Rolling out hospital automation to improve patient safety: Q&A with Serene Chin

Sumit Dutta

Digital disruption and digital transformation are intrinsic to 21st Century healthcare.

Technological advancement brings along greater accessibility to big data as well as new and sometimes costly eHealth solutions. Subsequently, IT project risk management and governance, benefits realisation and improved stakeholder engagement are necessary for successful project delivery.

In this interview Serene Chin, Deputy Director, Integrated Health Information Systems and SingHealth CIO. Serene shares details of the outpatient automation and integrated health information systems at the KK Women's and Children's Hospital in Singapore, and also delves into the challenges, benefits and limitations of healthcare digitisation.

Could you give an overview of the KK Women’s and Children’s Hospital Project?

Serene: This project, we call it the Emergency Outpatient Pharmacy Automation Project. When it first started the project objectives were basically twofold. One is in regards to patient safety.

We hope to improve our patient safety in terms of the near misses and also to reduce or even eliminate medication errors. The second objective is actually more to do with efficiency and overcoming the labour shortage. We are looking at efficiency to help to eliminate manual routine tasks -so automation in this regard especially comes with many benefits.

How are you rolling out automation to enhance efficiency and patient safety?

Serene: At the KK Women’s and Children’s Hospital we have rolled out a number of automation projects in the pharmacy area. Nearly six years ago, we rolled out the inpatient pharmacy system, and back in 2004, we rolled out the automation of the drug dispensing machine and the operating theatre and also the pick stations at the various wards.

Then just last year, we rolled out the outpatient automation. So we actually rolled out in phases, and we did that on purpose, with the rationale being, it’s that we don’t want to choke up our resources –our resources are well-spread –because there are resources in IT as well as the pharmacies.

In rolling out our automation we were very thorough. We have a well-planned schedule as well as a well-planned testing schedule where we put in intensive system integration testing as well as user acceptance testing. On top of that we also have a paper exercise to make sure our scenarios are well covered and well organised.

How are you working to bring staff on the automation journey?

Serene: I think staff buy-in is very important as it contributes to the success of the overall project. So we make sure that we have a good communication plan right from the start of the project.

We spell out the objectives to our staff and they actually look forward to the project because they believe that with automation, they can actually do away with a lot of unnecessary manual, routine work, and that they are able to spend more time on value-add tasks like counselling patients on drugs. So for the most part they actually really look forward to it. Good communication really is the key though. We make sure that at certain intervals, we actually update our staff. Whenever there are issues, we also keep them informed so that they feel that they’re part of the process.

What are some of the key challenges you’ve faced during your transformation journey?

Serene: There are lots of challenges. One of the biggest was trying to source upfront a commercially available product, because with a ready product, it actually means it can shorten our timeline in terms of implementation, and also reduce the risk. We tried to sourced it over about two years, but we couldn’t find a product available to, for example, pack a bottle of syrup for children.

So what happened is that then we started talking to vendors and we started discussing with them; ‘are there any options that can help us to build the machines to meet our objectives? And lo and behold, we found an engineering company and the company was very willing to collaborate with us.

Another challenge, as with many projects is timeline. As we’re government funded, the government funding requires us to implement the project within a certain timeline. And we actually only have one year to build this machine as well as to implement the other few machines for our outpatient pharmacy automation. The other challenge is actually, in the midst of the project, we did encounter issues because the engineering company was not able to deliver the machines on time and we–panicked due to out limited schedules, but nonetheless, we actually put in a lot of paper exercise scenarios to make sure that our testing plan is well covered.

And finally, when the machine was actually delivered, the testing was actually very smooth. Everything worked very well and we also have even locks to ensure that our results, once tested, are actually accurate.

Having implemented this technology what results have you seen?

Serene: Having run our systems now for about a year, the results are very encouraging. We collect our statistics pre-implementation and post-implementation so that results can be compared. I’m very glad to report that in terms of patient safety, since the day our automation services were launched last year, we have had no near misses at all, and in terms of medication errors, we also do not have medication errors to report –which has improved patient safety. In terms of efficiency we have educe the emergency waiting time during peak hours at the hospital.

While we’re not yet able to achieve average waiting time as the automation project requires a certain threshold of time for the machines to pick the drugs, pack them and verify them, but regardless our average waiting time has improved by 31%. Looking to other areas, in terms of patient and staff satisfaction, survey results show that they have gone up by 20% and that is also very encouraging. Staff have reported they are very happy with the results of the automation project.

Finally, we’ve been able to achieve more than a 90% traceability on the drugs administered, so,  in the event of recall, we are able to quickly carry out a recall to avoid any adverse impacts on our patients, which is obviously great.

This interview was conducted in support of the Digital Healthcare Summit