Whenever I share that I work at SingHealth Community Hospitals (SCH) with people I meet, they often respond, “Oh, you’re working in a step-down care facility.”

Let me put this in perspective. A step-down care institution provides an intermediate level of care between a higher acuity facility (e.g. a general hospital) and care in the community (e.g. general practitioners (GPs)). By the time patients are transferred to a community hospital, they are more stable medically and require less resources, hence care is also more affordable. SCH manages patients with a spectrum of needs, ranging from sub-acute medical conditions and dementia to those requiring rehabilitative and palliative care.

While this is conventionally perceived to be step-down care, it gives the unintended impression that care at a community hospital equates to slow medicine, slow nursing and slow rehabilitation. At SCH, this is far from true.

A holistic care plan

During patients’ recovery and rehabilitation journey, there are appropriate care partners that step up care at every point.

Take Mr Tan (not his real name), for example, who sustained a hip fracture. As he requires surgery, an acute hospital is the appropriate care partner to deliver this intervention. Post-surgery, early mobilisation and intensive rehabilitation are key to reduce de-conditioning and restore functional mobility, and the appropriate care partner now changes to SCH. The SCH care team works with Mr Tan to achieve his health goals so that he is able to walk independently again and resume everyday activities, such as meeting his friends at the kopitiam.

While in SCH, Mr Tan can participate in social prescribing activities curated by our Well-being Coordinators. Social prescribing, as opposed to prescribing medications, is an approach that connects people to activities, groups and services in their community to meet the practical, social and emotional needs that affect their health and well-being¹. By doing so, SCH steps up care beyond just addressing the medical needs of our patients to encompass health-social integrative care.

Upon Mr Tan’s discharge from the community hospital, his care is transferred to community providers like his family physician, community nurses and social care partners, who will continue to keep him in good health, with the aim to reduce readmissions to the hospital.

From Mr Tan’s health journey, we see that there is a stepping up of care at every stage, including at the community hospital. ‘Step-down care’ therefore can be misleading; in my opinion, ‘continuing care’ more aptly describes the care delivered by SCH’s doctors, nurses and allied health professionals.

SCH is unique because it is the nexus between acute hospitals and the community. Our name includes both ‘hospital’ and ‘community’. Our raison d’etre is therefore inextricably tied to caring for patients who often have complex medical and social needs, optimising their well-being and successfully transitioning them back home and into the community. This is a tall order, but one that challenges, motivates and reinvigorates the SCH team every day.

En route to a healthier Singapore

Against the backdrop of a rapidly ageing population, SCH is preparing to be community hospitals of the future (CHoF). We envisage CHoF to enable direct patient admissions from the community, such as through GPs, instead of requiring patients to be first admitted to the acute hospital. With a highly skilled healthcare team, CHoF will also be able to manage patients with higher complexity sub-acute conditions, thus freeing up acute hospital beds for those with serious medical ailments. Technology, such as tele-rehabilitation and tele-monitoring, will be harnessed to shorten community hospital stays while allowing part of the rehabilitation to take place in the patient’s home.

The role that community hospitals play in Singapore is set to expand in the coming years. Embedded within SCH’s DNA is the principle of person-centred care, focusing care on the needs of the individual rather than on only what the doctor thinks is best for the patient; as well as the spirit of innovation, where we will constantly seek to reimagine and transform care.

The next time I tell people that I work at SCH, I hope they will share stories about their loved ones receiving excellent care at our community hospitals, and how they have a deeper understanding of the impact that social conditions have on health. There is a quote from the movie, Turbo: “No dream is too big, and no dreamer is too small!” That inspires me to believe we can be a worldclass community hospital.

¹ Source: National Health Service, England

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