National Medical Excellence Awards 2018

• Senior Consultant, National University Centre for Oral Health, Singapore

• Associate Professor, Faculty of Dentistry, National University of Singapore

• National University Health System

Patient-centeredness is at the core of Associate Professor Patrick Tseng’s delivery of care. He goes by the adage “to always put yourself in your patient’s shoes” and strives to deliver treatment in the safest manner possible.

A/Prof Tseng specialises in Endodontics – the dental specialty focusing on the diagnosis and treatment of the dental pulp. The prospect of having to undergo endodontic treatment, such as root canal therapy, typically strikes fear in patients. Nonetheless, A/Prof Tseng’s skills and proficient management of conditions have resulted in minimal discomfort for his patients. He has consistently received one of the highest number of compliments as a clinician in the National University Hospital (NUH). His ability to put his patients at ease with the assurance that they are in good hands has garnered him multiple referrals both locally and regionally. Highly accolated for his consideration towards his patients, A/Prof Tseng accommodates to his patients’ schedules as much as possible. He makes every patient feel like a VIP and has received the NUH Star Award in 2002 and SPRING Singapore’s Excellent Service Award in 2007.

A pioneer in Endodontics with 33 years of clinical experience, A/Prof Tseng is always driven to discover safer and more effective treatment methods. In 2001, he was invited by world renowned Endodontists, Dr Cliff Ruddle and Professor Pierre Machtou, to observe the development of a revolutionary root canal file system in California which was safer, more efficient and produced more anatomically accurate canal shapes. Capitalising on the advantages of the system, he worked with the Swiss endodontic file manufacturing company, Dentsply-Maillefer, to produce a manual version of the rotary Endodontic files and co-developed the latter. He was instrumental in the testing and modification of the design of the files and handles, which are now widely used in the undergraduate teaching programmes throughout Asia, Europe and in many parts of the world.

Evident of his leadership in Endodontics, A/Prof Tseng receives regular invitations to be a keynote speaker at regional events. Through these opportunities, he has successfully boosted the popularity of the National University of Singapore (NUS) Faculty of Dentistry’s three-year Endodontics programme, which has gained a solid reputation in the region.

A/Prof Tseng has left indelible footprints at the institutional, national and international levels. He has served as a committed team member of the National University Health System for three decades as a dedicated clinician at the National University Hospital and an educator at the Faculty of Dentistry at NUS. He continues to be involved in both undergraduate and graduate teaching, imparting his knowledge to nurture the next generation of dental healthcare professionals. He started teaching in 1991 and achieved Associate Professorship in 2005.

In 1992, A/Prof Tseng helped to formulate the criteria for Endodontic certification for the Academy of Medicine. He was involved in the setup of the Graduate Programme in the faculty in 1999 and has been a longstanding member of the Specialist Committee for Endodontics of the Faculty of Dentistry, NUS, which has overseen the training of dentists in the specialty of Endodontics since 2004.

At the national level, A/Prof Tseng was the Chief Dental Officer at the Ministry of Health from July 2006 to April 2018. He has overseen a number of key reforms during his tenure, notably setting up the Dental Specialist Accreditation Board in 2008 and initiating the registration and regulation of dental specialists, which was necessary for the management of more complex dental cases. He also made basic cardiac life support and continuing professional education mandatory for dentists to ensure that they keep up with the rapid changes and developments in dental practice.

A/Prof Tseng has also been a member of the editorial board of the Journal of the American Association of Endodontists since 2005, which is a recognition of his standing in the field of Endodontics. He is also involved in research as a member of the editorial boards of the Singapore Dental Journal and the Hong Kong Dental Journal.

All in all, A/Prof Tseng is a highly regarded and respected leader in the dental community and the Endodontics field, and for his passionate contributions to better patient care, not just locally or regionally, but internationally.

For his exceptional contributions to the advancement of safety and quality in patient care and the field of Endodontics, A/Prof Tseng is awarded the 2018 National Outstanding Clinician Award.

