Gill Kamaljeet, International Biz Dev Manager for Singapore's National Healthcare Group

This is David Williams, CEO of MedTripInfo.com. Gill Kamaljeet Singh is General Manager of the International Business Development Unit with Singapore's National Healthcare Group or NHG. Gill took a group of international media on a tour of NHG's Tan Tock Seng Hospital recently. Before the tour, he gave us this introduction of Healthcare in Singapore, and NHG specifically. You can't see the slides as you listen to this report, but Gill's passion and the impressive nature of NHG come through loud and clear.

Gill Kamaljeet Singh: The Singapore Healthcare system is basically divided into three. Sorry, divided into two to make it simpler for you, so you don't get confused. One big group is called the Government Hospitals where we have two clusters. I'm trying to make it as simple as possible. So, one group, two big clusters; these clusters have got a few hospitals that they manage. My cluster is called the National Healthcare Group. There is another cluster called Singapore Healthcare Services. We are both Government Hospitals. We are both government - and the other group will be, where all the private hospitals are. Some of your friends have gone to Raffles Hospital if I understand. Don't worry, I'll make this presentation more fun.
Now, National Healthcare Group belongs to the Government. When you walk around my hospital later, open your eyes, smell, touch the wall - our walls are very clean; they are not dirty, OK? You won't see my patients lying by the basement, no such thing, OK? You use your finger and you do that, it will be clean. That's how clean Singapore hospitals are - and I'm serious - you see, I'm not smiling.
So in my group, I have four hospitals; The Alexandra Hospital, I have the National University Hospital, Tan Tock Seng Hospital, and Institute of Mental Health. These four hospitals are managed by us. In addition to that, we have a working relationship with Johns Hopkins, they take care of our cancer patients in this hospital. Except National University Hospital, they have their own cancer center, so we have our own local doctors in there. We also have Singapore's only skin center, which belongs to my group, National Skin Center, which is just a stone's throw away from here, we have the Cancer Institute, the Eye Institute, and also the Heart Institute. Now, this portion here, this is mainly for the people of Singapore. Foreign patients and private patients...
Now, the National Healthcare Group, if you look at it here, all medical facilities are operationally responsible to the Ministry of Health through the National Healthcare Group. So the hospitals report to the National Healthcare Group, National Healthcare Group reports to Ministry of Health. Now, a quick glance at our Alexandra Hospital, there's the entrance. In the Tan Tock Seng Hospital, there's National University Hospital, Singapore's only University Hospital at this point. And of course, we have the Institute of Mental Health over there. Singapore is extremely small, 269 square kilometers. Again, so basically we drive a BMW from one point to the other point, maximum 40 minutes. The great thing is, from Changi Airport, if you go to my University Hospital, we are one traffic light away. From the airport to the National University Hospital, we are just one traffic light away.

Now, if you look at Tan Tock Seng Hospital, the location of Tan Tock Seng Hospital, if you are familiar with Orchard Road, we are not in Orchard, we are just outside Orchard Road, so there is no traffic congestion. So you see, the strategic location of the hospitals is extremely important. I thought this would be a fantastic forum to discuss medical tourism. A lot of patients from the US, from UK, from Canada, all they think of is, if I want to travel around my country, the location that I go to has to be cheap. Period. They don't care if they see cows on the road; they don't care if your roads are not clean; they don't care if there are patients lying on the floor; they really don't care - all they want is cheap.

Now, I'll explain to you the Singapore version, my version of medical tourism. You need to have four factors with you; you need to have excellent chemical outcome indicators, you need to have international accreditation, you must have competitive pricing, and the country that you go to must have excellent, PEST factors. Not many people know what is PEST factors; only if you are marketer, you know what's best factor, because Philip Kotler taught us that. OK? Political, Economic, Social and Technology, I'll explain to you one by one now.

