The National Kidney Foundation Annual Report 1 July 2010 ~ 30 June 2011
Contents Vision & Mission 03 Chairman s Message 04 CEO s Message 06 Highlights of Key Achievements 08 Board of Directors 10 Organisation Chart 12 Corporate Governance 14 Clinical Dialysis Treatment & Care 26 Our Dialysis Centre Sponsors 32 Holistic Rehabilitative Care 33 Promoting Kidney Transplantation 38 Advancing Clinical Management & Care 39 Working with Other Organisations to Enhance 45 Healthcare Management Supporting Research in Kidney Diseases 46 Vision Providing high quality programmes for: affordable subsidised care rehabilitation of patients to achieve a better quality of life Community Outreach Encouraging Volunteerism 50 Raising Funds through Community Support 54 Educating the Community 56 Finance and Administration Continuously Enhancing IT Systems 60 to Improve Productivity Operations Strengthening Operational Efficiency 62 Human Resource Enhancing Organisational Capabilities 64 Financial Statements 67 Mission prevention of kidney disease in the community in partnership with our donors. With donors support, we will organise cost-effective and comprehensive education and health-screening programmes against kidney-related disease for the community. We will provide high-quality, cost-effective and affordable subsidised care and rehabilitation, including haemodialysis and peritoneal dialysis for our kidney patients. We will promote renal transplantation as this offers best long-term survival and quality of life. We will maximise utilisation of public donations for patient care and ensure that we are transparent and accountable to our donors. For our staff, we will continually enhance their expertise through continuing professional education and improving the work environment. 2 3
With the rising number of kidney patients, NKF disbursed subsidies for dialysis, medication and auxiliary services to its needy kidney patients and beneficiaries amounting to $26.0 million, which is 9% higher compared to $23.9 million the financial year before. Chairman s message NKF has come a long way and achieved much in rendering vital services to those suffering from kidney failure. All our efforts would not have been possible without the support of a caring community. As at end of the financial year, NKF s total kidney patient and beneficiary population grew by 4% to 2,832. We are pleased to let you know that 55% of our haemodialysis patients pay $50 or less a month out-of-pocket, which is less than $4 per session. With the rising number of kidney patients, NKF disbursed subsidies for dialysis, medication and auxiliary services to its needy kidney patients and beneficiaries amounting to $26.0 million, which is 9% higher compared to $23.9 million the financial year before. To make way for the Housing and Development Board s en bloc redevelopment plans for 2011 in Bukit Merah, the Singapore Contractors Association Limited (SCAL)-NKF Dialysis Centre has ceased operations. We are happy to inform you that patients at the centre have moved to a new dialysis centre, the Woh Hup-NKF Dialysis Centre in Ghim Moh, which began operations in July 2011. This new centre has 20 dialysis stations compared to 14 stations at Bukit Merah. Thus, it will be able to accommodate 120 dialysis patients, compared to 84 dialysis patients at Bukit Merah, an increase of 36 in terms of patient capacity. Thanks to a legacy gift of $4.75 million from our supporter, the late Madam Wong Sui Ha Edna, NKF will establish a new dialysis centre at Blk 271 Tampines Street 21. The Wong Sui Ha Edna-NKF Dialysis Centre is expected to be ready in May 2012. The centre will have 22 dialysis stations, which can serve 132 kidney patients. This is NKF s second dialysis centre in Tampines to meet the demand for dialysis places in the east of Singapore. In our on-going efforts to promote peritoneal dialysis (PD), a home-based treatment, NKF started its PD Home Visit Service as part of its newly launched Peritoneal Dialysis Community Support Programme. Nurses trained in PD management visit patients at their homes with the aim of guiding them and ensuring proper self-management of treatment. The medical care that we provide to our patients, the machines and processes, keep our patients alive. However, patients well-being is just as important. Hence, besides providing high quality dialysis at charges that our needy patients can afford, we also look into their emotional, psychosocial and economic needs. Amidst rising inflation, NKF, together with the Singapore Buddhist Lodge, are extending more help to the neediest kidney patients by providing a total of $200,000 worth of basic food necessities yearly through its newly launched Grains of Hope Programme. The holistic care approach in meeting patients needs is an integral part of NKF s treatment programme to ensure optimal rehabilitation. There is also a pressing need for us to push on with our health education and screening programme to help reduce the incidence of kidney and its related diseases in the community. Many Singaporeans suffer from diabetes and high blood pressure, the leading causes of kidney failure in Singapore. Many are unaware that they have these diseases. It is better to prevent the onset of kidney diseases through early detection so that precautionary measures can be taken. We are proud to inform you that NKF s Kidney Discovery Centre (KDC) at the NKF Centre started operations on 18 January 2011. Many schools, tertiary institutions and organisations have visited the KDC where they went through a learning journey to appreciate the kidneys, kidney diseases and their treatments. The work of the NKF would not be possible without the support of the community. We would like to once again thank all our supporters for your unwavering love and compassion in giving life and hope to needy kidney patients in Singapore. Yours sincerely Gerard Ee Chairman The National Kidney Foundation 4 Annual Report 2010/11 5
CEO s message On behalf of our kidney patients, I would like to express our gratitude to all our donors, volunteers and supporters for giving each one of them a second chance at life. Our patients live with hope today because you care. Through your support, we are not only able to meet the daunting challenge of providing kidney patients with quality, affordable dialysis treatment, but allrounded care through our psychosocial support programmes, which are vital in their long road to recovery. To be afflicted with kidney failure is a terrible blow for anyone. It is a nightmare of painful, continuous dialysis treatment, countless hospital visits, frustration, loneliness, insecurity, depression, depletion of savings to pay for expensive dialysis treatment and unbearable guilt in being a burden to their families. They feel that the world has given up on them. Through your support, we are not only able to meet the daunting challenge of providing these patients with quality, affordable dialysis treatment, but all-rounded care through our psychosocial support programmes, which are vital in their long road to recovery. NKF s medical social workers provide support to help patients come to terms with their illness and motivate them to function emotionally within the community. As part of our Patient Welfare and Benefit Programme, NKF provides transport subsidies for patients such as amputees who have to travel to and from the dialysis centres by taxi or ambulance. We also help defray the bus and train expenses of poor patients when they travel to and from the dialysis centres for treatment. Continuing our efforts to provide more help to the poorest of the poor, NKF identifies such patients at its Placement Clinic where, apart from medical assessment, patients undergo psychosocial and nutritional assessment. This enables us to understand their specific needs and provide them with the necessary support to improve their lives. Through its medical and social welfare programmes, NKF provided subsidies totalling $1.18 million during the financial year, up from $953,000 in the last fiscal year. NKF needs around $58 million a year to support various highly subsidised programmes for kidney patients, as patient numbers and operating costs continue to rise every year as more and more patients join the NKF. The ageing patient population is yet another pressing concern as older kidney patients tend to have medical complications or other chronic diseases such as heart problems. This results in the need for highly specialised care for these elderly patients, further contributing to the increasing costs. We are pleased to let you know that the NKF Charity Dinner on 15 April 2011 raised $1 million in aid of needy kidney patients. The event was graced by former President and Mrs S R Nathan. This is the first time that the new NKF had organised a major fundraising event. The strong support from various individuals and organisations is by far the clearest indication that NKF s continuous efforts to be cost-efficient in operations, as well as be transparent and accountable to its donors and the public, have borne fruit. As we continue to strive to meet the needs of kidney patients as well as the community, we look forward to your continued support. Yours sincerely Eunice Tay (Mrs) Chief Executive Officer The National Kidney Foundation 6 Annual Report 2010/11 7
Highlights of Key Achievements Clinical Finance & Administration Financial Governance With the increasing number of kidney patients, the amount of subsidies disbursed for dialysis, medication and auxiliary services to needy kidney patients and beneficiaries amounted to $26.0 million, which is 9% higher compared to $23.9 million the financial year before Complied with Code of Governance for Charities and Institutions of a Public Character (IPCs) established by Charity Council The 2 investment mandates were renewed during the financial year 55% of subsidised patients pay out-of-pocket $50 or less a month Introduced Grains of Hope programme, extending more help to its neediest kidney patients by providing a total of $200,000 worth of basic food necessities yearly Clinical 19 grants awarded through Research Fund to medical researchers for the advancement of treatment and prevention of kidney diseases Patient Well-being Organised various events and activities which helped improve patients emotional, psychosocial and fitness needs Organised educational sessions by medical and health specialists for caregivers on how to manage patients better Community Outreach Encouraging Volunteerism The number of volunteers at NKF has grown to over 600 individuals since the volunteer programme was launched in June 2007 Over 450 volunteers helped to deliver food provisions and food vouchers bi-monthly to 386 of our neediest patients Provided 53 volunteers with training to equip them with professional volunteer skills Raising Funds through Community Support With strong support from various individuals and organisations, the new NKF s inaugural Charity Dinner raised $1 million in aid of needy kidney patients Educating the Community Started operations of the Kidney Discovery Centre with over 2,000 upper primary, secondary and tertiary students and teachers, as well as 61 oganisations visiting the centre, as part of a learning journey on kidney diseases and its prevention Implementing New IT Systems and Infrastructure Developed new systems and enhanced existing ones to improve NKF s internal processes Operations Established a new dialysis centre in Ghim Moh New dialysis centre in the pipeline at Tampines 19 supporters donated 54 new dialysis machines Human Resource Fine-tuned the Balanced Scorecard in which new initiatives were incorporated into the corporate strategy to achieve NKF s goals 8 9
Board of Directors MR CHAY YEE MENG Member MR CHRISTOPHER CHUAH Member (from 1 July 2011) MR GAN SEOW ANN Member MR JOHNNY HENG Member (from 1 July 2011) MR DAVID MA Member MR NG BOON YEW Member MS NG LAI YEE Member (from 25 November 2010) MR PHILIP TAN Member MR GERARD EE Chairman ASSOC. PROF MAK YUEN TEEN Deputy Chairman PROF TAY BOON KENG Member MS WONG SU YEN Member (from 16 November 2010) PROF WOO KENG THYE Member MR YATIMAN YUSOF Member The National Kidney Foundation 10 Annual Report 2010/11 11