• Deputy Medical Director (Education), National Cancer Centre Singapore

• Senior Consultant, Division of Medical Oncology, National Cancer Centre Singapore, SingHealth

• Associate Professor, Cancer & Stem Cell Biology Programme, Duke-NUS Medical School

• Clinical Senior Lecturer, Yong Loo Lin School of Medicine, National University of Singapore

Associate Professor Toh Han Chong is widely respected and recognised as one of the world’s leading authorities on immunotherapy. His international accomplishments speak volumes of his unbridled dedication towards the war against cancer. Equal is his love and devotion to his patients, and his passion for nurturing the next generation of youth, medical students, research technologists, research officers, postdoctoral fellows, clinical fellows and junior faculty members.

A/Prof Toh is one of the earliest pioneers of Cell and Cancer Immunotherapy in South East Asia and has been leading the programme for over 15 years. The programme was an uphill enterprise, with Singapore then having modest translational cell therapy and cancer immunotherapy capability, infrastructure and knowledge workers; while also facing wider scepticism about the clinical relevance of cancer immunotherapy as a treatment for cancers. His work on immunotherapy is now widely regarded as one of the standard pillars of cancer treatment and was named ‘Breakthrough of the Year 2013’ by the journal Science.

Together with co-leader Dr John Chia, who is also one of his protégé, A/Prof Toh launched and established a consortium of over 65 clinical sites across Asia in the landmark global investigator-initiated randomised Phase 3 clinical trial exploring the role of aspirin in an adjuvant setting for colorectal cancer (‘ASCOLT’). Since 2009, what started as a two-man seed idea at National Cancer Centre Singapore (NCCS) has grown into a global leading clinical trial involving 1200 patients. ASCOLT has successfully secured international grants from Switzerland and Australia, in addition to local funding from the National Medical Research Council (NMRC) under the Ministry of Health. This internationally recognised study has been widely cited by global key opinion leaders such as Professor Ian Tannock, Sir John Burns and Professor Peter Rothwell. If shown to confer a survival benefit, this trial would have a major impact on the treatment on colorectal cancer, saving costs and millions more lives globally.

A/Prof Toh has published extensively in 97 journal publications. In recognition of his excellence in research, he has been invited to speak and lecture at numerous local, regional and global oncology events.

A/Prof Toh is currently the Chairman of the Board of the SingHealth Investigational Medicine Unit (IMU) and played a major role in the establishment of the SingHealth IMU. Together with then SingHealth Deputy Group CEO Prof Soo Khee Chee and then SingHealth Group Director of Clinical Research Prof Fong Kok Yong, A/Prof Toh identified key operational and management staff to establish IMU from its infancy. He also rallied academic clinicians across Outram campus to conduct their early phase and proof-of-concept clinical trials in the IMU. The SingHealth IMU today is one of the two early phase clinical trials unit in Singapore. Its reputation is on par with top early-phase clinical trial centres across Asia, including South Korea, Taiwan and Hong Kong.

A/Prof Toh has an extraordinary commitment and passion to teach and mentor the doctors and healthcare professionals of tomorrow. Many of his protégés have gone on to achieve successes in their careers. Dr John Chia won ‘Best Poster Award’ at ESMO 2011 for his a first-in-human clinical trial study for a nasopharyngeal cancer vaccine. Another protégé, Dr Marissa Teo won the L’Oreal International Women in Science Award for her work in cell therapy at A/Prof Toh’s laboratory. Currently, A/Prof Toh is responsible for developing structure, curriculum and content for Research and Education as the Academic Vice-Chairperson (Education) of the SingHealth Oncology Academic Clinical Program (ACP). His commitment to nurture the next generation is not limited to within the cluster. He has been invited on a regular basis to speak during the National Healthcare Group Research Preparatory and Study Design Workshops. These workshops are aimed at gearing up young clinical researchers and potential future clinician scientists.

A/Prof Toh has been awarded numerous accolades for his contributions and leadership in Singapore and around the globe, such as the NMRC Clinician Scientist Awards in 2009 and 2017; Gordon Research Conference for NPC (Hong Kong) Outstanding Poster Presentation Award in 2016; the Duke-SingHealth AM-ETHOS Mentoring Award in 2016; Duke-NUS Graduate Medical School Best Teacher Award (Molecules and Cells) in 2008 and the National Excellent Service Award (Star Award) in 2004.

