"FROM GUINNESS TO BRIGHAM"
My first encounter with the KK
Hospital was in 1984. I was then given the task to start up the
newly built NUH.
From KKH to NUH
I went to the KKH to consult the
late Prof SS Ratnam. His reputation was awesome and as a young
officer, I went to the meeting with some anxiety. But he quickly
put me at ease; in fact we hit it off very well. Our first
positive encounter eventually led to a long and productive working
relationship in NUH.
It helped ensure a smooth transfer
of the University O&G Department from the old KKH to the new NUH.
From NUH to KKH
Later, when the government decided
to restructure the other public hospitals, my involvement in this
assignment eventually led me to KKH as its CEO in 1990.
During that posting, I became
involved in the planning of the new KKH and chaired its Hospital
Planning Committee. One basic issue which we had to address was
whether it was still appropriate to build a maternity hospital in
From Mother to Child
It was divisive, with many holding
different and strong views. Many were against a hospital solely
devoted to O&G, as some patients might have other medical problems
and would require multiple specialists for joint management. The
positive experience of the new O&G Department in SGH led by Prof
Charles Ng lent considerable weight to this school of thought.
But the past reputation of KKH as a
maternity hospital tilted the debate somewhat. The KKH brand name
was considered too valuable to be diluted by other medical
specialties if it were to become a general hospital. After all,
which other Singapore hospital has the honour of a place in the
Guinness Book of World Records? More significantly, the KKH name
was associated with the first IVF baby and many other
breakthroughs in O&G. Prof Ratnam's Unit was a mecca for doctors
and clinician scientists. KKH was on the world stage, synonymous
with excellence in O&G.
The paediatricians joined in the
debate. Unlike the obstetricians, they were unanimous in arguing
for a Children's Hospital in Singapore. They advanced a clever
argument that adding a Children's Wing to an O&G hospital would
help realise their dream, besides bringing other medical
specialties to the women patients who might need them. That
settled the debate. Hence, the KK Women's & Children's Hospital
Keeping Our Roots
But we made a conscious decision to
retain "KK" in the naming of the new hospital. Through these
initials, we keep the historical linkage to our roots.
I played a part in planning the new
KKH. It is a beautiful hospital with an efficient layout. But we
made our share of mistakes. We had not fully anticipated the
significant drop in birth rates. In particular, we failed to
anticipate that Medisave would lead to more births in private than
in public hospitals. Unlike the past when practically every
Singaporean was born in a public hospital, Medisave made it
affordable for many mothers to deliver their babies in private
The combined effects of these two
structural trends have resulted in the new KKH being under-utilised.
Bed occupancy is about 65%, below average. Number of babies born
is one-third what it used to do.
The question is where do we go from
here? One obvious response is to fight and win back our obstetric
market share. This means fighting with the private hospitals for a
share of a shrinking pie.
What for? As a government, we
should be pleased that Singaporeans are finding private obstetric
care affordable. Then our limited resources can be re-deployed to
serve more pressing needs, like oncology and geriatrics, where
patients may not be able to afford private hospital care. Time to
At the same time, when we look
beyond O&G, we see women living longer and presenting with many
conditions which require our care: osteoporosis, oncology,
geriatrics, strokes, etc. Their needs beyond O&G are growing and
contribute to the crowding in the general hospitals. See the long
waiting in TTSH Emergency Department as an example.
So I suggested to Dr Ivy Ng that we
rewrite the mission of KKH to go beyond O&G. Besides the
Children's Hospital which should continue to benchmark against the
likes of the Boston's Children's, let's also aim to be the best
hospital in Asia for women's health, serving all the healthcare
needs of women as well. A good model for this development is
Boston's Brigham & Women's Hospital. Let's be the Brigham's of the
East. In Asia, there isn't quite such an entity yet and we have
the potential to fill this gap.
It struck an immediate chord among
the clinicians there. They were seized with it and were ready to
charge ahead. I was infected by their enthusiasm. I advised them
to work out a practical strategy that allows us to pursue this
incrementally and opportunistically. My side interest is also to
help relieve over-crowding elsewhere, in TTSH and SGH.