Organisation Chart Chairman CEO Finance & Administration Clinical Planning & Compliance Corporate Affairs Community Partnerships Operations Human Resource Clinical Finance Information Technology (IT) Admissions Medical Services Nursing Services Care & Counselling Exercise & Fitness Clincal Affairs Medical Records Office Bio-Medical Engineering(BME) Purchasing Logistics (Facilities) Administration (Facilities) Building (Facilities) (L-R) May Chua Kaldip Kaur Dr. Nandakumar Deby Sarojiuy Palakrishnan Rowena Yeo Chong Kwek Foo Clinical Affairs Nursing Services Medical Services Care & Counselling Nursing Services Medical Records Office Dietetics Management Team (L-R) Lim May Lan Planning & Compliance Maria Cheng Human Resource Assoc. Prof Evan Lee Clinical Eunice Tay Chief Executive Officer Liew Yok Yin Finance & Administration Andrew Wong Operations Jane Guo Community Partnerships Yap Chai Kian Corporate Affairs Finance & Administration (L-R) Ingrid The Finance Job Loei Admissions Catherine Goh IT Operations (L-R) Ganesan Sundaramurthy BME Joyce Tong Purchasing The National Kidney Foundation 12 Annual Report 2010/11 13
Corporate Governance Roles and Responsibilities of Board of Directors The Board acts in the best interest of NKF with the aim of improving the quality of care for patients who are afflicted with kidney diseases. It also ensures that there are adequate resources for the operations and programmes of NKF and that such resources are effectively and efficiently managed; that there are processes in place to ensure that NKF complies with all applicable laws, rules and regulations; and there is an appropriate code of conduct which upholds the core values of NKF and processes to ensure compliance with the code. Day-to-day management of NKF is delegated by the Board to the management team headed by the Chief Executive Officer (CEO). Initiation of new programmes and activities, reviewing viability of current programmes and significant transactions require the approval of the Board. The Board also reviews and approves the annual budget prepared by management. Board members are expected to avoid actual and perceived conflicts of interest. Where Board members have personal interest in business transactions or contracts that NKF may enter into, or have vested interest in other organisations that NKF has dealings with or is considering to enter into joint ventures with, they are expected to declare such interests to the Board as soon as possible and abstain from discussion and decision-making on the matter. Where such conflicts exist, the Board will evaluate whether any potential conflicts of interest will affect the continuing independence of Board members and whether it is appropriate for the Board member to continue to remain on the Board. The Board has also ensured that NKF is in compliance with the requirements in Financial Reporting Standards (FRS) and the Recommended Accounting Practices for Charities (RAP6) and the Code of Governance for charities and IPCs. Composition of our Board of Directors The Board strives to ensure that Board members as a group has core competencies in areas such as accounting and finance, management, law, medicine, strategic planning and technology and that it incorporates a degree of diversity. All Board members must be independent. Independence refers to not having any family, employment, business and other relationship with NKF, any related companies or their officers that could interfere, or be reasonably perceived to interfere, with the exercise of the Board member s independent judgement made in the best interest of NKF. The CEO is an ex-officio non-voting member of the Board and attends all Board meetings unless otherwise directed by the Board. In addition, other members of management are invited from time to time to attend and make presentations at Board meetings. The Board believes that to be effective, it should not be too large, whilst at the same time ensuring that there is a sufficient range and diversity of expertise and viewpoints. In light of regulations for charities and IPCs, the Board will need to have a minimum of 10 members. As at end of the financial year, the Board had 12 members. The Board met 4 times during the financial year on the following dates: NKF BOARD MEETINGS HELD: September 21, 2010 November 16, 2010 (including AGM) January 18, 2011 May 25, 2011 Key Corporate Governance Initiatives NKF is committed to lawful and ethical behaviour in all its activities and requires that its Board of Directors, employees, volunteers and consultants conduct themselves in a manner that complies with all applicable laws, regulations and internal policies. In keeping with this commitment and NKF s interest in promoting open communication, NKF has complied with the Code of Governance for Charities and Institutions of a Public Character (IPCs). NKF s Governance Evaluation Checklist for the period 1 July 2010 to 30 June 2011 can be viewed at the Charity Portal www.charities.gov.sg. NKF also has a Reserve Policy to provide clarity in the Foundation s management of its reserves and to provide stakeholders with the assurance that the Foundation is well managed and that it has, where appropriate, a strategy for building up reserves. The policy applies to that part of the Foundation s income that is freely available for its operating purposes. It excludes: Endowment Funds; Restricted/ Designated Funds; and any part of unrestricted funds that is not readily available for use or already committed. The Board resolved that the Foundation should maintain adequate reserves to cover at least 5 years of annual operating expenditure in view of the long-term dependencies of NKF patients and beneficiaries. Below is the Reserve Policy Statement for the year ended 30 June 2011: in S$ 000 Current Year Previous Year % incr / (decr) (as at 30 Jun 2011) (as at 30 Jun 2010) Unrestricted Funds (Reserves) 262,523 255,410 3% Restricted / Designated Funds Endowment Fund 3,586 3,842-7% Elderly Patient Fund 545 767-29% Children Dialysis Fund 17,317 17,375 0% World Kidney Fund 264 274-4% Research Fund 5,767 6,666-13% Subtotal 27,479 28,924-5% Total Funds 290,002 284,334 2% No. of years Reserves Coverage of Annual Operating Expenditure 3.6 3.7-2% 14 15
Corporate Governance Current year reserve increased by $7 million to $263 million and is adequate to fund 3.6 years of annual operating expenditure. Although the current year reserve was higher, the reserve coverage of operating expenditure decreased 0.1 year in view of the higher operating expenses due to inflation and increase in number of patients, beneficiaries and related welfare programmes. Annual operating expenditure, for the purpose of the Statement of Reserves, represents the total gross annual expenditure of the Foundation adjusted for inflation and projected capacity increases. The above is based on the assumption that the Foundation does not receive any income from: (a) its dialysis activities (i.e. insurance claims, government grants, payments from patients) or (b) donations. However, since the Foundation is expected to continue to receive income from its dialysis activities, the ratio based on the net operating expenditure (i.e. gross operating expenditure minus dialysis income) will increase to approximately 6 years, same as last year. As the current reserve level of approximately 6 years is above the Foundation s target of 5 years, in line with the Code of Governance, the Foundation will not engage in new fundraising activities. Fundraising shall be limited to targeted donations/sponsorships to fund new projects e.g. for the building of new dialysis centres. 11 Committees to Cover Key Areas of Management NKF has 11 Committees to assist the Board in covering key areas of management and improve its oversight of management and its accountability to stakeholders. All committees have written terms of reference which are approved by the Board. Minutes of committee meetings are provided to the Board. Audit Committee The Audit Committee s primary function is to assist the Board in fulfilling its oversight and fiduciary responsibilities to act in the interest of NKF s members and stakeholders as a whole, in particular, in the areas of financial accountability and reporting. The role of the Committee is to review the efficiency and effectiveness of the Foundation s material internal controls, including operational and compliance controls, risk management and evaluate adherence; ascertain the adequacy of the Foundation s corporate governance, policy and procedures, and the extent of adherence thereto; serve as an independent and objective party to review the integrity of the financial information presented by management to the members, regulators and the general public; provide communication between the Board and both the external and internal auditors; and review and ascertain the extent of independence of the external and internal auditors. Annually, the Committee reviews and recommends the appointment of the external auditors. The Committee also meets with the external and internal auditors at least once a year without the presence of Management. For the financial year, the Committee reviewed and approved the internal and external audit plans; reviewed the external and internal audit reports on the findings of their audits and reviews and their subsequent follow-up. The Committee also reviewed with the external auditors and the internal auditors the Audited Financial Statements and recommended them to the Board for approval. NKF has a Whistle Blowing Policy that provides employees with accessible channels to the Chairman of the Board, the Chairman and members of the Audit Committee and the internal auditors (partner in charge) for reporting suspected fraud, corruption, dishonest practices or other similar matters. During the financial year, there were no complaints reported by employees. Chairman Mr Ng Boon Yew (till 17 January 2011) Chairman Raffles Campus Pte Ltd Mr Philip Tan Yuen Fah (from 18 January 2011) Company Director Members Committee Meetings Held: July 14, 2010 September 13, 2010 Mr Chay Yee Meng (till 31 January 2011) Chairman & CEO InfoWave Pte Ltd Assoc. Prof Mak Yuen Teen (till 31 January 2011) National University of Singapore Business School Mr Lim Joo Boon (from 1 February 2011) Company Director Mr Alfred Shee (from 1 February 2011) Certified Public Accountant, Alfred PF Shee & Co Donor Relations Committee The Donor Relations Committee was established in January 2009. The main objectives of the Donor Relations Committee are to review and ensure that NKF has the appropriate policies and procedures to ensure compliance with the Code of Governance Good Fundraising Practices. It will review and approve all fundraising programmes on a yearly basis. As needed, it will raise community awareness on financial and other assistance needed by the Foundation. It will review and recommend to the Board, the use of Commercial Third-Party Fundraisers if the need arises. Chairman Mr Steven Chong Teck Sin (till 31 July 2010) Company Director Mr Chay Yee Meng (from 1 August 2010) Chairman & CEO InfoWave Pte Ltd Members Committee Meetings Held: September 1, 2010 October 8, 2010 October 29, 2010 Mr Chew Hai Chwee (till 31 July 2010) Chief Executive Officer Surecanlah Mr Lai Kwok Kin (till 31 July 2010) Managing Director WeR1 Consultants Pte Ltd January 27, 2011 May 24, 2011 Mr William Yeoh Oon Siew (till 31 July 2010) Er. Chong Chin Hin, PMP (from 11 October 2010) Vice President SIPM Consultants Pte Ltd Ms Mo Shuyi (from 21 September 2010) Vice-President Business Development Infinite Frameworks Pte Ltd Mr Teo Chin Seng (from 1 August 2010) Senior IT Consultant, Independent (Org) 16 17
