Workload and Work Stress of Healthcare Professionals in Singapore

Mdm Speaker, direct comparative studies on workload and work stress of healthcare professionals are not readily available. One other way is to look at the statistics on the number of doctors and nurses per 10,000 population compiled by the Organisation for Economic Cooperation and Development (OECD).

The doctor to population ratios for Australia, Japan, South Korea, the United Kingdom (UK) and the United States (US) ranged from 22 to 34. Singapore's doctor-to-population of 21 doctors per 10,000 population is comparable to the ratios of Asian economies like Hong Kong and Taiwan, at 18.

For nurses, the nurse-to-population ratio in Australia, Japan, South Korea, the UK and the US ranged from 56 to 115. Singapore's ratio in 2014 was 69 nurses per 10,000 population, which is comparable to the ratios of Hong Kong and Taiwan at 66 and 60 respectively.

While these ratios may provide a broad comparison, we need to be mindful of the differences in healthcare demand, clinical practices and operating environments across different countries.

We are committed to providing good quality healthcare for Singaporeans which is accessible and affordable. To prepare for an ageing population, the Ministry of Health (MOH) has been building more healthcare facilities, such as acute hospitals, community hospitals and nursing homes. We are on track to meet our target of providing 9,000 acute beds, 3,000 community hospital beds and 17,000 nursing home beds by 2020.

We are also hiring and training more healthcare professionals so that healthcare institutions have sufficient manpower to care for our patients. Between 2011 and 2014, the number of registered doctors in Singapore has increased by about 22%, from 9,600 to 11,700. The number of registered nurses has increased by about 19%, from 31,700 to 37,600.

Our public hospitals have been working closely with union leaders and healthcare professionals to provide a conducive work environment. This is an ongoing effort. Initiatives that have been implemented include flexible work arrangements for nurses, shorter rotating shifts for doctors, workflow process optimisation and adoption of information technology to streamline and minimise administrative workload. We will continue to work with our stakeholders to strive for further improvements

Another important area is for all of us – Ministry, hospitals, as well as patients and their loved ones – to show appreciation and support for our healthcare workers. Often, a simple "thank you" or a nice gesture can go a long way to motivate our healthcare workers to continue doing their best to serve the public with care, professionalism and commitment.

I thank the Minister of State for his helpful reply. Just a few very brief clarifications or supplementary questions. Firstly, just to clarify the doctor-to-population and nurse-to-population ratios, does it include the entire population of the island, including foreigners, or does it include just citizens and permanent residents? That is just one clarification.

Secondly, as the Minister of State kindly acknowledged, the doctor-to-population ratio may not capture every relevant dimension to the issue. There is the matter of disease incidence and caseload may differ according to disease incidence, such that the doctor-to-population ratio may not be a perfect approximation of relative workload. So, would the Minister of State or MOH consider conducting at least one initial benchmarking study to assess the relative caseload for doctors and nurses in our country, with respect to other countries with whom it may be useful to compare?

In terms of looking at the issue of caseload, would the Minister consider studying this issue in the context of the panel that has been convened to look into healthcare work processes in relation to the Hepatitis C infection cluster?

Would the Committee and the Ministry consider looking at workload – while not being a direct trigger or direct causal factor to the incidents that we have seen – but would that Committee consider workload to be, perhaps, a contributory or underlying context that might explain some of these incidents, and consider if anything needs to be done on that front, with respect to mitigating the risks of such healthcare-associated infections in future?

Mdm Speaker, I thank the hon Member for his supplementary questions.

First, the clarification on the doctor- and nurse-to-population ratio – this measures the total population. The hon Member has also asked whether we could initiate a study to look at caseloads and workload. I think there are other benchmarks that we could use to assess staff well-being in our healthcare institutions. For example, our hospitals conduct employee engagement surveys every two to three years, and this is used to gauge morale and job satisfaction. We also use the survey results to further improve staff motivation, engagement and retention.

This survey is extended to all groups of healthcare staff – doctors, nurses, allied health professionals, administrative and ancillary staff. In the latest survey, seven out of eight of our hospitals have either higher or comparable job satisfaction scores, compared to the Singapore national norm. This is something which we will continue to keep track.

I think the suggestion from Mr Perera about looking at how we can further improve the work environment for our healthcare professionals is something we will certainly consider. We are looking at not just the work environment for our healthcare workers, but also how we can use the opportunity to improve productivity which will lead to better quality of care, better service for our patients and also to look at whether we can reduce the manpower requirements for our healthcare sector to be ready for an ageing population. These are ideas which we will take a look at, in our continuous effort to try and improve productivity and sustainability of our healthcare system.

I also want to take the opportunity to assure Mr Perera that we are doing a thorough review on how to improve infection control and also to look at the detection and response to outbreaks. The investigations that were done by the various hospitals and the professionals indicate that workload has not been a direct cause of these infections. There were other reasons for the outbreaks.

Nevertheless, I think improving work environment, making sure that our healthcare workers have the support to do their jobs well and to look after their patients well, are areas which the Ministry will certainly work closely with our hospitals and unions, to improve over the years.