medicine (Assembly Line) Khoo Teck Puat Hospital Woodlands Medical Centre (2017) Yishun Community Hospital (2016) 8
  9. 9. Population Classification Managing The Population In The North Well Healthy Well Unhealthy Unwell Unhealthy (Early Stage) Unwell Unhealthy (Late Stage) Frail and Dying Population Health Programmes Ageing In PlaceCare Model Pre-illness Illness Post-illness KTPH YCHWMC Acute care & Chronic Disease Management Wellness Centre/ Community GPs, Polyclinic, KTPH Nursing HomesSetting of Care Yishun Community Hospital 9
  10. 10. 4 Design Concepts 1. Health Promoting 2. Improve community health 3. Enable ageing in place 4. Design hassle-free experience 10
  11. 11. Health Promoting Hospital 11 Design Concept 1
  12. 12. The Thinking Behind The Design Be The CHOICE ARCHITECT RELATE REPEAT REFRAME Shape The PATH 12
  13. 13. Innovation : Create a Living Lab at KTPH 13
  14. 14. Workplace Health Health for Life System Personal Health Record Risk Stratification Corporate Health Report Lifestyle Maintenance (Low Risk) Lifestyle Modification (High Risk) Disease Modification (Chronic Disease) 1. Overview of employees’ health status 2. Determine target Interventions 3. Focused resources on relevant staff Measure outcomes, progress report, etc inputs outputs Health Risk Assessment Biometric Parameters/Lab Inx Clinical Practice Guidelines Current Evidence HR inputs 14
  15. 15. Determinants : Philosophy, Value, Attitude, Knowledge, Discipline 15
  16. 16. 16 26.91 23.26 59.89 29.51 3.07 30.43 7.67 14.86 2.47 1.94 0 10 20 30 40 50 60 70 2011 2012 Very Poor Poor Fit Good Excellent PARTICIPATION 2380 staff 77%
  17. 17. PARTICIPATION 3088 staff 85% 17 Annual Staff Health Screening
  18. 18. Individual Health Screening Reports • Patient Portal • View all your health screening results • Visualize your health status over the years 18
  19. 19. Improve Community Health 19 Design Concept 2
  20. 20. Health Education in the Community • Mini Medical School • Workplace health programmes • Community health programmes Mini Medical School 1st Run Jan 2013 LIVE! Programme in workplace and community 20
  21. 21. Sharing Best Practices With Workplaces 21
  22. 22. Sembawang Shipyard Onsite Diabetes/HBa1C & Eye Screening & Tele-consultation Service Innovation: Facilitated Network @ Sembawang Shipyard Foot Screening & Skills for Life
  23. 23. Global Healthy Workplace Award 2013 23
  24. 24. Piloting Population Health: A Transformation @ Sembawang & Choa Chu Kang IN SHORT, TO CHANGE SOME 140,000 PEOPLE IN 3 YEARS Better Health Awareness Better Health Management A Healthier Environment In three years, we target to support at least 50% of screened residents age 40 years and above to take greater personal responsibility for their health. 24
  25. 25. Ageing In Place Design Concept 3 25
  26. 26. Subsidised Private Fiscal year 2010 Fiscal year 2011 The Impetus To Innovate A Local Challenge – High Bed Occupancy at KTPH 26
  27. 27. 70% of health determinants can be changed or modified Socio-economic pressures Unsafe homes Self-medication PolypharmacyUntrained caregiver Things we would never see until we made home visits – and those we can change Determinants Of Health Can Be Modified 27
  28. 28. Service Innovation: Setting Up Community Wellness Centre And Nursing Post 28
  29. 29. 29 Discharge triage Transitional Care Programme Patients that requires continued medical support at home after discharge Community Nurse Programme Care plan Allied Health support Therapists Dietitian Pharmacist Clinical support GP Palliative Early Review Clinic Social support Financial Volunteers Domestic support Community Nurse Post 1. Community engagement 2. Early disease detection & management An Integrated Discharge Plan In The Community 29
  30. 30. Home modificationEnhancement for Active SEniors (EASE) Collaboration with grassroots & community agencies Home help Community Case Management Service Home medical & nursing Temporary domestic help upon early discharge Integrated Single Point of Contact AIP Partners 30
  31. 31. Before home visits-- After home visits Average no. of admission for a single FF Average length of stay for a single FF Pilot Study: Early Results 400 patients completing 6 months of care 6.17 days 3.5 admissions 1.2 admissions 5.94 days 47% No Readmission 31
  32. 32. Design Hassle-free Experience Design Concept 3 32
  33. 33. Know What The Patients Value Treat/AdviseDiagnose Respect for patients‟ dignity Clear and accessible information Integrated care and services Consistent, good quality care and services Cost effective care 33
  34. 34. Provide a level of patient care and service good enough for our own mothers, without the need for special arrangements. 34
