FPS Textbook PDF

Work-Study Diploma in Patient Management & Services Frontline Patient Services BS71008 Second Edition April 2024 For term April 2024 to September 2024 School of Business & Services ITE College West BS71008: Frontline Patient Services CONTENTS UNIT 1: PERFORM PATIENT ADMINISTRATIVE FUNCTIONS..................................................... 6 1.1 Overview of Singapore Healthcare System....................................................................... 6 1.2 Duties and Responsibilities of a Patient Service Associate.............................................. 17 1.3 Areas of Effectiveness Required of a PSA...................................................................... 20 1.4 Importance of Communication in Healthcare................................................................... 27 1.5 Professional Image of a Patient Service Associate.......................................................... 29 1.6 Methods of Enquiries...................................................................................................... 30 1.7 Types of Enquiries.......................................................................................................... 31 1.8 Guide to Enquiry Handling.............................................................................................. 32 1.9 Types of Patients' Personal Information.......................................................................... 33 1.10 Ways to Respond to Patient’s Queries............................................................................ 34 1.11 Communication Skills in Practice..................................................................................... 35 1.12 Importance of Product Knowledge.................................................................................. 38 1.13 Ways to Achieve Patient’s Satisfaction............................................................................ 38 1.14 Framework of a Patient’s Journey................................................................................... 39 1.15 Methods of Registration.................................................................................................. 40 1.16 Types of Registration...................................................................................................... 41 1.17 Categories of Patient Classification................................................................................. 42 1.18 Types of Subsidies and Schemes................................................................................... 43 1.19 Steps in Processing Payments........................................................................................ 45 1.20 Procedure for Non-Payment............................................................................................ 45 1.21 Types of payment methods............................................................................................ 45 1.22 Bills Layout/ Content on Outpatient Bills.......................................................................... 47 1.23 Types of Billing Errors..................................................................................................... 50 1.24 Causes of Billing Error.................................................................................................... 53 1.25 Corrective Action(s) for Billing Errors.............................................................................. 54 1.26 Procedures in Scheduling Appointments and Surgeries.................................................. 55 1.27 Appointment and Outstanding Bill Reminders................................................................. 56 UNIT 2: PERFORM PATIENT ADMISSION.................................................................................. 52 2.1 Types of Admission........................................................................................................ 52 2.2 Types of Communication Models in Healthcare Setting................................................... 54 2.3 Qualities and Characteristics of a Positive Interaction and Experience............................ 60 2.4 Methods of Verification.................................................................................................... 62 2.5 Importance and Objectives of Personal Data Protection Act............................................ 69 2.6 Types of Patients’ Personal Information.......................................................................... 70 2.7 Procedures in Handling Deposits.................................................................................... 70 2.8 Types of Different Wards (Acute Hospital)....................................................................... 71 2.9 Methods of Obtaining Signature...................................................................................... 71 BS71008: Frontline Patient Services 2.10 Features of Bed Management System............................................................................ 72 2.11 Procedures of Bed Booking and Other Facilities.............................................................. 72 2.12 Hospital Policies on Change Requests............................................................................ 73 2.13 Procedures to Transfer from Admission to Wards/ Other Facilities.................................. 74 2.14 Roles of Staff in Charge for the Transfer of Patients........................................................ 75 UNIT 3: PERFORM PATIENT DISCHARGE................................................................................. 76 3.1 Process for Patient Discharge......................................................................................... 76 3.2 Procedures for active listening and responding to patients............................................. 80 3.3 Ways to Identify Patient’s Needs..................................................................................... 80 3.4 Hospital Policies for Discharge........................................................................................ 82 3.5 Medicine Ordering for Patients........................................................................................ 83 3.6 Checklist of Documents to Be Given Upon Discharge..................................................... 84 3.7 Strategies for Patient Engagement.................................................................................. 87 3.8 Features of a Customer/ Patient Relationship Management System............................... 89 3.9 Reasons for Relationship Building in Healthcare............................................................. 93 3.10 Categories of Patient Classification after Discharge........................................................ 94 3.11 Types of Patient Classification........................................................................................ 94 3.12 Stakeholders involved to Retrieve Patients/NOKs' Personal Information......................... 95 REFERENCES............................................................................................................................. 96 BS71008: Frontline Patient Services UNIT 1: PERFORM PATIENT ADMINISTRATIVE FUNCTIONS 1.1 Overview of Singapore Healthcare System a. Singapore Healthcare Governing Bodies In Singapore, there are several governing bodies responsible in the development and growth of our healthcare system. They are: i. Ministry of Health (MOH) Ensures good and affordable basic medical services are available to all Singaporeans through the provision of: subsidised medical services and individual responsibility for healthcare costs. ii. Ministry of Health Holdings (MOHH) Holding company of Singapore’s 3 public healthcare clusters Main role is to enhance public healthcare sector’s performance through Infrastructure development Joint recruitment of healthcare professionals National IT network development Talent management and HR framework 6 BS71008: Frontline Patient Services iii. Agency for Integrated Care (AIC) Drives the development, enhancement and integration of community care in Singapore. Works closely with MOH and home care providers to ease the capacity crunch in acute and intermediate and long term care (ILTC) facilities. Coordinates and facilitates care integration (post discharge). Creates a vibrant care community iv. Health Promotion Board (HPB) Established in 2001 HPB plays a role in formulating and implementing health policies and programmes Aimed at improving the nation’s health. Provides credible and authoritative source of evidence-based health information Wide range of health promotion and disease prevention programmes. v. Integrated Health Information System (IHiS) Supports MOH by raising the level of IT development in healthcare institutions Plays the main role in digitising, connecting and analysing Singapore’s healthcare ecosystem Aims to improve population health and health administration. Seamless integration of data, use of machine learning and robotics helps to enhance patient safety and experience. in 7 BS71008: Frontline Patient Services b. Healthcare Services and Facilities i. Primary services ii. Hospital services iii. Dental services iv. ILTC vi. Support Services v. TCM Healthcare Services & Facilities i. Primary healthcare services Primary care is the foundation of our healthcare system. As the first line of care in the community, our primary care professionals are often the first point of contact with patients. In Singapore, primary care is provided through an island-wide network of outpatient polyclinics and clinics run by private general practitioners (GPs). Primary care Polyclinics GPs They treat acute conditions such as upper respiratory tract infections, manage chronic illnesses such as diabetes, and keep the population healthy through preventive measures such as targeted health screening. Polyclinics GPs Operate as a ‘one-stop’ healthcare centre. There are 23 polyclinics located throughout Singapore Provide subsidised primary care, which includes medical treatment, preventive healthcare and health education. Primary healthcare providers who offer medical services, advice and treatment to individuals of all ages. Meet about 80% of the total primary care demand. 8 BS71008: Frontline Patient Services Source: Primary Care Networks MOH has introduced the Primary Care Networks (PCN) scheme to encourage private General Practitioner (GP) clinics to organise themselves into networks that support more holistic and team-based care. Under the scheme, patients receive care through a multi-disciplinary team (including doctors, nurses and primary care coordinators) for more effective management of their chronic conditions. gain access to additional ancillary and support services provided by the PCN such as diabetic foot and eye screening, as well as nurse counselling, which are important for good management of chronic conditions. The PCN scheme is part of MOH’s strategic shift to move care beyond the hospital to the community, so that patients can receive effective care closer to home. With an ageing population, chronic disease prevalence and complex care needs will be on the rise. A strong primary care sector will serve as the bedrock of our healthcare system, and help Singaporeans keep healthy and manage their chronic conditions holistically within the community. 