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Delivering care from Toa Payoh Hospital to Changi General Hospital

Changi General Hospital (CGH) Emeritus Professor Fock Kwong Ming shares first-hand insights on his 55-year journey in healthcare.

Prof Fock with framed photographs of classes he taught back at Toa Payoh Hospital.

With the restructuring of Toa Payoh Hospital (TPH) on 1 April 1990, the hospital embarked on new programmes to improve service and care. “We had a strategic planning exercise then where we came up with a statement to encourage staff to achieve a high standard of quality care, which was to provide a level of patient care and services good enough for our own mothers without the need for special arrangements,” says Prof Fock Kwong Ming, who was then Senior Consultant, Department of Medicine of TPH, which closed on 15 February 1997 and moved its staff and patients to New Changi Hospital.

Stepping into healthcare

With a diverse and enriching career in healthcare over the past 55 years, Prof Fock is currently Emeritus Consultant, Department of Gastroenterology and Hepatology at CGH. He was formerly the Chairman, Medical Board (CMB), CGH, from 1999 to 2007 and helmed the Department of Medicine and Division of Gastroenterology at both TPH and CGH. In addition, he held several key positions in healthcare, as well as several chairing and advisory roles in various committees.

Prof Fock had decided to choose the medical vocation over another as he could do more helping people as a doctor. He was about seven years old when his 55-year-old grandfather suddenly developed diabetes, was diagnosed with liver cirrhosis and subsequently passed away from cancer of the liver. His uncle had asked Prof Fock to join him in finding a cure for horrible diseases. “Even if I can’t cure them, at least I can try to relieve their pain and suffering,” recalls Prof Fock of the motivations that shaped his thinking at the time.

As a medical student, he was always in a rush, but enjoyed meeting his fellow students by the palm trees of TPH in his final year. “Something unique then was that we had tutorials on head injuries by neurosurgeons outdoors under the palm trees. It was hot but we learnt a lot.”

After graduating, Prof Fock was posted to TPH. A small hospital building that also contained living quarters for staff, the various care team members knew each other well, giving the hospital a very homely feel. “Many of our patients and staff followed us from TPH to the New Changi Hospital despite the distance; they shared that they liked the culture.”

Prof Fock training medical students on his ward rounds at TPH.

Challenges of the time

There were several challenges in healthcare in the early days, recounts Prof Fock. Firstly, infrastructure requirements were growing rapidly. With the Toa Payoh and Ang Mo Kio towns being developed around TPH and more residents moving in, there was a need for a bigger hospital to house the rising number of new patients.

The need for more healthcare manpower was another challenge, with a growing demand for more doctors, nurses and allied health professionals. TPH was contributing to the supply of nurses in Singapore with the opening of the School of Nursing for Pupil Assistant Nurses in 1965, where Prof Fock was invited by the nurses to give lectures at. He also taught medical students, a number of whom have gone on to become heads of medical departments around Singapore.

The 1980s were characterised by rapid growth and expansion. With the 400-bed TPH running at full capacity in the mid-1990s, patients had to be transferred to other hospitals, necessitating the move to a bigger hospital. In 1989, there was news that TPH would be moving to a new site. Prof Fock was nominated to serve on the Hospital Planning Committee, planning for a shift to a larger site at Toa Payoh Rise and subsequently Bedok Reservoir. As the area around Bedok Reservoir was not developed at that time and infrastructure was lacking, Prof Fock suggested a location nearer to an MRT station instead. This would ultimately end up as CGH’s present location.

In the 1990s, there was a change of hospital administration — from a model left behind by the British colonial authorities, to an American model. TPH was the second public hospital in Singapore then to undergo the restructuring.

Prof Fock reminisces on his healthcare journey at Toa Payoh Hospital.

Transitioning to Changi

Several months after the soft opening of the New Changi Hospital in 1997, staff and patients from the old Changi Hospital moved over to the new building. Most of the patients from the old Changi Hospital were chronic patients, a contrast to the acute patients at TPH. The care teams worked very closely together to align their routines and practices, and ensure smooth operations. “It is not about the building, but the people. There is a strong family spirit and bonding among the CGH staff and even patients, which continues till today. This is something intangible and valuable,” says Prof Fock.

The medical services and specialty centres at the New Changi Hospital also had to be scaled up to keep in pace with the constantly growing demand. Prof Fock also focused on introducing outpatient specialist clinics for continuity of care and scheduling of elective procedures to improve patient outcomes.

“We made promises to our patients, namely to provide the population in the east with 90% of their medical needs,” says Prof Fock, in his role as the CMB of CGH at that time. “For that to happen, we had to ensure that we had the various medical disciplines that we did not have in TPH, such as dermatology, rheumatology, oncology, otolaryngology (ear, nose and throat), ophthalmology (eye) and psychiatry.”

Toa Payoh Hospital and the old Changi Hospital moved to the Simei site where Changi General Hospital now stands.

In addition, CGH introduced surgery services such as in-house neurosurgery, vascular and plastic surgery. “The critical issue was balancing the population health needs with the infrastructure and manpower available,” he highlights.

With healthcare constantly evolving, Prof Fock and his team recognised the importance of innovation, publication and teaching. $1 million was put into clinical research at CGH at that time, enabling researchers to compete at the national level for funding for further research. Besides healthcare development, Prof Fock also encouraged the staff to sharpen their administrative skills to equip themselves with the tools to lead teams better.

Prof Fock having joy at work with a karaoke session with colleagues.

Reflecting on how healthcare has changed over the decades, Prof Fock recognises that patient care has also evolved. “Previously, it was us looking after your needs. Now, it is about gaining your trust that we are able to look after your needs.” CGH’s vision today encapsulates it all — Your Trusted Care Partner, Innovating Healthcare for Tomorrow.

