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Team Excellence Symposium - Healer: MSK Pathways

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shi haiyuan

on 25 September 2012

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Transcript of Team Excellence Symposium - Healer: MSK Pathways

Soldier Performance Centre Musculoskeletal injuries Why are they important? They are common:
1 in 3 seen in Medical Centres They cause attrition:
50% of medical downgrades in the SAF "Top threat to [operational] readiness"
~ US Army Medical Corps *Long waiting times to be
seen by hospital specialists Lack of special imagings in SAF **No specific training in [military]
Sports Medicine for SAF Medical Officers Most Medical Officers are NSFs and
function as general physicians 8,000 full time soldiers referred/year

6 weeks to first appointment on average After a long wait ... <50% of referred
patients receive
special scans What do we have? 32 SAF Medical Centres 5 Physiotherapy Centres Stakeholders involved 2010 Data: 8,000 Referrals to specialists Sees specialist for 1st time ONLY 5% surgery ?? less than 1/2 receives
special imaging 6 weeks Months later ... HQ Army Medical Services and Soldier Performance Centre of HQ Army Medical Services Doctors (SAF Medical Officers) and Patients (Injured troopers) Public Hospitals (CGH) Improving Competence/Confidence
(Sports Medicine) 2. Project Selection Lack of [Training] Time Lack of Training Institution/Program Lack of exposure Fixed Roadmap for most NSF MOs 3. Potential Solutions What If ... Create a Set of Easy-to-use
Pathways for MOs Redesigning training
program to incorporate Sports Medicine Diverting/outsourcing
to external specialists
Centres 1. Physical flip-chart that leverages on MO's existing knowledge

2. Tackles the root problems of a) Time b) Training program c) Exposure 1. Concise teaching package aimed at specific injuries unique to the SAF
with collaborated training sessions with established local specialist centres

2. Tackles the root problems of a) Training Program b) Lack of Exposure d) Fixed MO roadmap 1. Specialist centre dedicated to SAF soldiers

2. Bypasses the root problems of a) Time b) Training Program c) Exposure d) Fixed MO roadmap 4. The Final Solution Why did we choose this solution?
[Decision Matrix Criteria]

1. Effective in addressing root problems (0.30)

2. Near term ease of implementation (0.21)

3. Fast implementation (0.21)

4. Low cost (0.14)

5. Innovative (0.14) 5 WHYS
Table top flip chart

> 95% of cases

15 pages SHORT

Grounded in basic clinical skills

Directs user to 4 distinct routes of patient disposition 5. Implementation and beyond Step 1:

Review of cases: What are the commonly injured areas of the body? Others (~5%) Step 2: a) Literature review and collation of information

b) Summarising and organising information into flow-charts

c) Preliminary Pathways drafted Step 3: a) Finalisation of Pathways with addition of colour coding and design elements Consultations with Subject Matter Experts
- expert consensus/support Feedback from current Medical Officers
- user friendliness Endorsement of final product with stakeholders' buy-in:


b) Medical Officers & Public Hospitals Standardisation: Step 4: Mass printing and distribution

All 32 SAF Medical Centres (across all 3 services) Yearly Post-implementation review

SUBJECTIVE - Constant feedback from stakeholders

OBJECTIVE - using centralised PACES records to track:
reduction in specialist cases

2 yearly [medical] revision of Pathways Sustainability: 6. Benefits Number of (UNECESSARY)
specialist referrals 20% 1,600 specialist referrals over Q 1, 2012 20% S$ 349,120l / year 83% or 5 weeks of waiting time t validated by Army Innovation Secretariat 7. Achieving our
Vision Intangibles: Professionalism Care (for soldiers) HQ Army Medical Services SPC SAF Medical Officers SAF Patients Public Healthcare Sector Vision:
To be the centre of excellence for management and
enhancement of soldier performance.
To manage musculoskeletal conditions and maximise operational manpower through evidence based sports medicine practise
Preserve Manpower and Enhance [Physical] Performance Challenge - 1st of its kind Regular MO + Criticality to Patient Care (0.33)
+ Potential Time/Manpower Savings (0.27)
+ Magnitude (0.20)
+ Ease of Achieving Aim/Implementation (0.13)
+ Potential Cost Savings (0.07) 5 Decision Matrix
Criteria high impact high impact medium impact 2010 data (8,000 referrals) (Pg 9: figure 4) Verified by:
CPT (Dr) Shi Haiyuan, Mr Marc Chionh
Data used/stakeholders involved:
HQ AMS/MOCC training program reviewed
Sports Med training programs Verified by:
MAJ (Dr) Noreffendy, CPT (Dr) Shi Haiyuan, Mr Marc Chionh
Data used /stakeholder involved:
HQ AMS/MOCC training programs/overseas training programs reviewed
SAF MOs and Sports Med Specialists Verified by:
Ms Grace Heng, CPT (Dr) Oh Han Boon, CPT (Dr) Kao Junyang
Data used /stakeholder involved:
MOHH Disease Burden 2010, Sports Med Specialists and SAF MOs Verified by:
CPT (Dr) Shi Haiyuan, CPT (Dr) Kao Junyang, Mr Marc Chionh
Data used/stakeholders involved:
Sports Med specialists, SAF Regulars trained in Sports Medicine and SAF MOs "Clinical evidence and expert backing?" ~ HQ AMS "Is it going to be user-friendly and yet not lack medical information?" ~ SPC "Will it slow down the consultation?" ~ SAF MOs "Won't a specialist referral result in better care for me?" ~ SAF patient "Can this reduce uneccessary specialist referrals?" ~Public Hospitals Spin Off ? " Centre of Excellence ..." "Musculoskeletal conditions ... Maximise manpower ...
Evidence-based Sports Medicine practice" In 1 week
Full transcript