Building 21st century healthcare

Liak Teng Lit wants to shake up the meaning of healthcare. Last year the CEO of Singapore’s Alexandra Health Systems oversaw the opening of what he sees as a new model of health provision in the form of the Khoo Teck Phuat Hospital (KTPH), located in Yishun in the north of the island.

With extensive experience in the industry, managing some of the Singapore’s biggest hospitals, Liak takes a somewhat surprising view of the industry: hospitals, he says, are the least important part of healthcare. To meet changing circumstances it is time to move away from being so hospital-centric.

In a recent wide-ranging talk to an SAS- NUS Business School alumni breakfast, Liak laid out what he sees as the challenges to building a 21st century health care delivery system.

On the political side, Liak says it’s a continual battle of the “haves” versus the “have nots.” He describes the two sides as “howling monkeys,” screaming from the top branches of the trees in the jungle.

On the economic side he says it comes down to a simple, lopsided equation – limited supply versus unlimited demand.  Throw in basic human nature – wanting to grab as much for ourselves as possible – and it’s easy to see the flaws in current healthcare system models.

In countries like Britain where health care is funded through taxes, he says the problem is that nobody wants to pay taxes. Liak thinks insurance is even worse because for insurance to work, claims have to be rare and the payout limited. In health care, claims are irregular and the payouts potentially large and unlimited.

He thinks the Singapore system, which mandates personal medical savings accounts but also provides government help for the needy, offers a model others could learn from, delivering healthcare financing that is robust and first world service.

Still, he claims he’s not in the health care business, but rather in the business of treating illness. And he says some doctors have become so sub-specialised in treating certain parts that they’re more of a technician than a doctor.

He would prefer to see health care treat people like cars – send them in for regular servicing and checks for high blood pressure and the like to spot problems early. And he says doctors should establish a good foundation in genomics, biochemistry, and anatomy before becoming a specialist.

The aging population is one of the fastest growing problems for the health care industry. Liak says in about 20 years Singapore will have more than 300,000 elderly, bedridden people, many with dementia.

No healthcare system can realistically accomodate those numbers, he says, so a key priority for him is what he calls “aging in place,” allowing patients who are bedridden and frail to be cared for in their own home in a comfortable and familiar environment, and even dying there with dignity.

Currently the hospital has about two dozen nurses looking after a few hundred patients this way, and the hospital provides a call center to give the nurses access to doctors, staff and other support they need.

Inevitably, though, someone is going to need a hospital – and Khoo Teck Puat Hospital is one of the newest and most patient-centric hospitals in Singapore. Liak, who was involved from the beginning in the planning and commissioning of the facility says they told the architect to design it with the patient – not the doctors and nurses – in mind.

hospitallake280The planners picked up innovative design ideas wherever they found them, borrowing not just from other top hospitals but also from cruise ship companies, automakers, hoteliers and others.

The result is an open, energy efficient facility, with lush gardens, comfortable outdoor seating areas and plenty of natural light and ventilation.

A key directive was to make it a place where the patient would never get lost.

“When they step in, 10 meters they get the emergency department, 20 meters they get to a clinic, and the furthest point is 100 meters, you get into the ward, the lift lobby.”

And if they didn’t get it right, there’s a push-button feedback terminal. Patients can push a smiley face or un-smiley face to rate the service. If they’re dissatisfied, another screen will pop up that will let them explain the problem in more detail.

The hospital also tries to be a good neighbor to the surrounding residents. The designers worked with government agencies on a joint project to turn an unattractive pond next to the hospital into a health-promoting park. It’s now popular with joggers and exercisers and attracts birds and other wildlife.

On top of the hospital itself, many of the rooftops have been turned into gardens. Not only do they hide the air conditioning ducts and other machinery from view, some of the gardens yield fresh herbs and vegetables that are used at the hospital or sold to staff and neighbors.

The inclusion of so much green space can hardly be a coincidence with Liak at the helm. The environment is one of his big areas of interest outside of healthcare. He’s the chairman of the Public Hygiene Council and refers to himself as the “chief rubbish collector” of Singapore.

He jokes, but it’s serious business. While the SARS epidemic a decade ago may be a fading memory, Liak worries about the next pandemic, which he fears could hit Singapore without warning.

“We are an air hub. Every year 50 million people fly to our airport. So anywhere an outbreak happens, before you know it, it will be here,” he said.

Even as he worries about that, Liak is overseeing construction of the next piece of the healthcare puzzle in the northern region. It’s Yishun Community Hospital currently taking shape next to KTPH. It will be open in 2015, and Liak says it will be even greener than KTPH.

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