9 BS71008: Frontline Patient Services Activity Share your perspective: How does the community benefit from the introduction of Primary Care Network? ii. Hospital services There are nine general hospitals, one women and children’s hospital and one psychiatry hospital. General hospitals provide multi-disciplinary inpatient and specialist outpatient services as well as 24-hour emergency departments. Source: MOH These public healthcare facilities are managed under three integrated clusters, where each cluster will have the full suite of healthcare services, from primary care to general hospitals and community hospitals; as well as a medical school. i. National University Health System (NUHS): Western region ii. National Healthcare Group: Central and Northern region iii. SingHealth: Eastern region 10 BS71008: Frontline Patient Services List of Institutions Acute Hospitals Western: NUHS Central: NHG Eastern: SingHealth National University Hospital Khoo Teck Puat Hospital Tan Tock Seng Hospital Woodlands General Hospital *Institute of Mental Health Changi General Hospital Singapore General Hospital Sengkang General Hospital *KK Women’s & Children’s Hospital Ng Teng Fong General Hospital Community Hospitals Jurong Community Hospital Yishun Community Hospital Woodlands Community Hospital (name tbc) Bright Vision Community Hospital Outram Community Hospital Sengkang Community Hospital Primary Care Bukit Batok Polyclinic Choa Chu Kang Polyclinic Clementi Polyclinic Jurong Polyclinic Queenstown Polyclinic Bukit Panjang Polyclinic Pioneer Polyclinic Ang Bedok Polyclinic Bukit Merah Polyclinic Marine Parade Polyclinic Outram Polyclinic Pasir Ris Polyclinic Sengkang Polyclinic Tampines Polyclinic Eunos Polyclinic Punggol Polyclinic Mo Kio Polyclinic Geylang Polyclinic Hougang Polyclinic Toa Payoh Polyclinic Woodlands Polyclinic Yishun Polyclinic Sembawang Primary Care Centre Table 1.1 List of institutions in the reorganisation (Image source: Ministry of Health Singapore, 2017) 11 BS71008: Frontline Patient Services All public acute hospitals and specialty centres in Singapore are operated as private companies wholly owned by the government. This allows public hospitals to have the management autonomy and flexibility to respond more promptly to the needs of the patients. Public hospitals receive an annual government subvention or subsidy for the provision of subsidised medical services to patients. They are subject to broad policy guidance by the Government through the MOH; and to be managed like notfor-profit organisations. iii. Dental services National Dental Centre (NDC), National University Centre for Oral Health, Singapore (NUCOHS) and some polyclinics and hospitals provide public dental services and specialist oral healthcare in Singapore. iv. Intermediate and long-term care (ILTC) Intermediate and long-term care (ILTC) refers to care facilities for individuals who no longer require the level of care dispensed at a hospital, but nonetheless require continued care. These services are typically required for: persons who need further care after being discharged from an acute hospital ; community-dwelling seniors who may be frail and need someone to watch over them or help them with their daily needs. Patients and their next-of-kin may apply for these services through the Agency for Integrated Care (AIC). v. Traditional Chinese Medicine (TCM) Traditional Chinese Medicine (TCM) is a holistic system of healthcare that encompasses various therapeutic approaches, including acupuncture, herbal medicine, cupping therapy, massage (Tui Na), and dietary therapy. In Singapore, TCM is recognised as a complementary healthcare system, and practitioners are required to be registered with the Traditional Chinese Medicine Practitioners Board under the MOH. The integration of TCM into the healthcare system reflects Singapore's multicultural and diverse approach to healthcare, allowing individuals to choose from a variety of medical traditions based on their preferences and needs. vi. Support Services Support services to hospitals and primary healthcare programmes include forensic pathology, pharmaceutical services and blood transfusion services. 12 BS71008: Frontline Patient Services Activity Based on your understanding, 1. which governing body assists patients and their family with the post-discharge care arrangement? 2. Identify the type of healthcare services or facilities required by patients who needs further care after their discharge from the community hospital. c. Singapore Policy Tools In Singapore, the MOH is responsible for developing regulatory, organisational, fiscal, and information tools for managing the healthcare sector. Using these tools, stakeholders can promote cost-effectiveness while achieving the aim of offering healthcare to everyone. Policy tools in Singapore’s healthcare system (Image source: Ramesh, M. & Bali, A.S, n.d.)  Organisational Tools Singapore began reforming its public hospitals in the mid-1980s in the face of mounting public expenditures on health. The reorganisation was intended to promote: economies of scale effective coordination and planning of resources better integration of inpatient and outpatient facilities a more effective patient referral system within each cluster. 13 BS71008: Frontline Patient Services  Fiscal tools Fiscal tools refer to financial instruments or strategies used to manage and allocate resources in the healthcare sector. Some common fiscal tools in healthcare include: Subsidies received by patients under subsidised care. Community Health Assist Schemes (CHAS) - a means-tested scheme that offers additional grants to low-income household for outpatient treatment. Pioneer Generation and Merdeka Generation Package - subsidies for insurance premiums and co-payments for elderly Singaporeans. Medisave - a compulsory savings established in 1984 to encourage individual responsibility for healthcare, while reducing the government’s fiscal responsibility. Medifund – a safety net to assist financial needy patients and ensure that basic healthcare is available to all. Out-of-Pocket (OOP) refers to cash payment. Such payments are largely an outcome of deliberate policy design to instil a sense of personal responsibility for one’s health.  Regulatory tools A key feature of Singapore’s healthcare system is the tight control over access to services. For example, in order to receive subsidy, patients would require a referral to consult the specialist. The doctor’s assessment at the primary care would then ensure appropriate consumption of services. The Medisave withdrawal limit is another example of regulatory tool in place, to reduce the likelihood of oversupply or over consumption of medical services by both healthcare provider and patients. Under the Private Hospitals & Medical Clinics (PHMC) Act/ Regulations, all healthcare facilities such as hospitals, medical centres, community health centres, nursing homes, clinics (including dental clinics), and clinical laboratories (including x-ray laboratories) are required to: apply for licence; and maintain a good standard of medical / clinical services. 14 BS71008: Frontline Patient Services  Information tools The provision of information is crucial in enabling patients to make an informed decision. Hence, information such as the occupancy rates of hospital beds, bill sizes, average costs and clinical outcomes for common medical treatments are published on MOH website. Public campaigns also provide information and encourage greater community participation to meet the health needs of the nation. “Let’s BEAT Diabetes” and “War on Diabetes” are two examples of public campaigns that aim to reduce individual’s risk of developing Type 2 diabetes. The recent Covid-19 pandemic has brought about a national vaccination programme to inoculate against Covid-19. To combat misinformation that may deter a citizen from getting protected, VacciNationSG campaign was launched to raise awareness of Covid-19 vaccine. E.g. VacciNationSG campaign launched to raise awareness of Covid-19 vaccine, combat misinformation | The Straits Times d. Challenges and Issues in Healthcare Although Singapore’s healthcare system has done well and evolved as one of the better health systems in the world, there are several challenges and issues that need to be addressed in order not to disrupt the system’s capability in serving Singaporeans well. 1. Healthcare financing Challenges & Issues in Healthcare 2. Aging population & managment of chronic diseases 3. Shortage of manpower 4. Hospital infrastructure 5. Communicable disease control 15 BS71008: Frontline Patient Services The major challenges are:  Healthcare financing The ‘3M’ system – Medisave, MediShield and MediFund - forms the unique healthcare financing framework of Singapore. Subsidies are only provided for basic medical care as everyone is expected to assume key responsibility of his/ her own health. To prevent one from being over-burdened by healthcare bills of their loved ones, there should be no inter-generational transfer of liabilities.  Aging population and management of chronic diseases There has been a shift in Singapore’s population demographics due to low fertility rates and rising life expectancy. Residents aged 65 years and above has increased from 8.7% in 2008 to 15.2% in 2020. By 2030, it is projected that 1 in 4 Singaporeans will be aged 65 and above. Aging has profound implications on our economy and society as chronic diseases become more common. Hypertension, diabetes mellitus and dyslipidaemia have become more prevalent, and the three most common causes of deaths were cancer, cardiovascular events and pneumonia. To assist citizens in their management of such conditions, CHAS, Chronic Disease Management Programme (CDMP) and ElderShield Life were launched.  Shortage of manpower A shortage of healthcare professionals is likely to result in a decline in healthcare quality and a rise in healthcare expenses. During the Healthcare Manpower Plan 2020, three strategies were proposed in to address the shortage: 1. equip the healthcare workforce with relevant skillsets 2. grow a strong local core by investing in fresh school leavers as well as mid-career entrants 3. improve work environment and patient experience with technology.  Hospital infrastructure Foreseeing an increasing demand for hospital beds and healthcare due to an aging population, the government is building more public hospitals, releasing more land for healthcare facilities as well as increasing the budget for healthcare.  Communicable disease control Globalisation has raised the number of large mass international gatherings (e.g. sporting events) and enhanced the risk of importation and exportation of infectious diseases. Infectious diseases (e.g. AIDS, H1N1, SARS, EBOLA, MERS, Zika, Covid-19) are challenging to control. as knowledge of treatment is often absent or scant. The threat of bioterrorism (intentional release of infectious agents into a targeted community) is also a growing concern for global and national health security. Being a major global trade and travel hub, it is imperative for Singapore to remain constantly vigilant against new diseases. 16 BS71008: Frontline Patient Services 1.2 Duties and Responsibilities of a Patient Service Associate A Patient Service Associate (PSA) is a role in the healthcare industry that involves providing administrative and customer service support to patients and healthcare professionals. PSAs may be assigned to work in various locations such as private and public hospitals, community and primary care settings, and inpatient or outpatient facilities. Depending on the assignment, PSAs may be exposed to different area of care provision. For instance, PSA at the ward may be trained in basic nursing such as feeding patients or helping to turn them on their beds to prevent bedsores. The specific duties and responsibilities of a PSA may vary depending on the type of healthcare facility and the specific needs of the patients and staff. Common duties and responsibilities of a PSA may include: Greet & welcome patients PSAs are the first point of contact for patients as they arrive at the healthcare facility. Greet and welcome patients with a smile to make them feel comfortable. Assist clinicians PSAs assist healthcare providers by preparing consultation rooms and assisting with simple translation. Schedule appointments PSAs help patients schedule appointments and complete registration paperwork to ensure that patients are seen in a timely manner. 17 BS71008: Frontline Patient Services Organise & maintain patient records PSAs assist with organisation and maintenance of patient records to ensure that patient information is accurate, up-to-date, and easily accessible. Coordinate with healthcare professionals PSAs work closely with healthcare professionals to manage schedules to ensure timely patient care. Maintain cleanliness in the clinic PSAs are responsible for maintaining a clean and organized front office area to ensure that patients feel comfortable and welcome Perform adhoc tasks PSAs perform general office tasks, such as filing, data entry, and printing, to ensure that administrative tasks are completed efficiently, in accordance to the Personal Data Protection Act. Answer calls PSAs answer phone calls and respond to patient inquiries to ensure that patients receive accurate and timely information. 