The tripartite partners in the healthcare sector - the Ministry of Health (MOH), the six Public Healthcare Clusters[1] and the NTUC’s Healthcare Cluster of Unions[2] - have come together for the first time to form a dedicated workgroup to further enhance productivity in the sector. The Healthcare Cluster Tripartite Workgroup is chaired by MOH and the National Trades Union Congress (NTUC).
Through training, job redesign initiatives and investment in technology and assistive technologies, it is envisioned that the employability and salaries of lower-wage public healthcare support staff will be enhanced.
Promoting Productivity
In March this year, the Labour Movement regrouped its 61 unions into 12 key industry clusters. This move was aimed at helping workers boost their productivity levels - and ultimately raise wages progressively. The Healthcare Cluster is one of these 12 clusters.
There has been significant progress in raising productivity in the public healthcare sector over the years. Going forward, even more can be achieved by facilitating sharing and diffusion of productivity initiatives and best practices across the healthcare clusters, for improved outcomes on an even wider scale. In this regard, the Workgroup aims to:
i. Coordinate productivity initiatives across the public healthcare sector;
ii. Facilitate sharing and diffusion of best practices and initiatives to raise productivity across the clusters;
iii. Enhance the skills, job value, employability, and salaries of lower-wage public healthcare support staff; and
iv. Oversee publicity efforts for public healthcare productivity initiatives.
In conjunction with the launch of the Workgroup, the clusters showcased various initiatives which have increased productivity through job redesign, workflow improvements, and the use of technology and assistive devices. A brief overview of some of the exhibits can be found at Annex A.
Promoting Sustainable Wage Increases
Pay Increase for Public Healthcare Administrative, Ancillary and Support Staff
Public healthcare administrative, ancillary and support staff partner healthcare professionals in the delivery of healthcare services, and play a key role in driving productivity improvements. It is important for our public healthcare institutions to share part of the productivity gains with the staff who have contributed to deriving them, to sustain employee involvement and good labour relations. At the same time rising demand for public healthcare services means that the work of these staff has become more demanding and complex. To this end, it is important to ensure that the public sector continues to attract, motivate and retain high performing staff.
After a review of healthcare staff salaries by MOH and the healthcare clusters, the 16,000 public healthcare administrative, ancillary and support staff will see an increase of between 4 and 10% in their base pay from this month.
Progressive Wage Model
Besides the salary increase, a Progressive Wage Model has been developed to help lower wage workers attain sustainable wage increases through productivity, training and job redesign initiatives. It involves creating a wage ladder and continuously setting wage milestones up the ladder for workers in different jobs and industries. It is built on top of a base of Workfare schemes, wage recommendations from the National Wages Council, and social transfer programmes.
While all workers earning a monthly salary of up to $1,700 will be included in the initiatives of the Workgroup, the effort will commence with projects relating to three key groups - Health Attendants (HA), Healthcare Assistants (HCA) and Patient Service Associates (PSA) – who collectively make up more than half of those in the target income group. The Tripartite Workgroup aims to help at least 2,000 of these workers move up the wage ladder progressively, such that they can enjoy a base wage increase of between 10 and 20% from 2012 to end 2014. An illustration of the Progressive Wage Model for the healthcare sector can be found in Annex B, with details of the progression pathway for each of the three target groups in Annex C.
[1] The six Public Healthcare Clusters are Alexandra Health, Eastern Health Alliance, Jurong Health Services, National Healthcare Group, National University Hospital and SingHealth Services.
[2] The NTUC’s Healthcare Cluster of Unions comprises the Healthcare Services Employees’ Union (HSEU), the Amalgamated Union of Public Employees (AUPE), the Amalgamated Union of Statutory Board Employees, and the Singapore Manual & Mercantile Workers’ Union.
