Exclusive interview: Chief Nurse, Tan Tock Seng Hospital, Singapore

By Nurfilzah Rohaidi

Yong Keng Kwang on micro-learning to boost skills among nurses.

Tan Tock Seng Hospital is one of the largest multi-disciplinary hospitals in Singapore, and employs around 3,600 nurses. Chief Nurse Yong Keng Kwang shares how he is equipping nurses to address the needs of an increasing number of elderly patients, and creating future leaders.

How are you reskilling your nurses to help them stay relevant?

We have a big focus on geriatrics. Singapore has a rapidly ageing population; and half of our inpatients are 65 years and above. We want to make sure that we can care for their needs.

For these patients, their primary disease may be diabetes, an orthopedics-related issue such as a hip fracture, or an infection, for instance. At the same time, the elderly have certain issues unique to them – they are more frail, they need a longer time to get out of bed, they need help to go to the toilet, they get dehydrated easily. A fever could lead to delirium.

We train our nurses to watch out for such signs, and they use certain techniques to help them manage some of these issues rather than use restrainers. We try to do these things so that we can provide a better experience and treat the root problems of the elderly conditions.

We also look at a new way of learning which is pretty common now for a lot of institutions, called micro-learning. We put bite-sized learning materials into the hands of individuals and allow them to learn at their own pace and time.
Recently we tried it out with what we call safe management of patients. We were looking at managing patients who are a bit aggressive and violent, maybe due to the nature of their condition – perhaps they are not of sound mind due to trauma or dementia. They may try to bite or strangle the nurses.

We wanted to train our nurses to manage such situations. For example, how do you distract them? How do you have a conversation to help them, and how do you lower a certain level of aggression?

We put these lessons in a bite-sized form, and complemented them with physical training. We’re also going to put them on our mobile micro-learning platform.

Do you have any tips for hospitals in the region wishing to upskill their nurses?

My tip would be to modularise your training materials. Make them bite-sized, around five to ten minutes on topics that they can pick up fairly fast. And then if you have only 10 minutes, perhaps you could quickly run through some of the basics in two to three minutes and allow five minutes for your nurses to practice.

For instance, while you are doing roll call, you can get them to practice how to release a stranglehold, for example. These kinds of things do not happen all the time, so staff may lack practice. When it is time for reminders, you can do it over roll call and won’t have to pull people into classes. This is useful if you do not have the digital platform for it.

That's one of the reasons why we do micro-learning, so that they can pull up the materials as and when they need to refresh their skills.

Tell use more about the leadership and engagement programmes at your hospital.

We believe that we need to harness the potential of all nurses. We wanted to make sure that we put in leadership practice that enable conversations, so people recognise that there are good ideas around how we can draw out the ideas.

We worked with the organisational development team to train our young leaders - senior staff nurses who are on the brink of becoming nursing supervisors. One example that we tried to do was, how do you conduct meetings? How do you encourage people to speak up during meetings?

And together with the organisational development team, we're trying to also get more tips to our leaders on how to run meetings in a more productive, constructive way. So this is to make sure that we continue to harness the ideas and potential of every individual.

We put our young leaders through leadership training to enable them to be more inspiring, to be able to draw to facilitate and enable conversations that allow people to expand their thoughts, or express themselves.

What are some challenges that you are facing in your work and how are you overcoming them?

One challenge is around activating patients or caregivers. There is this tagline that we use all these years, and that is: nurses beyond nursing, nursing beyond nurses. So that means nurses should look at upskilling themselves to go beyond the current conventional work of nursing. And for nursing to be beyond nurses, some of that needs to be passed on to the informal caregivers, as well as the patients.

But we do have to consider more factors, including the patients’ motivations themselves - whether they are motivated to help themselves, or to change their lifestyle. So a lot of work is being done to see whether we can learn how to activate or motivate a patient.

Another challenge is around healthcare innovation. I think the current companies that are in the market focus a lot on medical technology, but not on technology that can help with workflows or change the way we care for people.

For instance, we want a Siri for nurses, so they can use voice-enabled tech to call for help if they are stuck with a clinical process but a patient needs assistance. So technological innovations remain as one of the challenges. Even though we have some ideas, and we see some of the ideas being done in another industry, it is still difficult to implement them in the healthcare industry.

Finally, what is your lunch recommendation in your home city or anywhere in the world?

A family favourite is a restaurant near my home in Singapore, a place on Havelock Road called Liang Kee.

Leading academics from the Asian Institute of Management (Philippines), Kyoto University (Japan) and University of Applied Sciences Neu-Ulm (Germany) will share how to develop leaders within the organisation during the Talent Management Stream at Hospital Management Asia on 11-12 September 2019. Download the latest agenda.