18 BS71008: Frontline Patient Services Process payments PSAs process payments and submit inpatient insurance claims to enable patients to receive the appropriate healthcare coverage. Provide general information PSAs provide patients with general information about the healthcare facility and its services, such as hours of operation, available services, and location. In recent years, the role of PSAs has evolved and expanded to include clinical work and care coordination. PSAs may be roped in to assist with: basic patient care like taking vital signs, assisting patients with mobility, bathing and grooming. simple medical procedures such as simple diagnostic tests, and first aid - after completion of specialised training provided by their institution. coordinating referrals to specialists and communicating with patients about their care plans. mentoring new colleagues to guide them in their new roles. quality improvement projects and initiatives aimed at improving patient outcomes, reducing medical errors, or streamlining workflows. collecting and analysing data, identifying areas for improvement, and implementing new processes and protocols to improve care. The work performed by a PSA is fast-paced and non-routine. Patients and their next-of-kin rely on the PSA to guide them through their patient journey. Hence, PSAs play a crucial role with great responsibilities. Teamwork is essential and failure to fulfil their responsibilities may result in serious lapse and detrimental consequences. 1. I forgot to arrange the follow-up appoint for patients. 2. I made a “minor” typo error during the entry of patient’s address in the system. Activity Do you think these are acceptable errors? What are the possible consequences? 19 BS71008: Frontline Patient Services 1.3 Areas of Effectiveness Required of a PSA PSAs are patient fronting, and the first human touchpoint for the patients and their nextof-kins. As ambassadors, their actions have a direct impact to the brand and service quality of their healthcare institution. The following 5 areas of effectiveness are important for a PSA: 1. Technical 2. Legal 3. Relationship building 4. Customer Service 5. Communication 1. Technical Technical skills are the abilities and knowledge needed to perform specific tasks. There is a wide range of technical skills and knowledge to be learned in the healthcare industry. Product knowledge is an understanding of the “product” features and functions, so that PSAs can provide patient appropriate advice when necessary. Technical skills Know how to operate queue system Product knowledge Understand how the system prioritises queue sequencing to address queries related to wait time. PSAs are trained to operate different systems. With the advancement in technology, systems are upgrading, and processes are ever changing. For example, self-help registration and payment services are now a common sight at most public hospitals and polyclinics. PSAs may be stationed at self-help kiosks to assist patients with the navigation and completion of transactions. On top of that, PSAs would need to have the technical capabilities to manage clinic operations in the event of a “downtime”, so that the information can be updated when the system resume “online”. 20 BS71008: Frontline Patient Services Activity 4 1. Name the types of system that are used in your clinic or hospital for the following functions: Queue Appointment Billing 2. What are the product knowledge essential for a PSA? 2. Legal There are legal obligations which the PSA and healthcare institutions need to uphold as they are entrusted with patients’ private information. Patient Confidentiality Under Section 13 of the Private Hospitals and Medical Clinics (PHMC) Act, it is an offence to disclose a patient’s medical information, or any information which relates to the condition, treatment or diagnosis of any person without their consent. Nevertheless, there are some exclusions where disclosure, made for the purpose of administering and enforcing other Acts, is allowed. For example – under the Infectious Diseases Act 1976, a medical practitioner must notify the relevant authorities within a prescribed time if he/she has reason to believe or suspect that their patient is suffering from a prescribed infectious disease or is a carrier of that disease. Personal Data Protection Act (PDPA) Patient’s personal data is protected under the Personal Data Protection Act (PDPA). We will learn more about this Act in Unit 2.5 21 BS71008: Frontline Patient Services 3. Relationship-building PSAs are ambassadors of the healthcare institution. A strong patient-provider relationship facilitates cooperation and provides greater opportunities to learn about the patient’s unique health needs. This enables providers to better connect patients with the treatments and resources to improve overall health. In another words, we thrive to build a common ground. You Common Ground Patient Building good rapport is the ability to connect with your patients on an emotional level, which will provide true advantage over other healthcare competitors. Benefits of good rapport include: making the experience enjoyable for both patients and PSAs. patients are likely to be less critical patients are likely to be more forgiving, when an honest mistake happens. However, we should be mindful to accord the same warmth to all patients, to avoid being accused of showing biasedness. 4. Customer Service (Patient Service) The basic expectations from a healthcare facility include: quality medical care a comfortable and safe atmosphere caring and empathetic staff well-maintained patient records respect for their data privacy efficient work processes To deliver or exceed patients’ expectations, every employee in the healthcare industry must acknowledge and embrace their role and responsibility to provide a great customer service experience. Great customer service starts with taking a patientcentric perspective where everyone in the healthcare institution has a critical role to play. 22 BS71008: Frontline Patient Services Singapore Health Quality Service Award (SHQSA) was established in 2011, as a platform to honour professionals from the healthcare sector who have demonstrated remarkable commitment to delivering quality care and excellent patient experience. More importantly, the award aims to pay tribute to healthcare professionals of diverse backgrounds who have worked together to deliver better care for patients. Singapore Health Quality Service Award 2018 Source: https://www.healthxchange.sg/news/what-would-you-do-to-go-the-extra-mile-for-patients https://www.youtube.com/watch?v=ugtl87luUnU Following the national initiatives, most institutions now have their own awards or recognition programs to acknowledge the hard work and dedication of their Patient Service Associates and other healthcare worker. Building customer relationship may not require extraordinary acts - rather small acts of true care and compassion goes a long way. These awards may take many forms, such as certificates, plaques, or monetary rewards. The benefits of recognising the contributions of PSAs can include: boosting morale increasing job satisfaction improving patient outcomes creating a culture of recognition and appreciation within the institution, which can lead to increased employee retention and productivity. 23 BS71008: Frontline Patient Services 5. Communication Providing clear and concise information provide patients the ease to navigate through the processes of the clinic or hospital. Sometimes, staff members may get comfortable with work processes and forget that some patients may be at the healthcare institution for the first time. It is always good to “over” communicate than to assume that patients know what to expect or where to proceed next. Clear communication and timely updates can also manage expectations and enable patients to better plan their time and make alternative choices. For example, informing patient that the doctor would be late due to an emergency surgery. What you say to a doctor, or a fellow nurse might be very different to what you would say to a patient and their family. Many people associate the word ‘drug’ with illicit substances, whereas health professionals view ‘drug’ as a chemical substance to cure symptoms of an illness. Choose your words to fit the situation and the audience. Use “medicine” instead when communicating with patients Verbal communication Words to share information with other people, includes spoken and written communication. Speech volume: Try speaking with more clarity instead of louder, especially to those older. Communication Pace: Certain words may sound similar if they are spoken quickly. Take the time to speak slowly and carefully to ensure your words are less likely to be mistaken by others. 24 BS71008: Frontline Patient Services Avoid slang and jargon: Avoid using bigger and more complicated words as well as slang or jargons for better communication. Listen: Communication is a two-way street. One of the most important communication skills is to stop and listen actively to what the other person is saying. Communication Tone: The ‘emotional contagion effect’ describes how your emotional state can affect another person's feelings. If you approach a distressed and angry patient with raised voice and forceful tone, you run the risk of escalating the patient’s emotion. However, if you use a gentle, caring tone of voice, it will very likely help to calm and defuse the situation. Body Language and Non-Verbal Communication Non-verbal communication is the process of sending and receiving messages without using words, either spoken or written. Our body language tells the story of our emotions far better than words do. Positive-language: If you are seething with anger and attempt to use positive-language, people will notice and likely respond to the message coming for your body cues rather than your voice.. Keep hands and arms in front of your body. Avoid crossing arms as it signifies disinterest or confrontational. Eye contact is important as it conveys honesty, openness and helps when being assertive. 25 Relax facial expressions to keep from grimacing, pursing lips, lifting eyebrows, or scowling. BS71008: Frontline Patient Services Personal Space: You can moderate your body language by utilising these different spaces. For example, lowering yourself to the same height of the patient whom you are communicating with or leaving plenty of space between you and a person who is angry or distressed, so as to ensure personal safety. Source: AI Art Generator - Create Art, Images & More | Leonardo AI Public distance for public address, formal for larger audience Intimitate distance for intimacy, loving touch, comforting Social distance - Impersonal, social, casual Personal distance for trusted friends, family and close conversation Source: Communication Skills in Healthcare: A Guide to Practice (ausmed.com) 26 BS71008: Frontline Patient Services 1.4 Importance of Communication in Healthcare Health issues can be stressful. Patients are often worried about their health conditions as well as financial issues. If communication is not carried out effectively, this can strain interactions between the involved parties. Benefits of good communication to patients/ next-of-kins are: Improve patient outcomes Clear and concise communication can help patients better understand their condition, treatment options, and health management. This can lead to better compliance with treatment plans, improved self-care, and better overall health outcomes. Enhance patient safety Communication is crucial for patient safety. Errors in healthcare often occur due to breakdowns in communication. When accurate and timely information is shared about a patient’s allergies and medical history, medications and tests can be ordered and prescribed correctly. Foster trust and confidence When healthcare providers listen to patients and respond to their concerns, patients feel more respected and valued. This can lead to improved patient satisfaction and increased loyalty to the healthcare provider. Improve patient’s compliance and participation in their own care When patients understand and agree with their treatment plans, they are more likely to follow through, thus preventing unnecessary repeated tests and/or procedures. This can lead to more efficient use of resources and reduced healthcare spending. Ways to encourage patients to take a more active role in their care: Brochures/ Newsletters: o Can cover a range of health-related topics. o Handy in providing important information related to the care needs o Serves as a reminder on what was communicated, enabling them to better adhere to treatments. Appointment reminders: o Adherence is also heavily dependent on keeping appointments. o Reminders are useful in alerting patients on upcoming appointments. o A customizable reminder message takes into account a patient's preferred method of communication (letter or text). Tech savvy patients can also make use of the HealthHub to access information on appointments. HealthHub: o One-stop online health content, information and services portal and mobile application. o Provides tools to encourage citizens to adopt healthy habits and take greater ownership of their own health through personalised content and rewards. 