Annex A
PRODUCTIVITY INITIATIVES IN THE PUBLIC HEALTHCARE CLUSTERS
Improvements in Work Processes
Alexandra Health (Khoo Teck Puat Hospital)
Between 2010 and 2011, KTPH set out to study how it could improve on its linen management system. It had been observed that the presence of many different types of linen, stacked randomly on linen trolleys, and with limited tracking of quantity proved rather frustrating for staff. Additionally, linen could not be placed inside the Assist Bathroom while patients showered, for infection control reasons. Staff hence spent a significant amount of time walking back-and-forth to retrieve linen.
Since the review, items on the linen trolley have been organized and labeled according to type, size, and quantity. A small linen trolley, parked just opposite the Assist Bathroom, has also been introduced. This mobile trolley reduces the number of visits staff need to make to the linen bay. Indeed, since its roll-out, this initiative has resulted in an over 73% decrease in the number of requests for linen top-ups. Besides the improved productivity, this initiative has also contributed to a more satisfied workforce.
As Mr Ang Kim Eng, an Environmental Service Associate with the linen department shared, “The linen trolley has made our work more efficient and reliable. We can now, at one glance, see what is available, quickly restock unavailable items, and easily distribute the linen to the wards. We are also happy that the trolley has reduced the time spent by the nurses in getting linen, and they can focus on caring for patients.”
Eastern Health Alliance (Changi General Hospital)
At Changi General Hospital, soiled trays, crockery and cutlery are sent to the Dietetic & Food Services department for washing using the Automated Guided Vehicle (AGV) system. The system is programmed to pick food trolleys up from the wards at specific times of the day, after each meal. Meal trays left after the scheduled pick-up times have to be sent down by staff. The ad-hoc nature of such returns, however, often resulted in meal trays not being placed properly in the dishwashing area, especially after operating hours. This resulted in the morning shift staff having to spend additional time clearing up the build-up from the night before. On occasion, Halal and non-Halal meal trays were also mixed-up.
CGH has since July 2011 introduced a new tray return bay, which is organised, and with food trolleys clearly labelled for Halal and non-Halal food trays. The washing area is cleaner, and where it used to take an average of 16 minutes to clear the area every morning, it now only takes 4.5 minutes – a 72% reduction in time spent. Staff are able to dedicate these time savings to other tasks. Additionally, since there is no access to the kitchen area after operating hours, the area is also safer. Overall, this simple yet impactful initiative has had a positive impact on staff morale and public perception of the hospital. Assistant Cook Mdm Chong Kim Ley said, “It is so much nicer to come to work in the morning and not to be greeted by the stacks and mess of the crockeries. Its time saving and I feel so relieved!”
Job Redesign/Enlargement
JurongHealth (Alexandra Hospital)
At JurongHealth, concerted effort is made to ensure that mature workers continue to upgrade their skills, and are motivated to handle more complex tasks. Aside from making good business sense, JHS believes that this results in a more motivated and inspired workforce. Sixty-year old healthcare assistant Mr Chua Kian Seng is a case in point. Based on his interest, Mr Chua was identified to attend the National Skills Recognition Skills Programme for Operating Theatre (Non-nursing) in 2005 and Management of Operating Theatre Cleanliness training programmes in 2009. He has completed both courses, and has since seen an enlargement in his portfolio. His additional duties now include assisting surgeons, nurses and anesthesiologists before, during and after surgery, helping to maintain a sterile environment for the patient and surgical team, and managing the equipment in the Operating Theatre and Endoscopy Room. Said Mr Chua, “I enjoy working in Jurong Medical Centre’s Day Surgery Operating Theatre as opportunities are given to me to exercise the skills which I have learnt from the courses that I have attended. The skills learnt also give me the confidence to work alongside the medical teams, and help and guide new colleagues.
National Healthcare Group (Tan Tock Seng Hospital)
In 2008, TTSH embarked on a job redesign project for 32 of its Health Attendants from the Central Sterile Supply Department (CSSD). The initiative, which aims to upskill staff, includes a 10-module in‐house Basic Sterilisation Course. Trainees are required to undergo 36 hours of theory lessons, pass a written test, and complete 74 hours of on-the-job training before they are certified competent. And all that hard work has paid off - the number of rejected complex instrument sets packed by staff has fallen from 94 in 2009 to 35 in 2011. Staff are also trained to use technology such as computers and hand held devices including PDAs to track surgical sets. This contributes to an annual saving of 3,600 hours of nurses' time a year, which is now redirected to focus on clinical matters.
