4. In which ways is the initiative creative and innovative?
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1. Forming the Taskforce
Our SingHealth Group CEO appointed the Taskforce, with a Steering Committee that would directly report the results and progress to her and the SingHealth Core Leadership. Three workgroups were established to work on different aspects of the project simultaneously, with the members in each workgroup being MSWs from the various institutions.
2. Harmonising the assessment form and creating the shared MSW electronic system
The first workgroup was tasked to review the workflows and processes that existed at each of the institutions. Following that, they were to consider which of the practices was most suitable for adoption, or if necessary, to re-design the workflow in order to facilitate patient-centric care. They were also to explore possible enhancements to the MSWs’ electronic system to support the revision of processes.
The second workgroup focused on the alignment of the Medifund assessments across institutions. The workgroup members had to consider the patient profiles at each institution, with special mention of the unique cases that were experienced before in the past. The members then discussed on how best to align the assessment guidelines and criteria in such a way that the patients’ financial and social circumstances could be considered in a more holistic manner.
The next task for this workgroup was to develop a new training manual for the MSWs. Revised guidelines and criteria were clearly noted in the manual which was shared with the various institutions. To facilitate easy understanding of the changes, training sessions were conducted for all MSWs before the implementation of the project through a train-the-trainer approach, whereby the Workgroup Leads trained one or two MSWs from each institution, who would then go on to train all the MSWs at their respective institutions.
The third workgroup looked into the harmonisation of approval processes and authorities to support the workflow and assessment changes. As changes in this aspect would impact the institutions’ management, representatives from each institution were tasked to seek their respective management’s support and buy-in for any proposed changes.
3. An anchor workgroup
The anchor workgroup was set-up midway through the project when the taskforce leaders recognized that decisions made by each workgroup had implications on the work of others. At the anchor workgroup meetings, Leads from each workgroup would share the status and recommendations from their area of work, and together they would evaluate the proposals and study the implications that these may have on other workgroups.
4. Engaging senior management and other stakeholders for support
Senior management’s support was sought at the beginning as well as before implementation. This served as a platform for the taskforce leaders to update on the progress of the project so that everyone in the organization would be aware of the changes and timelines. Communication sessions were arranged with finance, business office, IT, pharmacy and operations departments to ensure that stakeholders were updated and on the same page.
Patients were also kept informed of the changes when they visited the MSWs. They were assured that their information would only be shared among the MSWs at different institutions, and could opt out of the information sharing if they so desired.
5. Implementation in phases
After the smaller-scale implementation of Phase 1a, the taskforce came together to resolve teething issues and identify how implementation of Phase 1b could be improved. Feedback and lessons learnt from the pilot phase were incorporated during the planning for the next phase to ensure that the same issues would not surface again, at the same time to allow better preparation for the roll out of Phase 1b on a larger scale to all Medifund patients.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The main stakeholder involved in both the design and implementation of the initiative were the MSWs, patients and IT staff from the various institutions as they have the experience and knowledge to facilitate workflow re-design and enhancement of the MSW’s electronic system to allow information sharing.
Pharmacists and Finance staff, whose work would be impacted by the Taskforce’s decisions, were also engaged early on in the project for their feedback on the new workflows and processes.
Another group of stakeholders that were important were the institutions’ authorities and SingHealth senior management, as without their approval and support it would have been much more challenging to implement the initiative and with much delay as well. Project administrators were engaged to help problem solve issues that occurred, especially if the issues required cross-institutional solutions and changes. Updates were presented at the various senior management meeting forums, where members include the CEOs, Chairman of Medical Boards, COOs and CFOs of all SingHealth institutions. Heads of departments as well as the leadership of the Ministry of Health were also engaged. These helped to garner widespread leadership support and buy-in for the initiative.
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6. How was the strategy implemented and what resources were mobilized?
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Key resources used were funds for IT enhancement so that the revised harmonised financial assessment form could be created on the MSW’s electronic system and shared across the institutions.
The electronic system enhancement costs a total of S$41,345, which was funded through SingHealth’s IT fund.
