MCI (P) 016/05/2017 FY2017 Q3 Medical social worker (MSW) Leong Si Jie (right) at the garden of St Luke s Hospital. MSWs like her help patients and caregivers cope with financial, psychosocial and emotional issues. Caring for the whole person St Luke s Hospital cares for the whole person and seeks to enhance the physical, psychological, social and spiritual aspects of patients well-being. This is all the more important when patients have complex, multiple needs. This article, the second of a series of three articles, looks at the social aspect of holistic care. A stroke survivor, Mr Tan (not his real name) was warded in St Luke s Hospital, and occupational therapist Tiffany Tam assessed his home to be unsafe. There was nowhere to sit in the living room except the floor. Piles of items were placed on chairs, tables and on the floor too. The door to Mr Tan s bedroom couldn t even be fully closed because of the clutter. For Mr Tan s safety, medical social worker Leong Si Jie arranged for volunteers to clear some clutter and convert another room into his bedroom for his safety and to create a healthy living environment. With new challenges brought on by his stroke, Mr Tan had difficulties getting his meals and travelling out of his home for medical appointments. Si Jie arranged for meal delivery and medical escort services, so he could cope well at home after his discharge from the hospital. Caring for the whole person, or holistic care, involves a multi-disciplinary team of doctors, nurses, therapists, medical social workers, other allied health professionals and pastoral care staff working together to journey alongside patients in the recovery process. The care is extended to families through education and counselling, as illnesses not only affect patients but also their loved ones. Vision Transforming community care www.slh.org.sg Mission A Christian healthcare provider enriching lives in the communities fb.com/slhsg St Luke s Hospital 2 Bukit Batok Street 11, Singapore 659674 giving.sg/slh
Integrated care to improve health outcomes DEMENTIA AW Dementia, a disease that affects the brain, is expected to affect 55,000 patients in Singapore by the year 2020. People with dementia may have poor memory, difficulties in communicating and exhibit changes in personality, leading to stress. To raise awareness about dementia and funds, St Luke s Hospital organised a charity film premiere on 14 November with the Singapore St Luke s Hospital team led by A/Prof Tan Boon Yeow, CEO (left), presented two integrated care paths at the International Conference on Integrated Care. When patients have multiple medical conditions and go through different care providers, there is a risk of fragmented healthcare. To improve health outcomes, St Luke s Hospital started two integrated care paths which were also chosen to be presented at this year s 17th International Conference on Integrated Care, Dublin. The conference was attended by more than 1,000 delegates from over 50 different countries. Hip fracture reduces functional independence and increases the need for caregiving. In 2016, a multi-disciplinary team of orthopaedic and geriatric doctors, therapists, nurses and care coordinators from both National University Hospital and St Luke s Hospital implemented an integrated care path. A review of 34 patients showed that these patients had good functional recovery and there was reduction of caregiver stress. Dementia Care Project (DCP) aims to help persons with dementia remain in community and to support their caregivers. In 2013, a mobile multi-disciplinary team (doctors, nurses, medical social workers, physiotherapists, occupational therapists, care coordinators and pastoral care staff) was formed to care for patients with dementia, with funding support from Ministry of Health. From its implementation to March 2017, DCP consistently achieved high caregiver satisfaction rate. LOW AWARENE A national health survey in 2010 found that many people with diabetes and high cholesterol levels were unaware of their conditions. Screening plays an important role in detecting disease so that appropriate care can be given early to lower the risk of ill health. To grow awareness and early detection, St Luke s Hospital works
ARENESS : BEFORE WE FORGET Film Society. In the film Before We Forget, Hong Kong s renowned action star Ti Lung plays a grandfather who, together with his family, grapples with the challenges of dementia. Many in the audience were moved to tears by the heartwarming film, which shows how family love plays a crucial role in helping people cope with dementia. Just like in reel life, people in real life need more than just medical care; they also need psychosocial, emotional and spiritual care. St Luke's Hospital has a specially-designed dementia ward with a multi-disciplinary team of doctors, nurses, therapists and other allied health professionals to journey alongside persons with dementia and their caregivers. The dementia ward has a range of activities including a personalised "lifebook to capture memorable life events and rehabilitation progress. SS, HIGH RISK with different partners to provide a wide range of services and coordinated care for the community. In one such programme, Project SilverCare, over 300 residents were screened for diabetes, blood pressure, cholesterol level, frailty and other conditions. For the third year running, Project SilverCare, on 27 August, was jointly organised by medical, nursing and pharmacy students from National University of Singapore, in partnership with St Luke s Hospital and National University Health System. Project SilverCare 2017 helped assess the health of Bukit Batok residents. St Luke s Hospital works with different community partners to carry out health screening and detect disease early.
