ASSOCIATE PROFESSOR DANIEL FUNG SHUEN SHENG
Chairman, Medical Board
Programme Director, REACH
Senior Consultant
Department of Developmental Psychiatry
Institute of Mental Health
MS GERALDINE WONG CHENG IM
Principal Medical Social Worker
Team Leader, REACH (North)
Department of Developmental Psychiatry
Institute of Mental Health
MS GRACE LI JIAYING
Senior Occupational Therapist
Team Leader, REACH (South)
Department of Developmental Psychiatry
Institute of Mental Health
MS CHAN MEI CHERN
Deputy Director, Operations
Head of Operations, REACH (North & South)
Department of Developmental Psychiatry
Institute of Mental Health
“For their significant contributions and holistic approach towards mental health care for the young through extensive inter-sector collaboration, community training, and early detection and intervention strategies.”
In 1995, the World Health Organization put forth the idea that schools play a vital role in reducing health risk. The majority of children and adolescents do not suffer from mental illness. However, there are some who are at risk of developing emotional, behavioural and/or neurodevelopmental issues. When this happens, early identification and intervention will alleviate the problem as the child and his family learn to manage the symptoms, and continue to build resilience throughout his childhood and adolescence.
Empirical findings have shown that community-based model of psychiatric care not only improves accessibility to services, but also reduces the stigma associated with mental illness. With this in mind, the Response, Early intervention and Assessment in Community mental Health (REACH) was set up under the auspices of the National Mental Health Blueprint in 2007 to support schools, community agencies and general practitioners in helping children and adolescents below 19 years old with mental health concerns.
REACH is led by the Institute of Mental Health (IMH) in collaboration with the Ministry of Education (MOE), social service organisations, general practitioners (GPs) and the National Council of Social Service (NCSS). It is represented by multidisciplinary mobile teams comprising medical doctors, clinical psychologists, medical social workers, occupational therapists and nurses. These teams provide assessments and interventions to students as well as support and training to community partners.
By 2011, REACH services had expanded from one to four mobile sub-teams (north, south and east school zones), with IMH leading two teams in the north and south regions, and KK Women’s and Children’s Hospital and National University Hospital leading a team each in the east and west regions respectively, to support all mainstream schools and by 2014, all Special Education (SPED) schools in Singapore. The formation of these mobile clinical teams is a major breakthrough of the traditional hospital-based psychiatric care model in Singapore by bringing services into the community, improving accessibility and timeliness for children and adolescents to receive care in the naturalistic environment.
REACH also helps build capability by training community partners (school counsellors, educators, GPs and staff in the social care sector) through a structured mental health training series. This brings about a multiplier effect to disseminate and impart the knowledge and skills to the different sectors, which translates to better quality of support for students who require mental health support in the community.
Since its inception in 2007, REACH has supported more than 6,000 students and trained more than 2,000 educators. REACH has also successfully carried out interventions and right-sited care in the community, reducing the number of new referrals to IMH’s Child Guidance Clinics (CGC) over the years.
In the last decade, REACH ventured beyond the boundaries of healthcare to build robust working relationships with all MOE mainstream schools and SPED schools, and a strong network of social service organisations and GP partners, forming an integrated mental healthcare support system for children and adolescents in the community. REACH has also extended its partnership with the six Madrasahs to provide mental health support to the student population as well as to explore working with preschools to support the mental health needs of pre-schoolers.
For their significant contributions and holistic approach towards mental health care for the young through extensive inter-sector collaboration, community training, and early detection and intervention strategies, REACH is awarded the 2018 National Clinical Excellence Team Award.
NUHS VALUE DRIVEN OUTCOMES (VDO)
ASSOCIATE PROFESSOR KEITH LIM HSIU CHIN
Group Chief Value Officer
National University Health System
Senior Consultant
Department of Radiation Oncology
National University Cancer Institute, Singapore
ASSOCIATE PROFESSOR JAMES YIP WEI LUEN
Group Chief Medical Informatics Officer
National University Health System
Senior Consultant
Department of Cardiology
National University Heart Centre, Singapore
Associate Professor
Department of Medicine
Yong Loo Lin School of Medicine
National University of Singapore
MS WONG SOO MIN
Group Chief Financial Officer
Corporate Office Chief of Staff
National University Health System
“For their outstanding contributions and achievements in the
development of a Value Driven Outcomes (VDO) methodology for the
benefit of patients and Singapore’s public healthcare system.”
With an ageing population, a growing chronic disease burden and rising healthcare costs in Singapore, the National University Health System (NUHS) Value Driven Outcomes (VDO) team embarked on a mission to achieve better value in healthcare with focus on both outcomes and costs.
One way to improve value is to be able to measure and compare it with benchmarks. Hence, the ability to assign quality measures and attribute costs of care to individual patient encounters is critical for visibility and transparency. By understanding the value of care, identifying deviations versus best practices, clinicians are equipped with data and analytics to drive the right optimisation.
The VDO project was first started in 2016. For each condition, individualised quality indicators from the four key dimensions – Clinical Quality and Safety, Appropriateness of Care, Patient Reported Outcomes and Patient Experience – were defined and correlated with cost metrics such as facility utilisation, medication, investigations and manpower cost. Data visualisation tools were deployed for users to track and analyse the outcomes of each quality indicator, cost drivers for each condition and the percentage of patients with defined care indicators. This is the quality of care delivered at the specific cost.
Driven by the insights from the VDO reports, the teams were able to initiate improvement plans such as:
(a) reduction in unnecessary length of stay;
(b) improvement in Deep Vein Thrombosis prophylaxis compliance;
(c) adoption of cost effective standard implants; and
(d) standardisation of investigations and medication usage.
NUHS started with projects on seven conditions in 2016 and expanded to 20 in 2017 across two hospitals – National University Hospital (NUH) and Ng Teng Fong General Hospital (NTFGH). Today, there are 53 ongoing projects across these two hospitals and the National University Polyclinics. These projects have resulted in a 4% weighted average increase in the number of patients achieving the defined care and a 6% weighted average reduction in costs of care. Overall, they have resulted in $11 million in savings to the public healthcare system in areas such as cost avoidance and reduction in tests.
With the expanded NUHS cluster, the VDO methodology was replicated in NTFGH in 2017, with mapping and implementation completed in less than four months, enabling the launch of six VDO projects. This has enabled both institutions to benchmark the cost of care and outcome indicators, and cross-share best practices to allow for improved costs and outcomes. In addition, the VDO approach pioneered by NUHS has since been adopted by the Ministry of Health and rolled out across Singapore in 2017 with seven VDO projects launched nationwide.
For their outstanding contributions and achievements in the development of a Value Driven Outcomes (VDO) methodology for the benefit of patients and Singapore’s public healthcare system, the NUHS VDO team is awarded the 2018 National Clinical Excellence Team Award.