Singapore Report: A Class Apart
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Khoo Teck Puat Hospital
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| Project completion date |
2010 |
| Contract form |
Public Service Conditions of Contract |
| Client |
Alexandra Hospital |
| Architect |
CPG Consultants / RMJM Hillier |
| Services / Environmental Engineer |
CPG Consultants |
| Structural engineer |
CPG consultants |
| Quantity surveyor / planning supervisor |
CPG Consultants |
| Main contractor |
Hyundai Engineering & Construction |
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Singapore’s healthcare facilities are world-class, reflecting its reputation for clinical excellence, reports Ruby Lai-Chuah.
Singapore is ranked by the World Health Organization as having the best healthcare system in Asia, with a multitude of specialised, expert treatments in oncology, gynaecology, cardiology, ophthalmology and many other specialities.
In fact, according to consultants, Watson Wyatt Worldwide, Singapore is acknowledged as having one of the most successful healthcare systems in thre world, both in respect of financial efficency and community health outcomes. Evidence of thius achievement are the nation’s 11 Joint Commission International (JCI) accredited hospitals and treatment centres, which is one-third of all the JCI-accredited facilities in Asia.
Market structure
Healthcare design in Singapore has progressed dramatically in the last two decades, with the Ministry of Health embarking on an ambitious task of redeveloping all the old government hospitals and creating new facilities to meet the ever-increasing healthcare needs of the nation. Public hospitals deliver 80% of care in the acute sector, with the remaining 20% provided by private hospital care.
There are currently seven public hospitals, with the eighth under construction in the north, and plans are being made for a ninth hospital in the west. There are also six national specialty centres for cancer, cardiac, eye, skin, neuroscience and dental care.
Public healthcare facilities fall under two broad clusters: the National Healthcare Group (NHG) and Singapore Health Services (SingHealth). Each cluster provides a full range of services, ranging from primary care at the 18 polyclinics, to secondary and tertiary care at the regional and tertiary hospitals and national centres.
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Khoo Teck Puat Hospital
The design of this 550-bed hospital, which is currently
under construction, comprises an 8-storey block for private wards, a 10-storey block for subsidised wards and a 6-storey block for specialist outpatient clinics. The emergency department and the diagnostic and treatment department are on the lower three floors, below the wards. The hospital has one main entrance which is designed for easy access to the emergency department and specialist outpatient clinics, with visitor lift cores to the wards nearby. Wayfinding is thus very clear. Pockets of green distributed throughout the hospital bring healing landscape to the patients. The hospital opens out towards a nearby pond which will be specially developed for the needs of the patients and visitors. The interior design is warm and homely, using natural materials to create a relaxed and comfortable feel for patients and visitors. Artistic displays will be used to conjure joyful and peaceful feelings.
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Private practitioners provide 80% of primary healthcare services while government polyclinics provide the remaining 20%. The doctors either work in their clinics located in the housing estates spread throughout the island, in commercial buildings and medical centres, or within private hospitals. There are six private hospitals, and several specialist centres providing specialist healthcare services for private patients.
There is also a comprehensive range of residential and community-based healthcare services that cater to the long-term healthcare needs of Singaporeans, comprising community hospitals, hospitals for the chronically ill, nursing homes, sheltered homes for the formerly-mentally ill, inpatient hospice institutions, home medical, home nursing and home hospice care services, day rehabilitation centres, dementia day care centres, psychiatric day care centres and psychiatric rehabilitation homes.
In 2005, Singapore welcomed 374,000 visitors specifically for healthcare and in 2006, there were over 410,000 international patients. This number is expected to increase steadily, with the encouragement of the government.
Singapore Medicine, a multi-agency government initiative aimed at developing Singapore into one of Asia’s leading destinations for healthcare services, was set up in 2003. The public and private hospitals are well-positioned to serve the ‘medical travellers’, by providing ‘essential’ healthcare, ‘affordable’ healthcare and 'premium' healthcare to patients from the region and as far away as the Middle East.