27 BS71008: Frontline Patient Services Benefits of good communication amongst internal colleagues are: Improve teamwork and collaboration When healthcare providers communicate effectively with each other, they can work together to coordinate care and improve patient outcomes. This can lead to a more efficient healthcare system and improved patient experiences. Increase work efficiency Clear communication helps in conveying expectations, deadlines, and priorities. which allows work to be done efficiently. Healthy work environment A workplace with open and positive communication contributes to a healthy work environment. Colleagues who feel heard, valued, and respected are likely to be more engaged, satisfied, and motivated. Activity 5 1. Do you know of any trainees having difficulty getting along with their fellow co-workers? Which is more difficult to manage - internal or external customers? 2. Is enquiring status of test result or requesting for force booking of appointment is an easy task? 3. How can we help non-tech savvy patients keep track of their appointments? 4. If you are communicating important information of pre-operation preparation, and the elderly does not seem to understand but nodded, what would you do? 28 BS71008: Frontline Patient Services 1.5 Professional Image of a Patient Service Associate Maintaining a professional image as a Patient Service Associate is important for building trust and credibility with patients and colleagues. Besides being effective on the job, how you carry yourself matters. The following are pointers to building a professional image. Communication Speak in a respectful and courteous manner. Use proper grammar and avoid inappropriate language. Listen actively to what the patient/ next-of-kin is trying to communicate Behavioural and attitude Adopt a positive and optimistic attitude, even when managing challenging situations. Be punctual and practise good time management. Body language Smile and adopt a welcoming posture Stand/ sit upright Use subtle nods to show that you are actively listening Appearance Be neat and appropriately attired at all times. If uniform is provided, ensure that it is clean and well maintained. 29 BS71008: Frontline Patient Services 1.6 Methods of Enquiries There are several methods that patients and visitors can use to make enquiries at a hospital. Some common options include: Face-to-face: Patients and visitors can personally approach a representative at the healthcare institution's service/ information desk.. Phone: Many hospitals have a dedicated phone line or call centre where patients and visitors can contact for information. Email: Some hospitals may provide an email address or an online contact form for patients and visitors to send inquiries. Social Media: Many hospitals have official social media pages. In today's technologically advanced world, most of us are accustomed to receiving almost instantaneous responses to private messages we send. Mail: Patients and visitors can also send inquiries to the hospital via mail, though this may result in a longer response time. Online: Many hospitals have websites with information about their services and facilities, as well as an online chat feature or online method to contact customer service. Members of Parliament (MP): Requests or enquiries may be made during meet-the-people sessions with MP. The MP would then submit a request on behalf of their constituents, and hospitals would respond in writing, with a copy to the MP. 30 BS71008: Frontline Patient Services 1.7 Types of Enquiries There are many types of enquiries that may be made at a hospital. Some common examples include: General enquiries Appointments Charges and billings Medical Visiting hours Duration of visit Directions and parking Types of available services and treatments Scheduling of new appointments Changes to appointments Availability of doctors Charges for specific services/ tests Questions about hospital bills Questions on insurance claims Request copies of medical records Medical report preparation time and fees Outcomes of medical tests or procedures 31 BS71008: Frontline Patient Services 1.8 Guide to Enquiry Handling a. Obtain patient's particulars Obtaining patient's details is essential for verification of identity as well as staff follow up. This includes their name, date of birth, contact details, date of admission/ consult and any relevant medical information. Some patients may have multiple admissions or are consulting in more than one specialist clinic. It is therefore important to verify the exact encounter that the patient is enquiring. Be mindful not to provide personal or medical information of patient. When in doubt, always consult your supervisor. b. Respond to patient's queries The next step is to respond to patient’s query promptly and effectively. This involves listening actively to the patient, to better understand the patient’s concerns. c. Advise patient on next steps Depending on the nature of the enquiry, it may be necessary to advise the patient on the next steps they should take. This may involve scheduling an appointment with a healthcare provider, providing instructions for self-care or home treatment, or referring them to another healthcare professional or specialist. If answers are not immediately available i. Excuse yourself to check with colleagues ii. If more time is required, request/ verify patient/NOK contact number. Assure patient or NOK that you would check and respond to him/her as soon as possible. It is important to document the patient's medical enquiry in their medical records to ensure that their care is coordinated and comprehensive. Information documented should include the nature of the enquiry, the response provided, and any follow-up actions or recommendations. Following up with the patient after their enquiry has been resolved is an excellent way to ensure satisfaction with the outcome. It also helps to demonstrate that their care and wellbeing are important. This can involve checking in with them over the phone or via email to ask about their recovery or to schedule a follow-up appointment. 32 BS71008: Frontline Patient Services 1.9 Types of Patients' Personal Information As we speak about PDPA and patient confidentiality, we understand the importance to protect the personal data of patient. Some common examples of personal information that may be collected from patients include: Personal identification: Patient's name, age, gender, race, nationality, and copies of NRIC, passport, or other forms of identification. Contact information: Patient's phone number, email address, and emergency contact information. Payment information Patient's financial status, MediSave balance, credit card details Insurance information Patient's insurance provider, insurance policy Medical history Patient's medical history, allergies, medications and treatments Activity Name one measures taken in your organisation to protect patient’s data, securing it against unauthorised access or disclosure. 33 BS71008: Frontline Patient Services 1.10 Ways to Respond to Patient’s Queries Listen actively Listen to the patient's concerns Includes paying attention to tone of voice, body language, and the words used to express their concerns. Ask questions to ensure full understanding of patient's concerns Be empathetic Patients want to feel heard and understood. Acknowledge their concerns and show empathy for their situation. Provide accurate information Encourage questions Provide clear and accurate information that is specific to the patient's situation Answer their questions as honestly and directly as possible. Avoid using medical jargon. Encourage the patient to ask any additional questions they may have Let them know who they can contact if they have further concerns. Use visual aids If appropriate, use diagrams, charts, or other visual aids to help explain complex medical bills or medical instructions. The aids can make it easier to remember what was explained to them. Summarise and check understanding Summarise the information to ensure that patient understood the information. Offer resources Provide patient with additional resources, such as brochures or websites, where they can find more information. 34 BS71008: Frontline Patient Services 1.11 Communication Skills in Practice Scenario 1: Patient Enquiring About Medical Bill A patient received a medical bill for a recent hospital visit and has some questions about the charges. The patient calls the hospital's billing department to get more information. Patient: Hi, I received a medical bill for my recent hospital visit and have some questions about the charges. PSA: Sure, can you tell me your name and account number so I can access your bill? Patient: My name is Sarah Tan, and my account number is 12345. PSA: Ms Tan, to verify your identity, may I have your NRIC number and day and month of your birthday please? Patient: Sure, my NRIC is T1234567A, 14 March. PSA: Thank you for the verification. I noted there are 2 inpatient bills incurred in March and April 2024. May I check which inpatient bill are you enquiring on? Patient: The March bill, I noticed that I was charged for a procedure that I do not remember receiving. Can you explain what that charge is for. PSA: Let me check for you. It looks like that charge is for a diagnostic test that was ordered by your physician. It is possible that you were unconscious or under anaesthesia during the procedure, so you may not remember it. Did you undergo procedure A? As procedure A requires this particular diagnostic test to proceed. Patient: Oh, I see, yes, I underwent procedure A but was not aware that a diagnostic test is required. PSA: The diagnostic test is required for the surgeons to locate the specific location of the area they are accessing. You have a follow-up appointment with the doctor in 2 weeks’ time. You may wish to check with the doctor as he would be able to provide a more detailed explanation on the diagnostic test requirement. Patient: I understand that and will speak to my doctor during my next appointment. Thank you for explaining the charges to me. PSA: You are welcome. If you have any further questions or concerns, do not hesitate to give us a call. 35 BS71008: Frontline Patient Services Scenario 2: Patient Requesting Financial Assistance for Medical Bills A patient received a medical bill for a recent hospital stay and is unable to pay the full amount due to financial difficulties. The patient calls the Billing Office to request assistance. Patient: Hi, I recently received a medical bill for my hospital stay, and I am having trouble paying the full amount. Billing Office: Yes, we can definitely help you with that. Can you tell me your name and account number so I can access your bill? Patient: My name is James Lee, and my account number is 12345. Billing Office: Okay, thank you Mr Lee. To assist you, I require information on your current financial situation as well as the reason for being unable to pay the full amount. Patient: Yes, I lost my job a few months ago, and I am currently unemployed. I cannot afford to pay a lump sum of $10,000. Billing Office: I am sorry to hear that. May I check if an instalment plan on your outstanding bill would help you with your current situation? Patient: I would like to seek help to reduce the amount, as I haven’t been able to find a job. Would you be able to help please? Billing Office: In that case, I would need to refer you to our Medical Social office. Are your agreeable with this, please. Patient: Yes. Billing Office: Thank you for consenting. Please allow me to provide your information to our Medical Social office. If you do not receive any call from them within the next 3 working days, please give them a call at 61234567. Patient: Thank you for your help. Billing Office: You are most welcome. 