department of surgery

What goes into building and leading a successful clinical department?

Beyond skills and techniques, the heart – compassion, empathy, drive – is the most important component for any clinical team, says A/Prof Tan Kok Yang, head of Khoo Teck Puat Hospital (KTPH)’s Department of General Surgery. He shares how the team has progressed over the past 10 years to carve its own path

Building a team with a shared vision

Against the backdrop of Singapore’s 200-year healthcare history, Khoo Teck Puat Hospital (KTPH)’s Department of General Surgery is a young outfit.

The department celebrates its 10th anniversary this year as part of KTPH, a 795-bed hospital that serves more than 550,000 people in northern Singapore.

A/Prof Tan
A/Prof Tan Kok Yang

A/Prof Tan Kok Yang, who has headed the department since 2012, recalls that the department started with just eight specialists, who transitioned from Alexandra Hospital in time for KTPH’s opening in June 2010.

Manpower was tight; but for him, the main challenge in setting up a new clinical department lies in charting the common direction as a team.

“Despite the small team we had, we knew what we needed to do. This was to get the services going, and to ensure the services are not only safe, but also of good quality… We just have to work a little bit harder, put in a little bit more to make things work,” says A/Prof Tan.

“For any young department, the biggest challenge is to build a team that shares a common vision and works well together. It’s not easy to assemble that kind of team, so over the years, we have had multiple discussions and retreats to identify focus areas to work on and explore common goals. That was crucial to build a cohesive team that is progressive and collaborative. That took quite a few years to develop.”

The department has since grown to be served by some 27 specialists, with a total of over 60 staff – making it one of the largest in KTPH. It has also expanded from mostly general surgical practice to offer a range of subspecialties, such as Hepatobiliary, Breast and Endocrine surgery.

Looking back at this journey, A/Prof Tan points to the importance of people development as one of the key factors that contribute towards success.

“Over the years, we learnt that when developing a department or a system, we cannot just concentrate on the processes. We also need to develop the people who are involved in the processes, help them understand the “why” behind certain things that they need to do, cultivate an internal drive and also address each other’s aspirations. After all, this is not just about the skills and the mind, but also about the heart.”

“If I were to do it all over again, I would put people ahead of processes even more, give priority to how we can help everyone develop their skills, mindset and heart to serve as much as possible.” Over the years, A/Prof Tan has watched younger surgeons grow over time into skilled clinicians with a heart – “who have surpassed my own abilities now” – which brings him a great sense of satisfaction and achievement.

The impact of COVID-19

The COVID-19 pandemic has had a great impact on surgical departments around the world, with elective surgery put on the backburner at many facilities. That meant surgeons have had to make challenging decisions on which patients to prioritise and schedule for earlier surgery.

Some of the surgeons at KTPH also took on management of COVID-19 patients. While this is a significant step outside of their usual work scope and comfort zone, A/Prof Tan notes that these experiences have become valuable lessons.

“I’m very encouraged to see the general enthusiasm from the surgeons to embrace the bigger picture of what a doctor actually needs to do. It’s great to see that though they may have found themselves in an uncomfortable situation, they were able to contribute meaningfully. A lot of them found that they have come out of these experiences having learnt something and have grown as individuals.”

Another silver lining amidst the pandemic lies in how it has sparked innovations, driven by the need to make surgery safer.

A/Prof Tan raises an example of an innovative idea from his surgeons to reduce the risk of COVID-19 virus transmission during laparoscopy (also known as keyhole surgery or minimally invasive surgery), which is considered an aerosol-generating procedure. The surgeons came up with a prototype, using common components that can be found in operating theatres, that would allow a filter to be retrofitted onto a suctioning unit and safely reduce exposure to potentially infectious aerosols.

What the future holds

Such innovations, that revolve around working within the resources on hand to develop cost-effective, value-based solutions, ties in closely with the idea of sustainable healthcare – a key trend to watch in healthcare, according to A/Prof Tan.

“Sustainability here can mean many different things,” explains A/Prof Tan. “It could be in terms of financials – how do we manage healthcare costs from escalating in an unsustainable fashion? Or how do we provide surgical care with less wastage which contributes to a sustainable environment?”

“There’s also sustaining clinician wellness – making sure that we continue to perform surgery at a high level, feel driven and enthusiastic, even as patients become older and present with more complexity.”

Another key trend he has identified is the growth of transdisciplinary care, where clinicians across departments come together to provide holistic care catered to the patient’s needs. “Good surgical care goes beyond techniques and skills, and beyond looking at pathology. We need to focus on the patient, understand their needs and wants, and explore what’s best for them. This also involves finding out who we need to collaborate with – in transdisciplinary care, we recognise that it’s not just only about the surgeon, but having people come together to provide that holistic care that our loved ones deserve.”

With a keen eye on “progressive and collaborative surgical care”, coupled with a focus on safety and culture of compassion, the sky’s the limit for what KTPH’s young surgery team can achieve in the future. To find out more about KTPH’s Department of General Surgery, please visit the KTPH website or follow them on Facebook.

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