Administrative manpower was provided on an ad-hoc basis (about 1 to 2 days a week) from 3 departments namely MSW, Group Allied Health office and Office for Service Transformation to support the Steering Committee and the 3 workgroups.
There were no other additional costs incurred as part of this initiative. However, in recognition of the fact that this initiative will raise productivity, the group was given a grant from the Ministry of Health to expand this project further to cover other assistance schemes.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The key outputs that enabled the success of our One Medifund Assessment initiative were
1. the creation of a seamless and improved experience for financially needy cross-institution patients, in the aspect of seeking financial assistance. Besides being able to have only one Medifund assessment regardless the number of institutions visited, any duplicate and redundant work is eliminated as well leading towards reduced touch points between patients and the MSWs.
2. the standardization of the Medifund assessment guidelines and criteria. Through standardizing the Medifund assessment guidelines and criteria, MSWs at different institutions would now require the same information from the patient, ensuring that the assessment being conducted at any institution would result in the same amount of assistance rendered.
3. the development of a shared MSW electronic system that allows accessibility to patients’ information and history. This, coupled with the standardised guidelines and criteria, enabled MSWs at the different institutions to now recognize the financial assessment done by each other and reduce the need for patients to be re-assessed when visiting a new institution.
4. the comprehensive training manual that was developed for the MSWs. The manual contained clear and concise information on the procedures, new guidelines and aligned criteria, and was made available to the institutions’ MSWs. Together with the training sessions, it facilitated a smooth implementation as everyone understood the changes and were able to adapt to it quickly.
5. a very highly motivated and collaborative team of MSWs, administrators and senior management. The task of harmonising the different Medifund assessment forms, guidelines and criteria were initially deemed too big a challenge to be resolved, almost impossible even. However, the commitment and motivation shown by the team members led to a strong collaboration, making it easier for the team to achieve success.
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8. What were the most successful outputs and why was the initiative effective?
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Both qualitative and quantitative evaluation strategies were employed to monitor and evaluate the implementation of the initiative.
1. Review by MSWs
For the qualitative aspect, three surveys were conducted with the respective institutions’ MSWs – pre, one-month post and six-months post implementation. These were to study the impact of the initiative on the MSWs’ job satisfaction.
2. Review by patients
Additionally, a patient survey will be conducted one year after roll out to find out how the initiative has impacted on patients’ experience and satisfaction. It is currently in progress, and results would be consolidated and analysed by February 2015.
3. Review of number of patients benefiting from such a shared facility
As for the quantitative aspect, system reports were generated to provide information on the number of touch points between patients and MSWs, and patients who had multiple Medifund assessments. With these data, the team is able to evaluate the benefit of the implementation of the initiative.
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9. What were the main obstacles encountered and how were they overcome?
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Initially, the main obstacles were getting buy-in from the institutions’ Medifund Committees and getting the MSWs to change their mindset and share the information that they have collected from patients for financial assessment. However, once they were able to comprehend the benefits that the change would have on patients in the long run, it was easier to get volunteers to participate in forming the workgroups.
During the course of the project, there was a strong preference by some institutions to continue with their existing frameworks, and they did not see why they should adopt other institutions’ practices. To address this issue, the Taskforce examined the concerns raised and met with the institutions’ management for discussions. An agreement was reached that we would adopt an 80-20 rule, to align the majority of the common processes while allowing deviation of 20% or less for specific situations.
As the changes proposed under this initiative would have wide-ranging impact on other stakeholders’ workflows and processes such as the Pharmacy and Business Office staff of the various institutions, the other major obstacle faced by the Taskforce was in garnering buy-in and support from these stakeholders. Recognizing this, the team members always made it a point to consider how each of the proposed changes may impact others, and sought to minimize it whenever possible, without compromising on patients’ experience. The stakeholders were engaged consistently from early stages of the project to ensure that their views, concerns and possible challenges were heard, and that they were updated on the progress of the project periodically so that they too would be ready when implementation was carried out.
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