A commitment to care throughout the years

Having looked after patients — from TPH to CGH — over a span of 38 years, Nursing Assistant Director Kaneswary tells us about her nursing journey.

Ms Kaneswary continues to care for her patients over almost four decades as a nurse.

“It was a new environment for us. There was the fear of the unknown, and we were not sure how we would manage.” These were Nursing Assistant Director Kaneswary d/o Kandasamy’s first thoughts when she and her team learnt that they would be moving from the former Toa Payoh Hospital (TPH) to a new custom-built general hospital facility in the heart of eastern Singapore at Simei.

But they quickly overcame their apprehensions and got down to work. “Thankfully, with the strong support of the team, we managed to share and exchange our ideas, and build a caring culture that resonates with the new hospital,” she recalls. The move was a good fit for Ms Kaneswary, as the new hospital’s caring culture nicely aligned with her own nurturing instincts.

What first sparked Ms Kaneswary’s interest in nursing was a chance encounter when she was a teenager. She was walking about in a mall when a frail elderly lady suddenly stumbled and fell in front of her. Without a second thought, she went forward to help, and the lady’s gratitude touched her, stirring up an innate desire to do something different and rewarding to help people. “That was the first time I felt the calling to be a nurse and care for the people around me,” she recalls.

Initially, Ms Kaneswary faced resistance and concerns from her family members about her decision, but she steadfastly stood by her choice. She started off as a Pupil Assistant Nurse (the equivalent of the current ITE nursing student training) and became an Enrolled Nurse upon the completion of her training. In 1985, she joined TPH and cared for patients undergoing surgery as well as those with orthopaedic conditions. “It has been a fruitful 38 years for me as a nurse, and never did I once regret my decision to embark on nursing as my lifelong career,” she says with a smile.

Keeping up with evolving healthcare needs

The wards have undergone transformations over the years. In the past, an open-ward concept enabled nurses to see all the patients on one floor at a glance. Today, wards are built to meet the various needs of patients, with increased privacy and attached toilets. Recording of patient information has also evolved, going paperless and digital, resulting in improved data security and easier access.

Nevertheless, the smaller TPH brings back fond memories for Ms Kaneswary, who remembers the nice and cosy working environment where she could meet colleagues along ward corridors every day, and catch up over friendly chats at the hospital cafeteria.

She also observed the shift in emphasis on the continuity of care after patients’ hospital stays in the last decade, as the patient profile has become more senior, with multiple diseases or chronic conditions. “The amount of engagement with community partners has increased tremendously at CGH,” she reveals. “We believe in caring for patients in their journey from the hospital to the community so that they stay healthy — and now this has become key to adopting a preventive healthcare approach.”

The award-winning innovative pillow was featured in Lianhe Zaobao in 2001.

Innovating healthcare

Innovation was already a buzzword at TPH. Besides providing nursing care, Ms Kaneswary was involved in multiple projects as part of the Quality Circle since 1994 — the equivalent of the modern-day Quality Initiatives programme, which involves the development of projects to improve patient care, safety and staff satisfaction.

A memorable initiative at CGH was conceived from the feedback of patients, who shared that they were experiencing abdominal pains after surgery despite taking painkillers. Working at the post-surgical ward at that time, Ms Kaneswary’s team came up with a prototype of a pillow that was waterproof, absorbent and comfortable. The pillow prevented the abdominal muscles from excessive movement arising from coughs and sneezing.

Upon trialling the product with patients with favourable results, the team worked with a partner to make more of the pillows for wards. These helped relieve patients’ pain, enabling them to consume fewer painkillers, and gave them a better sense of security knowing that their surgical wounds were protected. Some of the patients were keen on bringing the pillow home, and some patients’ children even asked for it. The innovation won the Three-Star Award at the National Quality Circle Convention in 2001. “This successful and positive intervention motivated me to work on more projects to help our patients,” she adds.

Advancing as a nursing leader

An avid learner, Ms Kaneswary underwent training to be a Registered Nurse, and later took an Advanced Diploma in Midwifery, a part-time degree course in Nursing, a Master’s in Health Science Management and a Graduate Diploma in Health Care Leadership Management, progressively climbing the nursing ranks.

As Assistant Director of Nursing at CGH, Ms Kaneswary currently works with a multi-disciplinary care team to oversee patient care in the surgical-orthopaedic wards from hospital to home. She is still actively involved in improvement projects that enhance the quality, productivity and safety of patient care, staff and the hospital.

Medicine and care delivery are evidence-based today as patients are more educated. “As the trusted care partner, CGH continually deepens our clinical expertise through research, innovation and education, so that we can provide the best care for our patients,” Ms Kaneswary explains.

Ms Kaneswary was featured in Caring
in 1992 for receiving the Most Courteous
Staff Award in TPH.

Going the extra mile for patients

Providing exemplary care for patients is not foreign to Ms Kaneswary, who attained her very first nursing accolade in 1992 as TPH’s “Most Courteous Staff”. She has since bagged 18 more awards, including the National Day Award Commendation Medal in 2022. “The awards inspire me in my work and give me contentment, but ultimately, it is most fulfilling when my patients receive the help they need,” she says.

On what makes CGH special in the hearts of patients and staff, Ms Kaneswary shares, “At CGH, our care team members go the extra mile and do our best for our patients and colleagues.” And to her peers and the next generation of nurses, she affirms, “Nursing is an excellent job! Continue to put in the hard work and you can succeed.”

Photos by Prof Fock and Ms Kaneswary.

Delivering care from Toa Payoh Hospital to Changi General Hospital