Hospital design – the Singapore style
Hospitals in Singapore are designed to meet international standards geared towards Western medical science, but are customised to the local climate and cultures. The design principles adopted in Singapore are:
- Patient and visitor-focused design
- Clean and green design
- Promotion of medical wellness
- Design in the urban context
- Patient- and visitor-focused design
Asian society is highly family-orientated. When patients come to the hospital, they are often accompanied by family members. Therefore, waiting areas need to be large enough to cater for the numbers. When patients are hospitalised, their visitors come in throngs, and often a caregiver will stay overnight. It is important to cater for this need by providing space and facilities for the visitors.
An important aspect of this is clear wayfinding to ensure that visitors do not get lost. This is accomplished by intuitive wayfinding with clear access to important landmarks (emergency department entrance, visitor lifts to wards, escalators to clinics, etc) as well as clear signage using international icons. As many visitors remain in the hospital for the whole day, facilities are provided to ease their stay. These may include a cafeteria, banking facilities, bookshops, a commercial
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Tan Tock Seng Hospital
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| Project completion date |
1999 |
| Contract form |
Form 24A |
| Client |
Ministry of Health |
| Architect |
CPG Consultants / Ellerbe Becket |
| Structural engineer |
CPG Consultants |
| Services and environmental engineer |
CPG Consultants |
| Quantity surveyor and planning supervisor |
CPG Consultants |
| Main contractor |
Ssang Yong-Guan Ho Joint Venture |
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High technology
Singapore hospitals are designed with excellent medical infrastructure. Many physicians received their speciality training from respected international hospitals and demand similar facilities in the local hospitals. The high level of training of support staff ensures that patients get the best medical care.
Integrated information systems are used in the hospitals, combining patient records, prescriptions and billing into one seamless system. Physicians can log on to wireless computers to access x-ray records, update patient symptoms and get all the required information at the touch of a button. They can note down the diagnosis and recommended treatment into the case sheet electronically, and enter the prescription.
The pharmacist receives the prescription electronically and can start preparing the medicine immediately so that when the patient goes to the pharmacy, the medicine is ready for collection. In addition, telemedicine is becoming popular in some of the hospitals, enabling doctors in Singapore to listen to the heartbeat of their patients in Jakarta and see them through teleconferencing screens.
In addition, in order to cut down on expensive manpower, automation is used in public hospitals – including technology such as the automated guided vehicle system for transporting linen, food and medicine; a pneumatic tube system to transport samples and case sheets; and pneumatic chute systems for transporting dirty linen and waste.
Clean and green design
Singapore is an equatorial country with high temperatures, high humidity and heavy rainfall. Energy is expensive as the country does not have any natural resources. The public hospitals are designed to keep energy usage down.
Natural ventilation is used wherever possible. For public hospitals, 65% of the wards are naturally ventilated, with only the private wards fully air-conditioned. This has an important impact on the ward design. The triangular ward form of
the Tan Tock Seng Hospital was found to have good thorough-ventilation for the wards. Where rectangular wards are used, the depth of the floor plate has to be kept fairly narrow and a single corridor system is preferred, instead of a race-track-style system with rooms in the middle.
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Tan Tock Seng Hospital
Singapore’s second largest acute care general hospital with 1,400 beds, plate comprising two triangles with visitors’ lifts and waiting areas located where their apexes meet. The shape allows thorough ventilation for non air-conditioned wards, and the central nurse station has an excellent view of all patient rooms. Specialist outpatient clinics, at one end, and wards, at the other, are situated above a podium which houses the diagnostic and treatment and support areas. There is also a helicopter landing on the tower block roof-top. The hospital received the American Institute of Architects Modern Healthcare Design Excellence Award. |
Wards are designed with large windows to give the patients a good external view. Building orientation is analysed and sunshades designed to ward off the strong afternoon sun. Naturally ventilated wards are provided with ceiling fans individually controlled by the patient.