Finance Committee Investment Committee Mr Kim Teo CEO, Boardroom Limited Medical Advisory Committee Corporate Governance The Finance Committee reviews the financial performances of NKF on a quarterly basis for reporting to the Board. Its functions include annual review of operating & capital expenditure budget and recommends to the Board for approval; review of quarterly financial performance against budget, and review and approval of Finance Policy and Procedures of NKF. It also reviews and approves all extra-budgetary expenditure beyond management authority and recommends to the Board for approval in respect of those cases that are beyond the authority of the Finance Committee. The Committee also oversees the Tender Committee. Chairman Mr Philip Tan Yuen Fah (till 17 January 2011) Company Director Mr Ng Boon Yew (from 18 January 2011) Chairman Raffles Campus Pte Ltd Members Committee Meetings Held: August 19, 2010 November 3, 2010 February 10, 2011 May 5, 2011 Mr Lim Joo Boon (till 31 January 2011) Company Director Mr Alfred Shee (till 31 January 2011) Certified Public Accountant Alfred PF Shee & Co Mr Chay Yee Meng (from 1 February 2011) Chairman & CEO InfoWave Pte Ltd Assoc. Prof Mak Yuen Teen (from 1 February 2011) National University of Singapore Business School The Investment Committee recommends, for approval by the Board, the investment policy to meet the investment objectives of NKF and suitably qualified external fund managers (FMs) to implement the investment policy. It also monitors and assesses the performance of the appointed external FMs, reports to the Board on the investment performance of funds under FMs management and advises on matters relating to investment administration. For the financial year, the 2 investment mandates were renewed on 3 January 2011. Chairman Mr Gan Seow Ann President Singapore Exchange Ltd Members Mr Lee Tiong Seng Partner and Head Asia Stone Harbor Investment Partners Singapore Mr Tan Keng Hock Ms Tan Min Lan Managing Director Head of Equities/Head of Research, Singapore UBS Securities Pte Ltd Committee Meetings Held: Mr David Tan Wei-Son Executive Director July 23, 2010 September 28, 2010 February 28, 2011 May 20, 2011 CIMB-TrustCapital Advisors Singapore Mr Lawrence Wong Liang Ying Executive Vice President and Head Listings Singapore Exchange Ltd IT Committee The IT Committee s function is to oversee major project implementation, review the annual IT budget and ensure budget compliance. Chairman Mr Chay Yee Meng Chairman & CEO InfoWave Pte Ltd Members Mr Lim Joo Boon Company Director Committee Meetings Held: January 12, 2011 June 23, 2011 Ms Ng Lai Yee Partner, Accenture Singapore Mr Teo Chin Seng Senior IT Consultant, Independent (Org) The members for the Medical Advisory Committee continued its 3rd term of appointment from January 2010 to 31 December 2011. It continued to advise the CEO and Medical Services on medical matters, including: patient care and education, the enhancement of the NKF dialysis programme, the development of dialysis centres, training and education of medical and paramedical staff, organisation of medical conferences and workshops, and any other medical matters assigned by the CEO. Advisor Professor Woo Keng Thye Emeritus Consultant Dept of Renal Medicine, Singapore General Hospital Chairman Assoc. Prof Evan Lee Senior Director Clinical Division, National Kidney Foundation Senior Consultant, Division of Medicine Nephrology, National University Hospital Members Committee Meetings Held: August 31, 2010 November 26, 2010 March 21, 2011 June 20, 2011 Assoc. Prof Chan Choong Meng Head & Senior Consultant Dept of Renal Medicine, Singapore General Hospital Dr Adrian Liew Seng Teck Head & Consultant Dept of Renal Medicine, Tan Tock Seng Hospital 18 19
Corporate Governance Dr Tan Seng Hoe Senior Consultant Nephrologist & Physician SH Tan Kidney and Medical Clinic Gleneagles Medical Centre Professor A. Vathsala Head & Senior Consultant Division of Medicine, Nephrology National University Hospital Professor Yap Hui Kim Head & Senior Consultant Division of Paediatric Nephrology Immunology and Urology The Children s Medical Institute National University Hospital Medical Review Panel (MRP) An independent Medical Review Panel, which was set up in July 2008, was re-appointed for a further 2 years from 1 July 2010 to 30 June 2012. There is no change to the Terms of Reference. The panel, comprising nephrologists from the Restructured Hospitals, will review patients who fail the medical review for admission into NKF s haemodialysis programme and wish to appeal against the rejection due to medical grounds. The members of the MRP are:- Dr Titus Lau Senior Consultant Dept of Renal Medicine, National University Hospital Dr Rajat Tagore Consultant Dept of Renal Medicine, Jurong General Hospital Patient Appeal Committee The Patient Appeal Committee assists in reviewing appeal cases of patients seeking financial and social assistance as well as for admission into NKF programme. These cases, which fall outside NKF s standard approval criteria, are referred to the Committee by NKF s Admissions and Care & Counselling departments. The Committee provides unbiased assessments of such appeals and provides impartial recommendations to the CEO. In addition, it also reviews and recommends action to be taken against recalcitrant or non-compliant patients. The Committee meets as and when the need arises to deliberate on all appeals, and recommends to the CEO to accept, reject or provide alternative solutions to the appellants. For the financial year, the Committee reviewed 19 patient cases. Committee Meetings Held: July 13, 2010 August 24, 2010 January 6, 2011 April 13, 2011 31 May, 2011 Chairman Dr Ling Sing Lin Former Senior Director Community Partnership Development Division Ministry of Health Vice-Chairman Dr Shanta Emmanuel (from 1 February 2010) Head Chronic Disease Management Office, SingHealth Members Assoc. Prof Chew Suok Kai (till 18 January 2011) Deputy Director of Medical Services Epidemiology & Disease Control, Ministry of Health Dr Vineta Bhalla (from 19 January 2011) Director Hosptial Services Division, Ministry of Health Ms Hui Soh Heng Nurse Manager Renal Unit, National University of Singapore Ms Esther Lim Li Ping Head of Department Medical Social Services, Singapore General Hospital Ms Jane Straaten Senior Nurse Manager Renal Services, Changi General Hospital Ms Tay Poey Noy Honorary Secretary Thong Teck Sian Tong Lian Sin Sia (NKF s dialysis centre sponsor at Woodlands) & Thong Teck Home for Senior Citizens Mr Yeo Say Ann NKF dialysis patient Remuneration Committee The Remuneration Committee exercises policy oversight of the Human Resource function in NKF. It ensures that NKF has appropriate remuneration policies and decides on the remuneration of its Senior Executives. The Committee also reviews and approves employee compensation and benefit packages which include performance incentive plans recommended by NKF management. Chairman Mr Gerard Ee (Acting) Chairman Council for Third Age Members Committee Meetings Held: August 20, 2010 November 18, 2010 March 4, 2011 Mr Chua Hoe Sing Managing Director HSC Glaston (Management Consultancy) Pte Ltd Mr Ronald Tan Hee Huan Executive Director Singapore Institute of Management Ms Wong Su Yen Senior Partner, Managing Director Mercer, ASEAN Assoc. Prof Wong Kok Seng Senior Consultant Dept of Renal Medicine, Singapore General Hospital 20 21
Research Committee Chairman Tender Committee Chairman Corporate Governance The Research Committee continues into its 2nd term of appointment from 19 April 2010 to 18 April 2013. Besides continuing to review new applications for grant calls under the Venerable Yen Pei-NKF Research Fund and deciding on the amount awarded, the committee also ensures good stewardship and accountability for the awards of the Research Fund. Committee Meetings Held: October 19, 2010 April 19, 2011 Professor Woo Keng Thye Emeritus Consultant Dept of Renal Medicine, Singapore General Hospital Members Assoc. Prof Chan Choong Meng Head & Senior Consultant Dept of Renal Medicine, Singapore General Hospital Dr Ho Chee Khun Senior Consultant Nephrologist The Kidney Clinic Pte Ltd Mount Elizabeth Medical Centre Assoc. Prof Evan Lee Senior Director Clinical Division, National Kidney Foundation Senior Consultant, Division of Medicine Nephrology, National University Hospital Dr Grace Lee Siew Luan Senior Consultant Grace Lee Renal & Medicine Clinic Gleneagles Medical Centre Dr Martin Lee Staff Physician Dept of Medicine, National University Hospital Dr Mooppil Nandakumar (till September 2010 and re-appointed as member from April 2011) Director of Medical Services National Kidney Foundation The Tender Committee is a sub-committee of the Finance Committee. The Committee supports and advises the Finance Committee on the procurement process to obtain optimum value and ensures that it is transparent and competitive. It reviews risk implications which may arise from the purchases and proposes measures to avoid or minimise such risks. The Committee also reviews conflict of interest, if any, during the procurement process. It independently evaluates the tenders submitted for each purchase in excess of $500,000. During the financial year, the Committee reviewed and awarded a total of 7 tenders for medical consumables and medical drugs as well as construction of an Interactive Education Centre. The total amount awarded was $12,168,415. Committee Meetings Held: July 21, 2010 October 28, 2010 December 16, 2010 January 27, 2011 March 24, 2011 June 16, 2011 Mr Alfred Shee (till 31 January 2011) Certified Public Accountant Alfred PF Shee & Co Assoc. Prof Mak Yuen Teen (from 1 February 2011) National University of Singapore Business School Members Dr Stephen Chew Consultant Nephrologist and Physician Mount Elizabeth Hospital Mr Lee Ho Wah Partner Rodyk & Davidson LLP Ms Phua Chiew Pheng Mr Tag Sin Siew Senior Vice President SingBridge International Singapore Pte Ltd Dr Tan Seng Hoe Senior Consultant Nephrologist & Physician SH Tan Kidney and Medical Clinic Gleneagles Medical Centre Assoc. Prof Tan Han Khim Senior Consultant Dept of Renal Medicine, Singapore General Hospital Dr Tan Seng Hoe Senior Consultant Nephrologist & Physician SH Tan Kidney and Medical Clinic Gleneagles Medical Centre Professor Yap Hui Kim Head & Senior Consultant Division of Paediatric Nephrology Immunology and Urology The Children s Medical Institute National University Hospital 22 23
Corporate Governance Volunteer Committee The Volunteer Committee reviews and provides advice and recommendations to NKF management on volunteer programmes policies and procedures, infrastructure and benefits for NKF volunteers. It also looks into the provision of insurance coverage for volunteers on the job as well as volunteer training to enhance their skills in their voluntary capacities. The Committee encourages community ownership whereby residents and organisations adopt a dialysis centre and volunteer their time to befriend patients and conduct enrichment classes. The Committee also helps to advocate and find opportunities for NKF volunteer team to promote programmes to corporations and religious organisations. The Committee s focus for the financial year continues to be on volunteer recruitment and programme development. Committee Meetings Held: September 30, 2010 December 7, 2010 February 24, 2011 June 2, 2011 Chairman Mr Yatiman Yusof Singapore High Commissioner to the Republic of Kenya Members Ms Christina Lim Poh Kheng (till 31 July 2011) Director (Brand & Marketing) NTUC Fairprice Mr Simon Neo Teck Koon Trainer & Psychotherapist Purple Chapter Ms Siti Zainab Bujal Manager Esbibi Wedding Services Dr Mabel Thng (from 16 November 2010) Kiwanis Club of Singapore (Delta Chapter) Ms Shirley Wong Swee Ping Managing Director BT Frontline Pte Ltd Dialysis Treatment & Holistic Care Promoting Kidney Transplantation Advancing Clinical Management & Care Working with Other Organisations Supporting Research Clinical º Dialysis Treatment & Care º Our Dialysis Centre Sponsors º Holistic Rehabilitative Care º Promoting Kidney Transplantation º Advancing Clinical Management & Care º Working with Other Organisations to Enhance Healthcare Management º Supporting Research in Kidney Diseases 24
