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Alexandra Hospital

Design Business Case Study

The Alexandra Hospital

Alexandra Hospital
Design Business Case Study
August 2009



Experience Design in the Healthcare Industry ....................................... 2


The Alexandra Hospital Story .................................................................. 3


Enhancing Patients Experience @ AH ................................................... 5


Designing the Healthcare Industry of Tomorrow ................................. 11

Alexandra Hospital
Design Business Case Study
August 2009

Alexandra Hospital - Case Study Report


Experience Design in the Healthcare Industry

Most people will typically associate the term design with its conventional
definition where the physical appearance and attributes (including how it will be
made) of a product or building are developed. However, not many will directly
relate design to more abstract products such as experience. Specifically,
experience design is the creation and delivery of experiences that are original,
unique, memorable and transformative, using spaces, objects, people and
channels as tools.1 It is driven by consideration of the moments of engagement,
or touchpoints, between people and brands, and the ideas, emotions, and
memories that these moments create.

Here, in Singapore, Alexandra Hospital (AH) is a good example of an

organisation which has successfully leveraged on experience design to
transform itself. Through a series of ongoing pilot projects, AH is ramping up
towards a reinvention scheduled to coincide with its move to Yishun Khoo
Teck Puat Hospital. Through these new initiatives, the hospitals patients have
benefited in many areas including shorter waiting time, access to better
information, and savings on medical bills. Similarly, with the implementation of
various information management systems, the staff members at AH are now
able to serve its patients more effectively and efficiently.

Source: Centre for Experience Design at the Singapore Polytechnic,

Alexandra Hospital
Design Business Case Study
August 2009

According to Liak Teng Lit, Chief Executive Officer of the hospital, their
intentions were not simply automating existing operations, but to redesign those
conventional and mundane tasks that collectively comprise hospital services,
facilities maintenance, and administration. The effort and resources expensed in
redesigning the patients experience prove to be worthwhile as apparent in the
results of the latest Patient Satisfaction Survey released by the Ministry of
Health (MOH) in 2008. Through this survey, it is evident that AH continues to
remain as the hospital with the highest level of overall patient satisfaction
amongst all the restructured hospitals in Singapore. In fact, the hospital has
attained this excellent achievement for the past five consecutive years.

The Dedicated Healthcare Industry


The Alexandra Hospital Story

AH was officially opened in September 1971. In its early years, it was one of the
top hospitals in Singapore, with about 15% share of all public hospital
admissions in 1980. However, sustaining this level of patient volume soon

Alexandra Hospital
Design Business Case Study
August 2009

became a challenge for AH, partly due to the emergence of full-service

hospitals which became more popular with patients over time. Consequently,
the number of patients admitted to AH dip to less than 5% of all public hospital
admissions in 2000. As the conditions of the hospital continued to deteriorate,
the need to overhaul the entire hospital soon became imperative.

One of the first steps taken by AH early in its transformation exercise was to
understand what matters most to its patients. Specifically, the AH team
conducted focus group discussions with various stakeholders, particularly its
patients, to better understand their expectations from a hospital. Findings from
the various focus groups showed that a good hospital should deliver the

Respect patients dignity;

Provide clear and accessible information;

Facilitate access to integrated care and services;

Deliver consistent, good quality care and services; and

Provide cost effective care.

Alexandra Hospital
Design Business Case Study
August 2009

Using these findings as key guiding principles, the hospital then embarked on
its journey to re-design the different functions and operations of the hospital. In
supporting this process, AH has also incorporated the use of relevant
management tools and philosophy, and adapting from best practices various


Enhancing Patients Experience @ AH

The dental clinic at AH used to receive complaints from callers who dialled to
make appointments. They were annoyed that the line was frequently engaged
and when they finally got through, they were directed to leave a voice message
to a mailbox which was usually full. This is one of the classic examples
commonly found in the healthcare facilities due to high patient volume and the
lack in process efficiency. At such instances, patients become frustrated with
the services offered and frown upon a second visit.