For his outstanding contributions in cancer immunotherapy which offers hope to patients, Associate Professor Toh is awarded the 2018 National Outstanding Clinician Scientist Award.

• Director, Division of Graduate Medical Studies, Yong Loo Lin School of Medicine, National University of Singapore

• Head, Division of Critical & Intensive Care, National University Hospital

• Senior Consultant, Department of Anaesthesia, National University Hospital

• National University Health System

Associate Professor Chen Fun Gee has been involved in medical education since 1987. He taught medical students and medical officers during their postings in Anaesthesia, as well as examination preparatory courses and workshops at the National University of Singapore (NUS).

A/Prof Chen was appointed a member of the Anaesthesia Specialist Training Committee in Singapore in 1996, and actively contributed to the training of Anaesthetists as an examiner in the Master of Medicine Anaesthesia postgraduate examinations where he shaped the direction of training. He was also an examiner for the University of Malaya Anaesthesia Postgraduate examinations, as well as the Hong Kong College of Anaesthesia fellowship examinations.

In 2002, A/Prof Chen was involved in the set-up of the specialty of Intensive Care in Singapore. He chaired the Ministry of Health Committee overseeing the setup and was one of the pioneer group of intensivists. He was also a part of the team of examiners that formulated and conducted the first Intensive Care licensing examinations in Singapore.

In 2009, A/Prof Chen was appointed Director, Division of Graduate Medical Studies (DGMS) in the Yong Loo Lin School of Medicine, NUS. He was concurrently appointed the Co-Chair of the Joint Committee of Specialist Training (JCST). As the director of the DGMS, he was responsible for the standards of assessment in all of the 11 Master of Medicine examinations as well as Master of Science, Speech and Language Therapy. During his tenure with DGMS, he worked with domain experts to start the NUS Audiology programmes as well as the Graduate Diploma of Mental Health and Graduate Diploma of Palliative Medicine programmes. These graduate diploma programmes upgrade general practitioners by equipping them with the skills to meet Singapore’s healthcare needs.

As the JCST co-Chair, A/Prof Chen worked with 35 specialties in Singapore in the transition to the American Council of Graduate Medical Education-International (ACGME-I) system of training. Working together with the Ministry of Health and NUS, the existing postgraduate training programmes were modified in accordance to ACGME requirements. Accreditation of non-ACGME programmes was started using similar processes and standards as those utilised by ACGME. Working with the American Board of Medical Specialties, US Board examinations were incorporated into the existing assessment systems in Singapore in 11 specialties.

As Chair of the Joint Committee of Family Medicine, A/Prof Chen worked in close collaboration with the College of Family Medicine for the training and assessment of Family Medicine trainees in Singapore. In 2012, he worked with Dr Ruth Lim, Chief Examiner and her team, to revamp the Master of Medicine in Family Medicine to ensure that Family Medicine graduates are well equipped to meet the needs of patients.

A/Prof Chen also chairs the Graduate Nursing Advisory Committee at Yong Loo Lin School of Medicine, NUS that charts the direction of graduate nursing education in Singapore. He is a member of several Advanced Practice Nurse committees that provide input on the curriculum, training, professional practices and licensing examinations for the Master of Nursing and the Advanced Practice Nurse internship programmes. In addition, A/Prof Chen worked with the Singapore Pharmacy Board to develop tools for the assessment of Pharmacy Residents. This is still work in progress and the first portfolio examinations for Pharmacy will commence in 2019.

A/Prof Chen is a practicing specialist in Anaesthesia and Intensive Care. Since 1992, he has been regularly invited as a speaker at Anaesthesia and Critical Care Medicine related conferences. Because of his interest in education, he has also been a regular speaker at educational conferences both locally and internationally. At the National Day Awards 2016, A/Prof Chen was conferred the Public Administration Medal (Bronze) for his contributions to the nation.

For his extraordinary dedication and distinguished contributions to medical education with the aim of advancing healthcare standards in Singapore, A/Prof Chen Fun Gee is awarded the 2018 National Outstanding Clinician Educator Award.