Rising Trend of NKF s Kidney Patient and Beneficiary Population Dialysis Treatment and Care NKF helps kidney patients through the following 4 main programmes: Patients 2,900 2,800 2,700 2,600 2,500 2,400 2,300 2,200 2,100 2,000 1,900 2,072 2,235 2,378 2,551 35% increase 2,696 2,801 Portable Subsidy Programme (started in 2008) Peritoneal Dialysis Haemodialysis 1. NKF s haemodialysis programme at its 24 dialysis centres 2. Helping beneficiaries on peritoneal dialysis at home 3. Helping beneficiaries dialyse at Restructured Hospitals or private dialysis centres through portable funding 1,800 1,700 Jun-06 Jun-07 Jun-08 Jun-09 Jun-10 Jun-11 Year Clinical 4. Helping children with kidney failure through Children s Kidney Centre In addition, NKF provides financial assistance to needy live donors through its Kidney Live Donor Support Fund. The total kidney patient and beneficiary population at 2,832 represent a 4% increase and amount of subsidies for dialysis, medication and auxiliary services amounting to $26.0 million for the financial year was 9% higher compared to $23.9 million the financial year before. Total Subsidies to Patients and Beneficiaries Total Number of Patients and Beneficiaries Amount of Subsidies ($ 000) As at As at Year ended Year ended 30 Jun 2011 30 Jun 2010 Variance (%) 30 Jun 2011 30 Jun 2010 Variance (%) Haemodialysis 2,398 2,330 3% 20,339 19,739 3% Peritoneal Dialysis 284 261 9% 1,834 1,673 10% Portable Subsidy 119 105 13% 1,818 910 100% Children Dialysis Subsidy 18 20-10% 790 612 29% (including funding to Children s Kidney Centre) Kidney Live Donor 13 6 117% 11 1 1000% 24,792 22,935 8% Medical and Social 1,182 953 24% Welfare Subsidy Total 2,832 2,722 4% 25,974 23,888 9% Patients Co-payment Per month (incl. GST) As at 30 Jun 2011 [Haemodialysis Programme] 55% of Haemodialysis Patients Pay $50 or Less a Month NKF s subsidised haemodialysis programme is to help its needy patients. 97% of our patients receive NKF subsidies and other form of subsidies while the remaining are full-paying patients, which is capped at 10% of NKF s haemodialysis patient population. During the financial year, 55% of our haemodialysis patients paid $50 or less per month. As at 30 Jun 2010 Increase / (Decrease) 2011 VS 2010 No. of Patients % of Patients No. of Patients % of Patients No. of Patients % Change $50 and less 1,309 55% 1,215 52% 94 3 $51 - $200 384 16% 380 16% 4 0 $201 - $400 259 11% 248 11% 11 0 $401 & above 380 15% 411 18% -31-3 Total No. of Subsidised Patients 2,332 97% 2,254 97% 78 0 No. of full-paying patients* 66 3% 76 3% -10 0 Total No. of Patients 2,398 100% 2,330 100% 68 0 *There are full-paying patients who receive sponsorships mainly from government organisations. 26 27
Dialysis Treatment and Care [ Haemodialysis Programme] [ Peritoneal Dialysis Programme] Patients 2,500 2,400 2,300 2,200 2,100 2,000 1,900 1,800 1,976 Rising Trend of Haemodialysis Patients 2,330 2,297 21% increase 2,161 2,037 2,398 Helping Beneficiaries on Peritoneal Dialysis In the area of Peritoneal Dialysis, the number of beneficiaries increased to 284 compared to 261 the financial year before, which is an increase of 9%. In total, $1.83 million in the form of subsidies was given out for the financial year ended 30 June 2011. Patients Rising Trend of Beneficiaries on Peritoneal Dialysis 400 300 200 100 96 196% increase 211 213 198 284 261 0 Jun-06 Jun-07 Jun-08 Jun-09 Jun-10 Jun-11 Year 1,700 Jun-06 Jun-07 Jun-08 Jun-09 Jun-10 Jun-11 Year Clinical Profile of Haemodialysis Patients 46% AGE 54% Profile of Beneficiaries on Peritoneal Dialysis 48% AGE 52% 1% 60 61 2% 60 61 26% 31% RACE 66% 45% GENDER 55% RACE 61% 54% GENDER 46% 7% 6% Chinese Indian Female Male Chinese Indian Female Male Malay Other Races Malay Other Races 28 29
Dialysis Treatment and Care Clinical Launched NKF Peritoneal Dialysis Community Support Programme Peritoneal dialysis (PD) is a home-based therapy. PD patients return home with the weighty task of taking over the dialysis themselves after being trained in the hospital. This experience can be daunting. NKF believes that continuing support beyond the hospital, in the home is essential to boost the confidence of PD patients in carrying out this therapy. Regular home visits provide opportunities to monitor, guide and ensure proper self-management of PD treatment. It facilitates early identification of problems and allows timely intervention. This will help to reduce hospitalisations and improve patients well-being. Whilst NKF strives to improve the support to PD patients, it acknowledges that collaboration with the PD teams from the various Restructured Hospitals (RHs) is paramount to benefit the patients. As such, NKF launched its Peritoneal Dialysis Community Support Programme, providing home visit service by working closely with the RHs to bring holistic care and support to the patients homes. NKF PD Home Visit is carried out by a team of PD nurses. The services provided during home visits include clinical assessment and PD proficiency assessment. The frequency of home visits depends on the necessity and urgency of the cases. The pilot project of this service was launched in February 2011 and confined to NKF beneficiaries from the National University Hospital. In June 2011, with the success of the pilot project, the service was progressively extended to all other NKF beneficiaries from other RHs, namely, Changi General Hospital, Khoo Teck Puat Hospital, Singapore General Hospital, Jurong General Hospital and Tan Tock Seng Hospital. Portable Subsidy Programme Portable Subsidy Programme Helps Kidney Patients with Other Medical Complications To ensure that no needy patient is deprived of dialysis treatment, NKF stepped up its Portable Subsidy Programme. Needy patients, who pass the means test but cannot be admitted to NKF s haemodialysis programme because they suffer from other medical complications, are provided subsidies to receive treatment at Restructured Hospitals (RHs)or private dialysis centres near the RHs where emergency services are readily available. At the end of June 2011, 119 needy beneficiaries were on the programme, compared to 105 at the end of June 2010. In total, $1.82 million in the form of subsidies were paid for the financial year ended 30 June 2011. [ Children s Dialysis Fund] Assisting Young Kidney Patients through Children s Dialysis Fund NKF has a Children s Dialysis Fund to subsidise the treatment costs for children suffering from kidney failure, as well as to sponsor the running costs of the Children s Kidney Centre at the National University Hospital. For the financial year, the total funding for the Centre and the 18 child beneficiaries amounted to $790,000. Patients 130 120 100 80 60 40 20 50% AGE 50% 60 10 0 61 72% AGE 28% 11 Rising Trend of Beneficiaries on Portable Subsidy Programme 6 Jun-08 Profile of Beneficiaries on Portable Subsidy Programme 36% GENDER 64% Female Male 32% Profile of Child Beneficiaries on Dialysis 61% 41 GENDER 105 39% 28% 6% 11% 119 Jun-09 Jun-10 Jun-11 Year 3% RACE Chinese Malay RACE Chinese Malay 59% Indian Other Races 61% Indian Female Male 30 31
Sponsors Thanks to our caring sponsors, NKF has been able to set up dialysis centres across Singapore, providing convenience and easy access to kidney patients living or working in the heartlands. Our Dialysis Centre Woodlands II Woodlands I Yishun Holistic Rehabilitative Care Dialysis Centres Aljunied Hong Leong NKF Dialysis Centre Blk 102, Aljunied Crescent, #01-265, Singapore 380102 Bukit Panjang Teck Whye Bukit Batok Jurong West Hong Kah Clementi Ang Mo Kio I Ang Mo Kio II Ang Mo Kio III Hougang II Hougang I Serangoon Toa Payoh Aljunied Kim Keat Ghim Moh Upp Boon Keng Bedok Tampines Simei Pasir Ris In addition to providing subsidies for dialysis and medication, NKF, in its efforts to provide holistic care, also provided subsidies through medical and social welfare programmes, which are essential components in holistic treatment. These subsidies totalled $1,182,000 during the financial year, up from $953,000 in the last fiscal year. Clinical Ang Mo Kio 1 Japan Airlines NKF Dialysis Centre Blk 17, Ang Mo Kio Ave 9, #03-01, Singapore 569766 Ang Mo Kio 2 Western Digital NKF Dialysis Centre Blk 633, Ang Mo Kio Ave 6, #01-5155, Singapore 560633 Ang Mo Kio 3 Pei Hwa Foundation NKF Dialysis Centre Blk 565, Ang Mo Kio Ave 3, #01-3401, Singapore 560565 Bedok Singapore Pools NKF Dialysis Centre Blk 27, New Upper Changi Road, #01-694, Singapore 462027 Bukit Batok NTUC Income NKF Dialysis Centre Blk103, Bukit Batok Central, #01-237, Singapore 650103 Bukit Panjang New Creation Church NKF Dialysis Centre Blk 274, Bangkit Road, #01-54, Singapore 670274 Clementi NKF Clementi Dialysis Centre Blk 326, Clementi Ave 5, #01-175, Singapore 120326 Ghim Moh Woh-Hup NKF Dialysis Centre Blk 1, Ghim Moh Road, #01-358, Singapore 270001 Hong Kah NKF Hong Kah Dialysis Centre Blk 536, Jurong West St 52, #01-497, Singapore 640536 Hougang 1 Singapore Buddhist Welfare Services NKF Dialysis Centre Blk 114, Hougang Ave 1, #01-1298, Singapore 530114 Hougang 2 NKF Hougang Punggol Dialysis Centre Blk 628, Hougang Ave 8, #01-108, Singapore 530628 Jurong West Sheng Hong Temple NKF Dialysis Centre Blk 744, Jurong West St 73, #01-19, Singapore 640744 Kim Keat Tay Choon Hye NKF Dialysis Centre 81 Kim Keat Road, Singapore 328836 Pasir Ris Tampines Chinese Temple NKF Dialysis Centre Blk 180, Pasir Ris St 11, #01-06, Singapore 510180 Serangoon Insurance and Financial Practitioners Association of Singapore (IFPAS) NKF Dialysis Centre Blk 201, Serangoon Central, #01-30, Singapore 550201 Simei Kwan Im Thong Hood Cho Temple NKF Dialysis Centre Blk 101, Simei St 1, #01-892, Singapore 520101 Tampines National Trade Union Congress / Singapore Pools NKF Dialysis Centre Blk 935, Tampines St 91, #01-333, Singapore 520935 Teck Whye Leong Hwa Chan Si Temple NKF Dialysis Centre Blk 113, Teck Whye Lane, #01-666, Singapore 680113 Toa Payoh Singapore Airlines NKF Dialysis Centre Blk 225, Toa Payoh Lor 8, #01-54, Singapore 310225 Upper Boon Keng Sakyadhita NKF Dialysis Centre Blk 19, Upper Boon Keng Road, #01-1220, Singapore 380019 Woodlands 1 Thong Teck Sian Tong Lian Sin Sia NKF Dialysis Centre Blk 825, Woodlands St 81, #01-30, Singapore 730825 Woodlands 2 NKF Woodlands Dialysis Centre Blk 365, Woodlands Ave 5, #01-490, Singapore 730365 Yishun Toa Payoh Seu Teck Sean Tong NKF Dialysis Centre Blk 203, Yishun St 21, #01-239, Singapore 760203 Grains of Hope Programme Helps NKF s Neediest Patients Amidst rising inflation, NKF, with the support of Singapore Buddhist Lodge, extended more help to its neediest kidney patients by providing a total of $200,000 worth of basic food necessities yearly. Currently, 386 NKF patients are each receiving a $60 food voucher, 5 kg of rice, 3 kg of bee hoon and 2 litres of cooking oil once in two months. Of these, 320 patients, or about 83% of them, have zero per capita income. 148 patients are 60 years old and above, with about 42% of these elderly patients having no children to support them. NKF launched this new programme called Grains of Hope on 5 April in conjunction with its 42nd anniversary celebration. This is not the first time the new NKF is taking proactive steps to look into the needs of its patients besides heavily subsidising their dialysis fees. Since 2007, NKF has been giving 140 poor patients under its welfare programme $30 food vouchers monthly. NKF mobilised over 450 volunteers working in pairs to help distribute the bulky food items to the patients homes. While visiting patients homes, it is also an opportunity for these volunteers to build friendships with patients and their families and to bring hope and encouragement to them. 32 33