So, for clinical outcomes, look at this. The country that you go to or the hospital that you go to must do a lot of clinical research. So if you look at my group, there are about 800 ongoing research projects each year, in NHG and 50 percent of my doctors do some form of research. Research is extremely important. You need to have outcome indicators. If I come to your hospital, if I go to your country, how safe are you? What are your outcomes? Patient needs to ask these questions; you cannot just pack your bags and, "I'm going to whichever destination, but Singapore." No; you need to find out all this. Now I have just covered clinical outcome indicators.

Next, you need to go through this International Accreditation. National University Hospital that belongs to me is the first hospital in Singapore to be JCI Accredited. National Healthcare Group is the first group in Singapore to be JCI Accredited. Besides that, in JCI, we have also achieved the Singapore Quality Class, the Singapore Service Class and three ISO's, 9000, 14000, 18000. And all these three ISO's -- most hospitals take one ISO at a time and then move on to the next and move on to the next. My hospital says, "I don't have time for that. I took all three at one shot."

IT is extremely important; to provide faster, better, safer and affordable healthcare for all our patients, IT plays an integral part for us to meet all this. OK? Look at this; Electronic Medical Record Exchange, which means if you go to Tan Tock Seng Hospital and then you get transferred to National University Hospital, your data can be seen in that hospital electronically. We also have an computerized clinician order entry system. This means, when you see my doctor in the clinic, after he does his consultation and all that, he keys in his computer and he says, "OK, Desiree basically I'm going to send you to go and do an x-ray", for example. You just, with your identification card, you go to my x-ray department, you just use your identification card, and they scan barcode, immediately they know exactly what request is required.

We don't fill up forms - that's passe, old-fashioned -- no forms to be filled up. Once they have done your MRI, you walk back to your clinic, the doctor is waiting for you, he sees you in the clinic, he keys in your identification, voila, your MRI appears on the screen. We don't use films any more - again, passe, old-fashioned. No more films, we use computers. And some countries you go, you see cows on the road; you come to my country, you see cows in the hospital. 'Computer On Wheels' - COW. My Cows are different, not the real anymore. If you go to the ward where the patient is hospitalized, we have Computers on Wheels. After your x-ray is done, we will move the computer into your bedroom and we will show you your x-ray outcomes right smack in your room. It goes on; there you go, you see film-less x-raying? My laboratory is fully automated; I also have automated guided vehicles. The kitchen is in the basement too. The kitchen cooks the food, once the food is ready, they put it on a tray, the tray is then transferred into the warmer, they put it in there, and then the warmer sits onto a computer, a robot. All the kitchen does is press some buttons, the whole trolley starts to move. It is able to maneuver corners, it is able to accelerate, it is able to decelerate, and is also able to stop anywhere here and you will hear an automated voice: "Please give way to AGV" if you are blocking its way.

After we have done this, competitive pricing is extremely important. Singapore is about 50% to 100% cheaper than in UK and US. No question about this; very simple and very clear. I've been getting quite a few patients flying in --22 hours in the air, they come to me. In fact, I have got a Canadian who just came and left. One of the many that came to me.

This guy came in; he had a decompression of his disc. So, all we have to do in decompressing, we fuse it. He stayed with me: "This is how it works, sir?" He touched idown...this is the NHG experience, he touched down at Changi Airport. I offered them meeting services. That means when you come out of the plane at the aero bridge, one beautiful lady with your name out there. First, "Wow" and then the lady says: "Sir, are you Mr. Alain?" for example, this patient was Alain.

So, he says: "Yes, I'm Alain."

"Please follow me." She whisked you through immigration first. She helps you with the bags. She walks you through Customs, once out of Customs, you see my driver there standing with your name. We walk you straight to the van, drive you to the hospital. He arrived in my hospital after 22 hours of flight at 6:30 in the morning.

He was hospitalized immediately. Surgeon came to see him at 10:00. At 6:00 p.m., he was operated. That was on Friday. Today, he is shopping in Orchard Road. And I'm talking spinal surgery. And this guy says: "I cannot believe it!" Efficiency, that's Singapore.

Quality and safety, it is extremely important. We have such posters that we paste around the hospital to educate our staff. Do not compromise on safety. Do not compromise on quality. We have 30 different kinds of posters that we paste at different timing during the year.