Finishes are designed with ease of maintenance in mind. Good quality vinyl sheet with seamless joints and coved-up skirting are used in most medical areas. These are easy to clean and are good in terms of sound absorption and comfortable on which to walk and wheel. Walls are finished with easily cleaned paint, and wall-guards installed to protect against damage by trolleys.
Promoting medical wellness
individual to assume personal responsibility for their own health and health expenditure. The government places an emphasis on encouraging self-reliance, keeping healthcare affordable and promoting a healthy lifestyle.
Hospitals also play an important role in promoting health education. Many public talks and exhibitions are held in public hospitals’ auditoriums and public spaces, encouraging people to incorporate physical activity into their daily life, teaching them how to read food labels and select healthier food. Public screening programmes are provided in the public clinics for early detection of diseases such as hypertension, diabetes and heart diseases.
Designing in the urban context
Land is very scarce in Singapore. Hospitals have to be built with a high plot ratio. Tan Tock Seng Hospital, for example, is 14 stories high, and the new Khoo Teck Puat Hospital is 10 stories high. Greater reliance has to be placed on vertical transportation using lifts, and building designs have to provide areas of refuge to which patients can be transferred in the case of evacuation.
Separate banks of lifts are provided for staff use, for transferring patients from wards to diagnostic and treatments areas, providing patients with privacy from visitors using the lifts. As there is limited ground, podium roofs are landscaped to allow patients garden space in which to relax and recuperate. Where possible, sky gardens are provided.
Emerging trends
Healthcare treatment is continuously changing, and hospital design has to keep pace with the Tan Tock Seng Hospital changing medical and social demands. With the growing sophistication of surgical skills, operations which in the past required patients to be hospitalised can now be conducted as day surgeries, with the patient going home within a few hours of the operation. This has reduced the demand of beds in the wards, but increased the demand on day surgical facilities.
Thus, the new Khoo Teck Puat Hospital, designed by CPG Consultants, has fewer beds than the Changi General Hospital even though it serves the same catchment size, but has a larger area for its diagnostic and treatment department.
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KK Women's & Children's Hospital
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| Project completion date |
1998 |
| Contract form |
Form 24A |
| Client |
Ministry of Health |
| Architect |
CPG Consultants / McConnel Smith and Johnson / Arkitek Tenggara |
| Structural Engineer |
CPG Consultants |
| Services and Environmental Engineer |
CPG Consultants |
| Quantity surveyor and planning supervisor |
CPG Consultants |
| Main contractor |
Ssang Yong Engineering & Construction |
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SARS has had a great impact on the healthcare scene in Singapore. Learning from the incident, hospitals are now geared towards providing more isolation rooms, and their emergency departments are designed to segregate the ‘suspected infectious’ from the other patients.
Khoo Teck Puat Hospital has an isolation ward, and many of the other existing hospitals have been refurbished to convert some wards into isolation wards. A new Communicable Disease Centre is being designed to cater for infectious diseases.
Another trend in Singapore is the growth of the private sector. The government has recently offered new sites for private hospital development, which will result in many new and interesting healthcare projects in the next few years.
With greater commercial input, we may see private clinics in medical centres, shopping centres located next to a general hospital, hotels built within the same medical complex to provide lodging for families of foreign patients and possibly to act as step-down nursing rooms for patients recovering from treatment. The permutations are myriad and will prove interesting.
Reputation for excellence
Singapore is a world-class healthcare destination, well known for its excellent healthcare facilities, skilled medical professionals and the latest medical technologies. Patients enjoy a wide range of clinical services, from basic health screening to complex medical care at Singapore's public and private hospitals, as well as national specialty centres. Patients also benefit from the clinical research carried out by public and national speciality centres and the many thriving pharmaceutical, biotechnology and medical technology industry. And Singapore doctors are kept abreast of the latest medical know-how through continuous professional training and seminars.
Singapore has gained a reputation of having a trustworthy healthcare system which allows patients faster access to safe, new healthcare products and services in technically advanced and comfortable facilities with the best of medical technology customised for the patients.
Ruby Lai-Chuah is a director of CPG Consultants
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