User-centred design – it’s always about leadership: The case of Singapore’s hospital in a garden

Khoo Teck Puat hospital in Singapore is a wonderful example of what can be achieved with user-centred design and fantastic leadership

You don’t expect to end up visiting a hospital after accepting a speaker invitation from the National University of Singapore and its Institute of Systems Science. But that’s what happened to me at the recent APECTEL conference for CIOs after hearing the dynamic Liak Teng Lit, group chief executive of the Alexandra Health System, give his views on innovation in health.

Before his current role, Liak was CEO of Singapore’s Khoo Teck Puat Hospital, where he played a significant role in delivering a hospital which is simply the most user-centric thing I’ve seen since the UK's Government Digital Service (GDS). And I mean user-centric at all levels – patients, staff and visitors.

The hospital's economics are mixed, with private patients subsidising public patients. But according to the current, equally dynamic CEO of the hospital, Chew Kwee Tiang (pictured), the public patients have the best views of what can only be described as the nearest thing to a hotel you will see – not something you could easily say about a public hospital in the UK.

It’s the small things that, to some, would seem extraneous to the core business of a hospital that are the most impressive – such as how they go about generating an ecology that will support the largest and most diverse butterfly population on the hospital campus; or how they think through what human behaviour is telling them and how they respond.

For example, when the hospital noticed that children loved to feed the fish in its beautiful ponds but were just throwing in any kind of food they had to hand, it responded not by erecting signs saying “Don’t feed the fish”, but by selling small amounts of proper fish food so the children could enjoy feeding the fish without damaging the ecosystem.

Another example is how the hospital comes up with innovative solutions to difficult problems, such as the management of patients with severe dementia. For many public hospitals, some sort of physical restraints are often necessary to ensure severe dementia patients do not wander off on their own.

But in Khoo Teck Puat, they paint the doors to look like bookcases so it is not easy for dementia patients to see where the exit doors are – while they are figuring that out, nurses can gently guide them back to where they need to go. On the wall above the nurses’ reception, a tally is kept of the number of days they have not had to restrain patients – 466 and counting. The nurses had a party when the total reached 365 days.

The sweet spot

There is a sweet spot in public service when you find yourself in a place with great leadership and an important mission. It empowers you to fight for the very best for the most vulnerable.

While visiting the geriatric ward, Kwee Tiang pointed out that each patient had a toilet and shower near their bed. She explained that traditionally, bathrooms and toilets are located in one block at the end of the ward – which, of course, results in lots of falls and wasted time for nursing staff as they take elderly patients on the long trek from one end of the ward to the other.

The nursing director pestered the then CEO, Liak, saying: “You have to make the policy-makers understand that this is the right thing for patients.” 

Many meetings and discussions followed, and one day he came back and said: “OK, we’ve got it.” This initiative has changed the design norms for hospital wards in Singapore.

There are not many hospitals in the UK that you would describe as being full of joy and of calm. Khoo Teck Puat is a wonderful example of what can be achieved with user-centred design and fantastic leadership.

I was particularly struck by its approach to death. In public wards, there may be up to five beds, and as a patient approaches death, staff have taken the view that this can be distressing for others in the ward. So there is an especially beautiful room, the Lily Room, that stands empty but ready.

When staff feel a patient is reaching the end of his or her life, they call the patient’s family, wheel the patient into the Lily Room, and in the privacy of that air-conditioned space, friends and family can gather round and stay as long as it takes until their loved one passes away. For people so committed to healing and prolonging life, this spoke volumes about their holistic approach.

Spirit of innovation

And the spirit of innovation remains constant. At the APECTEL conference, Ian Wilson, vice-president of operations at Marina Bay Sands Hotel, referred to the hospital's use of robots to ferry food trays from floor to floor. Given the logistical challenges of his huge hotel, he suggested he had lots to learn from Khoo Teck Puat. When Kwee Tiang heard this comment, she replied: “I’m going to visit them again soon because we have loads to learn from them.”

Perhaps this is what distinguishes public sector learning in Singapore from that in the UK. It does not involve “learning sets”, where the same sector continually benchmarks itself, trying to be “best in family”, but rather it widens its vision to see what different sectors have to offer because that is where real innovation happens.

So is it any wonder that Liak Teng Lit, so immersed in the healthcare sector, chooses the comic book theorist Scott McCloud to quote most frequently and fervently, and whose words are writ large in the hospital learning centre: “Learn from everyone, follow no one, look for patterns and work like hell.”

Emer Coleman is business development director of TransportAPI, an SME powering change and innovation in transport. She is also the founder of Disruption, a digital consultancy specialising in digital leadership

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"User-centered designs" are rarely considered by very short-sighted US-based Big Business. In the long term, catering to the needs of users can become a huge money-maker for business. In the short term, it's a bit more expensive and that generally ends the conversation. We don't fix our bridges even though our customers cross them. We don't fill our potholes even though our customers crack their axles on their way to see us. And we certainly don't worry about the betterment of our users even though happy users are better customers. We need to remember that there's a real world beyond our obsession with the bottom line.
What amazed me most of all, is how these simple and cheap measures allowed getting such a great results. Nothing prevents from adopting their ideas in IT world.