Those who complete the training are also re-designated as CSSD Assistants, and enjoy a pay increment of $80 and a move to a salary range with a higher ceiling. 59-year old Mr Wong Koon Khian, a pioneer graduate of the scheme, shared his views on this initiative: “I learnt a lot from the training, which has provided me with the skills to take on more responsibilities. I’ve been given many opportunities to upgrade myself and I’m happy with my job.”
Improvements in Technology
National University Health System (National University Hospital)
Since 2009, NUH has been processing invoices using AIDC, or Automated Identification and Data Capture Technology. While this may sound complicated, the system has in fact simplified the operational workflow for staff. Where it used to require 6 steps to process each invoice, it now only requires three steps, saving up to $19,000 annually. And staff benefit too. As 62-year old Mr Chua Teck Siang shared: “I can do the work faster now. I am also happy to have learnt more IT skills because of the new system.” And the system looks set for an upgrade, with the enhanced version promising a larger-screen tablet instead of PDA device, real-time transfer of data and enhanced interface capability.
SingHealth (KK Women’s and Children’s Hospital)
In 2011, KKH implemented the Electronic Meal Ordering System (eMOS) to replace its manual system of meal ordering. Under the manual system, patients’ meals were recorded on order forms and entered into a database. However, as with all manual systems, it was subject to inaccurate data entry, illegible words, and missing forms, which resulted in delayed meal service or even wrong meals being served to patients on occasion. Time was then spent identifying the cause of the error, and on service recovery. Processing special meal orders, changes to previously entered meal orders, and orders from newly admitted patients also took up a fair amount of effort and time.
With eMOS, the time spent on taking and collating meal orders has been reduced by 54 man-hours each day, or almost 20,000 man-hours annually! Staff are also trained to handle the eMOS system, and nutrition knowledge and other soft skills are imparted, making for better skilled and confident staff with more positive interaction with patients. "The upgrading of skills, time savings and efficiency brought about by eMOS now allows our staff to better focus on patient care and interaction, and this has enhanced satisfaction among our patients as well as our staff," said Mr Chong Pang Boon, Director, Patient Support Services Division, KK Women's and Children's Hospital.
ANNEX B
ANNEX C
INITIATIVES TO SUPPORT PROGRESSIVE WAGE MODEL FOR KEY TARGET GROUPS
Health Attendants (HA) and Healthcare Assistants (HCA)
The Tripartite Workgroup plans to promote more widespread adoption of assistive devices across the public healthcare clusters to boost productivity, and to enable HAs and HCAs to perform their work more efficiently. With time savings, they will be able to learn and perform higher value-added jobs, enabling them to enjoy a higher salary.
In addition, HAs can also move to become HCAs with skills upgrading and training under WDA’s Healthcare Support WSQ (Workforce Skills Qualification) framework.
HCAs can also look forward to more career progression opportunities. The Tripartite Workgroup is exploring the possibility of alternative entry requirements to existing upgrading pathways, to enable HCAs to take on specialisation, higher positions or even become Enrolled Nurses. Through job enlargement, HCAs will be able to play a bigger role in patient care.
The Public Healthcare Clusters are encouraged to tap on NTUC’s e2i’s Inclusive Growth Programme (IGP) to obtain funding for productivity initiatives which benefit low-wage workers.
Patient Service Associates (PSA)
PSAs are the face of the healthcare sector - they are the first, as well as the last touch point for patients and their families. With the increasing patient load in recent years, the expectations and stress on our PSAs has increased significantly.
The Tripartite Workgroup will look into re-designing the job scope, as well as exploring more career progression pathways for PSAs. Those who perform well will also be groomed to become Service Executives. The Tripartite Workgroup is studying the best practices from the public healthcare clusters to identify a model which is suitable for implementation across the sector.
