Nurses on the frontlines of care and innovation

By Ming En Liew

In Singapore’s Tan Tock Seng Hospital, nurses aren’t just working tirelessly on the ground caring for patients. They’re also toiling away behind the scenes finding new and inventive ways to improve care and efficiency.

At the Nursing Innovation Bunch, nurses lead the charge to develop new and innovative ways to improve work efficiency and patient care. Image: GovInsider

The role of nurses is manifold. Beyond being caretakers, they often also take up the mantles of patient advocacy, patient education, administration, emotional support, and more. In Singapore’s Tan Tock Seng Hospital (TTSH), nurses don an additional hat as innovators.

The hospital is home to the Nursing Innovation Bunch (NIB), a group dedicated to creating novel solutions to address the day-to-day pain points identified by hospital staff. The NIB was established in 2020, and joins other innovation initiatives like the hospital’s Centre for Healthcare Innovation Living Lab to bring the ideas of nurses, healthcare workers and other allied health professionals to life.

As its name suggests, nurses are the main drivers for innovation in the NIB. The group is responsible for guiding their fellow nurses through design thinking processes and supporting their product prototyping at the Living Lab. They also assist project teams in seeking funding , and the testing of solutions within the hospital’s dedicated experimental wards if necessary.

GovInsider sits down with a group of these nurses to understand how their work intertwines with their role as caretakers, and why innovation is key to better patient care.

Innovation in unlikely places


“Many of the solutions that healthcare needs, need not come from healthcare,” says Christopher Soh, Deputy Director of Nursing at TTSH.

For instance, inventory-related issues can be solved by turning to the dry cleaning industry, which has been using RFID (radio-frequency identification) technology to track their supplies for more than 20 years, he explains. RFID works much like barcodes or access cards, where an item is tagged and can be scanned for identification.

In another instance, a mobile game originally designed to show appreciation for nurses became the springboard for a game that helped with the care of geriatric patients suffering from dementia, once the NIB laid eyes on it.

The original mobile game was created by students from Singapore’s Nanyang Polytechnic for Nurses Day 2022. It was designed as a way to help nurses destress from their physically and mentally demanding jobs, a spokesperson from the polytechnic told GovInsider.

“We wanted the game to be simple, yet meaningful, for them,” they added. As such, the mobile application comprised three different games that referenced traditional Singaporean childhood games, such as Scissors, Paper, Stone or Country Eraser – where erasers with country’s flags on them would try to flip their erasers atop their opponent’s to ‘conquer’ their flags.

 Singaporean childhood games like Five Stones and Country Eraser were adapted into a mobile game and are being used by NIB to engage geriatric patients with dementia. Image: Old School Delights/Facebook

But when staff from the NIB saw the game, they realised the potential it had to help patients as well. James Tan, Nurse Manager at TTSH, explains that games like matching mahjong tiles can help to improve dementia patients’ memory, for example. Using the tablet to play such digital games can also help with their hand dexterity, he adds.

Today, the app is being tried as part of reminiscence therapy for geriatric patients. This form of therapy involves invoking pleasant memories of patients’ childhood, while stimulating their cognition to reduce the risk of dementia.

Simple innovation


Innovation doesn’t have to be rocket science, Soh says. A simple solution the NIB developed to help patients tell apart individuals dressed in personal protective equipment is one example of this.

During the pandemic, patients were left in helpless situations where they were unable to identify doctors or nurses when they needed assistance. Meanwhile, healthcare workers themselves were wasting time trying to identify the colleagues they were looking for.

“It’s really frustrating when we have to work with various people…but we didn’t know who was who,” says Lim Mei Ling, a Senior Nurse Manager at TTSH.

Seeking a solution, the answer came in the form of the humble tape. Staff from the NIB devised a system in which different coloured tapes represented different roles. Blue, for instance, would indicate that the individual is a staff nurse. These tapes would be pasted on top of their outfits, so that they’re easily identifiable from a distance.

While simple, the tape system actually came about as a result of much deliberation. Initially, the team had considered using coloured shower caps. But in the middle of a pandemic where medical supplies were scarce, Soh recognised that shower caps were in limited supply. True enough, coloured shower caps were later sold out nationwide, reaffirming their decision to use coloured tapes.

This simple solution helped to improve staff productivity during the pandemic, as they no longer had to waste time walking around trying to identify different staff members. This allowed them to spend more time on higher-value tasks, like caring for and interacting with patients, Lim adds.

It even helped with contact tracing at the peak of the pandemic as it allowed hospital staff to identify individuals through CCTV footage, Soh says.

Testing in real-world scenarios

The Smart Ward appears to be an ordinary ward on the surface, but functions as a testbed for nurses and other healthcare professionals to try out new innovations before rolling them out for wide-scale implementation. Image: GovInsider

“It’s really because of our patients that we have so many medical and surgical technologies,” Lim says. There is, after all, no point in trying to create new processes if it does not bring increases in productivity or benefit the patients, she elaborates.

But it can be difficult to determine the success of a new innovation without having the opportunity to try it out in a real-world scenario. “You can only view and see the whole end in mind at the wards,” Lim explains.

This is why it is important for the hospital staff to have a platform like the Smart Ward, which Lim heads. As a fully-functioning ward with patients, the aim of the Smart Ward is to try everything, Lim explains. It functions as a testbed for hospital staff to try out various innovations, from new technologies to process change.

Once new technologies are approved for testing by Singapore’s Health Sciences Authority, they proceed to the next stage of testing at the Smart Wards. There, different healthcare staff will try out the innovation, provide feedback, and work to improve on it.

Technology as an enabler

The automated bed turner can relieve nurses from the laborious task of turning bed-ridden patients, allowing them to focus on higher-value tasks like patient advocacy. Image: GovInsider

“The Smart Ward sounds like it’s all about technology, but I like to disagree with that,” Lim says. “Technology is our enabler, it’s our extra pair of hands.”

The Smart Ward is, for example, testing out an automated bed turning device. Traditionally, two nurses had to turn bed-ridden patients every two hours to prevent them from getting bed sores or skin irritations from lying in one position for extended periods of time. With the automated bed turner, the task now only requires one nurse to be present.

Nurses will still be present to change the patient’s diapers, assess their skin, and converse with the patients, Lim explains. But technologies like the bed turner can help alleviate the manual labour required, allowing them to spend more time interacting with each patient instead.

Another piece of technology making rounds in the Smart Ward is a robot the nurses have affectionately named Peter. Peter can help to serve food to patients and even sing them birthday songs, Lim shares. Whereas two nurses were previously required to push dining carts around the wards to distribute food, with Peter’s help, only one nurse is needed.

“The idea is not to use automation and robotics to replace humans,” Soh says. “It’s to augment humans, so that they can spend more time and manpower on value-driven tasks.”