  35. 35. Define Hassle-free Hospital Doing things right for the patients, and delivering value safely, from the time he enters, till he gets out of the hospital. -wait -delay - reworks luevalue Wow! 35
  36. 36. Innovation is for improving our patients‟ experience and it is everyone‟s responsibility. Share a Common Understanding of Innovation
  37. 37. Patients Flow Fast & Yet Safe Enhanced Allied Health Services such as Radiology, Lab, Pharmacy etc 37
  38. 38. Patient Value Stream (SOC, DEM) We Know You Know me Diagnose me Treat me Advise me Patient Flow Patient Education Head-to-Toe Diagnosis/Treatment Anticipatory Care 20mins 20mins 20mins0 mins 0 mins 0 mins 0 mins 60mins Information / Material Flow Know me Recognise me Direct me Diagnose me Track me Treat me Advise me Close encounter with me 38
  39. 39. 39 Pt Info Transport Investigations (Outpatient) Medications TCU Portering Transport Investigations Treatment Diet Pt Info Nursing care Portering Diet Pt Info Nursing care Surgery Portering Preparation Transport Nursing care Investigations Treatment OT Listing Pt Info Diet Pt Info Investigations Treatment Clerking Nursing care Pt Info Orientation Portering BMU Financial Counselling Dressing Lab test Investigations Pt Info Assessment Pt Info Clerking A & E Triage Registration Wait for Consult Consultation Post Consult Treatment Discharge Inpatient Admission Nursing Assessment Medical Assessment Pre-Operation Operation Day Post Operation Recovery Discharge Admission for Acute Illness 1. Medicine consists of systems, processes and interdependencies 2. Patients‟ requests are not requests of parts of us, but requests of the whole 3. To make any significant impact, the change must include all Why Is Change So Difficult In Healthcare? 39
  40. 40. Visual Management At The Emergency Department Consult Info Board Triage 40
  41. 41. Current Way of Admitting A Patient In DEM Front counter staff needs to use 6 different softwares to admit one patient to the ward Financial Counselling Hospital Patient Management & Billing System Checking Insurance A&E Careline System Bed Management System Medisave 41
  42. 42. World view: top part Bed Management: Overview of Bed Status 42
  43. 43. Bed Management 43
  44. 44. Bed Census 44
  45. 45. Dr orders test in SCM Phlebo takes & dispatches blood Lab receives & processes blood Blood result available in SCM Problem: “Nurse disintermediation” syndrome. • Nurse totally out of the loop! • Because NO more paper trail & visual cues. • Lab orders and results no longer visible unless nurses watch SCM all the time. 45 Electronic Lab Order Workflow
  46. 46. Problems • CT/MRI orders with Patient Consent not easily tracked • Nurses unable to chase doctors to obtain consent • Numerous calls (at least 2-3 calls) needed between ward nurses and Radio dept to check consent/IV plug/fasting status, fix appt and arrange patient transport. Dr orders MRI in SCM Dr explains procedure & takes consent from patient Nurse faxes completed consent to Radiology Dept Radiology calls back to give MRI appt Radiology calls at appt time to send patient down MRI result in SCM 46 Electronic CT/MRI Order Workflow
  47. 47. Nursing AndonRadiology Andon Pharmacy Andon SCM 47 13 Andon „Eco-Systems‟
  48. 48. Lab Order status Lab Result status Rad Order status Consent status ECG order Discharge tracking Nursing Andon
  49. 49. 49 Andon Board for Pharmacy 49
  50. 50. C-IVOC2012 Handling Patients Quick Links Appointments Planned Appointment Currently Warded Regular Patient C41 PSA Jamilah Previously Attended Health Screening
  51. 51. Building Patient Journey through C-IVOC C-IVOC2012 Medical Care Me Recognize and Direct Me Know Me Discharge Me Keep in- touch with Me SA P FIC O SC M PF S SA P IS H iHF L SC MSA P IS H iHF L SC M SC M SA P IS H SA P IS H Phase 1 Data from Multiple Sources SAP, SCM and iHFL iPharm MRMS MRMS PF S EL PIS 51
  52. 52. Computerised, Integrated View of Customer (C-IVOC) • Know me • Identify me • Direct me • Track me • Clear the way for me • Close the encounter with me • Stay in touch with me Thomas* 52
  53. 53. Use Of Technology To Improve Service At Multiple Touch Points Experimentation in teletriage and teleconsult Queue ViewerBed Management System MMS – Wound Care Self Registration 53
  54. 54. 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 Touching Lives, Pioneering Care, Making A Difference, Designing Touchpoints 54