First poster, just an example - Patients safety every step of the way in providing care. Second poster says - Patient's safety is critical to us, we practice time out. Just like NBA basketball, the coach will say time out. We do that as well. We do time out in the theater.

OK what we do in the theater is - this guy is a surgeon, hypothetically OK. Let's say, I'm the surgeon. My patient is Stephen Mo. I check: "Correct patient?" My nurse will say: "Yes, correct patient Stephen Mo." My next question, I will ask: "And we're supposed to amputate Stephen's leg?" The nurse will say: "Yes, according to the record." She says correctly: "You're supposed to amputate Stephen's leg." The last question I will ask: "Am I supposed to amputate his right leg or left leg?" The nurse will say: "Yes, you're supposed to amputate his right leg."

It may sound lame. It may sound boring, no brainer. Even Vietnamese doctors don't do it. Why do Singapore doctors do it? You cannot afford to make a simple mistake. Your simple mistake like this was going to cost the patient a leg.

My nurses do not wear face masks. They don't wear goggles. They don't wear gloves. The reason is...we don't wear gloves and all this because we practice hand washing. Before you touch your patient, you wash your hands. After you touch your patient, you wash your hands as well.

And why we don't we wear face masks and gloves and all that? Because those patients who are infectious, we have isolation rooms with negative or positive pressure depending on how infectious you are. So, having such rooms, only then my nurses will be gowned and masked up if you're infectious. If you're not infectious, we don't make you frightened as well, OK?

Competitive pricing and then international accreditation, clinical outcome. What is PEST factors? Let me explain to you, why come to Singapore? Come to Singapore because of the first "P" -- Political -- OK? Singapore has one of the world's best governments with no social unrest. Today, if the government decides to raise gasoline prices, nobody will demonstrate on the road, I guarantee you that. Ladies, I encourage you to walk on my streets at two a.m., nothing is going to happen to you.

"E" for Economic -- look at this, total GDP in 2005 -- look at my GDP in 2005. OK? The government operating expenditure in healthcare is only this amount, which accumulates to about four percent of the GDP -- very small, extremely small.

"S" for Social -- total number of visitors in 2005, 8.9 million total visitors. We are a multiracial, multilingual setting that puts overseas visitors at ease. You don't see the Muslim fighting with a Buddhist; you don't see me, a Sikh, fighting with a Chinese -- my wife is Chinese.

Another important component of Singapore's healthcare system is its excellent pool of medical expertise. Technology -- "T" -- Singapore healthcare system ranks among the top six.

So, you see, there are a lot of best factors why foreign patients should come to us. If the country that is trying to promote medical tourism, if you have one, two, three, four, then you talk about medical tourism. You walk into my MRT or my Metro, you sit in it, you look at it -- you can basically lie down on the floor, that's how clean it is. It's really clean, very efficient, rarely breaks down, always on time.

Let's go on to my presentation proper. OK. NUH, started 24th June 1985, first government owned restructured hospital. Very simple, layman's terms, government give me a pack of money, a piece of land, "Go build a hospital."

"I want you to build a hospital this big, this size. I want it to be totally private in the way you run your business, but operationally you are responsible to me, Ministry of Health, I am your boss. But because I want it to be efficient, you hire who you like, you buy all the equipment you like; just run efficiently."

Subsequently, the program was so successful, all government hospitals became restructured. OK? NUH is now a 928-bed tertiary care hospital with 22 clinical departments, three dental centers and six paramedical units.

This building, what has happened is, because we have been receiving increasing number of foreign patients last year, my hospitals, two hospitals, NUH and Tan Tock Seng -- two hospitals admitted 65,200 foreign patients. So, this building, what we have done is -- because we have increasing number of foreign patients coming to us -- we decided to go into service differentiation, because we are running out of space.

So, what we do is -- you see, there's a building over here. This whole piece of land is about two hectares. So this building, we keep the people of Singapore in there. The people of Singapore stay in these buildings over here, while foreign patients and Singapore private patients; they stay in buildings like this. So it's like flying in the Singapore Airlines; you have Economy Class, Business Class -- same thing, same airline, same stewardess, same smile, same service, except different ambience, different physical evidence.

