Meet the nurse who led an innovation movement in a Singapore hospital

By Ming En Liew

A nurse’s humble journey of spearheading an innovation movement within a hospital, and her dreams of bringing this spirit of innovation into the community.

Ho Pei Wah Laura, Deputy Director of Nursing at Tan Tock Seng Hospital, won the Exemplary Leader Award at the COVID Public Sector Transformation Awards Ceremony this year for her work in leading nurses in the battle against the pandemic.

‘Innovation’ – with this one word, what comes to mind?

Perhaps it’s the numerous inventions that have changed our world for the better. The ubiquitous light bulb that allows lives to continue even after the sun sets; the smartphones that today have become an encyclopaedia, dictionary, telephone, and more; or the planes that allow us to travel across the world in mere hours instead of months.

Innovation, however, doesn’t always need to be revolutionary. For Ho Pei Wah Laura, Deputy Director of Nursing at Tan Tock Seng Hospital (TTSH), innovation is “prudent”.

“I wasn’t born from a silver spoon,” she told GovInsider. With limited resources at home, she watched her mother come up with inventive and frugal ways to address day-to-day grievances.

Raffia strings became makeshift window grills when her mom strung them across their flat’s windows to prevent birds from flying in and stealing food; while recycled materials were sewn together to create a trendy school bag when a young Laura was envious of her friends having fancy bags in school.

“Innovation, really, should not start with high costs,” she says.

It is this humble perspective of innovation that Ho is bringing to the halls and wards of TTSH.

Simple innovations to make a difference

Ho was one of the pioneers seconded to TTSH’s Kaizen Office when it was first incepted in 2008 – a department named after the Japanese philosophy of continuous improvement, with a mission to improve processes in the hospital through innovation and design thinking.

“They needed a nurse who had that knowledge and insight because we know many of the operational processes,” she explains. It is this awareness of the numerous workflows in the hospital that allowed Ho and a fellow nurse to devise ingenious, yet simple, ways to improve efficiency in the hospital.

With just cardboard at their disposal, Ho worked with her team to design a makeshift trolley that could hold up to six sets of patient case notes each. These trolleys were stationed at each ward cubicle.

Previously, doctors kept their case notes in a central trolley that was wheeled around the wards. Every time a doctor had to check on a patient, they spent time searching for where the trolley was on the floor, Ho explains. With this nifty invention, doctors no longer wasted time walking around searching for their case notes.

The trolleys went on to see 20 years of good use by doctors, and have just recently been phased out as hospitals made the switch to electronic medical records.

The invention of these trolleys also sparked a shift towards decentralisation in the hospital, as nurses also decided to station storage cabinets in individual wards rather than at a central location. These cabinets contained regular consumables that patients often needed, like diapers, so that nurses could easily access these items without needing to leave the ward.

Such a change improved patient safety on top of efficiency, Ho says. “If the nurse walks out [of the ward], patients are out of the line of sight,” she explains. But this change introduced new challenges as well, one of which was the need for a nurse to now have an additional role of topping up each of these six cabinets.

“Apart from fabricating, brainstorming, or innovating a prototype, we also have to refine our workflows,” Ho says. This is where the team looked at role redesigns within the healthcare team to maximise efficiency and maintain patient care standards. Rather than having a nurse fulfil these duties, they instead delegated it to the hospital’s custodians.

“[Innovation] cannot be a silo,” Ho says. “It’s important to involve more stakeholders in the co-creation process.”

An ecosystem of innovation

Ho has been at the forefront of inculcating this spirit of innovation across all levels of hospital staff from the onset – from nurses and doctors, to housekeepers and senior management. 

“When you’re in the Kaizen Office, you’re not wearing a nursing hat anymore,” she says. “You have to change your hat to reach out to all of TTSH’s population.”

Ho worked with a fellow nurse to develop a training curriculum to equip others with the relevant skills for problem-based innovation, like the Lean methodology. This is a set of principles often used by businesses to guide their improvement process.

“We used the ‘train the trainer’ approach, because we have more than a thousand staff, and it can’t be us training the whole hospital population on our own,” she explains. They worked with heads of departments to identify those keen to participate in this movement, and facilitated a series of workshops that will allow them to pass on the knowledge to their peers.

This meant having to cater to staff of all educational levels and language preferences, Ho says. The team had to find ways to conduct the sessions not just in English, but also in other languages like Hokkien or Tamil – whether by themselves or by bringing in external trainers.

Another factor of consideration was the staff’s work schedule, Ho says. These training sessions often had to be done over the weekends, as some staff cannot simply take time off from their duties since they had to care for patients.

These sessions combine a mix of classroom sessions and practical training, where participants would identify an area of waste or inefficiency and brainstorm ways to improve it. They would also be encouraged to showcase these ideas to their supervisors and the hospital’s senior management staff.

“We celebrate the success with them, and allow them to showcase themselves so they take pride in what they’re doing,” Ho says.

Innovator at work, nurse at heart

But while Ho’s role today has evolved beyond just clinical duties, she remains a nurse at heart and keeps her nursing hat close by. “Whenever I have little pockets of time, I will still go up to the wards and catch up with the nurses,” Ho says. In times when there is a shortage of manpower in the hospital, Ho will still change into her scrubs and join the nurses in their work.

“If it’s for patients, you need innovations that can sustain them from hospital to home.”
- Ho Pei Wah Laura, Deputy Director of Nursing, Tan Tock Seng Hospital

An important part of patient care is being able to extend that care beyond the four walls of the hospital. “If it’s for patients, you need innovations that can sustain them from hospital to home,” says Ho.

“My hope and dream is that we should have more nurses in community nursing to manage patients [there],” Ho says. It’s very destructive to both patients and family members when a loved one is admitted to the hospital, she adds.

In delivering care to these community patients, Ho also says that she is frequently inspired by their ingenuity.

One patient that she visited had devised a way to tie bottles of cold water to the back of the fan, so that the fan would blow cool air instead. Others would use metal chopsticks to change wound dressings and disinfect these chopsticks by boiling them, as opposed to using the disposable forceps typically used by hospital staff which cost more.

Innovation for the future

With an ageing population in Singapore and a global shortage of nurses, Ho recognises the importance of innovation in preparing for the future.

Beyond simple process changes and modifications to existing tools, she is keen to look into how technology can come in to augment the work of nurses. Automation and AI, for instance, can help to alleviate the workload of nurses by taking over some of the menial and repetitive tasks that nurses currently do, like keying in records, Ho explains.

This will then help to free up the nurses’ time to do more valuable tasks like spending time with the patients and their families, she adds.

Ultimately, Ho’s passion for innovation can easily be traced back to her motivations for becoming a nurse in the first place – the component of caring. As a nursing director, the name at the front of her title is still “nursing”, she emphasises. It is with this in mind that she continues to pave the way for innovation in the hospital, led by a desire to improve the work of her fellow nurses while ensuring they can best care for their patients.