Supporting our Healthcare Providers: The Singapore Experiment · Supporting our Healthcare Providers: The Singapore ... CIMA 2011 Conference. Temasek Singapura Singapore Lion City

Supporting our HealthcareProviders:

The Singapore Experiment

Kokpeng LimTrauma Recovery &Corporate Solutions,

CGH

CIMA 2011 Conference

TemasekSingapuraSingaporeLion City

“The Little Red Dot”World Atlas: 2nd densest country in world 7197/sq km

• Total land area = 692.7km2

(267.45 sq miles)• Population (~ 5 million):

– Chinese: 76.7%– Malay: 13.9%– Indian: 7.9% Indian– Others: 1.5%

• Religion:– Taoist: 31%– Buddhist: 28%– Muslim: 18%– Christian: 10%– Hindu: 4%

• Official languages: English,Mandarin, Malay, Tamil

• General Literacy rates(>15y/o) (2002): 93.7%

• Unemployment rate: 4.4%

http://en.wikipedia.orgwww.stb.gov.sg

Strategic LocationMajor air and sea crossroads2nd busiest portTrans-shipment hub

http://en.wikipedia.org

Multi-cultural Festivals

Healthcare: HospitalsThe Straits Times 6 Nov 2011

Private Sector 7 Acute Hospitals

Beds: 1466

Public Sector

7 Hospitals: 5 Acute, 1 Women’s & Childrens’,1 Psychiatry

Beds: 6871

Staff: Approximately 13,000

Copyrights ©CGH 2011

Supporting Our HealthcareProviders: The Beginning

Peer Support was initiated in

Changi General Hospital

Dec 2002

15 volunteers

Trained in: Individual Crisis Intervention & Peer Sp

Group Crisis Intervention

Plenty of Passion!

……and then…..


SARS Mar 2003• 238 Cases (33 deaths)• HCWs = 40.8% (97)• Source of Infection = 73.5%

Healthcare Institutions• Crisis of Fear!

• CGH Peer Sp Volunteers:• Mgt Consultation• Strategic Planning• Defusing• 1-on-1 (PPE):

• Ward Staff• Quarantined Staff

• Respite Centre• Other hospitals relied on

Medical Social WorkersA WAKE UP CALL! Copyrights ©CGH 2011

Post-SARS:Growing concern… Medical Teams deployed for Disaster Sp

Asian Tsunami

Gunong Merapi …

Disease outbreaks and Public Health related issues

Recurrence of SARS, Pandemic Flu preparations, H1N1…

Mass casualty situations…

Threat of terrorism

…Final booster….


MOH Mental Health Blueprint(2007)

National Mental Health strategy Initiatives in areas of mental health promotion and

prevention, integrated mental health care, mental healthmanpower development and research

Emphasis on mental health education

Early detection and intervention

Training/equipping of mental health professionals

Partnership with stakeholders

Provided political and government emphasis onmental health/wellness issues

Provided funding!


Staff Crisis Management System2008-2012 (5 Years)

Aim: Set up a self-sustaining peer supportprogramme in the 7 public hospitals

Target: 10% healthcare workers in the publichospitals (approx 1300 peer supporters)

Objective: provide emotional support, helpbuild resistance, resiliency and recovery in theevent of any work-related critical incidents inpublic hospitals


Staff Crisis Management System2008-2012 (5 Years) PHASE 1 (2008) - Introduction

Establish Project Office Obtain buy-in from hospital management Hospitals to identify hospital coordinators Initiate peer training (ICISF and train local trainers)

PHASE 2 (2009) – Build Internal Capacity Train-the-trainer programmes for hospital coordinators Develop hospital PSP structure & SOP for staff support Encourage hospital ownership of the PSP

PHASE 3 (2010) – Self Sustainability Hospital budget for PSP Internal hospital capability to train peer supporters Streamlining and making SOPs operational

PHASE 4 (2011 onwards) – Integration & ContinuityCopyrights ©CGH 2011

Ng Teng FongHospital (2013)

18 Polyclinics

Staff Crisis Management SystemOrganisation

SCMS Project Office/TRaCS, CGH

Specialist Centres


Where We Are NowPhase 4: Integration & Continuity

PSP structures established in 7 Hospitals

Crisis Coordinators and Dys appointed

Team Leaders: 102/(125)

Peer Sp Vol Recruited: 1356/(1200)

Hospital PSP SOPs implemented

Participated in Hospital EmergencyPreparedness Exercise (Mass Cas, DiseaseOutbreak, Radiation)


Peer Support Skill Training

Peer Supporter Basic Skills

Individual Crisis Intervention & Peer Sp

Mental Health First Aid (MHFA)

Team Leaders

Basic skills


Suicide Prevention, Intervention & Postvention

Advanced Group Crisis Intervention


Peer Support Skill Training

Hospital PSP Co-ordinator Basic skills


Suicide Prevention, Intervention & Postvention

Advanced Group Crisis Intervention

Strategic Response to Crisis

Trainer for Individual Crisis Intervention & Peer Sp

Mental Health First Aid

Regular refresher training, updates and relatedcourses for peer volunteers


Peer Training Status (Aug 11)

