The Apple CEP Journey

3rd Operations Summit

Tuesday
24 Nov 09
 Overview

Remembering the Apple Framework

Communication & Learning

Measure

Drill Down

Improve

Visualise

Energise

Moving Forward
 Remembering the Apple Framework

5. Energise 1. Measure

- Harvest Day - Surveys

- Awards & Recognition - Feedback
- Walkabout - Audits
- Patient & Staff
Advisory Group

4. Visualise
Core Attributes
- Compliment / Treating patients with
Suggestion Wall Empathy, Care &
- Achievement Board Professionalism
- Apple Cards to ensure
Healthy & Satisfied Patients
Enabled through 7 Habits

3. Improve 2. Drill Down

- Patient Experience Map

- People
- Patient Focus Groups
- Service & Process
- Environment
 Communication & Learning

Communicating the CEP

CEP Posters CEP Note Pad CEP Cards

Learning
New Staff Existing Staff Supervisors/
Managers
Refresher Reinforce
Apple Basic Orientation with
(through roll- through audits
(CEP Standards) Apple Basic
call) and roll-call

Roll call
Service Service Recovery (Learn from
Recovery (through roll-call) complaints &
compliments)

Apple Intermediate Training

(Service Habits to (Practicum based on role play and
WOW) case studies)
 Measure: Background

Media Research Consultants was commissioned by TTSH to conduct 2

cycles of Customer Satisfaction Surveys and Patient Focus Groups in Jan
2009 (762 patients) and Jul 2009 (1,053 patients)

Objectives are
– To assess the level of patient satisfaction so as to fine tune the level of
service provision
– To obtain a baseline ratings to be used as a benchmark against similar
surveys conducted by MOH

Following each survey, a group of patients surveyed were invited to attend a

focus group. Valuable insights were obtained after each session.
 Measure: Overall Satisfaction – TTSH
% Excellent or Good

Q: On the whole, how satisfied are you with TTSH?

60.0
53.3
48.7 47.8

40.0
31.4
26.8 25.7
19.5
20.0 15.9 15.1

3.7 3.3 1.7 4.2

1.1 1.7
0.0
Jul 09 (n=1,053) Jan 09 (n=762) MOH 08(n=791)
Excellent Good Satisfactory Poor Very Poor
 Measure: Key Service Factors

90 .0 86.4

78.3 78.6 81.5

80 .0 76.9
74.5 71.2 73.7

68.6
70 .0

60 .0
F acilities C are K & S of K & S of C & C of C & C of C lear K & S of A lliedC & C of
C oordinationD octors Nurses D octors Nurses E xplanation Health A llied Health
on
procedures &
care

J u l-0 9 J a n -0 9 M O H 08
 Drill Down: Patient Focus Groups

Almost concurrently, 3 focus groups

discussions were held to gather feedback from
patients about their TTSH expectations.

Respondents were recruited from the then
ongoing Customer Satisfaction Survey.
A mixture of satisfied and unhappy patients
from A&E, SOCs and Wards were invited to
attend the session.
I waited for nearly 2 hours and was crying from
the pain.. I hid in one corner because I don’t
want anyone to see me crying…even in all
these pain, they must ask for payment first…
they didn’t even offer a wheelchair

…I waited from 12pm to 2pm…it was the first time I

am seeing him.. I went in, I just sat down, and he told
me –” I can’t look at your illness, you can go see
someone else better, don’t waste your time” – The nurse asked me if I need a
he never checked me.” ward, I told I had to make a call
first, ask my parents about it…
she just stared at me and rolled
her eyes…
...the nurse ask me “Why are you outside? I
thought you are sponging your
grandmother?”…I was like “am I working for
TTSH?”…I told her, “its your job, Im not there
to do it”, she just walk away without doing
anything.
 Drill Down: Patient Focus Groups

Almost all of the lapses could be attributed to the breakdown of communication in one
or more of the following forms:

• Communication between TTSH and the public on processes :

for example, on - Why do you have to wait? (Public communication efforts)

• Communication between doctor and patient

• Communication between doctor and medical team

 Improve: Recognising Your Efforts

Specialist Outpatient Clinics

- Names of staff (PSA or nurses) be placed on the door of the rooms that they are serving
- Billing Staff to use signature board when returning change or credit card
- LCD Picture frame with Staff picture and name on running slide show – can be used to flash Patient Service Survey
Scores of clinics as well
- Feedback card will be given to patient immediately upon service rendered
- Service Ambassador

Wards
- NOs doing daily rounds to identify and flag problematic cases for enhanced communication and care by team
- Nurses doing daily communication updates during visiting hours
- Nurses doing post discharge call to all patients the day after discharge