• Deputy Group Director, Education (Graduate), SingHealth

• Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

An anaesthesiologist for nearly 30 years since 1990, Associate Professor Lim Boon Leng has taken on a range of roles in education, both nationally and internationally. He mentored Anaesthesiology trainees for their specialist examinations, moved on to taking on membership roles on the national Specialist Training Committee (Anaesthesiology) from 1998 to 2011, and the Subspecialty Training Committee (Intensive Care Medicine, ICU) from 2006 to 2014; to improve the training of both anaesthesiologists and intensivists.

A/Prof Lim is not just dedicated to teaching clinicians. He wants to keep raising the bar on medical knowledge and skills so that successive generations of clinicians and educators are better than the previous. He was one of the pioneer intensivists to initiate the Fundamental Critical Care Support Course in 2000, which still runs today, to train anaesthesiologists, respiratory and emergency physicians, nurses and allied health professionals involved in the care of ICU patients.

A/Prof Lim Boon Leng is currently a Senior Consultant at the Singapore General Hospital’s (SGH) Department of Anaesthesiology. Previously Program Director for Critical Care Module of Duke-NUS Medical School between 2008 and 2016, A/Prof Lim was involved in the planning and executing of its critical care curriculum when the school was established in 2008.

When the Singapore specialist training transited from the UK-based model to US-based ACGME-I Residency training system in 2009, A/Prof Lim was appointed Associate Designated Institutional Official (DIO) from 2010 to 2012, and promoted to DIO for the SingHealth Residency from 2012 to 2018. A/Prof Lim led many transformational changes. He successfully attained accreditation for all 34 residency programs and initiated the Essentials in Clinical Education, an online course, in 2015 to improve the pedagogy of SingHealth Residency teaching faculty. It covers five key domains such as design and planning of learning activities, assessment and feedback to learners. The course has since been extended to nursing and allied health teaching staff.

During A/Prof Lim’s tenure as DIO, he was also an encouraging and patient mentor who made sure to build rapport with the pipeline of budding clinicians and was always there to provide guidance on challenging cases. He attended every resident event and mingled with them to receive any first-hand feedback they might have, including the challenges they faced during their training.

A/Prof Lim worked closely with the Medical Education Coordinating Committee and Manpower Standards and Development Division under Ministry of Health (MOH) to improve residency programs. To prepare Singapore’s top residents for leadership roles, he planned the Singapore Chief Residency Program with MOH Holding’s Healthcare Leadership College. In 2017, he introduced the SingHealth Residency Leadership Program, with a similar objective to build up a pool of leaders among the residents.

As the SingHealth Deputy Group Director of Education (Graduate), A/Prof Lim also sat on various MOH committees to help drive healthcare training policy.

Internationally, for his work in educating and training anaesthesiologists in China, A/Prof Lim was appointed Honorary Executive Committee Member of the Chinese Society of Anaesthesiologists in 2004 and awarded Outstanding Contribution Award in 2009. He was also made Honorary Visiting Professor of Xi’an 4th Military Hospital in 2002, and Qingdao Medical University in 2007 and 2016.

For his dedication and passion in pushing the boundaries of postgraduate medical education and training; and for his outstanding leadership in creating an environment for teaching and learning, A/Prof Lim Boon Leng is awarded the 2018 National Outstanding Clinician Educator Award.

• Deputy Group Chief Quality Officer, National Healthcare Group

• Deputy Chairman, Medical Board (Clinical Quality & Manpower Development), Khoo Teck Puat Hospital & Yishun Health

• Head and Senior Consultant, Laboratory Medicine, Khoo Teck Puat Hospital & Yishun Health

• National Healthcare Group

A passionate advocate of patient safety and quality care, Associate Professor Wong Moh Sim plays an instrumental role in the overall planning, development, implementation and evaluation of corporate strategies to drive quality, patient safety and clinical risk management within Khoo Teck Puat Hospital (KTPH) and National Healthcare Group (NHG).