Tan Tock Seng Hospital was founded by Mr. Tan Tock Seng, a philanthropist, in 1844. The hospital bed status is about 1,293 beds -- that's how big it is. This hospital is Singapore's second largest hospital; NUH is Singapore's third largest hospital. I control two of the three biggest hospitals in my group.

This is the building -- amazing building, triangular in shape and it's won for Best Design Award being triangular. But we have a reason for making it triangular, OK, and I'll show you the reason in a short while. When this hospital was built, it was built with a vision and a passion.

NUH total staff strength: 3,500; Tan Tock Seng: 3,900. WHO says that if you want to run a hospital, 40-45% of the staff strength must comprise of nurses. Look at this -- NUH, 47%; Tan Tock Seng, 43%. You can have great doctors, but you need great nurses. OK? Doctor can operate great; he can do a successful operation, patient ends up with an infection. So, nurses are extremely important.

This column here belongs to NUH, this column here belongs to Tan Tock Seng: 928 beds and also 292 beds, six individual ICUs, four individual ICUs. Most hospitals have only one ICU, 20-bedder. Neurosurgery, heart surgery, orthopedic surgery, you do your hernia repair, everything in one ICU. I don't do that. I have six individual ICU. Cardiothoracic, coronary, medical, surgical, pediatric and ICU, OK. In my Tan Tock and in my NUH.

Tan Tock Seng, I have coronary, medical, neurology and surgical. I have 19 operating theaters in NUH, I have 24 operating theaters in Tan Tock Seng, 12 specialized centers in NUH, four over here and nine specialist unit here, 23 specialist unit here.

Each day, NUH is operating at 184 patients; Tan Tock Seng is operating on 214 patients. Each day, even while I am talking to you. That's how big I am. I need to be efficient to be this way, and I am, that's why I'm JCI accredited.

And the good news is, NUH has just been re-certified by JCI, we've just been through the exercise last week. The auditors came in from U.S. They audited us. They gave us thumbs up. So, we have the extension of another three more years.

Physical environment is extremely important in the hospital setting. Extremely. So, all those rich people are trying build hospitals, physical environment is the number one priority. What the patient sees with the eye, they will conclude how great your doctors are or how cool your nurses are, by what they see. So, do you want to walk into a hospital that looks like this? Nice, clean. You know a clinic like this and so you walk in...nice floor, maroon wall, nice lighting. They feel very at ease. They want to have such a feeling.

This is our inpatient room where the patients get hospitalized. This is how it looks like. This is a single room, one patient with a bed, OK.

This is our deluxe room. Basically, deluxe room is top of the range, you are given two rooms. This is the lounge area and this is the patient's room over here, OK. This is selling like hotcakes. Because it's affordable. Because you get one room over here and one room over here for 250 US dollars. Your wife or your husband who does not need to stay in the hotel. Stay here. Not a problem, you know. Nice lounge. And a room like this will cost you 250 Singapore dollars, about 170 US.

Meals that we give you are: morning breakfast; then we give you morning tea. Then we serve you lunch, then we serve you afternoon tea. Then we serve you dinner, then we serve you night snack. You'll come in skinny, you go out fat. Then we have to do bariatric surgery to make you feel thinner [laughter].

Remember, I'm saying here why Tan Tock Seng Hospital... the wards are triangular? Look, this is a ward; we will be going to the wards. We will show why it is triangular. By the nurse and the doctors staying in this area, they are able to see all the rooms on this side and all the rooms on this side. Gone are the old fashioned days. Nursing counter is here, the patient's room is on all the way the other side. You know, these are all same.

In addition to that, we even put up LCD monitors of plasma televisions. Big ones right in the middle here, OK. The purpose of this television is to tell the nurses station, for example, OK, Stephen is my staff so I can use his name all the time. Stephen is hospitalized in which room? Let's say it is room No. 11. Who is his doctor? Where is he currently? OK, let's say for example Stephen goes to the rehab department, the screen will indicate Stephen is in rehab department.