36 BS71008: Frontline Patient Services Activity What challenges do you encounter when speaking/responding to the following groups of people? Write down some of the challenges and discuss.  Doctors  Nurses  Patients  Next-of-kin  Others 37 BS71008: Frontline Patient Services 1.12 Importance of Product Knowledge It is important for healthcare professionals and support staff to have a thorough understanding of the products and services offered by their healthcare organisation. Otherwise, staff appear clueless and this would not reflect well on the healthcare institution. Below are three ways to increase one’s understanding of products and services: 1. Stay up to date: Review updates and changes to your organisation's products/services on a regular basis. Information is usually transmitted via internal communication such as email or circular. 2. Understand the features: Be familiar with the features of each product/service. Make sure you have the key information to answer general questions and whom patients can contact to obtain more detailed information. 3. Know the limitations: Understand any limitations or restrictions of the products/services provided by your organisation. It is best to provide this information early, as some patients may be unwilling to invest time and effort to learn more when they are aware of the limitations. 1.13 Ways to Achieve Patient’s Satisfaction Patient satisfaction is an important indicator of the quality of care delivered in a medical setting. Here are some strategies to increase patient satisfaction: Provide prompt and efficient care: Patients value prompt and efficient care and may be more satisfied if they do not have to wait long for appointments or treatment. Communicate clearly and effectively: Patients may be more satisfied if they feel that their healthcare providers are listening to them and explaining things clearly. Involve patients in their care: Patients may be more satisfied if they believe they are an active participant in their healthcare and have the ability to make informed treatment decisions. It is critical that you obtain the patient's consent before involving their next- of-kin in their care. Provide a conducive environment: A clean and comfortable environment can help to improve patient experience. 38 BS71008: Frontline Patient Services Take care of their emotional needs: Show empathy and compassion. Patients may be more satisfied if they feel that their healthcare providers are caring and compassionate. Be Responsive: Address patient concerns and complaints promptly. Patients may be more satisfied if their concerns and complaints are addressed promptly and effectively. 1.14 Framework of a Patient’s Journey A patient's journey refers to the experience of a patient as they receive healthcare services from a healthcare organization. The framework of a patient's journey typically includes several key stages, including: 1. Pre-treatment: Activities such as scheduling appointments, completing registration paperwork, and gathering necessary information or documentation may be included in this stage. 2. Treatment: At this stage, healthcare services such as consultations, diagnostic testing, and treatments are provided. 3. Post-treatment: Includes follow-up care, such as additional appointments or rehabilitation, as well as discharge planning and coordinating care with other providers. 4. Follow-up: Involves ongoing care and management of the patient's condition, including monitoring and treatment as needed. Outpatient Journey Schedule an appointment Arrive at clinic/ Registration Eye check/ Blood test/ X-ray Doctor's consultation Collect Medication Payment and Follow-up Appointment An outpatient journey refers to the experience of a patient who receives healthcare services on an outpatient basis, meaning they do not require admission. The outpatient journey may include several stages, including: Scheduling an appointment: The patient contacts the healthcare facility to make an appointment, or they may be referred to a specialist by their primary care doctor. There are several types of referrals, which are as follows:  Referred by polyclinic/ GP  Referred by Emergency Department  Self-referred  Referred by another specialist  Follow-up review after admission 39 BS71008: Frontline Patient Services Patients are advised to arrive at least 10 minutes before appointment time. The use of HealthHub or hospital apps enable patients to self-register, even before arriving at the clinic. Patients would alert the staff once they have physically arrived at the clinic. Alternatively, patients may register via the self-registration kiosk, or at the registration counter after arriving at the clinic. Arriving for the appointment: The patient arrives at the healthcare facility for their appointment, which may involve registration in at a reception desk or kiosk and completing any paperwork that is required. Upon registration, patient will be issued a queue number on their mobile app or registration ticket. The ticket will advise patients of the consultation room the doctor is in. Advise patients to take a seat at the waiting area or outside the consultation room. It would be good to inform patients that queue number are not called in sequence or that consultation is by appointment and not on a first come-first-serve basis. Seeing the healthcare provider: The patient attends their appointment, which may include a consultation, diagnostic testing, or treatment. Receiving follow-up care: After the appointment, the patient may be given instructions for follow-up care, such as taking medications or returning for additional appointments. Overall, the outpatient journey is designed to provide patients with the necessary healthcare services on an outpatient basis, allowing them to receive care without having to stay overnight in a hospital. 1.15 Methods of Registration  HealthHub – a Singapore digital health platform that provides services and information to help individuals manage their health and wellness.  Hospital app: Each integrated cluster also developed their own application. - Singhealth: Health Buddy - NUHS: OneNUHS - NHG: NHG LEAP  Clinic registration: Manual registration process managed by the PSA at the counter. Self-registration kiosk: Can be used to perform self registration at the clinic. 40 Source: https://www.singaporehealthcaremanagement.sg/Abstr acts/Poster%20Exhibition/Documents/CO028%20%20Eugene%20Sim_SGH%20(Revised).pdf BS71008: Frontline Patient Services 1.16 Types of Registration   First visit: refers to their first visit to a healthcare facility for a specific medical concern. Repeat visit: subsequent visits to the healthcare facility for the same or a similar medical concern. Documents required vary depending on the type of registration you are performing. First visit (FV) Repeat Visit (RV) i. Identification documents i. Appointment Card a. NRIC/Birth Certificate (for children ii. Any form for further investigation(s) under 15 years old) ordered, that may have been given OR during earlier visits. E.g., x-ray, ultrasound, mammography, blood test Entry/ Re-entry Permit / Employment Pass / Dependent Pass / Work Pass / Student Pass / Visit Pass ii. Referral letter from family doctor / polyclinic, if any. iii. Any prior medical reports / results, investigation results and images relevant to the medical condition that is in consultation. iv. Baby Bonus / Pioneer Generation (PG) / Community Health Assist Scheme (CHAS) cards, if any. v. Letter of guarantee (LOG) from employer/ insurance company. Steps to Register Patient 1. Greet patient and check if they have registered online. 2. Check if it is their first visit (FV) at the clinic. a) For FV, perform full registration by verifying their personal details such as name, NRIC number, contact number and address. Request for their referral letter, LOG or any benefits card. b) For RV, verify name, contact number and address to ensure correct patient, and at the same time update their contact details if there are any changes. 3. Once completed, initiate consultation case on system and advise patient on their queue number and direct them to the correct waiting area. It is good practise to always provide information to all patients, as if it was their first time to the clinic. 41 BS71008: Frontline Patient Services 1.17 Categories of Patient Classification According to the guidelines of MOH, there are two types of patient classification: - Subsidised - Non- Subsidised/ Private Subsidised Patient Only Singaporeans and Permanent Residents (PRs) are eligible for hospital subsidies if they are referred by:  Polyclinics  A&E of Restructured Hospitals  Subsidised outpatients from Restructured Hospitals  The Singapore Armed Forces (SAF)  Voluntary welfare organisations under the purview of MOH  General Practitioner (GP) participating in the Community Health Assist Scheme (CHAS) where the patient is a CHAS cardholder.  Discharge from inpatient subsidised class ward (B2 or C) for follow-up outpatient treatment. Moreover, these referrals must be made without reference to a specific doctor. Subsidy is only applicable to patients who are not existing private patients for the same medical condition. Subsidised patients will be cared by a team of doctors, under the supervision of a consultant. The doctor attending to them may change at each visit. Non-Subsidised Patient Patients are considered a private patient based on their first visit if they are referred by:  Self - referral; Walk-In.  General Practitioner (GP).  Restructured Hospitals with SOC private status and/ or reference to a specific doctor.  Polyclinic and/ or specifying a consultant by name.  A private doctor or private hospital, with or without reference to a consultant by name.  Discharge from inpatient ward class A or B1 and requires outpatient follow-up treatment.  Industrial accident case. All foreigners and non-residents are considered as private patients. Cost of FV and RV are priced differently as well. 42 BS71008: Frontline Patient Services 1.18 Types of Subsidies and Schemes The healthcare financing in Singapore has a multi-payer financing framework. Multiple schemes / payers can cover a single treatment. Subsidies Affordable Health Care Up to 80% at public healthcare institutions MediSave Personal Savings To pay for healthcare bills MediShield Life (& other insurance) MediFund smaller Basic Healthcare Insurance To help with larger healthcare bills healthcare Safety Net To provide help to needy Singaporeans (Image source: ScienceDirect, 2019) Subsidies Heavy government subsidies are available for all basic healthcare services. Singaporeans can choose subsidised inpatient care and specialist outpatient care at the public hospitals if they have appropriate referral from primary care. Emergency services are subsidised for all patients. Portable subsidies for lower- to middle-income are also available at private general practitioner (GP) and dental clinics under the Community Health Assistance Scheme (CHAS) and long-term care. As part of individual responsibility, patients have to co-pay a part of the treatment cost. Subsidies account for a large part of healthcare financing, with the remaining payable by MediShield Life or other insurance, MediSave/cash and Medifund if necessary. 