Non Subsidised Services

- Service Improvement Boards for staff improvement ideas
- NSS Patient Satisfaction Survey
- Teambuilding Retreat on 31 Oct 09
- Improvement of NSS Amenities and Ambience
- Establishment of NSS call Centre (in progress)

AHS & CSS

-Training of managers to motivate the team using - Bi-weekly audits
different modes of persuasion: pathos, ethos and - Mystery Shopper Audits
logos - Walkabouts
CSS
- Internal service quality audits AHS
- Fun & creative roll calls
- Role plays
- Individualized self motivating quotes
- Service role models
 Improve: Sharpening Your Saw

Roving CEP Quiz

- To proactively spread the Apple Philosophy and
CEP standards to more frontline staff
- 32 frontline units covered: SOCs, AHS, CSS,
Wards, ED

Apple Bites Newsletter

- Monthly newsletter to share snippets of service

related information with the staff

- Contents include: Service messages penned by

TTSH staff, audit findings, service activity updates etc

- Recommend using it as a roll call material to

keep up the momentum of good service

Doctors’ Service Kits

- Kit consists of a personally penned letter from a

patient and a thumb drive containing CEP messages

- Content of letter contrasts the different levels of

service experienced by one patient

- Adds a personal touch and element of reality – good

service does make a difference to patients’ overall well
being
 Visualise: Embracing New Media

Be Exceptional Intranet: http://beexceptional

- CEP Training Materials
- Best Practices
- Chat Roll
- CEP Blog

Be Exceptional Facebook Account

- Set up on 2 Oct 09
- No. of Friends: 38, No. of Fans: 18

Be Exceptional You Tube Account

- To upload videos taken during Apple Activities
- CEP Activity Videos Uploaded: 17
- Video Views: 2,214
 Visualise: Our Service Commitment

Wall Mural

- Puts forth the hospital’s service commitment to the

patients and NOKs

Lift Decal

- Constant reminders to our staff to give way to patients

- Inculcate a “patient first” value

 Visualise: Show That You Are Good!

TTSH Service Quality Challenge 2009

- Aim to boost staff spirits for the MOH CSS Survey

scheduled for 26 Oct 09 – 6 Nov 09

- A fun and energising activity to inject some positive

competition and variety in the staff’s daily routine work

- Total of 10 246 compliments received over 2 weeks

TTSH CEP Roll Call Video Contest

- Aim to encourage and reward frontline units to
conduct their service training in fun and creative ways

- Total of 14 submissions from: SOCs, AHS, CSS,

Wards & NSS
- Engaged hospital wide participation through:
- Social Media: Videos posted on YouTube
- Intranet: Videos on YouTube linked to the
Intranet for staff to view
- Staff Voting: All staff can vote for the “Most
Popular Video” on the Intranet
Total of 8256 votes gathered
 Energise: Time to Celebrate!

Apple Refresh Launch:

- Reinforce Apple Philosophy following first launched in Oct 08
- Gear staff up for the MOH CSS from 26 Oct – 6 Nov 09

Apple Refresh Launch – The Roadshow:

- Road show activities are planned with CEP
standards in mind:
• CEP Exhibition: know more about CEP
• CEP Quiz: test your CEP knowledge
• Makeover by Jean Yip: how to look good
• Origami: follow through instructions from your
buddy
• Wii: exercise to feel good
• Spot the Smiles: differentiate between the
real and fake smiles
Active & Harvest Day
- Celebration of both Active Day & staff’s achievements in
service quality
- Rationale: Apart from keeping up their strength and
energy to take on a demanding patient workload, they are
also professionally fit in upgrading their skills and raising
the bar of their service quality standards, as well as fit in
balancing family, social community and personal
responsibilities
- Awards for CEP Roll Call Video Contest & TTSH Service
Quality Challenge were given out
 Moving Forward

Measure and Benchmark

• More frequent and systematic feedback and audit framework
• Real time feedback solutions
• Patient Feedback Survey on Consulting Doctors

Training and Improvement

• “Exceptional Service Habits” by HRD
• Learning Trips to Service Leaders of various industries

Reward and Recognition

• Formalise and standardise Service Award Systems
• Service Competencies to be incorporated into Total Performance Management
• Accreditation with National Standard Body

Collaborations Across Units

• Service Day
 Moving Forward

Service Training Certification for Doctors

• Uses the handwashing certification approach
• Set up the basic process of what is minimum service standards and
expectations

Sharing Focus Groups Recordings Through Podcasts

• Using Be Exceptional Intranet as a platform
• Can be shared through training sessions, Hospital Conferences etc

Clinician Participation in Focus Groups

• Engage clinicians more actively in listening to patients