A/Prof Wong is no stranger to clinical quality. She was the first Patient Safety Officer at Alexandra Hospital (AH), and was instrumental in putting together the patient safety and quality improvement framework in AH. She helped lead AH to achieve its maiden JCI accreditation in 2005 and has continued to play a leading role in subsequent iterations of JCI audits for KTPH. As AH’s first Patient Safety Officer, A/Prof Wong helped NHG to establish the Patient Safety Framework, along with other Patient Safety Officers from NHG, and actively participated in numerous patient safety training activities at institutional and cluster levels.

A/Prof Wong is also the clinician lead for the Yishun Health patient safety collaboration with the Cognitive Institute for Speaking up for Safety. Her role is to build a strong culture of safety and quality by empowering staff to support each other and normalise collegial two-way communication to prevent unintended patient harm.

A/Prof Wong is a faculty member of the Singapore Healthcare Improvement Network (SHINe) for the Large Scale Initiatives to Reduce Harm. She helped develop the change package and measurements for the Healthcare Associated Infections (HAI) Workstream for Institute for Healthcare Improvement (IHI) and local faculty. Under the guidance and mentorship of the HAI Workstream faculty, nine institutions have been coached to implement an evidence-based catheter-associated urinary tract infection (CAUTI) prevention bundle, with seven institutions achieving institution-wide spread of this bundle. More than 350 incidents of CAUTI have been prevented from April 2014 to September 2017 with a cost avoidance of more than SGD$1.5M.

A veteran in laboratory management and workflow, A/Prof Wong heads the Department of Laboratory Medicine in both AH (2002-2005) and KTPH (2005-till date). Under her leadership, the department has grown its service to one of excellent national standards — providing quality laboratory service which strives to provide faster, cheaper and better care for patients.

Using Clinical Practice Improvement Programme (CPIP) and Toyota Production System methodologies, she not only improved operational efficiency but also designed improvement projects for better clinical outcomes. One of her successful initiatives was a turnaround time of less than 45 minutes for 95% of all laboratory results from the Department of Emergency Medicine in 4 months. She received a CPIP Project Commendation for the achievement.

In 2006, A/Prof Wong chaired and led the NHG Critical Laboratory Results Collaborative, to improve the communication of critical laboratory results. As a result of the work done by the collaborative, NHG established its own list of Critical Laboratory values, and instituted many processes to ensure reliable communication with appropriate and timely management of patient care. Dr Wong was also part of the efforts to introduce the concept of open communications to NHG, and to date remains an active trainer in the Open Disclosure programme.

A/Prof Wong is a firm believer in continuous learning. She actively involves herself in staff training and pushes them to update themselves regularly. She is currently teaching at the Department of Pathology at Yong Loo Lin School of Medicine, National University of Singapore.

At the national level, A/Prof Wong serves on various committees, including the Singapore Association of Clinical Biochemists (SACB) and Technical Advisory Committee for Chemical Metrology at the Health Sciences Authority (HSA), where she chairs the workgroup and advises on the development of local proficiency testing programmes and feedback on the interpretation of performance of participating clinical laboratories to HSA.

For her exemplary contributions to developing and advancing the field of patient safety and clinical quality improvement, as well as her inspiring dedication in designing interventions to sustain positive change, A/Prof Wong is awarded the 2018 National Outstanding Clinical Quality Champion Award.

In 1995, the World Health Organization put forth the idea that schools play a vital role in reducing health risk. The majority of children and adolescents do not suffer from mental illness. However, there are some who are at risk of developing emotional, behavioural and/or neurodevelopmental issues. When this happens, early identification and intervention will alleviate the problem as the child and his family learn to manage the symptoms, and continue to build resilience throughout his childhood and adolescence.

Empirical findings have shown that community-based model of psychiatric care not only improves accessibility to services, but also reduces the stigma associated with mental illness. With this in mind, the Response, Early intervention and Assessment in Community mental Health (REACH) was set up under the auspices of the National Mental Health Blueprint in 2007 to support schools, community agencies and general practitioners in helping children and adolescents below 19 years old with mental health concerns.

REACH is led by the Institute of Mental Health (IMH) in collaboration with the Ministry of Education (MOE), social service organisations, general practitioners (GPs) and the National Council of Social Service (NCSS). It is represented by multidisciplinary mobile teams comprising medical doctors, clinical psychologists, medical social workers, occupational therapists and nurses. These teams provide assessments and interventions to students as well as support and training to community partners.