After extensive discussions, we now
have a plan to work towards this new goal. KKH will progressively
expand its existing services, adding medical specialties that will
complement its existing O&G services. It will also include
specialties that have the potential to draw international
Over the next few months, the
following specialty services for women will be added or expanded:
the Breast Service, ENT Service, Orthopaedic Surgery and Plastic,
Reconstructive and Aesthetic Services. Once these have stabilized,
new services such as Ophthalmology, Psychological/Psychiatric
Services, and Adolescent Medicine will be considered. With this
full suite of services, KKH will be able to cater to all the
special healthcare needs of women, just as it is already a
comprehensive general hospital for children.
Used to Remaking
I am optimistic that the new goal
can be achieved. KKH is used to re-making itself and thrive. When
it started off nearly 150 years ago, it was a general hospital for
both locals and foreigners. Over the years, it was at various
stages, a hospital for seamen, a police hospital, a pauper
hospital, a war-time emergency general hospital, a women's
hospital, and now a women and children's hospital. But for most of
its long history, it served the needs of women and was hugely
And neonates too. During my term in
KKH, I was particularly struck by the dedication and devotion to
excellence by our neonatologists, led by Dr Tan Keng Wee and Dr Ho
Nai Kiong. Both were some of the most competent, and yet pleasant,
clinical heads I have the privilege of working with. With falling
birth rates, the bureaucratic response would have been a merger of
both neonatal units. But this would have been a disaster.
I kept the two units apart, so that
both could continue to compete, not in a silly destructive way,
but compete to produce the best results for their patients. They
pushed the frontier of neonatal care and as a result, I believe
KKH is now among the best in neonatology in this region.
At the same time, our
paediatricians are diligently converting their dream of a hospital
for sick children, to reality: advanced care that matches some of
the best elsewhere, yet very caring and holistic. Singaporeans
should be very proud of our Children's Hospital which has an
expanding international patient base.
Leader in the East
KKH has strong and deep roots. It
has good genes to be able to grow into a mighty institution. It
can be a world leader, for example, not only in conjoined-twin
separation surgeries, but also to help the patients lead as normal
a life as possible, through proper rehabilitative care. It can be
a world leader in all aspects of women's and child health.
Besides medical excellence, we must
particularly up-hold our high ethical standards. Prof Ratnam used
to lament at unnecessary caesarean sections. He suggested to me
that we should equalise the consultation fee for delivery, whether
it was vaginal or caesarean. I thought it was a sensible idea and
NUH became the first public hospital to do so. I hope this is now
the standard model for charging deliveries, at least in public
Prof Ratnam also taught me the
importance of peer review and transparency in both clinical and
But we were not perfect. Once, a
colleague in the mortuary made a mistake. He released the wrong
dead baby to a couple. The baby was duly buried. Soon after
burial, we discovered that the baby actually belonged to another
couple who had earlier decided not to claim the body. The second
baby was still in the mortuary.
It was a devastating discovery for
us! But we did not take long to decide that we should come clean,
admit the mistake, make amends and change work procedures to
ensure that such mistakes will never recur.
For those of us who went through
the trauma, it was an enduring lesson in the importance of living
by our high ethical standards. I hope that over time, more of
these little anecdotes will emerge and join the KKH institutional
memory. That is how values get transmitted; that is how great
institutions are built.
With rapid advancement in medicine
that allows us to do ever more for our patients, healthcare
professionals will face ever greater ethical, philosophical and
even religious challenges. Just because we can, does not always
mean that we want to. It takes considerable wisdom to know when to
intervene and when to let go. There will be many questions that
past generations of healthcare professionals never had to
confront, but you will have to answer. Having strong and deep
ethical roots will help you resolve the many dilemmas you will
The Best Is Yet to Be
KKH was one of the great
institutions before. It has what it will take to be among the very
best in the future. Adapt to the changing needs of the patients
here and in the region. Serve them well. Be guided by strong
principles and ethical standards.
Work at it and good luck.
www.moh.gov.sg Newsroom 10 Jul 2005