43 BS71008: Frontline Patient Services Medisave Under the Central Provident Fund (CPF) framework, Medisave is a national medical savings scheme that helps all Singapore Citizens and Permanent Residents set aside part of their income to help pay for their own or immediate family member’s healthcare need. Regular savings via Medisave ensures that patients have savings to tap on for healthcare expenses. Thereby reducing their cash outlay. Medisave can be used for inpatient care, outpatient care, premium payments and long-term care. MediShield Life This is a basic hospitalisation insurance plan administered by CPF Board, which helps to pay for large hospital bills and selected costly outpatient treatments such as chemotherapy and kidney dialysis. MediShield Life offers protection for life for all Singaporeans and permanent residents, regardless of age and health conditions (including pre-existing conditions). It is structured so that Medisave/cash outlay for large hospital bills can be greatly reduced. MediFund A government-funded financial assistance program for individuals who are unable to pay for their healthcare expenses Pioneer / Merdeka Generation Package Pioneer Generation refers to Singaporeans who were born in 1949 or earlier while Merdeka Generation refers to Singaporeans born in 1950-1959. The government introduced healthcare subsidies and benefits to thank these groups of Singapore citizens for their contributions to the country's early development. Community Health Assist Scheme (CHAS) CHAS is a scheme that provides subsidies to lower-income Singaporeans for outpatient healthcare services at participating general practitioner (GP) clinics and dental clinics. 44 BS71008: Frontline Patient Services CareShield Life CareShield Life is a national insurance program that provides financial protection for individuals who are unable to pay for their long-term care needs due to severe disability. 1.19 Steps in Processing Payments The four steps in processing payment are: 1. Create a positive impression 2. Verify patient identity 3. Explain the bill 4. Collect payment Smile, provide eye contact, patient with a nod. acknowledge Check that it is the correct patient, address patient by name and update changes in contact information Inform patient on service rendered, and explain charges and payment method. Check with patient payment method. on his/her preferred 1.20 Procedure for Non-Payment A patient may not have brought sufficient funds to pay at the healthcare institution. If a patient has problems with payment, offer to mail the bill to his/her residential address. Advise patient to arrange for payment within 2 weeks upon receipt of the bill statement. Those who require financial assistance, Gently probe to understand reason for non-payment Offer instalment plan Refer patient to Medical Social Worker 1.21 Types of payment methods To offer more convenience to patients, healthcare institutions offers a wide range of payment methods such as:  Cashless payments  AXS  Cash  HealthHub / Hospital application  Cheque 45 BS71008: Frontline Patient Services In line with Singapore's vision of a Smart Nation, IHiS has enhanced electronic payment capabilities to offer patients a wide range of digital payment options at public healthcare institutions (PHIs). To increase PHIs' operational efficiency, IHiS' ePay project team identified four key areas of improvement. Source: Streamlining Payments for Better Efficiency and a Seamless Billing Experience (ihis.com.sg) 1. UPOS Terminals Enable payment through a single terminal regardless of the payment option chosen. Helps to: Lower operating costs. reduce transaction time reduce human errors reduce training duration 2. Online Payments Introduce and standardise online options by enabling credit and debit card payment via PHIs’ corporate websites or HealthHub. 3. Cashless Transactions with PayNow Corporate Patients only need to scan a single QR code and be redirected to the payment screen. This helps to improve the overall patients’ experience when they see a doctor. 4. SGQR Code SGQR is a single QR code that combines the QR codes of the multiple electronic payments. Patients can look for this label to select the available payment options; and healthcare institutions only need to display one SGQR label instead of multiple labels. Source: SGQR Infographic (mas.gov.sg) 46 BS71008: Frontline Patient Services 1.22 Bills Layout/ Content on Outpatient Bills Common information reflected in outpatient bills include: Name of healthcare institution Name, ID and address of patient Date and time of visit Consultation fees Cost of diagnostic tests/ examinations Medicine It can be confusing for patients when different institutions adopt different formats of bill presentation. Hence, to eliminate this and enhance understanding of healthcare charges, a consistent format in presenting the details of healthcare bills was rolled out in April 2021. Bill Presentment for Public Healthcare Institutions (PHIs) The new bill format will:  Standardise information Healthcare bills across healthcare institutions and care settings should all be using the same format of bill presentation.  Clearly indicate the pre-and-post subsidy costs The various financing schemes that are utilised will be reflected clearly.  Provide options on bill payment methods Bills should include an SGQR code for online payment for added convenience. Patients can also access their bills and make payments on HealthHub. 47 BS71008: Frontline Patient Services The bill shown below is for illustrative purposes only. Source: https://www.moh.gov.sg/cost-financing/bill-presentment-for-public-healthcare-institutions 48 BS71008: Frontline Patient Services Source: https://www.moh.gov.sg/cost-financing/bill-presentment-for-public-healthcare-institutions 49 BS71008: Frontline Patient Services 1.23 Types of Billing Errors Billing errors 1. Incorrect Patient Information 2. Wrong Charge Code 3. Medisave Claim Error 4. Wrong Payment Mode 1. Incorrect Patient Information Healthcare professionals are susceptible to this mistake - inputting wrong information, as they are faced with a fast- paced and stressful working environment. Misspellings and typos in the address, account number, birth date or other identifying information can lead to problems. Some errors, like incorrect information in the insurance ID, will result in the claim being rejected. Rejected claims are upsetting to patients and can lead to complaints. These errors can be prevented by double- checking patient information and other vital details before confirming the entry. Source: https://www.researchgate.net/figure/Patient-information-errors_tbl2_237004260) 50 BS71008: Frontline Patient Services 2. Wrong Charge Code Charge codes refer to individual codes assigned to specific charges, that are tagged to a type of service, medication or medical supply provided. Source: https://axenehp.com/accountability-hospital-health-system-pricing/ It is possible for a doctor, the nurses, or service staff to miscode the services. Entering the wrong charge code may result in a patient being billed for services which they had not received or being charged more than those that were actually executed. Even simple typographical errors can have significant consequences. Diagnosis and treatment codes must match. A mismatch can cause the insurance company to reject the claim and the patient will be responsible for additional costs. Differences between Rejected and Denied Claims REJECTED CLAIMS DENIED CLAIMS Due to errors from staff Due to claims are determined incorrectly inputting patient or by insurance company to be unpayable and reasons for insurance information. denying the claim will be attached to the claims. Can be resubmitted once errors Can be appealed and are rectified reprocessed in some cases. Source: https://www.softwareadvice.com/resources/fix-5-examples-medical-claims-errors/ 51 BS71008: Frontline Patient Services 3. Medisave Claim Error The Medical Claims Authorisation Form has to be completed in the presence of a healthcare service staff. This authorises the CPF Board to deduct from the agreed Medisave Account. MediSave account can be used to pay for hospital bills incurred by: patient patient’s spouse patient’s children patient’s parents patient’s grandparents (provided they are Singaporeans/permanent residents) Medical Claim Authorisation Form MediSave account holders need to sign the Medical Claim Authorisation Form (MCAF) to utilise their Medisave, MediShield Life or Integrated Shield Plan (IP). In order to ensure proper deduction via Medisave account, the form has to be completed correctly. Any missing/incorrect information or incorrect forms submission will result in billing issues. Therefore, it is vital for healthcare professionals to fill in accurate and complete information. 4. Wrong Payment Mode Healthcare institutions accept various modes of payment. Patients’ preference for payment of medical bills is usually in the following order:  Insurance  Medisave  Debit/Credit Card  Cash It is critical for service staff to confirm patient’s payment preference and input the correct payment mode in the system. Failure to do so will result in patient’s frustration, especially if his medical bill was deducted from his Medisave account instead of his insurance plan. Source:https://www.aia.com.sg/en/life-matters/planning-for-the-future/managing-healthcare-costs-in- singapore.html 52 BS71008: Frontline Patient Services 1.24 Causes of Billing Error Root cause analysis (RCA) is a process to investigate what, how and why an error happened. It also helps determine preventive measures to deter the error from recurring. RCA is based on the theory that mistakes do not just happen but are linked to a certain latent cause. The aim of RCA is to identify the major contributors that caused the error. For example, finding out the reasons behind non-adherence to procedures. Are other service staff facing the same issue? Were there other tasks that made it difficult to follow the recommended procedure? After the causal factors are identified, identify root causes by reasoning why the causal factors exist or occur. Bottom-line, RCA focuses primarily on systems and processes, not on individual performance. To be successful, the objective of a RCA must not be to assign individual blame. Rather, a team works to understand a process(es), the causes or potential causes of variation that can lead to error and identify process changes that would make these variations less likely to recur. Patient’s Medisave account was deducted for a dental surgery that he undergone. System shows payment is to be deducted from Medisave Staff assumed that patient prefers to pay via Medisave System auto-selects payment via Medisave Medisave was used to pay for patient’s last visit Previously, patient did not have any insurance plan Staff to check with patient whether he has an insurance plan when requesting for his preference for payment mode 53 BS71008: Frontline Patient Services 1.25 Corrective Action(s) for Billing Errors The table below highlights the critical mistakes, with its corresponding corrective actions. EXAMPLE Incorrect Patient Information Change of address not updated Verify patient contact information Retrieval of wrong patient’s profile Ensure correct profile by checking 2 patient identifiers Diagnosis and treatment code mismatched Confirm with patient on procedure performed Charged for a more expensive service Check procedure against the list of charge code, if unsure Patient requested for the MCAF (Single Institution), but staff submitted the MCAF (Multiple Institutions) Check to ensure that the correct MCAF form is given to patient for signing Spouse’s Medisave was deducted instead of patient’s Confirm the Medisave request before processing Confirm MediSave ranking in the system Wrong Charge Code Medisave Error Wrong Payment Mode ROOT CAUSE CORRECTIVE ACTION ERROR TYPE Medisave was deducted instead of insurance Confirm patient’s preferred payment mode before processing It is vital to identify errors in billing and then take corrective measures to prevent it. Corrective actions are steps taken to address a problem or issue that has been identified in a system or process. They may involve changes to the system or process, or additional training for employees. 54 BS71008: Frontline Patient Services 1.26 Procedures in Scheduling Appointments and Surgeries Below is a general overview of the process of scheduling appointments and surgeries: 1. Appointment Request: a. Patients initiate the scheduling process by requesting an appointment, either through phone calls, online portals, or in-person visits. OR b. doctor arranged a surgery as part of patient’s treatment plan. 2. Verification and Information Gathering: Verify patient details, collect necessary information, and ensure all required documentation is complete. This may include insurance information, medical history, and any specific pre-appointment instructions. 