By 2011, REACH services had expanded from one to four mobile sub-teams (north, south and east school zones), with IMH leading two teams in the north and south regions, and KK Women’s and Children’s Hospital and National University Hospital leading a team each in the east and west regions respectively, to support all mainstream schools and by 2014, all Special Education (SPED) schools in Singapore. The formation of these mobile clinical teams is a major breakthrough of the traditional hospital-based psychiatric care model in Singapore by bringing services into the community, improving accessibility and timeliness for children and adolescents to receive care in the naturalistic environment.

REACH also helps build capability by training community partners (school counsellors, educators, GPs and staff in the social care sector) through a structured mental health training series. This brings about a multiplier effect to disseminate and impart the knowledge and skills to the different sectors, which translates to better quality of support for students who require mental health support in the community.

Since its inception in 2007, REACH has supported more than 6,000 students and trained more than 2,000 educators. REACH has also successfully carried out interventions and right-sited care in the community, reducing the number of new referrals to IMH’s Child Guidance Clinics (CGC) over the years.

In the last decade, REACH ventured beyond the boundaries of healthcare to build robust working relationships with all MOE mainstream schools and SPED schools, and a strong network of social service organisations and GP partners, forming an integrated mental healthcare support system for children and adolescents in the community. REACH has also extended its partnership with the six Madrasahs to provide mental health support to the student population as well as to explore working with preschools to support the mental health needs of pre-schoolers.

For their significant contributions and holistic approach towards mental health care for the young through extensive inter-sector collaboration, community training, and early detection and intervention strategies, REACH is awarded the 2018 National Clinical Excellence Team Award.

With an ageing population, a growing chronic disease burden and rising healthcare costs in Singapore, the National University Health System (NUHS) Value Driven Outcomes (VDO) team embarked on a mission to achieve better value in healthcare with focus on both outcomes and costs.

One way to improve value is to be able to measure and compare it with benchmarks. Hence, the ability to assign quality measures and attribute costs of care to individual patient encounters is critical for visibility and transparency. By understanding the value of care, identifying deviations versus best practices, clinicians are equipped with data and analytics to drive the right optimisation.

The VDO project was first started in 2016. For each condition, individualised quality indicators from the four key dimensions – Clinical Quality and Safety, Appropriateness of Care, Patient Reported Outcomes and Patient Experience – were defined and correlated with cost metrics such as facility utilisation, medication, investigations and manpower cost. Data visualisation tools were deployed for users to track and analyse the outcomes of each quality indicator, cost drivers for each condition and the percentage of patients with defined care indicators. This is the quality of care delivered at the specific cost.

Driven by the insights from the VDO reports, the teams were able to initiate improvement plans such as:

(a) reduction in unnecessary length of stay;
(b) improvement in Deep Vein Thrombosis prophylaxis compliance;
(c) adoption of cost effective standard implants; and
(d) standardisation of investigations and medication usage.

NUHS started with projects on seven conditions in 2016 and expanded to 20 in 2017 across two hospitals – National University Hospital (NUH) and Ng Teng Fong General Hospital (NTFGH). Today, there are 53 ongoing projects across these two hospitals and the National University Polyclinics. These projects have resulted in a 4% weighted average increase in the number of patients achieving the defined care and a 6% weighted average reduction in costs of care. Overall, they have resulted in $11 million in savings to the public healthcare system in areas such as cost avoidance and reduction in tests.

With the expanded NUHS cluster, the VDO methodology was replicated in NTFGH in 2017, with mapping and implementation completed in less than four months, enabling the launch of six VDO projects. This has enabled both institutions to benchmark the cost of care and outcome indicators, and cross-share best practices to allow for improved costs and outcomes. In addition, the VDO approach pioneered by NUHS has since been adopted by the Ministry of Health and rolled out across Singapore in 2017 with seven VDO projects launched nationwide.

For their outstanding contributions and achievements in the development of a Value Driven Outcomes (VDO) methodology for the benefit of patients and Singapore’s public healthcare system, the NUHS VDO team is awarded the 2018 National Clinical Excellence Team Award.