In ensuring the continuity of their business, AH embarked on its plan to enhance

its patients experience a core factor to retain and attract existing and new
patients to their hospital. One of the key considerations in the design process
was to first begin with the needs of a patient in mind. Particularly, the design
plans had to ensure that the structure of the entire hospital was intuitive and
patient-friendly. It was critical for everything to be done right for the patient from
the time he entered, till he left the hospital. He should receive healthcare safely

Alexandra Hospital
Design Business Case Study
August 2009

and in a timely manner.

From appointment bookings and registration, to

inpatient care and pharmacy, systems and processes must be developed with a
holistic and integrated approach so that there is minimal inconvenience to the
patient. In other words, the designing of the hospital system was unlikely to
succeed if each of these systems and processes were developed independently.

In executing the various systems and processes, AH chose to benchmark its

practices from the best-in-class. They adapted appropriate management tools
and philosophies such as the Toyota Production System (TPS) and Six Sigma
to help improve the hospitals workflow and efficiency. This was further
complemented by various initiatives and schemes to wow their patients at
various touchpoints during their visit to AH. To this end, Mr. Liak Teng Lit, CEO
of AH, emphasised the importance of learning from everyone, including those
from beyond the industry. AH studied and adapted from various highperformance processes and systems used by world-class organisations. Other
than healthcare institutions, AH also learned from leading organisations in
various industries including hospitality, airlines, finance, and manufacturing.
While Mr. Liak stressed that it was important to learn from everyone, he also
cautioned that it was important to recognise that organisations should not only
simply follow the footsteps of others, but to also take into account their own
unique situation, and adapt accordingly.

First begin with the needs of a patient in mind- Mr. Liak Teng Lit

Alexandra Hospital
Design Business Case Study
August 2009

The Design Tools

Toyota Production System (TPS)

TPS, also known as lean management, is a management philosophy which
applies a set of principles to help companies completely eliminate waste (muda),
overburden (mudi) and unevenness (mura) in all areas of the business, so as to
ensure that operations are smooth and efficient.

Unlike the Toyota car manufacturing factory, where automation can be easily
applied, the application of technology to healthcare confronts a large array of
difficulties to quantify and draw links between human task and kiosk-based
information appliances. As such, AH faced a trickier task of redesigning
traditional labour-intensive, hands-on jobs around the new technology to
minimise work time and not staffing levels.

The Toyota Production Line

Alexandra Hospital
Design Business Case Study
August 2009

In this regard, in order to better appreciate how the various principles in the TPS
can be applied, the hospitals senior management visited the Toyota plant and
its workshops in Japan, physically looking at the nuts and bolts of its operations
to learn how they can apply similar principles back in the hospital.

A visit to the Toyota Factory

Following that, AH staff including its senior management conducts regular

walkabouts around the hospital. Through such sessions, they are able to see for
themselves, the various issues and problems in the wards, clinics and other
areas. The hospitals staff members are also encouraged to keep a lookout for
tell-tale signs. For example, if they spot patients waiting and looking impatient
at the pharmacy, they are encouraged to speak to patients or the staff to
ascertain the reasons.

Many improvement projects, regardless small or big, have also been

implemented throughout the hospital. The staff members at AH are always on a
continuous search for better and more innovative ways of handling daily

Alexandra Hospital
Design Business Case Study
August 2009

procedures to achieve maximum quality, improve efficiency and eliminate waste.

The nature of projects varies, ranging from process changes such as the
introduction of trolleys for easy reach by nurses when they are carrying out a
cannulation, to the introduction of systems such as CareLine and A&E Queue
Viewer. Through the implementation of these projects, patients have benefited
from greater convenience and more efficient services as illustrated below.

