Singapore’s medical facilities provide vital learning points in its patient-centric designs and creative collaborations for cutting-edge care
The 590-bed Khoo Teck Puat Hospital is a “hospital in a garden and garden in a hospital” that has incorporated the healing power of Nature in its hospital design
This mini waterfall that empties into a pond with 100 species of fish within a tropical rainforest with birds and butterflies, 40 and 50 species of each, is part of Khoo Teck Puat Hospital’s healing environment.
A gurgling mini waterfall that empties into a pond with 100 species of fish. Birds and butterflies, 40 and 50 species of each, fleeting about a tropical rainforest. This is no botanic garden. It is Khoo Teck Puat Hospital (KTPH), a 590-bed general and acute care hospital that was opened in northern Singapore in June 2010 and managed by Alexandra Health System. Like the hospitals that are coming up in Singapore, the new kid on the block is designed to break the mold of hospitals as cold, institutional places.
Welcome to the new age of hospitals in Singapore where, over and above world-class medical care, tremendous thought has been invested into infrastructure, particularly the design and use of technology, to create healthcare facilities that are worthy of international attention and emulation.
Healing Outdoor Spaces
A shift in emphasis within the healthcare industry arose in the US and UK in the 1990s. The idea that beyond the healthcare professionals, other factors within the hospital can contribute to patient care began taking shape and the concept of patient-centered care surfaced. The healing power of exposure to Nature, a 1,000-year-old belief that had been sidelined by modern medicine’s emphasis on drugs and surgery, was revived. Therapeutic outdoor spaces and interior design that took into consideration patients’ needs began to be incorporated into hospital design in an effort to provide holistic healthcare.
In this area, Singapore has been taking the lead in Asia. The two newest public hospitals to be opened in the last decade, KTPH and Ng Teng Fong General Hospital (NTFGH), are testaments to this paradigm shift. KTPH beautifully combines healing gardens with patient-friendly design to create a “hospital in a garden and garden in a hospital”.
“We designed KTPH to be a ‘hospital in a garden and a garden in a hospital’ with only one thought in our mind - to provide a soothing and healing environment to help our patients recover well,” said Donald Wai Director, Hospital Planning, Alexandra Hospital System (AHS).
Having managed Alexandra Hospital with its sprawling 20 acres of garden or 70% of the hospital’s total land area, AHS already knew the garden hospital concept would be a workable one. So, KTPH has terraces and therapeutic green spaces carved out. It also boasts eight rooftop gardens that span 700 square meters with some 50 species of fruit trees, and 50 types of vegetables and herbs, some of which go to the hospital kitchen for inpatient meals.
Another unique design feature of KTPH is its open concept, the result of careful consideration.
“When we first started building the hospital, we wanted to make sure the hospital didn’t take away anything from the town it was built in. Instead, it would enrich the neighborhood by bringing back familiar community elements, and be a welcoming, health-promoting space for residents,” said Mr Liak Teng Lit, Group CEO, AHS.
Conscious effort has been made to include the neighborhood. Benches, shady hideaways, cozy corners, and gazebos dot the grounds, drawing people in for quiet respite or interaction. Located in the northern part of Singapore, its site next to Yishun pond was a deliberate decision. The kilometer-long promenade along the pond is an extension of the hospital, providing a place for patients and staff as well as the community to exercise, recuperate, and interact. The pond affords the wards the calming vista of sparkling waters and verdant landscape, too.
Healing Interior Designs
If KTPH is a fine example of the use of outdoor spaces for healing, then the newly opened NTFGH is a prime specimen of interiors created with patient care in mind. The newly opened integrated healthcare hub in the West of Singapore comprises the 700-bed NTFGH and the 400-bed Jurong Community Hospital (JCH). The twinned hospitals run by Jurong Health Services (JHS) to provide integrated care to the population in the west are the first hospitals in Singapore to be designed and built together from the ground up as an integrated development to complement each other for better patient care, greater efficiency, and convenience.
The hospital planning process took into account how patient care, treatment, and rehabilitation could continue seamlessly between the hospitals. The JHS planners took great pains to optimize the narrow strip of land dedicated for the development to create the most conducive healing environment for its patients. The result – distinctive fan-shaped wards.