Holistic Rehabilitative Care Public Transport Subsidy Programme Under the Public Transport Subsidy Programme, which is part of NKF s Patient Welfare and Benefit Programme, needy patients such as amputees who require special transportation to and from dialysis centres but cannot afford the additional costs, were given subsidies for the taxi and ambulance expenses for their 3 dialysis sessions every week. For the financial year, a total of 135 patients received subsidies amounting to $468,410 for these expenses. Another 142 needy patients received $30 a month to top-up their EZ Link cards for their bus and train expenses to and from dialysis centres, which amounted to $51,689, of which $50,000 was donated by the Singapore Buddhist Lodge. Promoting an Active Lifestyle for Patients NKF organised its Patients Active Day (PAD) on 26 September 2010 and 27 March 2011 at the Chinese Garden and East Coast Park respectively. Around 400 patients, their caregivers and staff came together at each event to have a time of bonding by participating in games, activities and exercises. The aim of PAD is to help patients develop a positive mindset and improve their physical and psychological well-being. NKF s exercise specialists introduced various mass aerobic workouts during PAD that were easy, fun and enjoyable. Competitions were held between the dialysis centres with the winners walking away with trophies and medals. Clinical Providing Home Glucose Monitoring Kit to Patients Nearly half of NKF s patients requiring dialysis have diabetes mellitus. These diabetic patients require good blood sugar control, even after starting dialysis, to reduce and slow down further complications. In order to achieve blood sugar control, regular monitoring of glucose is required. Cost is a major factor for non-compliance in monitoring glucose. To address this issue, NKF provided free blood glucose monitoring kits to dialysis patients. Currently, about 550 patients are doing regular home glucose monitoring. These patients are more aware of their diabetic control status and are taking proactive measures for better diabetic control. Providing Foot Care Services for Patients Peripheral vascular disease and diabetic neuropathy leads to development of foot ulcers in diabetic patients. If left untreated, it could lead to gangrene and amputation. NKF is currently working with the Diabetic Society of Singapore to develop a foot screening programme to identify and counsel high risk patients. To improve patients physical fitness, group exercises were also conducted regularly for patients at our Wellness Centre at NKF HQ during weekdays. These exercise regimes are customised to fit the different functional fitness levels of our patients. 34 35
Holistic Rehabilitative Care Providing Education and Support to Caregivers Helping Patients with Their Psychosocial Needs Clinical Year-end Celebrations to Lift Patients Spirits As a psychosocial rehabilitative effort to help minimise patients life-long struggle with dialysis, NKF organised a series of year-end parties in December 2010 across its 24 dialysis centres for over 2,500 patients, caregivers, donors, volunteers and staff that spilled over to the New Year. It was a time of bonding, friendship, joy and laughter, where patients were able to take their minds off their plight to enjoy a fun-filled day with friends and loved ones. During this season of goodwill, 16 generous corporate sponsors and 13 individual donors devoted their time and energy to make the celebrations an unforgettable time for patients. Other than sponsoring outright donations, some sponsors personally organised and participated in the parties and donated food, prizes and gifts. As the life expectancies of our patients increase due to advancement in medical technologies, more and more patients are living longer. This also takes a heavy toll on the caregivers in terms of their continual commitment and dedication in providing care to their loved ones. Often, the caregivers receive inadequate support and the rewards are intangible, so they suffer frustration and a sense of helplessness. Understanding what caregivers are going through, NKF launched the Caregivers Support Programme in April 2010. NKF collaborated with the Asian Women s Welfare Association (AWWA), which has experience in caregiving education and support, to provide training in caregiving to patients family members. During this financial year, AWWA conducted a training session Developing Problem Solving Skills to Manage Family Conflicts to caregivers on 24 July 2011. NKF also organised educational sessions by healthcare specialists for caregivers on how to manage the patients better. Caregivers and patients attended sessions on Medical and Physiological Makeup of Renal Patients on 27 February 2011, Eating Well on Dialysis on 1 April 2011 and Feeling stressed out? Tips on Caring for Your Loved One with Other Caregivers on 5 June 2011. As there are more sick and non-ambulant patients, caregivers have greater responsibilities. NKF will continue to look into ways to improve the Caregiver Support Programme so that they will become more equipped and effective in their caregiving responsibilities. The Medical Social Services arm of Care & Counselling department, which consists of medical social workers (MSWs), was set up in 2006 to enhance the existing patient care. The MSWs provided the psychosocial support to enable the patients to come to terms with their circumstances. The goal is to work towards motivating them and empowering them to take control of their condition for a better quality of life. The MSWs also provided NKF-administered financial assistance to patients. This includes the Annual Patient Assessment (APA) where the MSWs look into patients socio-economic circumstances to determine their affordability towards their dialysis contribution. The MSWs also facilitated the Patient Support Group programme, which provides patients with an avenue to interact and establish an informal social network. The support group conducts workshops that would empower patients in their rehabilitation and improve their quality of life. Thus far, 9 groups of patients participated in disease management talks and 3 groups participated in costume jewellery-making. Other groups took part in bakery classes, the New Paper Big Walk, social outings and a karaoke tea session. Through these activities, patients can interact more while gaining new knowledge and skills that will enhance their lifestyle as part of their rehabilitation process. 36 37
Promoting Kidney Transplantation Advancing Clinical Management & Care Clinical Since the launch of NKF s Kidney Live Donor Support Fund in 2009, 13 applicants have received funding (as at 30 June 2011) approved by the Transplant Ethics Committee and NKF management. An initial amount of $10 million from the existing NKF surplus fund had been set aside for this Fund. The Fund is used to provide financial assistance to needy live donors and is limited to kidney-related medical welfare and insurance. The funding coverage includes: 1) Cost of annual health screening and medical follow-ups as directed by Restructured Hospital physicians 51-year-old Mr Mohamad Ali Haji Salleh, who gave his kidney to his 22-year-old daughter, Nurul Jannah, is a beneficiary of NKF s Kidney Live Donor Support Fund. Thanks to him, Nurul says, I feel I can go out and live life again. Courtesy of The Straits Times Clinical Quality Team Quality Assurance Plan Clinical Outcomes Patient Outcomes Nursing Outcomes (Processes) Quality Assurance Quality Assurance activities continued to focus on clinical and operations outcomes, which were supported by the workgroups in the Quality Assurance Plan. Quality Assurance Operations Outcomes Application Process Patient Flow & Census (Admission) IT Outcomes Patient Management Team System Data 2) One-time reimbursement for loss of income equivalent to actual loss of 2 months of a person s income or $5,000, whichever is lower Nutritional Outcomes Medical Records Medical Records Team 3) Reimbursement of Hospitalisation & Surgical insurance premiums (capped at CPF Basic MediShield premiums) Medical Equipment Team Patient Safety Outcomes Pharmacy Management Pharmacy Management Team 4) Insurance coverage for Group Living Policy based on sum insured of $100,000 Infection Control Team Infection Control Outcomes Communications Communications Team The National Kidney Foundation 38 Annual Report 2010/11 39
Advancing Clinical Management & Care [ Clinical Outcomes ] Clinical Clinical Quality Nursing Services continued to improve its operational performance in nursing practices for safe delivery of care. Quarterly Cross Audits Quarterly cross audits on infection control, clinical and operational procedures were conducted to ascertain consistency in practices and patient safety. Evidence-based Nursing Practices to Improve Quality of Care Delivery The momentum towards sowing a culture of continuous exploration for improvement in the delivery of care was upheld via various channels of effort. An educational compact disc that aids the teaching of Clinical Quality Improvement (CQI) tools was developed and distributed to all 24 dialysis centres. The educational compact discs were utilised by the dialysis centres to train nurses to enhance the understanding on CQI applications and improve the standards of CQI projects. All 24 dialysis centres formed a CQI team each; a special session was conducted in the first quarter of the year to better equip the CQI team leaders and members. Senior Nurse Clinicians carried the role of project consultants and advisors to the few dialysis centres allocated under their care. On 16 June 2011, 6 selected best teams presented their projects in an in-house CQI finals competition. Four projects were submitted for poster presentation at the Healthcare Quality Improvement Conference 2011 organised by the Ministry of Health on 10 & 11 October 2011. One of our submissions was selected for poster presentation. Nutritional Outcomes Malnutrition is evident and common in many NKF patients. It is therefore important to identify and manage these patients closely. In view of this, the Dietetic Department embarked on the following programmes: 1) Nutrition Screening At the Placement Clinic In the last financial year, 343 patients were screened, of which about 32% of them were having moderate or severe malnutrition. This group of patients was given follow-up once their placements were confirmed at NKF dialysis centre or referred to hospitals for dietetics follow-up. At the Dialysis Centre On top of referrals from the dialysis centres, the dietitians would screen patients who were deemed malnourished based on the 2 monthly routine blood tests. Advice to the patients was given and all the interventions documented in their medical records for other healthcare providers especially nurses, to help with the follow-up on patients compliance. 2) Counselling 3) Education In collaboration with Temasek Polytechnic, NKF produced a series of audio visual education materials to enhance patient understanding and awareness on renal diet. The videos come in English, Chinese and Malay languages to cater to patients needs. 4) Continuous Improvement and Collaboration Based on our observational study done in 2009/2010, it showed that nutritional supplements helped to improve nutritional status of malnourished haemodialysis patients. As such, NKF prescribes nutrition supplements to malnourished patients. At the dialysis centres, the dietitians embraced the Continuous Quality Improvement Projects initiated by the Nursing Team, providing nutrition-related inputs. The Nurses Research Task Group started on-going research projects to apply Evidence-Based Nursing practices (EBN) from theory to practice. A new approach by NKF s Nursing Clinical team was taken to cascade this information through monthly Clinical Sharing Sessions for nurses. Counselling for patients was done either individually or in groups. Group sessions were useful for sharing concerns on dietary needs. There were 6 group counselling sessions conducted at the dialysis centres from July 2010 to June 2011. 40 41