To elaborate on one of the systems used, CareLine is an all-in-one database

which not only stores electronic medical records, but also facilitates the carecoordination activities within the department. Through the system, staff at the
emergency department can retrieve patients past records instantly, and monitor
their waiting time and treatment progress through real-time updates with the
support of electronic signboards. The improved online facility now also features
the A&E Queue Viewer which shows the average waiting time of patients in the
department and the number of patients waiting to be seen by a doctor. With the
various systems put in place, the patients are now happier and enjoy their visits
more as the waiting time is reduced from an average of 25 minutes to 14
minutes despite having more patients admitted than before.

A&E Queue Viewer

Alexandra Hospital
Design Business Case Study
August 2009

Six Sigma @ AH
In March 2001, AH embarked on the Six Sigma Project with the objective to
provide patient-centred quality healthcare that is accessible and seamless,
comprehensive, appropriate and cost-effective.

The Six Sigma is a business management strategy tool which seeks to improve
the quality of process outputs by identifying and removing the causes of defects
(errors) and variation in business processes. In general, it involves a process
mapping procedure, comprising the following five steps:

Define project goals and the current processes.

Measure key aspects of the current processes and collect relevant data.

Analyse data and determine the relationships between them.

Improve or optimise the processes based on the findings from the data

Control to ensure that any deviations from target are corrected before they
result in defects. Set up control mechanisms to continuously monitor the

Specifically, using the Six Sigma, AH managed to improve its key processes in
terms of boosting efficiency, reducing defects and costs, and enhancing
patients satisfaction. In this regard, project teams were formed to examine the
various areas that require systems improvement, one of which was the patient


Alexandra Hospital
Design Business Case Study
August 2009

turnaround time at the hospitals Specialist Outpatient Clinic (SOC). By applying

the Six Sigma to streamline work processes, the SOC managed to successfully
reduce the turnaround time for patients from an average 3 hours to 90 minutes
at the 95th percentile.

By focusing their efforts to design or re-design their operations, AH has created

a win-win solution for both the hospital and its patients. Specifically, the hospital
is benefiting from more efficient use of its resources, while the patients are
enjoying good quality healthcare at affordable prices. In fact, with the
implementation of the various initiatives, AH is able to offer the lowest average
bill size per patient as compared to the other hospitals.


Designing the Healthcare Industry of Tomorrow

AHs approach brings two interesting and innovative elements into the
conventional implementation mix: a drive to break down tasks and re-engineer
them more efficiently, and a desire to manage for success at the individual level,
with a comprehensive understanding of individual responsibilities and how they
impact on other staff in the healthcare service chain. The experience of AH has
indeed successfully demonstrated how design can be incorporated to benefit
organisations, particularly service providers.


Alexandra Hospital
Design Business Case Study
August 2009

In this regard, for Singapores healthcare industry to stay in the forefront, one of
the key differentiators is for the local healthcare institutions to design and
develop their operations around its patients. The healthcare providers need to
first establish a clear understanding of their customers needs, and to keep an
open mind to learn and unlearn. They also need to constantly adapt from best
practices, and to engage every level of the organisation to seek continuous
improvements to its systems and processes, using technology to enhance their
performances where possible.

In the longer term, the AH team is working towards

achieving the vision of a hassle-free hospital, a
challenge put forth by the Minister for Health, Mr.
Khaw Boon Wan, during his initial announcement of
the relocation of AH to become a regional hospital in
Yishun (to be named Khoo Teck Puat Hospital). In
particular, the AH team is tasked to build a hospital
designed with patients unambiguously at the centre
of the focus, with technology fully exploited for the
benefit and convenience of patients It will be a
hospital which is well linked and to which the
patients can be transferred seamlessly It will be a
hassle-free hospital. Come 2010, with the opening
of the Khoo Teck Puat Hospital, patients can look


Alexandra Hospital
Design Business Case Study
August 2009

forward to a new healthcare institution which is designed with patients at the

centre of focus, with technology and resources fully exploited for the benefit and
convenience of patients.

Building Tomorrows Healthcare Industry