3. Appointment Scheduling: The healthcare facility schedules the appointment or surgery based on availability and urgency indicated by the doctor. 4. Patient confirmation: The patient is notified of the appointment or surgery date and time, location, and any preparatory instructions. 5. Preparation and Coordination: Ensure that the necessary resources, including medical staff, equipment, and facilities, are coordinated and prepared for the scheduled surgery. This involves collaboration among different departments and personnel. 6. Patient Education: Educate patients about any pre-surgery requirements, such as fasting, medication adjustments, or specific pre-operative tests. Provide clear instructions to enhance patient readiness. 7. Post-appointment/Surgery Follow-up: Facilitate a smooth check-in process on the appointment or surgery day. After the appointment or surgery, follow up with patients to monitor recovery, provide postoperative care instructions, and address any concerns. 55 BS71008: Frontline Patient Services 1.27 Appointment and Outstanding Bill Reminders After the appointment or surgery, the patient may be provided with post-discharge or follow-up instructions, such as medications or additional appointments. Some healthcare institutions provide the appointment details before patient leaves the clinic or hospital, while others notify patients via call/ SMS or inform them to check the appointment details in HealthHub. Patients can then change their appointments using the HealthHub or the hospital’s mobile application. Regardless of the types of appointment booking processes adopted by the healthcare institution, it is important to note that all outstanding bills need to be paid, especially when force booking is required. Patients with outstanding bill would receive a bill payment reminder approximately 7 days after their visit. These reminders are automatically generated as part of bill collection efforts. Activity How do healthcare providers make sure patients are seen at the right time and avoid the risk of patients rescheduling appointments outside the recommended review date range? 56 BS71008: Frontline Patient Services UNIT 2: PERFORM PATIENT ADMISSION Admission of a patient means allowing and facilitating a patient to stay in the hospital unit or ward for observation, investigation, and treatment of the disease he or she is suffering from. Source: https://www.slideshare.net/anjalatchi/admission-procedure-for-hospital-services-nabh-pptpptx 2.1 Types of Admission Source: PrudentialMY on YouTube: Part II, A quick guide to hospital admission 52 BS71008: Frontline Patient Services Admission into the hospital is categorised into: Unplanned (urgent) admission Patient may arrive at hospital in their own transport or in an ambulance. This is known as an ‘unplanned presentation’. If their condition needs urgent treatment, they will be admitted through the emergency department on arrival at hospital. A specialist emergency nurse, called the triage nurse, will assess patient’s condition, provide first aid and work out how much treatment is needed. Waiting time largely depends on: The severity of patient's condition The presence of patients with more serious/ urgent condition. The availability of medical personnel How busy the emergency department is at that time. There are 4 levels of priority: Nonemergency Priority 4 Minor accidents (Ambulant) Priority 3 Major emergencies (nonambulant) Priority 2 Priority 1 Resuscitation & Critically-ill patients  Emergent admission o unplanned and usually happens when a patient required A&E attention and was subsequently admitted for further investigation and treatment in the hospital.  Observation admission o This usually occurs in the observation ward of the A&E department. o the patient is placed under observation to enable a medical practitioner to determine whether inpatient care is required. Pre-planned admission Patients are admitted based on the kind of treatment they are receiving and its urgency.  Elective admission o refers to a scheduled admission of a patient for a planned medical procedure or surgery, such as a hip replacement or a heart bypass surgery. o This type of admission is usually pre-arranged by a physician or a surgeon, and the patient is given a specific date and time for their admission to the hospital. 53 BS71008: Frontline Patient Services  Direct admission o typically refers to a patient being admitted to the hospital without going through the emergency department or any other intermediary department. o This means that the patient is admitted directly to a hospital bed, either by a physician or by self-referral, based on the patient's medical condition.  Transfer admission o the admission of patients who are transferred from other facilities/ hospitals. SBAR SBAR Communication tool was originally designed by the US military for communication on nuclear submarines. This communication tool has since been applied to different healthcare settings, particularly in relation to improving patient safety. Purpose of SBAR allow staff to communicate assertively and effectively reduce the need for repetition reduce likelihood for errors. Source: SBAR – written by ACT Academy. [email protected] 2.2 Types of Communication Models in Healthcare Setting When to Use SBAR SBAR provides the structure for the sender and recipient of the information. Both users know what to expect. It helps to ensure that the sender is not interrupted by the receiver with questions that will be answered later on in the communication. SBAR can be used by anyone in the healthcare setting – across different disciplines and different levels of staff. Junior staff may feel comfortable updating or recommending a particular situation on patients, especially when communicating with senior staff. S – Situation    Identify your name and the site/unit you are calling from. Address the patient by name. Share the reason for your communication. For example, “This is Brenda, PSA from Clinic L. The reason I’m calling is because patient Mdm Tan Beng Lum, has just arrived for her appointment at the clinic, complaining of shortness of breath and abdominal pain.” 54 BS71008: Frontline Patient Services B – Background   Provide the patient’s reason for admission. Explain significant medical history as well as patient’s background. Examples of patient background include: o Date of last admission o Prior procedures o Current medications & allergies o Pertinent laboratory results o Other relevant diagnostic results For example, “Mdm Tan Beng Lum – a 58-year-old woman, was admitted 3 months ago for removal of cyst in her right ovary. The cyst was about 5cm, benign. She was recovering well after surgery and was discharged 5 days post-surgery. She showed no other signs of medical complications.” A- Assessment This information is obtained from the doctor. You will need to document the information given by the presiding physician.  Vital signs, Contraction pattern, Clinical impressions, concerns. For example, The vitals taken by the nurses, showed an elevated heart rate and blood pressure. The patient reported a pain score of 7/10 for abdominal pain. R–  Explain what is needed – be specific about request and time frame. Recommendation  Make suggestions.  Clarify expectations. For example, Doctor Howard is requesting for a CT scan for patient. When is the next available time? SBAR could be used in any health care situations such as:  Inpatient or outpatient.  Urgent or non-urgent communication.  Conversations between clinicians, either in person or over the phone.  Conversations with peers – change in shifts.  Communication between different disciplines – example general medicine and dietician  Escalating a concern.  When patients move between healthcare institutions – example integrated home care services and hospital care services. 55 BS71008: Frontline Patient Services Activity: SBAR in application In groups of 3s and 4s, apply SBAR tool based on the given scenario. Mdm Neo Kim Lian, 74 years old, has been staying in St. Luke’s community hospital for 3 weeks since her discharge from TC General Hospital. She has been undergoing rehab exercises since her hip operation. In a routine examination by the nurse manager, they discovered that she was breathless, developed a fever and was too weak to stand up. She requires immediate medical attention and needs to be admitted back to TC General Hospital. Apply SBAR tool to communicate Mdm Neo’s case to TC General Hospital. 56 BS71008: Frontline Patient Services REDE Relationship Establishment Development Engagement Developed by Cleveland Clinic, REDE communication model is a conceptual framework for teaching and evaluating relationship-centered communication. It is a tool which allows users to enhance their communication skills and develop a more reflective competence by refining their skills, adopted under different settings. REDE focuses on three primary phases of Relationship: Establishment, Development and Engagement. Phase 1: Establish the relationship.  Create a safe environment/ atmosphere for the patient. This helps in fostering trust.  Convey value and respect. Welcome the patient and their next-of-kin. The first impression matters as this would establish the climate of the environment.  Provide assistance for patients and their next-of-kin Help patients who are unfamiliar with the use of self- registration kiosks. Explain their visitation journey at the hospital where necessary.  Display empathy. Empathy is the ability to imagine oneself in another’s place and to understand the person’s thoughts and feelings. Patients may experience some form of anxiety when they visit a clinic. Seeing a clinic full of patients can be daunting and uncomfortable. To make matters worse, patients may have to wait at least 1.5 to 2 hours before seeing the doctor. How would you demonstrate the ability to “establish the relationship”? Discuss and write some points down. 57 BS71008: Frontline Patient Services Phase 2: Develop the relationship. Genuine curiosity and interest are essential first steps in building relationship. Building relationship may be easier with patients whom you meet regularly at the clinic.  Listen reflectively by using verbal and non-verbal cues. o Non-verbal cues such as nodding, direct eye contact and leaning forward. o Verbal cues such as “mm-mm”, “go on”, “I see”. o Do not use judgemental tone or words.  Use open ended questions Elicit the patient’s narrative by using open-ended questions such as “tell me more…” or “what happened next?” The purpose is to get the patient to talk about their current situation.  Gather the patient’s perspective using VIEW The purpose of gathering information is to determine if the patient is receptive about the illness and treatment. Examples of using VIEW, − Vital activities – How does it disrupt your daily activities? − Ideas – What do you think is wrong? − Expectations – What are you hoping we could assist you with today? − Worries – What worries you the most? A patient arrived at the clinic for a follow-up check. Instead of his usual cheerful behaviour, he appeared to be gloomier. Greet the patient and try to strike up a conversation. Listen to the patient. Apply VIEW in your conversation. 58 BS71008: Frontline Patient Services Phase 3: Engage the relationship.  Share diagnosis and information. o o o Ensure that patient understands the treatment plan. Sometimes patient struggles to understand what the doctors have explained; thus, you may have to reiterate or explain in a language which the patient is familiar with. Remind patients to go for their appointments.  Provide closure. o o Ensure patients understand their follow-up appointments, which location they should visit next if their journey at the hospital has not ended. Check with patients for mode of payment. The doctor has examined and shared the prognosis with the patient. The patient has 3rd stage cancer. Patient is sitting outside the doctor’s room, looking lost and upset. What could you do? Discuss and write what would be your action to comfort or empathise with the patient. 