Advancing Clinical Management & Care Infection Control The effort towards optimising Infection Control (IC) standards continued with active runs of programmes throughout the year; enhancing the continuity of both staff and patients awareness on its importance. i. Participation in global audit collation via submission of our audit findings for the 24 dialysis centres Clinical Hand Hygiene The quarterly IC audits continued to reflect progressive improvements in hand hygiene standards with an average achievement rate of 97% compliance. Our commitment to the second year of the World Health Organizations (WHO) Patient Safety Challenge cum Saves Lives: Clean Your Hands Global Annual Campaign was marked via several participations namely: ii. Circulation of WHO message and education article on Hand Hygiene: Clean is Safe Care via our intranet iii. Dissemination of WHO educational materials on Hand Hygiene Improvement slides and Glove Use Information Leaflet. The 8 members from the National Infection Control Task Group attended the Hand Hygiene Audit Workshop organised by the Infection Control Association in June 2011. In collaboration with the Agency for Integrated Care (AIC) and United Medical Centre, the Infection Control Team conducted a Hand Hygiene Assessment Workshop in April 2011 for 52 NKF participants. Infection Control (IC) and Quality Week In conjunction with the IC Week on 13 November 2010, NKF organised the third Infection Control workshop focusing on Vascular Access Infection. The programme included management and precautions on care of the vascular access. The objectives of the programme were to create awareness and adopt lessons learnt from other institutions. The theme emphasised on the importance of hand hygiene. The external speaker, Dr Brenda Ang, Infectious Diseases Consultant, Tan Tock Seng Hospital, gave a talk on Management of Vascular Access. Approximately 250 participants attended the workshop. Overseas Infection Prevention & Control Training Course The NKF collaborated with the Bach Mai Hospital, Hanoi (Vietnam) to conduct basic Infection Control training from 25 to 29 October 2010. The programme had two separate sessions to suit the needs of the trainees: i. 3-day training programme on Basic Infection Prevention and Control attended by 95 participants ii. 2-day training programme on Infection Prevention and Control in Renal Care Unit attended by 38 participants The participants included dialysis nurses, doctors and technicians from the dialysis centres and departments across 13 provinces in Vietnam. 42 43
Advancing Clinical Management & Care Streamlining Patients at Admission Unit [ Operations Outcomes ] Working with Other Organisations to Enhance Healthcare Management Clinical The Admission Unit monitors the capacity status at the dialysis centres and the utilisation of the dialysis places available for allocation so that it can better plan for the long-term needs of kidney patients. All 24 dialysis centres were at near full capacity with close to 95% utilisation throughout the year. There were a total of 431 chairs in all 24 dialysis centres. This equated to 2,586 places, of which 42 were isolation facilities, 6 rehabilitation places and 48 emergency places. Providing Patients with Appropriate Support at Placement Clinic Patients who passed the means test were assessed at the Placement Clinic by NKF doctors for their suitability to be accepted into NKF s haemodialysis programme. To help identify individual patient s needs so as to provide the appropriate support in their rehabilitation, all patients who were seen at the Placement Clinic underwent medical, nursing, nutritional and psychosocial assessment. Patients were seen by doctors, nurses, dietitians and medical social workers. This one-stop assessment at the Placement Clinic will enable patients to receive the support needed that best suits their needs to help them achieve optimal rehabilitation. It will also help in enhancing our current rehabilitation programmes and developing new ones based on patients evolving needs During the financial year, 359 patients were seen at the Placement Clinic and 313 patients were accepted into NKF s haemodialysis programme. Those who were not suitable for community dialysis were referred back to the Restructured Hospitals. The hospital will assess the patient and recommend an alternative dialysis treatment plan. Involvement with Hospital Nephrologists and Family Medicine Doctors As a routine, patients on dialysis were seen once in every 6 to 8 weeks by the medical team. The Department of Medical Services continued to engage the services of nephrologists and family physicians from Restructured Hospitals (RHs) and private centres. At the end of the financial year, there were 13 visiting nephrologists from the RHs and private dialysis centres and 3 family medicine doctors who helped review the patients regularly. Collaboration with Restructured Hospitals In light of the difficulty in recruiting doctors for community dialysis centres, the Ministry encouraged Voluntary Welfare Organisations to form alliances with the RHs to ensure a proper system of clinical governance with accountability. NKF met up with 2 RHs and proposed 3 thrusts of collaboration - medical coverage, continuity of care and collaborative efforts. Joint Committee on Specialist Training (JCST) Accreditation NKF has been granted partial accreditation by JCST for a period of 5 years effective 1 July 2010. Through the Advanced Specialist Training (AST) programme, AST trainees from the RHs can opt to be attached with NKF on a part-time (6 months) or full-time (3 months) basis to get exposure and experience in outpatient satellite haemodialysis. The training is recognised as part of the AST programme for Nephrology. 44 45
Clinical Supporting Research in Kidney Diseases The Venerable Yen Pei-NKF Research Fund continues to receive applications relevant to basic and clinical renal research. Response to the research fund grant calls has been enthusiastic. There has been a total of 8 Grant Calls since 2007 with a total of 74 projects funded by NKF. Currently, 33 projects are on-going with 15 projects completed by June 2011. During the financial year, the 7th and 8th grant calls were opened to all Restructured Hospitals and National Centres in July 2010 and January 2011 respectively. Details of Grant Calls Awarded Grant Call Date Proposals Proposals Total Amount Received Approved Approved 7 th Grant Call Jul 2010 8 8 $ 516, 500/- 8 th Grant Call Jan 2011 11 11 $920, 000/- The research committee will be organising the NKF 1st Scientific Meeting cum Research Forum next FY which will be held on 4th February 2012. The Scientific Meeting will focus on dialysis and recent advances and will serve as a platform for researchers and healthcare professionals to share and exchange ideas and foster discussions to advance renal care. The research forum will showcase the projects funded by the Venerable Yen Pei NKF Research Fund. The Forum will comprise oral and poster presentations. There will be three top prizes for oral presentation and a top prize for poster presentation. Approved Projects for FY 2010/11 7 th Grant Call Expected Date of Project Title Recipient Completion Prevention of tenofovir-related renal tubular Dr Lawrence Lee Soon-U Dec-2013 toxicity: Strategies and mechanisms Targeted inhibition of signal transducer and Dr Gautam Sethi Dec-2013 activator of transcription-3 pathway for the treatment of metastatic renal cell carcinoma Clinical prevalence and associated factors of Prof P Ganesan Adaikan Dec-2013 erectile dysfunction in uremia Mood, cognitive, physical functioning and Assoc. Prof Ng Tze Pin Dec-2012 quality of life in older adults with chronic kidney disease (CKD) Improving end-of-life care in renal patients Dr Alethea Yee Chung Pheng Dec-2011 with a clinical coordinated pathway. Risk factors for failed ureteroscopy and the role Dr Chong Yew Lam Dec-2012 of alpha-adrenergic antagonists Usefulness of Neutrophil gelatinase-associated Dr Wee Choon Peng Jeremy Dec-2011 lipocalin as a biochemical marker for acute kidney injury in patients with sepsis and cardiac failure Control of Fasting Hyperglycemia and Fatty Dr Martin Lee Beng Huat Dec-2013 Acid Metabolism in Diabetes Mellitus by the Nuclear Receptor HNF4A1 46 47
Clinical Supporting Research In Kidney Diseases 8 th Grant Call Expected Date of Project Title Recipient Completion Augmentation of glutathione levels through oral Assoc. Prof Gan Yunn Hwen Jun-2014 N-acetylcysteine supplementation in Type 2 diabetic patients to increase resistance to bacterial infection Reducing nephrotoxicity of vancomycin: Dr Jolene Oon Jun-2014 A prospective, randomised study of continuous versus intermittent infusion of vancomycin The origin of anti-c1q autoantibodies-a key Assoc. Prof Lu Jinhua Jun-2013 nephritogenic factor for proliferative lupus nephritis Activation of Na+/K+-ATPase with a rat derived Assoc. Prof Bian Jinsong Jun-2014 DR region specific antibody-a new approach to treat renal ischemic diseases Functional analysis of mir-196a in human renal Assoc. Prof Lim Hsiu Kim Lina Jun-2013 cell carcinoma A multi protocol investigation to compare the Prof Gade Pandu Rangaiah Jun-2012 effects of intra-dialytic exercise on physiological changes and toxin removal in maintenance hemodialysis patients Characterization of Sarcomatoid Renal Cell Dr Huang Dachuan Jun-2014 Carcinoma-Roles of Epithelial Mesenchymal Transition and Cancer Stem Cell in the Progression and Metastasis BIM genotypes in patients with lupus nephritis : Prof Fong Kok Yong Jun-2014 associations with lupus pathogenesis and treatment response The clinical and psychosocial impact of living Dr Terence Kee Jun-2014 kidney donation Thermo-responsive magnetic nanoparticles for Dr Lee Chee Wee Jun-2014 combined modalities of kidney cancer ISN/RPS Classification of Lupus Nephritis- Dr Howe Hwee Siew Jun-2014 Clinical and Outcome Correlations in a Singapore cohort 48 ducating the Community Raising Funds through Community Support Encouraging Volunteerism Community Outreach º Encouraging Volunteerism º Raising Funds through Community Support º Educating the Community
Encouraging Volunteerism Community Outreach NKF Circle of Hearts Engaging Volunteers to Help Patients Since its launch in June 2007, the number of volunteers at NKF has grown to over 600 individuals. New organisations and groups have also come forward to do voluntary work at NKF during the financial year. They include Kiwanis, Alpha Phi Omega group, 618Aliens With Care, Pinnacle Outsourcing Services, Chapel of Resurrection, Baker Tilly Consultancy, Oneº 15 Marina, Civic Ambulance Services, Dunman Secondary School, Raffles Institution and Paya Lebar Methodist Girls School (Secondary). This brings the number of organisations and groups in the programme to 22. NKF s volunteer programme, Circle of Hearts, seeks to inspire kidney patients to rise above their adversities so that they can lead a reasonable quality of life. NKF volunteers provide friendship, care and emotional support to its patients. By including various volunteering activities as part of the patients healing process, NKF hopes to help them cope better with their long-term illness. Befrienders Programme Providing Friendship and Hope Volunteers befriend patients by providing a listening ear and friendship to patients during their long hours of dialysis at the dialysis centres. Activities include bringing patients for outings, celebrating special occasions and engaging with patients through different activities like Bingo games and musical performances. Enrichment Programme Imparting New Skills This programme, conducted by volunteers, continues to help patients acquire new skills and pass their time more meaningfully. Cooking and art & craft sessions were organised by volunteers at various NKF dialysis centres to benefit patients. Many of NKF patients have children who need the necessary tuition to cope with their studies. However, these needy patients find it financially challenging to pay for their children s tuition fees. Started in 2009, tuition agency SmartLab volunteered its services by providing 10 students from the levels of primary four to secondary with free tuition. With this support, our patients can focus on their rehabilitation and lead productive lives knowing that their children s academic needs are also taken care of. Volunteers also provided free haircuts to our patients, benefiting many needy patients since this service started in April 2010. Volunteers also continued to transport patients to or from the dialysis centres and their homes as well as for hospital visits. To help meet patients social needs, student volunteers played music, sang and performed magic acts at the various dialysis centres. These students volunteer as part of their school s Service Learning programme in which they not only serve the community, but also learn to identify the needs of the community and to reflect on their own experiences in working with the community so that they have a better understanding and appreciation of what it involves. Student volunteers also interacted with NKF patients through craft sessions providing fun and bonding time. 50 51
