Scaling Greater Heights in Patient Care (and Increasing Job Satisfaction) Through Workforce Upskilling

With the changing healthcare landscape, healthcare institutions will need to innovate and upskill our workforce with essential capabilities to keep abreast of these changes. At Tan Tock Seng Hospital (TTSH), we are at the forefront of the transformation journey to improve patient care and experience, which includes studying the future paradigm of healthcare, redesigning care processes, introducing and enhancing automation, and upskilling our workforce with essential capabilities.

Transformation at the Core of TTSH’s DNA

Among the crucial workforce that underwent job redesign and upskilling in the hospital are the Patient Service Associates (PSAs) who play a vital role in our patient care journey. In 2011, TTSH was the first hospital to introduce an exclusive PSA Framework, to empower PSAs to provide value-added services, including basic clinical tasks traditionally undertaken by nurses, phlebotomist, and pharmacy technicians. Traditionally limited to administrative tasks such as registration and billing, our PSAs are now trained to perform basic clinical tasks such as venepuncture and uroflowmetry. To date, close to half of our PSA workforce are trained in at least one basic clinical skillset, on top of their administrative duties.

Greater Role for PSAs in Patient Care Journey

The “PSA for PSA” framework has been well received internally. Our upskilled PSAs feel a stronger sense of belonging and job satisfaction in the hospital with greater empowerment and involvement in the multi-disciplinary care of patient.

Opportunities for Other Professionals to Upskill

With our PSAs taking on basic clinical tasks, it also allows the rest of our workforce (e.g. nurses) to upskill themselves. Similarly, over the years, our nurses have been trained competently to perform tasks on behalf of doctors, such as conducting counselling and/or physical examination for patients in selected disciplines, which allow the nurses to practice at the top of their licenses.

For instance, the nurse-led TTSH Arthroplasty Assessment and Counselling (TACC) Clinic was introduced, where trained nurses conduct individualised assessment and counselling using a Patient-Reported Outcome Measures (PROMs) tool on top of physical examination and measurements on patient’s operated knee. Similarly, nurses in the eye clinic are trained to carry out intravitreal (IVT) injections to better support the doctors in the growing eye care needs of the ageing population. In some clinics, the nurses are also trained to reorder x-rays for doctors. These upskilling efforts have allowed the doctors to focus on patient care, and improved both patient care and clinic efficiency.

Upcoming Opportunities for PSAs at the National Level

This transformation journey was further catalysed with the formation of the Ministry of Health Job Skills and Training (JST) workgroups in May 2022, which looks at the redesign of PSA roles (e.g. PSAs taking on clinical tasks in addition to administrative tasks).

The National Healthcare Group (NHG) and TTSH are leading the outpatient job transformation with representatives from the other clusters to formulate sector-wide strategies, together with the Ministry Of Health Singapore and the Healthcare Service Employee’s Union (HSEU), to ensure better career progression and job satisfaction.

More Structured Training Opportunities

In the new Financial Year, we will see more of our PSAs upskilling themselves to take on basic clinical tasks in different care settings within the hospital. At the national level, we have harmonised the skillsets and competencies of our PSAs across the three healthcare clusters, and worked with Singapore SkillsFuture (SSG) and Continuing Education and Training (CET) Centres to develop structured training programmes specifically for PSAs across all settings to upskill themselves. The Higher Certificate in Healthcare (Operations) and Advanced Certificate in Healthcare (Operations) will prepare our PSAs for the redesigned roles or supervisory roles. These training are accredited by SSG and will be recognised nationally by all public healthcare institutions.

Enhanced Career Progression for PSAs on Redesigned Roles

With the enhanced roles and greater accountabilities, our PSAs will be recognised through an enhanced career development pathway (CDP).

A structured CDP provides a roadmap for PSAs' career advancement with a defined training competencies and required skills and experience. PSAs can now look forward to achieving their career advancement by fulfilling the required competencies or skillsets as laid out in the CDP.

In addition, the job titles of PSAs have been revised to better commensurate with their redesigned duties and the level of work they do. 

With these positive changes at both the national and institutional level, we hope that our PSAs will experience greater job satisfaction and explore true purpose as a healthcare worker.

This article is contributed by TTSH's PSA Framework Job Design & Career Development Workgroup, led by Mr Michael Leow, Head, Ambulatory Operations. The Workgroup is also guided by MOH and HSEU to look at job redesign, as well as developing and implementing a harmonised framework for training and career progression pathway for PSAs across the healthcare clusters.