  55. 55. Design Approach FOCUS ON PATIENT EXPERIENCE Patient Value Met • Quality • Respect • Information • Care integrated • Effective Outcome Achieved •Diagnose, treat, advice •Better, Faster, cheaper, •safer Value stream •Identify Value •Value Stream •Flow •Pull •Pursue Perfection workplace •Location •Layout •Automation •Human factor •Health promoting Service/Care Processes •Model of care •Care standards •Service standards Customer Experience •AH Service Ways •Touchpoint •Care point Design Line of visibility DESIGN THINKING  WHAT THEY WENT THROUGH  HOW THEY FELT DURING THEIR EXPERIENCE  IDENTIFY PROCESSES THAT NEEDS TO SUPPORT THESE PATIENT SERVICES LINE OF VISIBILITY 55
  56. 56. Our Approach 1. Agree on what is patient Value. 2. Articulate patient value streams. 3. Identify service touch points (WOW) 4. Act on functional, mechanic and humanic clues 5. Take small steps in rapid succession. 6. Do what you can with what you have. 7. Learn, teach, design and do. 56
  57. 57. •Do what you can with what you have •Little touch points count Teaching & training aid for patient and staff 57
  58. 58. Silent clock Anti-slam device Night light Message boardFloral headboard Electronic patient locator Ideas From Staff & Patients Ergonomic food tray 58 Apples and Blankets
  59. 59. Ideas that Save lives 59
  60. 60. | Design Thinking in AHS| Eye Clinic Patient Waiting Experience 60
  61. 61. INTRODUCTION BACKGROUND: TO SOLVE WAITING TIME ISSUES OUR FINDINGS: THE WAIT HAS TO BE JUSTIFIED “Patients do not mind waiting, as long as they know what, why and how long they are waiting for.” 61
  62. 62. INTRODUCTION BACKGROUND: TO SOLVE WAITING TIME ISSUES OUR FINDINGS: PATIENT’S VALUE HAS TO BE MET “I felt very shiok after the doctor did such a thorough check on me, no wonder I had to wait so long! It was worth it!” 62
  63. 63. INTRODUCTION REFRAME THE PROBLEM STATEMENT IT‟S ABOUT ENHANCING THE EXPERIENCE OF THE WAIT AND DELIVERING VALUE TO THE PATIENT WAITING TIME/TURN AROUND TIME IN THE CLINIC ORIGINAL PROBLEM REFRAMED PROBLEM 63
  64. 64. RESEARCH FINDINGS WHAT DO PATIENTS VALUE? KTPH HEALTHCARE INNOVATION AND RESEARCH COMPETENCYCONCERNCLARITY To help patients feel more empowered in their experience. To help patients feel like they are being cared for. To assure patients that they are in good hands. (e.g. providing a suitable waiting room environment, testing environment, the human touch) (e.g. eliminating inconsistencies, informatio n communicated to the patients) (e.g. seamless processes, communication within staff and healthcare system, well-equipped machines) 64
  65. 65. OBSERVATION FINDINGS CLUES TO PATIENTS‟ ANXIETY AND NEED FOR SIMPLICITY NEED TO KNOW THE NECESSARY “ She was telling me so many things inside, I don’t think I can remember all of them, so I wrote the important details on my hand so that I won’t forget.” PATIENT‟S PERSPECTIVE PATIENT‟S PERSPECTIVE “I don’t like the feeling of missing out on things I should have told the doctor after I leave the consult room, that is why I am writing down all my problems while I wait for my turn.” AFRAID TO LEAVE OUT INFORMATION 65
  66. 66. RESEARCH FINDINGS “I was trying to cooperate, but he was just dripping until the drops keep rolling down my face. He asked me to look up, but I wasn’t sure how up is up.” HAVING THE RIGHT ENVIRONMENT PATIENT‟S PERSPECTIVE STAFF‟S PERSPECTIVE “From my past experience working in other eye clinics, it is a common problem to get elderly to do the dilation drops as it is harder for them to lift up their heads.” DIFFICULT FOR ELDERLY PATIENTS NOT GUIDED IN THEIR EXPERIENCE TO COOPERATE WITH US 66
  67. 67. PROTOTYPE BUTTERFLY ON CEILING AS VISUAL CUE 1st Prototype 2nd Prototype Without Target With Target 67
  68. 68. OTHER PROTOTYPING EXPERIMENTS IN THE EYE CLINIC DILATION TROLLEY ORIENTATION GUIDE 68
  69. 69. Job Shadowing Training Nursing Home NursesTelemedicine Exposure Telemedicine at Nursing Homes Care Delivery Innovation
  70. 70. Dream Ward Service Innovation in the Wards Mood lighting One click control Flexible security One-click room service KTPH Navigator Ward notifications Visual Nurse call Personal Calendar Patient Message Board Upcoming features Health Services
  71. 71. Keeps track of patient‟s weight without getting them out of the bed 71 In-bed Patient Weighing System Improving Nursing Work Efficiency
  72. 72. Hopscotch How to Play InstructionsFitness Drive-through Stations Health Promoting Innovations
  73. 73. • Match and exceed the best performers • Standards set by other industries • Lowest infection rate • Shortest length of stay • Lowest average bill size Learn From Everyone Kameda Medical Center, Japan Mayo Clinic, Rochester, USA Aravind Eye Hospital, India 73
  74. 74. Learn From Everyone 74

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