Peer Sp Vol Trained

Individual Crisis Intervention : 1032

Group Crisis Intervention : 121

Advance Group : 53

Suicide : 82

Strategic Response : 25

Mental Health First Aid : 1142


Continuity: Self-sustainability Training material – MoA with ICISF & MHFA

to localise and print

Trained Trainers in 7 Hospitals ICISF Individual :17

ICISF Group : 3

ICISF Adv Group : 2

ICISF Suicide : 2

ICISF Strat Resp : 2

MHFA : 24

Hospital Mgt commitment to fund the PSPafter SCMS funding period (end 2012)


EVALUATION:PSP UTILISATION STATISTICS2009 - Aug 2011

Peers provide post-support feedback toHospital Coordinator

For admin accountability

No names

Type of critical incident

Type of intervention used

Category of staff supported


PSP UTILISATION STATISTICS2009-Aug 2011

Total

Type of Intervention

Ind 1 on 1 Formal 589

Ind 1 on 1 Informal 967

Defusing 14

CISD 17

CMB 70

Individual 1 on 1 InterventionFormal = 37.9%Informal = 62.1%

Group InterventionDefuse = 34.1%CISD = 41.5%CMB = 24.4%



Total

Activated By:

HOD/Sup 311

Self 632

Peer Supporter 122

PSP Tm Ldr 117

Colleague 131

Activation MethodHOD/Sup = 23.7%Self = 48.1%Peer Supporter = 9.3%PSP Tm Ldr = 8.9%Colleague = 10%



Total

Supported Staff

Nursing 772

Allied health 227

Admin 151

Ancillary 179

Medical 82

Supported StaffNursing = 54.7%Allied Hlth = 16.1%Admin = 10.7%Ancillary = 12.7%Medical = 5.8%


Total %

Work Stress 445 30.0

Family 257 17.4

Assault 166 11.2

Conflict @ work 160 10.8

Health related 129 8.7

Performance 78 5.3

Others 78 5.3

Work Investigation 57 3.8

Sudden Death 52 3.5

Accident 30 2.0

Harassment 14 1.0

Witness Trauma 9 0.6

Threat to life 6 0.4

PSP UTILISATION STATISTICSTypes of Incidents


EVALUATION:Usefulness of PSP training

Survey administered pre- and post- course forthe Individual Crisis Intervention & Peer SupportCse (Jun 2010-Jul 2011)

Survey Population: Total runs = 28 runs

Healthcare = 23 runs

Govt Ministries = 2 runs

Institutes of Education = 3 runs

Participants = 521 pax

Does the Individual Crisis Intervention & Peer Sp Cseimprove Resiliency?


Does the Individual Crisis Intervention& Peer Support Cse improve Resiliency?

Survey questions provided by Dr George Everly: I am confident that I will be able to deal efficiently with

unexpected events.

I am inclined to seek emotional support from friends and family.

I try to look for something good in a negative situation.

I will be inclined to take things in my stride.

I will be able not to dwell on things that I can’t do anything about.

I believe I will be able to adapt to change.

I believe I will bounce back after an illness or hardship.

Scoring: 5 point scale: 1 (Not at all) - 5 (A great deal)

Scores 1-3 = Negative; Scores 4-5 = Positive


Does the Individual Crisis Intervention& Peer Support Cse improve Resiliency? Survey Data Jun 2010 – Jul 2011

Question Pre-cse%

Post –Cse%

Difference%

1. I am confident that I will be able to dealefficiently with unexpected events

33.78 66.99 +33.21

2. I am inclined to seek emotional supportfrom friends and family

52.98 68.33 +15.35

3. I try to look for something good in anegative situation.

58.16 84.84 +26.68

4, I will be inclined to take things in mystride.

44.15 66.99 +22.84

5. I will be able not to dwell on things that Ican’t do anything about.

36.08 69.67 +33.59

6. I believe I will be able to adapt to change 70.44 84.45 +14.01

7. I believe I will bounce back after an illnessor hardship

70.63 84.07 +13.44


Sustaining the Drive… We need Critical Incidents to sustain Ministry and

Hospital Mgt interest!

Ministry Programme Mgt Ministry Endorsement & $$$ A credible champion – volunteer/volunteered Clear objectives and organisation Road map for peer skills training and upgrade Confidentiality: practice and perception

Hospital Mgt Senior Mgt support and ownership Middle and Line Managers trust Publicity, education & buy-in – peer volunteers & staff

acceptance


Sustaining the Drive…

Hospital Peer Support Programme

Recruitment and sustaining the interest

Scheduling training time

Retaining the peers

Evaluating the system….focus on the 3 Rs

Impact of peer training

Utilisation of PSP services

Supported staff feedback

External evaluation


What’s Next…?

Expand PSP to the other public healthcareinstitutions e.g. Polyclinics, Specialist Centres

PSP in other Ministries

…..moving peer support and CISM traininginto the Singapore private sector workplace


Documents

Supporting our Healthcare Providers: The Singapore Experiment · Supporting our Healthcare Providers: The Singapore ... CIMA 2011 Conference. Temasek Singapura Singapore Lion City