Encouraging Volunteerism Helping Out at NKF Events Commemorating International Volunteer Day Over 150 volunteers helped out at these various events: NKF s Patients Active Day events at the Singapore Chinese Garden, East Coast Park and at Marina Barrage. NKF s fund-raising event at the Filipino Association Singapore Anniversary on 29 August 2010 Ministerial Community Visit @ Marsiling (community awareness) on 26 September 2010 The 5th of December every year has been designated as International Volunteer Day (IVD) by the United Nations since 1985. Its aim is to thank volunteers for their efforts and increase public awareness on their contributions to society. NKF s Volunteer Management team met up with their volunteers in groups at the dialysis centres. The volunteers made food hampers and presented them to patients. The volunteers were all given certificates of appreciation for their continuous commitment to NKF s cause and the corporate volunteers were presented with plaques for their organisations commitment and support. Feedback from the volunteers were also gathered to continuously help improve NKF s volunteer programme. Community Outreach Ngee Ann Polytechnic Outreach (community awareness) on 8 October 2010 NKF s Kidney Health Week at Bishan Junction 8 from 5 to 11 July 2010. NKF Charity Dinner at Orchid Country Club on 15 April 2011 Garage sale by a donor on 26 March 2011 Fundraising event at Sheng Hong Temple Mid Autumn Festival on 18 September 2010 & Vesak Day on 17 May 2011 NKF Year-end Parties at all 24 dialysis centres Providing Training for our Volunteers The following recipients of Outstanding Service Awards for 2010 were: Individuals: 1. Vandana Bhounsle Business Executive 2. Chan Choo Keng Auditor 3. Tiruchelvam S A Durai Activity Marketing 4. Fong Kok Liang Businessman 5. Hanidah Homemaker Organisations: 1. Aljunied-Hougang CCC 6. Low Siam Luan Homemaker (2nd consecutive year) 7. Tan Jui Ming Purchasing Officer (3rd consecutive year) 8. Jackson Toh Businessman (2nd consecutive year) 9. Agnes Arini Wirawan Assistant Restaurant Manager Chairman of NKF Volunteer Committee, Mr Yatiman Yusof presented the plaques to the following organisations for their efforts in making a difference in the lives of NKF patients: NKF continued to provide and equip its volunteers with professional training. It continued to collaborate with UniSIM to organise training sessions for its volunteers. 30 hours of training sessions on How to be a Better Helper and Volunteers Who Wish to Become Paracounsellors using the Egan s Model were conducted, benefiting 53 volunteers. 2. B Braun Singapore Pte Ltd 3. Bedok Methodist Church 4. Boscombe Life Church 5. Changi Simei A.C.E. Alumni 6. Church of Our Saviour 7. Civic Ambulance Services 8. Paya Lebar Methodist Girls School (Secondary) 9. School of Human Development and Social Services, SIM University 10. Singapore Buddhist Youth Mission 11. Sultan Mosque 12. SmartLab Educational Centre 13. Youth Men s Christian Association (YMCA) [ ] If you would like to volunteer in NKF s Circle of Hearts programme, please call 6299 0200 or email us at VMTeam@nkfs.org 52 53
Raising Funds through Community Support Donors Rally to Contribute to NKF Charity Dinner Community Outreach Receiving strong support from various individuals and organisations, the inaugural NKF Charity Dinner raised $1 million in aid of needy kidney patients. This no frills event, held at the Orchid Country Club on 15 April 2011, was graced by former President and Mrs S R Nathan. The funds were raised through the sale of 100 tables, outright donations and the auction of Mr Nathan s calligraphy piece and personal brush set during the event. This is by far the clearest indication that NKF s continuous efforts to be cost-efficient in operations, as well as be transparent and accountable to its donors and the public, have borne fruit. This is the first time that the new NKF had organised a major fundraising event. Mr Nathan showed his support by writing a Chinese calligraphy piece on stage during the charity dinner. He wrote the words, which means Benevolence, to symbolise the love, compassion, charity and humanity that donors, volunteers and supporters have shown to kidney patients over the years. The calligraphy piece was auctioned together with Mr Nathan s personal brush set, which he has been using for calligraphy writing. This is the first time Mr Nathan had offered his personal brush set, together with his calligraphy, to be auctioned for charity. Five Chinese temples Loyang Tua Pek Kong, Singapore Buddhist Lodge, Lorong Koo Chye Sheng Hong Temple Association, Amitabha Buddhist Society (Singapore) and Thong Teck Sian Tong Lian Sin Sia joined hands to successfully bid $110,000 for Mr Nathan s calligraphy piece and personal brush set. The five temples then topped up the donations received through this event with another $80,000 to achieve $1 million. As a further act of compassion, they donated these precious items back to NKF. NKF presented Mr Nathan with a picture called The Tree of Hope, which symbolises the love and support of the community for kidney patients. The tree trunk is in the shape of two hands supporting 24 heart-shaped thumbprints of patients, which represent NKF s 24 dialysis centres. Besides donations, other organisations offered their services. The WuDang Sheng Hong Health Preservation Centre staged a Tai Chi performance, while Paya Lebar Methodist Girls School (Secondary) put up a collection of cultural performances. 54 55
Educating the Community Community Outreach The establishment of the Kidney Discovery Centre was made possible by the generous donations of the following organisations and individuals: Kwan Im Thong Hood Cho Temple Singapore Buddhist Lodge Thong Teck Sian Tong Lian Sin Sia The Late Mr Hunter Caldwell Amitabha Buddhist Society (Singapore) Lee Foundation The Late Mr Teoh Hai Swee Mr Tang Peng Koon Amundi Singapore Limited Ms Loy Sook Heng Loyang Tua Pek Kong Learning Journey at the Kidney Discovery Centre NKF believes that early education of the functions of the kidneys, kidney diseases, and the treatment of renal failure should be in place for young Singaporeans, so that the myths and mysteries of these conditions can be clarified at a young age. The Kidney Discovery Centre (KDC) was established to address these concerns by taking school children between 10 and 16 years of age on a learning journey to appreciate the kidneys, kidney diseases and their treatments through guided visits. Housed at level 2 of the NKF Centre, the KDC also caters to adults to create awareness on the early detection and prevention of kidney diseases. Since the KDC started operations on 18 January 2011 till the end of the financial year, over 2,000 upper primary, secondary and tertiary students and teachers, as well as 61 oganisations have visited the centre. During the learning journey, students were taken around the centre which showcases exciting and hands-on exhibits that offer both fun and facts. It has 4 main sections with interactive displays Human Body & Function of Kidneys; Kidney Failure & Prevention of Kidney Diseases; Future Development of Treatment of Kidney Diseases; and History of Dialysis in Singapore (NKF Milestones). Students learnt about the kidneys; the plight of kidney patients; their physical and dietary constraints; and the emotional traumas they have to face in coping with kidney failure. Through this experiential learning programme, students learnt to value their health and how to lead a healthy lifestyle. They can also relay their knowledge to their family members in taking care of their health. At the end of the learning journey, students participated in quizzes to test their knowledge on what they have learnt. Providing Health Screening and Education to the Community NKF continued providing health screening services to companies at their premises. For a minimal charge, employees of companies have the convenience and flexibility of having their health checked without disrupting their work. There were 12 companies which engaged our health screening services and a total of 1,535 people were screened. Another 1,510 people were screened during NKF s Kidney Health Week from 5 to 11 July 2010 at Bishan Junction 8 Atrium. NKF also provided public education services such as health talks to raise the community s awareness on renal disease. One of its key strategies was opening the doors of NKF s dialysis centres in the heartlands for the community to experience first-hand the plight of a kidney patient, as well as providing free health screening to the public. 56 57
Educating the Community Community Outreach Creating Greater Awareness on Kidney Disease Prevention Early detection is always the key to better treatment results, as well as reducing the growing number of kidney diseases, both globally and in Singapore. One of the solutions in tackling this problem is to educate the public, as well as the primary care clinical staff on the causes and prevention of renal diseases. This would include the primary care physicians, nurses and the general public. Thus, the NKF co-organises symposiums on kidney diseases and their management, so that healthcare providers can detect and better manage the condition of their patients. As part of World Kidney Day 2011, NKF, Singapore Society of Nephrology and Singapore Nurses Association co-organised a symposium with the theme, Protect Your Kidneys, Save Your Heart. The National Kidney Foundation 58 Held on 13 March 2011 at the NKF Centre, the symposium, specially for non-renal nurses, covered topics on kidney diseases and how they can lead to heart disease. A total of 234 nurses from the Restructured Hospitals and other healthcare institutions attended the symposium. Annual Report 2010/11 Continuously Enhancing T Systems to Improve Productivity Finance and Administration º Continuously Enhancing IT Systems to Improve Productivity
Finance and Administration Continuously Enhancing IT Systems to Improve Productivity With the completion of the implementation of NKF s IT Master Plan, the current year s strategy was focused on improving NKF s internal processes. The Clinical System was enhanced to enable nurses to record patients attendance at dialysis sessions and identify reasons for absenteeism. This facilitated accurate patient billing. In addition, with the analysis of absenteeism, clinical staff are better able to manage patients. In Operations, two new systems were developed to improve service levels to the dialysis centres (DCs), as well as improve the department productivity and effectiveness. The first project was the automation of the service management of NKF medical equipment for the Bio-medical Engineering (BME) Department. The engineers of this department are responsible for the maintenance of medical equipment at NKF s 24 DCs throughout Singapore. This system provides the engineers with email alerts for ad-hoc service requests, as well as prompts them ahead of time when the machines are due for preventive maintenance. In addition, the maintenance history is tracked and all replacement parts of every machine are accounted for. This process automation has increased the productivity and service level of our engineers, as well as keeping our machines in good running order for a longer period of time. The second project was the automation of request for logistics support. The new system enables the logistics staff to better manage and optimise the usage of the fleet of 5 vehicles, as well as the pool of 7 drivers. Presently, the department handles an average of 300 requests per month for services like daily delivery of supplies to DCs, transportation of patients to HQ for exercise classes and ad-hoc transportation for staff attending external meetings. NKF continues to review and upgrade its systems in its efforts to enhance its productivity in this tight labour market and contain our operating costs. trengthening Operational Efficiency Operations º Strengthening Operational Efficiency 60