Or for example Josephine is due for discharge in 17 minutes. The screen will indicate Josephine has to leave the hospital by 17 minutes. For the Americans' needs, we have Starbucks.

Clinical services, we have the Cancer Institute. Basically anything and everything relating to cancers, we are able to handle it. The Eye Institute, we have the full range of services where we do cataract operations, we do the full works, OK. Skip, skip, and skip.

The Heart Institute, we have cardiology, we do the full specs, full range including the nuclear cardiology, international cardiology. These are some of the pictures that we have. This is a nuclear scan machine and angiogram going on there. After the patient...if he requires open heart surgery, this is a heart institute, we do cardiac scan, vascular surgery, cardiac surgeries, we do every year about 1100 open heart surgeries - above 1100 open heart surgeries. Of course we do aneurysms, carotid, thoracic surgery, vascular abscess surgery.

These are our ICU's; this is what one of the ICU's look like. Now, we do not deny our patients windows and clocks in an ICU setting. So you look, we have windows out there. We even give the patient a clock, so that when they lie down and they look out the window, if they see daylight and the clock says, "three, " they know it is three p.m. not three a.m. These are psychological factors we must be sensitive to.

Look at my Women's Clinic. My strengths include IUI, IVF and timing of ovulation. Look at the physical environment of my Women's Clinic. Most of my clinics are designed to be one-stop centers, so which means you see the doctor in rooms like this, you do your ultrasound there, you do your pelvic examination there, you come up, you collect your medication from this counter, you pay the cashier over hear - off you go.

The only time you need to leave the clinic for an examination is when you need to do a mammogram. We started our IVF unit in 1982; '83 we achieved Asia's first IVF Baby, in '85 we achieved Asia's first GIFT Baby, '87, Asia's first Frozen Embryo Baby. Thereafter, receiving three Asia First Awards, we went on to achieve five World's First awards. Look at that, 1988, World's First, 1981, World's First, 1982, World's First, World's First in '94 and World's First in '97. We do approximately about 400 fresh cycles of IVF in one year.

In General Surgery, we have the full range of General Surgery Services. This is Liver Transplant - we did 100 liver transplants to date. Started in 1990, our success rate is 85%. Is our ENT, Ear, Nose and Throat Clinic, we have the full range. We don't have to go through the list. Medicine Clinic, we also have the full range. Again, I'll just quickly pass that by.

This is the wellness center -- Institute of Mental Health - I only have one slide on this. Basically patient that flies in from overseas, if you have got 'Alcohol Dependent, ' you can come to us, we can help you. OK? If you have sexual dysfunction, you come to us, we can help you. OK? Marital and Couples Therapy, Family Therapy, Relaxation Therapy, you come to us. My nurses don't wear nursing uniforms in our Institute of Mental Health. They are dressed more like Spa Therapists - pretty rainbow T-Shirt and nice trousers.

Then our International Patient Liaison Center, the unique thing about my department is, I control both the marketing and the liaison work of department. Very important to us is, we put our patients first. OK? "Patients first" is very important.

What are the services we render in our International Patient Liaison Center? We are a one-stop service center that gives our potential customer easy access to our services. We are creating about seven liaisons. We make it easy for patient referrals, and most importantly, we provide personalized and specialized quality service to our patients.

Services that we render include -- you can call me from Vietnam, from Philippines, from US, from UK, and say, "I don't have a place to see in Singapore besides the hospital where my wife is staying." No problem. We do accommodation, transportation, we do Airport pick up. We pick you up from the Airport free of charge without any cost. But if you come to Singapore to go for shopping, don't call me.

We do free Airport pick ups, we do Ambulance and Emergency Care Services, we do offer assistance before, during, after admission. We do everything, OK? We provide the food services over there.

These are our offices that we have set up in the region; we have offices in Russia, Myanmar, Vietnam, Philippines, Indonesia is the biggest. We have offices in Cambodia, Bangladesh and Pakistan. I am done with my presentation. Thank you very much.