27 Jan 2011
One dietitian’s passion for food led her on a quest to improve patients’ eating habits by looking more closely at the offerings in the hospital’s foodcourt. She then worked with vendors to introduce healthier food choices.
Another team of hospital staff identified delays in the blood transfusion process to cut waiting time for patients and improve staff productivity.
Their efforts were recognised by the inaugural Singapore Health Quality Service Award, presented yesterday at the National University of Singapore’s University Cultural Centre.
The award, the first of its kind dedicated to service in the public health-care industry, was established by health-care group Singapore Health Services (SingHealth).
There were more than 2,500 award recipients from SingHealth institutions, such as the Singapore General Hospital, and partner organisations, like Bright Vision Hospital and St Andrew’s Community Hospital, in six categories.
Among the winners, four individuals from the Clinician, Nurse, Allied Health and Ancillary categories were conferred the Superstar awards and two teams stood out in the Best Team awards of Service Initiative Improvement and Clinical Practice Improvement.
Headline: Improving on food court dishes
Call it an occupational hazard. Ms Christine Ong could not help but scrutinise the food choices in her hospital’s foodcourt.
What she saw made her realise that telling her patients how to eat healthily was not going far enough. How could they, when they were confronted with unhealthy choices all the time?
So the chief dietitian at KK Women’s and Children’s Hospital went to work on the vendors at the hospital’s Kopitiam foodcourt to make healthy adjustments to the menu.
She reckoned it was part of her job. After all, her patients and their visitors would be among those sampling the fare.
Ms Ong, 42, said: “The dietary messages that people get must be consistent, from what is being told to them to what is being offered in eating places.”
She led a team of close to 10 hospital staff on a project to introduce small but significant changes to dishes sold on hospital premises.
For her efforts, she was conferred a superstar – the highest accolade – in the allied health category of the inaugural Singapore Health Quality Service Award yesterday.
The first phase of the project began in October 2009 when she convinced stall owners to offer at least one dish which contained 50g, or half a serving, of vegetables.
Stall owners, some of whom had previously offered only a single leaf of vegetable, increased the vegetable serving size at no extra cost to the public.
Charging more would be counter-productive to promoting an environment of healthy eating for cost-conscious customers, she said. So to get the stall holders to buy into the project, the team asked only for small changes to their dishes.
Then in July last year, they moved to get stall owners to introduce wholegrain options.
All noodle stalls now offer brown rice beehoon.
The dessert stall now sells wholemeal sandwiches. Customers can also ask to replace the coconut milk with low-fat evaporated milk in desserts like bubor hitam (black glutinous rice dessert).
Some stall holders got creative, selling oat prata and popiah with toasted oats, instead of peanuts.
Madam Agnes Eng, 62, a stall assistant at the “Oleh Oleh" popiah stall, said about a quarter of the 200 rolls sold every day are the ones with oats.
The going was tough in the beginning, said MsOng. At random audits, she and her team found some stalls charging extra for the healthier dishes.
Some stall assistants forgot to key orders for healthier options into the cash register, as requested. This made it difficult for the team to tabulate the take-up rate of healthier dishes.
However, the Kopitiam management stepped in to get stalls to comply with the project.
Currently, the project is on track to achieve its aims, said Ms Ong.
Some 15 per cent of purchases made by both the staff and visitors at the foodcourt are for healthier food items. She hopes this will increase.
Healthier food options are prepared at the customer’s request.
Ms Ong said: “People always have a choice of when and how they want to have healthier food dishes.”
The third phase of the project will be launched next month and will focus on educating the public on their caloric consumption.
The task of documenting the calorie count of more than 100 dishes in all 14 stalls at the foodcourt has been done with help from final-year students from the applied food science and nutrition course at Temasek Polytechnic.
Food items with a high calorie count, like fried chicken wings, will be labelled a red food item.
With this “traffic light” system, red signals foods which may be eaten occasionally, orange for that which should be eaten in moderation and green will be for food that can be eaten frequently.
Whenever Janice (not her real name) needed a blood transfusion for her illness, thalassemia, she knew it would entail taking a day’s leave for the procedure.
The 33-year-old patient, who has the procedure every four months, told Mind Your Body she would be at the Singapore General Hospital (SGH) specialist K clinic at 10am for a full blood count. She would wait for an hour for the results, then go to her doctor, who would decide if she needed a transfusion.
If he gave the go-ahead, she would have a second blood test to determine a matching donor.
By the time she was given a transfusion, it would be late afternoon and the whole process would wrap up at around 7pm.
When a team of nine from the Haematology Centre, blood bank, K Clinic and portering service at SGH took a harder look at how much time patients were spending on same-day transfusions, Janice was roped in to share her experiences with them.
Led by nurse clinician Tan Chor Kien from the Haematology Centre, the team decided they had to streamline work processes that had been in place for a decade.
For their work, the Quick Blood team at SGH was recognised as the Service Initiative Improvement team winner at the inaugural Singapore Health Quality Service Award yesterday.
They looked at 29 patients from December 2008, who had visited the hospital for a total of 44 times for transfusions.
Patients who have chronic blood disorders like thalassemia and anaemia may require regular blood transfusions.
The team found that, from the start of the appointment to the commencement of the blood transfusion procedure, the waiting time in 41 per cent of the cases was more than 41/2hours. The other cases took less time.
Thanks to feedback from Janice and other patients, the hospital now collects two samples of patients’ blood prior to the doctor’s consultation, so that patients do not have to wait twice for their blood to be tested.
In every transfusion, patients’ blood samples are dispatched to the collection centre at the blood bank where staff will find a compatible donor match.
In the past, staff had to sort through all the patients’ files and pick up those which required same-day blood transfusions.
Now, these files are enclosed in red folders, which quickly signals to blood bank staff that these are the pressing cases.
Some aspects of the workflow, such as screening a patient’s blood for abnormal antibodies and doing compatibility tests on donor’s blood, cannot be compromised.
Ms Corrine Chua, manager at the blood bank, said: “It will take from 90 minutes to 120 minutes to complete one patient’s specimen match.”
Previously, once a match was found, the blood bank would alert the Haematology Centre which would fax a request for a porter to pick up the donor’s blood packet.
But faxes can be missed and there would be no acknowledgement from the porter that the fax had been received.
Instead of a fax, the Haematology Centre and blood bank are now connected online.
Now, once a match is found, the blood bank activates the porter service online and roving porters are alerted on their personal digital assistants. This means the Haematology Centre no longer has to fax requests to porters.
Ms Tan said proudly that “a bigger pool of patients can benefit from the shorter waiting time”.
After the changes were put in place in June 2009, the same group of patients was followed up.
This time, 92 per cent of the cases enjoyed waiting times of 41/2hours or less, exceeding the team’s target of 90 per cent, she said.
It has had an effect on hospital staff as well. From clocking an average of 26.6hours of overtime work per month, each employee now clocks only 13 hours.
Senior staff nurse Kaliani Letchumanan, 45, who helps to set up blood transfusions for patients, is happy to head home early to have dinner with her husband and two children aged five and 13.
She said: “There is definitely better work-life balance now.”
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Dept of Dietetics & Nutrition Services
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