59 BS71008: Frontline Patient Services 2.3 Qualities and Characteristics of a Positive Interaction and Experience 1. Patient-First Mindset Having a patient-first mindset simply means that the key focus of the organisation’s strategies and processes are centred on the patients and what they want. Patients needs ALWAYS comes first. In the midst of stress and exhausting processes, healthcare professionals forget to treat patients as people, who wants to be listened, understood and really cared for. Patients need to be ‘seen’ as customers, and not captives. Healthcare professionals need to constantly remind themselves that: “It’s all about them, not me or the organisation – that’s why I’m here.” Healthcare professionals need to be able to:  put the needs of the patient first  ensure patient’s needs are met  go out of the way to ensure the patient is satisfied 2. Positive Attitude Healthcare professionals that are deemed ‘positive’ are those that exhibit enthusiasm. They display a “can do” attitude and are usually optimistic about their ability to make a difference and accomplish success. A healthcare professional with a cheerful demeanour also puts patients at ease and helps them to feel comfortable, amidst the pain and anxiety that they are feeling. It is not enough to just provide clinically competent care, attitude and character are just as important as competence. 3. Professional Competence It is critical for healthcare professionals to possess good knowledge about job-related issues in order to serve patients efficiently. As such, healthcare institutions need to ensure that their staff are competent in the following areas:  Technical skills and knowledge These are fundamental competencies in order for a staff to be professional and proficient. Imagine going to the eye clinic and asking how long the visual acuity check will take, only to be told, “Sorry, I don’t know. I only do registration.” All staff have to be equipped with current and updated knowledge on equipment, systems, policies and procedures, which in turn will increase their confidence and performance levels.  Soft skills It is paramount that healthcare professionals have the necessary soft skills, as they are highly involved in daily interactions with the patients. These soft skills include communication skills, problem solving skills, flexibility, interpersonal skills and teamwork. 60 BS71008: Frontline Patient Services 4. People Orientation Caring for a patient starts with connecting. It involves taking the initiative to build rapport with patients. This starts with showing personal interest in patients by making eye contact, smiling and addressing the patient by name. Take a few extra seconds to make time for a connective moment, acknowledge the patients’ sentiments, tune into their feelings and talk to patients with the genuine interest to help. The rule of thumb to being people-oriented is to be present, personable and patient. 5. Basic Respect Great healthcare professionals respect people and their personal space. They are mindful of confidentiality requirements and different cultures and traditions. It is important to consider patients as individuals who require their own privacy and needs. Some ways to show basic respect include:  start a conversation with the patient by addressing the patient by name and explaining the care activities that will be taken, step by step  ask for permission before beginning any medical check or treatment to avoid embarrassing the patient  observe the personal space of patient  consider the patient’s need for time, when making decisions 6. Resourcefulness A core attribute of a healthcare professional is the ability to know where to find information even if he/ she does not know the answers. A resourceful healthcare professional is able to  solve problems for patient.  find alternative solution(s) for patient.  work around rules, when appropriate, to resolve or avoid problems. Resourcefulness helps saves time and money for both the patient and healthcare institution. It can also result in a much better outcome, such as decreased suffering, improved well- being and better quality of care for the patient. 7. Reliability When providing service or care to patients, healthcare professionals need to ensure:  Safety – carry out activities or procedures without harming patients  Appropriateness - provide information/service necessary for patients based on their needs  Effectiveness - do what is best for the patient instead of doing what is the easiest  Efficient - good management of resources such as time, manpower, equipment and effort 61 BS71008: Frontline Patient Services 8. Personalised Responsiveness Every patient wants to feel special and treated as individuals. Therefore, it is necessary for healthcare professionals to understand that every patient has their preferences and expectations. It is also paramount to take every patient’s unique situation into consideration when offering information and/or solution. i.) ii.) iii.) iv.) v.) vi.) vii.) viii.) 2.4 Methods of Verification Steps in Pre-Registration Checks Failure to correctly identify patients may result in medication errors, transfusion errors, testing errors, wrong person procedures, and the discharge of infants to the wrong families. The practice of involving patients through “two patient identifiers” is essential in improving the reliability of the patient’s identification process. The use of two identifiers also helps ensure a correct match between the service or treatment and the individual. Thereby eliminating errors and enhancing patient care. As a PSA processing registration at admission, it is crucial to  verify patient’s details with the information recorded on the system  ensure that financial counselling and relevant forms have been signed and completed  prepare the necessary casefiles/ folder for patient’s admission Online With the introduction of tele-consultation, online patient verification became part of the work process. Online patient verification refers to the process of verifying a patient's identity and information through an online system. Below are examples of how online patient verification can be performed:  Secure login: Patients can log in to a secure online portal using a unique username and password to verify their identity and access their medical records.  Verification codes: Patients may be sent a verification code via email or text message that they can use to confirm their identity and access their online account. 62 BS71008: Frontline Patient Services  Biometric verification: Patients may be able to use biometric authentication methods, such as facial recognition or fingerprint scanning, to verify their identity. Other devices such as the Real-time Location System (RTLS) may also be used to verify and track patient’s movement within the healthcare facility. Hospitals using RTLS tag require every patient to wear a wrist identification band, which will be attached upon admission. The band will hold information such as the patient’s name, NRIC, ward number and address to enable identification by hospital staff. Online patient verification can help to improve the efficiency and accuracy of healthcare processes and can also help to protect patients' personal and medical information. It is important to ensure that online patient verification systems are secure and comply with relevant laws and regulations. Offline Offline patient verification in a hospital typically involves the process of confirming a patient's identity and information without the use of electronic systems. It is usually performed manually by hospital staff.  Photo identification: Patients may be required to presentation of NRIC, Birth Certificate or passport to verify their identity in person at the emergency department.  Verification by healthcare staff: Patients may be asked to provide personal and medical information to healthcare staff (e.g. at the operating theatre), who can verify the information by checking it against the patient's medical chart. Activity What would you do when patients appear frustrated when their identity is checked so often? 63 BS71008: Frontline Patient Services 2.5 Importance and Objectives of Personal Data Protection Act Personal data refers to data, whether true or not, about an individual who can be identified from that data; or from that data and other information to which the organisation has or is likely to have access. Personal data in Singapore is protected under the Personal Data Protection Act 2012 (PDPA). The PDPA establishes a data protection law that governs the collection, use, disclosure and care of personal data. It recognises both the rights of individuals to protect their personal data, including rights of access and correction, and the needs of organisations to collect, use or disclose personal data for legitimate and reasonable purposes. Appointing a Family Representative In line with patient’s confidentiality, patient consent is required for any sharing of information. The care team may check with the patient for an appointed spokesperson for them to communicate with. Ideally, it should be the next of kin. Sometimes families may want a member with a medical background to receive the updates. Families may have the best intentions, but the patient’s rights always come first. Activity 1. Provide examples of ways PDPA may be infringed during the course of work as a PSA. 2. What are the possible consequences of disclosing information to a patient’s family member? 69 BS71008: Frontline Patient Services 2.6 Types of Patients’ Personal Information Patients' personal information refers to any information that identifies a specific individual such as identify, financial, or medical history. 1. Identity Examples include name, NRIC/ FIN/ passport number, contact number, email, emergency contact. 2. Financial Examples include MediSave, insurance, credit card. 3. Medical Examples include patient's medical history, illnesses, allergies, medications. 2.7 Procedures in Handling Deposits A deposit is normally collected at the time of the patient's admission to cover their estimated hospital bill. The amount varies, depending on the type of cases and the classes of ward chosen. When is it required? For patients opting for Private A/B1 wards, a deposit is required because deduction from Medisave cannot fully cover the hospital charges. Patients who are unable to pay the deposit should re-consider their choice of ward. Foreigners / non-residents Exemptions Deposit payment may be exempted in the following situations: patient produces a Letter of Guarantee from their employer in Singapore. patient is covered by insurance and produced the Letter of Guarantee prior to the admission For foreigners/ non-residents, a letter of guarantee from a local firm or insurance company or a banker’s guarantee will have to be furnished. Generally, patients opting for subsidised ward are not required to furnish a deposit if they have sufficient balance in their Medisave accounts to cover the hospital charges. Those who face financial difficulties will continue to receive basic health services at subsidised wards. 70 BS71008: Frontline Patient Services 2.8 Types of Different Wards (Acute Hospital) Private Class A Class B1 Subsidised Class B2 Class C Team based care based on patient’s choice of specialist Single room or up to 5 beds with attached bathroom facilities Team based care based on an assigned specialist Between 6 to 12 beds with shared bathroom facilities 2.9 Methods of Obtaining Signature Upon the admission to the hospital, patient is deemed to have agreed to the required treatment for their medical condition. Some procedures may require additional consent in writing. These consents would be explained and obtained by the attending doctor. The following are methods to obtain signature (online and offline):  In-person signature: The patient can sign the consent form in person, either in the hospital or at the physician's office.  Electronic signature: Many hospitals now use electronic medical record (EMR) systems that allow patients to sign consent forms electronically. This can be done using a computer, tablet, or smartphone.  Witness signature: If the patient is unable to sign the consent form themselves due to a physical or mental disability, their next-of-kin can sign the form on their behalf. 71 BS71008: Frontline Patient Services 2.10 Features of Bed Management System Bed management involves identifying available beds in the hospital and allocating them to patients. It can be a daunting task due to: constant fluctuations in the planned and emerge

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