REDUCING MULTIPLE APPOINTMENTS St Luke s Hospital, together with NUHS and Frontier Family Medicine Clinic, receiving their medal from Gan Kim Yong, Minister for Health (second from left), for the PAC programme. When patients have multiple medical appointments due to complex medical conditions, patient care may become fragmented, with suboptimal health outcomes. To deliver more person-centric and seamless care to patients with multiple chronic diseases, St Luke's Hospital and the National University Health System (NUHS) pioneered its Patient Appointment Consolidation (PAC) programme in 2014. This programme consolidates medical appointments with fewer doctor follow-ups, improving coordination of care. Patients receive greater continuity of care and convenience, with reduced time and cost from attending appointments. This benefits their caregivers too. The PAC programme was subsequently also rolled out at the Frontier Family Medicine Clinic. For their achievements in the PAC programme, St Luke s Hospital, together with NUHS and Frontier Family Medicine Clinic won the overall Excellence Champion Medal, which is one of the National Healthcare Innovation & Productivity (HIP) Medals.
PATIENT- CENTRED CARE AT HOME Home care, as the name suggests, enables patients to be cared for at home. Instead of patients going to hospital, a multi-disciplinary team of people from the hospital care for patients at home. To enhance home care services, St Luke s Hospital s Home Care Team visited healthcare providers in Japan to learn from their care delivery. Patient-centred care is important to the team, who was able to observe how Japanese home care providers delivered care centred on respecting patients rights and quality of life, upholding patients dignity and assisting with their last wishes. For example, services by different providers are wrapped around the patient, who may be attended to by a doctor, nurse, dentist, pharmacist, case manager and home helper round the clock at home. PROVIDING CLINICAL CARE AND MORE Dr Grace Chiang is pursuing a Master of Public Health at Johns Hopkins University and hopes to formulate innovative solutions to empower seniors to age in place. Dr Grace Chiang is passionate about caring for seniors. The experience of working with patients and the nurturing environment in St Luke s Hospital s spurred her to go beyond providing clinical care as a doctor. She is pursuing a Master of Public Health at Johns Hopkins University and hopes to conduct further research in ageing and frailty, formulate policies and innovative solutions to empower seniors to age in place. Dr Chiang is a recipient of the Agency for Integrated Care s Community Care Manpower Development Award, which recognises healthcare workers who have made a difference to those under their care and supports them in their further training. In addition, Dr Chiang was awarded with two scholarships: VOICES 2017, Asian & Pacific Islander American Health Forum (APLAHF) and Johns Hopkins University Scholarship Support for National Board of Public Health Examiners, Certification in Public Health. St Luke's Hospital (SLH) is a Serving, Loving and Healing organisation not just for patients but staff too. The hospital looks after staff (eg through training and development) and in turn they look after patients better. When patients lives are enriched, communities are transformed. St Luke s Hospital provides home care including home medical, home nursing and home therapy, with services such as chronic disease management, wound care, changing of tubes and catheters, and physiotherapy, occupational and speech therapy. The study trip was sponsored by the Agency for Integrated Care. St Luke s Hospital s Home Care Team visited healthcare providers in Japan to learn how best practices overseas may be applied to transform community care in Singapore.
ON THE ROAD TO RECOVERY AND BEYOND Shak Keng Choong was a building facilities manager when his world turned upside down earlier this year. His father found him immobile in the living room. Shak was rushed to an acute hospital for head surgery. Simple activities he had taken for granted, he could no longer do. I forgot how to use a pen. How to use a fork and spoon. How to use my hands, Shak said. He was transferred to St Luke s Hospital for rehabilitation, involving physiotherapy, occupational therapy and speech therapy. His determination to get better saw him able to go to the toilet on his own after one week. His memory improved. After three months, he could walk unaided. He still returns to St Luke s Hospital for outpatient therapy. With his parents by his side and the St Luke s Hospital team, Shak looks forward to the day when he can complete his university studies. Shak Keng Choong (right) overcame the odds and continues to attend outpatient therapy at St Luke s Hospital. Season s greetings! Christmas is a time of giving and receiving. To give to St Luke s Hospital and our patients, visit giving.sg/slh Happy holidays and a blessed 2018 Created by Valeria_aksakova - Freepik.com