Focus group at the hospital
It seems like I'm creating a recurring column about my hospital stories from Singapore, but this time I didn't visit the institution as a patient. Well, technically I did, but not as a patient in need of medical attention, but rather as a feedback-giving patient.
Since I had interacted with the local Alexandra hospital as both a patient and a family member within three months, I was included in a statistical sample and invited to participate in a focus group discussion on a Saturday morning. I have organized countless focus group discussions myself, and I know how difficult it can be to gather interviewees. So, I immediately said yes, and besides, I had something to say, since my daughter and I are practically regulars there.
An agency handled the organization, and they clearly didn't leave anything to chance. They called me about a week before the event, and then messaged me on WhatsApp every few days (everyone uses WhatsApp here, even the government and officials communicate through it). On Friday evening and Saturday morning, I received a message asking if I was coming.
The Saturday morning message literally said, "you're on your way, right?" I replied that I wasn't yet, since I live a 10-minute walk from the hospital, but would it count if I was just preparing my coffee at home? They replied, "Of course, enjoy your coffee!"
Compared to this, it's worth taking a look at the parent institution, the National University Hospital, which is just 4 bus stops away from here. It's a mega-city with logistics that rival an airport.
Ten people were called to participate in a focus group on a Saturday morning, including Chinese, Malays, and Indians in roughly the same proportion as the general population. There were both older and younger participants, with slightly more women than men. Each person was given a name tag with their first name and there was coffee, tea and cookies available on a buffet table throughout the two-hour group interview.
In addition to two representatives from the research company conducting the interview, there were also three high-ranking employees from the hospital present, all of whom were women. The highest-ranking of the three was responsible for development and shared that the entire hospital would be rebuilt by 2027, essentially creating a new hospital while preserving the colonial-style main buildings. The purpose of the group was to collect feedback from patients and their families who have been through the hospital and to incorporate this feedback into the design of the new hospital.
It seemed that this was much more focused on the interaction between staff and patients/family members and only secondary to the physical environment, as architects and designers were not present. For example, the chief of the admission area and the head of the emergency department were present instead.
The discussion mostly centered on the experience of using the Urgent Care Unit from the perspective of patients and their accompanying family members. As everyone had been in either one or both roles, everyone had a lot to say.
They showed pictures of the entrance and discussed different arrival scenarios, such as arriving by ambulance, taxi, car, or on foot. What exactly happens to you? Who do you meet first? How do you know where to go? How long can you stay with your family member? How do you stay in touch? Who informs you, what does the patient know, what does the escort know?
During the COVID period, it was clear that only the patient could enter the hospital. Now, one accompanying person is allowed, but they are not allowed into the examination rooms (unless it is a child, as in the case of my daughter), and family members sometimes have to wait for hours in uncertainty (as it is an emergency).
They discussed how it could be improved. Should more people be allowed in ("then half the 'kampong' will crowd there")? What kind of information should the family member receive and from whom? Where can they wait? Should it be furnished? Since waiting times can be long, many people said that a phone charger was the most important tool, as doctors and patients can contact them through it. The hospital plans to install large tablets on the beds, on which the patient can video call their family member with a single button press. However, everyone present said that it would be a good second solution, but they prefer to be able to go to the bedside in person regularly. Many of them were elderly themselves, caring for their husbands or even older parents who may have dementia. They explained that in a crisis situation, the first few hours are critical because the patient is just regaining consciousness and doesn't know where they are, and there is no familiar face to help stabilize the situation.
The other technological idea package was related to asking for help, specifically related to emergency calls (i.e., ambulance calls). They showed a demo video in which the husband fell ill during breakfast and the wife asked for help by pressing buttons on a tablet, providing the most important symptoms and immediately consulting with the hospital's triage department on video. Based on the information received, the ambulance is already instructed, but if they come on their own, the bed and treatment team are also ready for the situation. Interestingly, we both rejected and supported this idea in equal numbers. I was one of the rejecters. The preparation of the bed and setting up of the team is in order, but I also agreed that in such a collapsible emergency situation (because in the video, the guy practically collapsed at the breakfast table), pushing the first step onto the desperate wife, who is frantically mistyping everything with shaky hands, is not the best move. In a worse relationship, I can already picture the husband writhing in pain while his wife is scrolling on her iPad or phone. The husband, in pain and anger, yells at her to stop playing Tetris and call the damn ambulance, while the wife won't stop talking about how she clearly told him not to eat all that junk.
In such a situation with a breakdown, it is crucial that someone or something restores a sense of security, that help is coming, and this cannot be accomplished by selecting symptoms from a list, ticking them off, and waiting for a call back to go in. At that moment, people cannot even remember their names, let alone whether their pain is abdominal. I suggested that there should be at least a human body diagram on the screen where they can mark where it hurts with a red dot, not a list full of Latin words.
However, the rest of the conversation was much more about what it's like to come in, register, wait, go through triage, see a doctor, what happens there, how they release you, how to get to the medication, how payment works, etc. Many very specific experiences were shared, there was much talk about languages and cultural differences, but without exception, the comments praised the hospital for how fantastically they handle these things. I agree with this and have written about it before.
This Alexandra Hospital is a small institution on a local scale. It is so small that I did not even know they had an inpatient department. I thought they only provided outpatient care, but no, they even have a rehab department that allows for longer stays. I always only went to the emergency department, then to the X-ray, to the pharmacy from the doctor, and then home. Now that we have gone through the entire complex to the interview room, I have seen how complex it is, with many annexes and departments.
In any case, there was a consensus among the group that we would like the new hospital to maintain the very friendly, family-like atmosphere that is there. Not just the garden and the appearance (it looks more like a holiday complex or sanatorium), but also that there are never any crowds and the attitude is very personal and kind. The same goes for the giant NUH hospital. The physical environment is hypermodern, a glass palace. That building empire conveys the message that all the pinnacle achievements of science and technology are gathered here, and everyone will receive the highest quality care in infinitely protocolled and organized conditions, from the cleaning lady's trolley to the top. What is received in that hospital is almost breathtakingly impressive. But its real value lies in being brought in by the ambulance and feeling like a poisoned mouse running in circles in the midst of nurses, technicians, and doctors, and one of the female doctors takes your hand and says, "Everything will be alright."
The two-hour conversation flew by very quickly. At the end, everyone received a $50 grocery store voucher.
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