Operations Strengthening Operational Efficiency Established a New Dialysis Centre in Ghim Moh To make way for the Housing and Development Board s en bloc redevelopment plans for 2011 in Bukit Merah, the Singapore Contractors Association Limited (SCAL)-NKF Dialysis Centre at Blk 96 Henderson Road has ceased operations. Patients at the centre have moved to a new dialysis centre at Blk 1 Ghim Moh Road on 4 July 2011. The new centre, named the Woh Hup-NKF Dialysis Centre, is the first dialysis centre where the main contractor, Woh Hup (Private) Limited, and its subcontractors, built the centre and fully sponsored the construction costs valued at $625,900. Work on the centre began in November 2010 and it started operations in July 2011. This new centre has 20 dialysis stations compared to 14 stations at Bukit Merah. Thus, it will be able to accommodate 120 dialysis patients on three shifts i.e. morning, afternoon and evening, compared to 84 dialysis patients at Bukit Merah, an increase of 36 in terms of patient capacity. New Dialysis Centre in the Pipeline at Tampines Thanks to a legacy gift of $4.75 million from the late Madam Wong Sui Ha Edna, the NKF will be setting up a new dialysis centre at Blk 271 Tampines Street 21. Planning and construction of the Wong Sui Ha Edna-NKF Dialysis Centre is underway and is expected to be operational in May 2012. The cost to build and equip the centre is estimated at $2 million. This is NKF s second dialysis centre in Tampines to meet the increasing demand for dialysis places by kidney patients living or working in the Tampines and surrounding neighbourhoods. The centre will be equipped with 22 dialysis stations, which can benefit 132 kidney patients. The Need to Upgrade and Replace our Equipment and Facilities at our Centres As the medical equipment and instruments have a limited lifespan, NKF needs to constantly upgrade and replace equipment at its 24 dialysis centres. For example, NKF s haemodialysis machines are considered for replacement when they reach 30,000 hours or 8 years of service, whichever comes first. In the financial period ended 30 June 2011, NKF incurred $1.60 million in the upgrading and replacement of equipment. The maintenance, refurbishment and upgrading of dialysis centres is an on-going process. 54 New Dialysis Machines Thanks to Caring Donors During the financial year, 19 supporters donated 54 new dialysis machines. One machine can benefit 6 patients. Therefore, 54 machines can benefit a total of 324 patients. NKF carried out plate-mounting ceremonies at the various dialysis centres to recognise dialysis machine donors. Ensuring Operational Readiness to Deal with a Crisis As part of NKF s Business Continuity Planning/ Management, we conducted a table-top exercise on 14 January 2011. The scenario of massive food poisoning causing major shortage of nursing manpower was played out. Call Tree Exercises involving every staff in NKF were also conducted on 6 December 2010 and 14 January 2011 to ensure that staff were familiar with the Call Tree procedures and that everyone would be contactable in times of crisis. nhancing Organisational Capabilities Human Resource º Enhancing Organisational Capabilities 62
Enhancing Organisational Capabilities Human Resource Continuing to Improve Operational Effectiveness and Efficiency NKF continued to fine-tune its organisational structure, focusing on its mission of providing quality dialysis services, as well as health awareness of kidneys and related diseases. It continued to provide training opportunities as well as education and engagement programmes for staff, ensuring a conducive and progressive work environment. As at 30 June 2011, the total number of employees in NKF was 671, of which 561 were in the clinical departments. Nurturing a Continuous Learning Habit Among Nurses Continuous learning to ensure nurses keep up with latest findings, best practices and enhance their development skills were actively encouraged via the provision of varied forms of training opportunities and the incorporation of training hours into individuals key performance index. Monthly journal sessions, diabetes mellitus workshops, infection control and quality conventions, in-service trainings in the dialysis centres, hands-on demonstration sessions and communication skills trainings are some of the regular trainings provided. Comprehensive in-house trainings on Introduction to Renal Dialysis for newly recruited nurses and Advanced Learning in Renal Dialysis for experienced nurses (to upgrade their nursing knowledge in renal nursing) are actively conducted. Annually, suitable candidates are given the opportunity for higher academic achievement; to pursue the full-time 8 months course of Advanced Diploma in Nephro-urology by Nanyang Polytechnic. Five registered nurses successfully completed the Advanced Diploma in Nephro-Urology in June 2011. NKF provides 40 hours of training for each employee per financial year. Providing Continuous Education Programmes for Staff The Human Resource Division provided continuous education programmes for its employees in the following areas: Encouraged career development of employees through sponsorship programmes (Master, Degree, Advanced Diploma and Diploma) Imparted leadership, coaching & mentoring skills for newly appointed and potential managers through Grow Leaders & Establish Organisational Relationship workshops Incorporated one to three months on-the-job training for new nursing employees for assessment of competency level Improved the communication skills of our foreign nursing employees through Conversational English programmes Improved the management of patients by organising Mastering Difficult Patient Interactions, Mastering Shared Decision Making and Communicating with Elderly workshops Gained better understanding of cultural differences in the diversified workforce through WSQ:Communication Relationship Management programmes Enhanced IT knowledge of employees through IT training with the enchancement of software upgrading 64 65
Enhancing Organisational Capabilities Financial Statements Human Resource Increasing Employee Engagement through 5Cs (Commitment, Communication, Compassion, Collaboration and Consistency) NKF continued its efforts in employee engagement through 5Cs to: Internalise desired behaviours; Promote and demonstrate the right beliefs and attitudes; Deliver quality care through quality service skills and behaviours; Improve the interaction with patients and customers In 2009, the Pass it On campaign was launched where employees wrote words of encouragement to fellow colleagues who demonstrated the qualities of the 5Cs and placed them on the Pass it On boards. To enhance this, the Pass it Online board was launched on the intranet in January 2011. To continue encouraging employees to give feedback via the Employee Suggestion Scheme launched in December 2009, a winner will be awarded the Best Suggestion of the Year award. The Super Dialysis Centre (DC) and Best Zone awards were launched in June 2011 to reward and recognise the collaborated efforts of our nursing employees in the dialysis centres and zone with the best teamwork, operational efficiency and productivity. Fine-tuning the Balanced Scorecard to Help Achieve NKF s Goals As part of NKF s continuing efforts to develop a culture of discipline, accountability and performance management to achieve its vision and mission, a one-day retreat on 27 August 2010 and 2 strategic learning sessions were conducted on 21 January 2011 and 6 May 2011. In line with NKF plans, new initiatives were incorporated into the corporate strategy after 10 follow-up review sessions. In view of these changes, Department Scorecards were also reviewed to align them to the Corporate Scorecard. The Balanced Scorecard software was successfully implemented in which every department started entering their data with effect from March 2011. xecutive Summary º Executive Summary 66
OVERVIEW OF FINANCIAL RESULTS FOR THE YEAR ENDED 30 JUNE 2011 FY 2010/11 FY 2009/10 Variance S$ 000 S$ 000 S$ 000 Dialysis and Prevention Services Income 26,651 26,340 311 Expenses (48,804) (43,523) (5,281) Results (22,153) (17,183) (4,970) Donations and Grants for Operations Income 26,829 24,369 2,460 Expenses (1,567) (1,339) (228) Results 25,262 23,030 2,232 Jun-11 Jun-10 Increase % Increase Haemodialysis Patients 2,398 2,330 68 3% Beneficiaries Peritoneal Dialysis 284 261 23 9% Portable Funding 119 105 14 13% Children Dialysis 18 20-2 -10% Kidney Live Donor 13 6 7 117% Total Patients and Beneficiaries 2,832 2,722 110 4% Administrative Costs Expenses (6,896) (6,880) (16) Rental Income 944 984 (40) Sundry Income 161 245 (84) Surplus / (Deficit) from Operations (2,682) 196 (2,878) Investment Income 5,909 6,506 (597) Overall financial performance for FY 10/11 resulted in a net surplus of $5.7m (transferred to reserves), made up of a deficit of $2.7m from operations which was more than offset by investment income of $5.0m and non recurring donations for capital items of $3.3m. Deficit from Operations Expenses (896) (855) (41) Results 5,013 5,651 (638) Surplus from Operations and Investment 2,331 5,847 (3,516) Donations for Capital Items Income 3,337 826 2,511 Total Transferred to Reserves 5,668 6,673 (1,005) Current deficit of $2.7m was $2.9m lower than the previous year which had a surplus of $0.2m despite net donations being higher by $2.2m (from last year $23m to current year $25.2m). This was attributed to significantly higher dialysis expenses which increased $5.3m from $43.5m to $48.8m resulting from higher number of dialysis patients and beneficiaries. Main areas of increase in expenses are as follows: o higher clinical manpower costs $2.9m and treatment costs $0.6m which were driven up by net increase of 68 haemodialysis patients and higher level of patient care. o increase in haemodialysis patient welfare programmes $0.2m. o increase in subsidies $1.2m associated with net increase of 42 beneficiaries. Administrative costs of $6.9m were essentially the same as last year. Investment Income The investment mandates with two fund managers which expired in September and December 2010 grew by $8m during the three-year tenure. The impact on current year was $3.4m, together with the growth of $0.8m in the new mandates which commenced in January 2011 and $0.8m from in-house investment, total net investment income for the period was $5m. Overall net income from investment declined by $0.6m compared with previous financial year, reflecting the impact of a weaker economy coupled with growing concern over inflation, US and Europe debt situations, Middle East crisis and fallout from natural disasters in Japan. Donations (Capital items) Non recurring donations towards purchase of capital assets of $3.3m were up $2.5m versus last year. The increase was mainly due to a legacy donation of $2m for the building of a new dialysis centre in Tampines and $0.5m for the replacement of dialysis machines at various dialysis centres. Surplus / Deficit for the year The overall surplus for the year amounted to $5.7m compared to $6.7m for the last financial year. 68 69
Annual Report 2010/11 81 Kim Keat Road, Singapore 328836 Tel: 6299 0200 Fax: 6299 3164 Email: contact_us@nkfs.org www.nkfs.org UEN: 200104750M