Said JHS Chief Executive Officer, Foo Hee Jug, “It is very gratifying to see our patients appreciate the many patient-centered features that we have included in the new hospitals. They tell us they really like the fan-shape design of our subsidized wards at NTFGH and JCH which are more spacious and well ventilated. Our ‘window for every patient’ design has proven to increase airflow significantly to provide better comfort for healing, as well as infection control, to benefit both patients and healthcare workers.”
In addition to its aesthetic appeal, the wave-like façade also offers curved light shelves above windows that provide primary shading, as well as greenery strategically planted outside every patient window for added shading. The hospital studied sun angles for a whole year when designing the wards so as to achieve optimum natural daylight while reducing glare from the sun.
Because the NTFGH and JCH were planned and built together, synergy between the two buildings for better patient flow and care has been made possible. NTFGH’s Emergency Department (ED) and other critical care services such as its Intensive Care Unit (ICU) and Operating Theatres, for example, are all located in one tower with a dedicated trauma lift so critical cases can be easily and quickly moved. To reduce waiting time, registration, triage, and consultation in its ED are concentrated in one room. NTFGH is also the first and only hospital with a critical care facility that merges its ICU with a High Dependency (HD) Unit so there is integrated care centralized in one location with one team. Locating the Specialist Outpatient Clinics in a single tower also means that patients can better coordinate their visits with different specialists. It has a “one queue, one bill” system, a patient-centered feature that enables patients to check in at any self-registration kiosk. This kiosk issues a single number ticket that contains the patient’s full itinerary for the day and allows for a one-time payment with a consolidated bill at the last service point.
How a hospital interprets care can have immense bearing on how it is run. In this, Singapore’s hospitals have endeavored to stay ahead. The idea of hospitals without walls – where care is brought to the community instead of having patients come to the hospital - has gained traction in recent years. And, KTPH has successfully adopted the idea. Its Ageing-in-Place Program (AIP) reaches out to patients who have been repeatedly admitted to the hospital. Upon their discharge, the AIP team visits them in their homes to help them better manage their health so they require less medical care. The hospital became the first in Singapore to win the 2014 United Nations Public Service Award (UNPSA) for this program.
“Just focusing on addressing medical needs, which constitute 10% of patients' health determinants, is inadequate to keep them well in their homes and community. 60% of one’s health is determined by social, behavioral, and environmental factors and the AIP Program pays attention to these holistically,” said Dr Wong Sweet Fun, Senior Consultant (KTPH’s Department of Geriatric Medicine) and Co-Director of AIP Program, explaining why KTPH decided to think out-of-the-box.
NTFGH has a similar program. Its Sub-Acute Ambulatory (SAFE) team of
doctors, nurses, and Allied Health Professionals assess the functionally challenged or elder patients at risk of re-admission in the homes three to seven days after their ED visit.
Another expression of its innovative care can be found in the KTPH’s geriatric and palliative care wards. It has a special dementia ward, the first in a public hospital, designed to look just like home. A glass wall offers a view of a garden where patients can take strolls. But most interestingly, the ward does not need to restrain its patients to prevent them from wandering away. Instead, it uses design to deter – the doors are painted to look like bookshelves, making them harder for the patients to find. KTPH also has a special room, Lily Room, reserved for patients at the end-stage and their families to say good-bye in private.
JCH has a Mobility Park, the first of its kind in Singapore. The park’s most interesting feature is a simulated public transport setting with an actual bus, taxi, and MRT train carriage. This provides patients a safe environment to practice going through their daily routines.
One of the most technologically advanced countries in the world, Singapore’s hospitals are setting the trend for cutting-edge care in Asia. At KTPH, an automated lab vehicle dubbed Amabelle collects and delivers test and investigation samples ensuring timeliness and improved workflow. The hospital also uses a robotic bed transporter system which halves the manpower needed to transfer patients and speeds up the process. Electronic Meal Ordering System (EMOS) allows patients to order their meals with an iPad. The paperless system minimizes wrong orders and improves productivity. The hospital has even capitalized on technology in its patient care. It is the first healthcare institution here to develop and use mobile apps to help patients manage their panic attacks and depression. The apps help users to pen, manage, and monitor their negative thoughts through cognitive restructuring.
At both NTFGH and JCH, Automated Guided Vehicles (AGV) transport cook-chill meals throughout the hospital three times a day. Using cook-chill technology, used largely by the air travel industry, thousands of meals are prepared in the central kitchen before being transported by the AGVs to be warmed at the wards.
Harnessing best practices and technology can translate to higher quality patient care allowing healthcare professionals to concentrate on their core duties of treating the patients.