Majority of discoveries made in laboratories do not get to the bedside. In 2008, more than

800,000 medical research papers were published but by 2011, only 21 new drugs had been approved by the US Food and Drug Administration. This divide between conception of an idea and clinical application is dubbed the “valley of death”.

To bridge this chasm, it is important to align research and administrative objectives, says Professor Salvatore Albani, Director of SingHealth Translational Immunology and Inflammation Centre, Senior Clinical Scientist at KKH and Professor at Duke-NUS Graduate Medical School.

“Translational medicine revolves around patients’ needs and is continually evolving. The administration of an organisation will need to adapt along with the clinician scientists to changing needs and objectives. The administration needs to be very flexible, patient and highly aware of the scientific vision and necessities of the scientists.”

Translational medicine requires high-level team work – with a shared vision, a plan of execution and a team built according to the expertise required. Without a common vision, the team risks entering another valley of death of the corporate kind where ideas are laid to rest due to lack of infrastructure, understanding, and communication.

Prof Albani uses a Formula One team as an analogy: “In a race, it is not just about the professional driver. The engineers, the technical experts and the manager all work towards winning. It is the whole team that makes the race happen. It does not make any sense to drive a great car when there’s no gasoline. The team needs to be committed to the same vision.”

Enny Kiesworo, Chief Operating Officer of Research in SingHealth, shares the same sentiment: “To rapidly align the objectives, we focus on the critical needs of our patients as a guideline in developing our strategies.”

Translational medicine is a highly competitive field. The institution needs to move very

quickly with agility to achieve results. This is when administrators play a key role, where good planning oils the engine. “Good planning is fundamental. Administrators must have good understanding of two dimensions - procedures, bureaucracy, accounting and project time frames, and the necessity for a leading research enterprise to move as fast as the others,” Prof Albani said.

Enny highlighted the importance of communication for a dream team to happen. She said, “Administrators and clinician scientists can better understand each other through open communication, close team work and high appreciation of each other’s roles, including appreciating the important role an administrator plays in supporting the running of successful research enterprise.”

Prof Albani emphasised, “Even though administrators and researchers may be, and most likely are, very different, they can be driven by the common vision of changing the face of medicine for the good of patients.”

Even though administrators and researchers may be, and most likely are, very different, the common vision of changing the face of medicine for the good of patients should be the drive.

- Prof Salvatore Albani, Director, SingHealth Translational Immunology and Inflammation Centre

November 2014 marked my fifth year in healthcare – a toddler in every sense of the word, but what a

fulfilling journey it has been.

At a recent townhall, a colleague commented that “as administrators, we feel like second class citizens”.

This prompted me to reflect upon the role that we play as administrators. Most of us do not have direct contact with our patients. The work we do may not seem to impact patients – ultimately, we do not heal, nurse nor comfort. But is that really so?

A key term in healthcare is “team-based multi-disciplinary care”. I recently read the article “Interprofessional Care Teams: The Role of the Healthcare Administrator” by Begun, White and Mosser1. It spoke of how often times when we think of “team-based”, we think of clinical professionals. Administrators are often not part of the equation.

Yet it is important that we, as administrators, must see that we have a shared responsibility to deliver care to patients.

We need to have an appreciation of how the system works, build our familiarity with clinical care, understand how different members of the healthcare team work, how we relate to one another – so that we can shape structures, strategies and culture.

A friend once commented to me that “The hospital administrator plays a vital role in saving lives, without having to take a scalpel in hand because you must make sure that your hospital operates efficiently and your system works. Then the care team can do their work properly.” How true that is.

If our HR machinery does not function, we will not be able to attract and retain a robust workforce that is optimally and rightly resourced to provide care to our patients.

Breaking the “class” divide between care teams and administrators

SINGHEALTH DUKE-NUS ACADEMIC MEDICAL CENTRE

THE voICE of ACADEMIC MEDICINE

MEDICINEToMoRRow’S

ISSUE 15, fEbRUARy 2015MCI (P) 054/07/2014

Crossing the valley of death: Effective administrative support needed

Continued on page 2

Administrators are important stewards to bring therapies from conception by the researcher to clinical application on the patient

Financing

Regulatory Issues

Clinical Application

Preclinical Research

Intellectual property

Clinical Research

Conception of an idea

Unmet medical need

By Jennifer WeeDirector, Communications, SingHealth and SGH

Feedback from a mentor is a valuable reflection of one’s strengths and weaknesses. It also creates

opportunities for both mentor and learner to reach for greater achievements in the learning journey.

During the years of training in Residency, it is important to have someone with experience to steady you when you stumble and remind you to be humble when you do well. Rapport is important in the relationship so that the learner can share issues openly and allow the mentor a good understanding of the learner’s training requirements.

I was fortunate to have a few good mentors during my Ophthalmology Residency. Associate Professor Ian Yeo, the Program Director, was supportive and approachable in guiding me. Even though I stumbled a few times initially, he did not give up on me. Instead, he told me to persevere and gave me numerous opportunities. He taught me to be a meticulous surgeon and reminded me that it took hard work to achieve surgical outcome excellence. He often says, “Everything in any intraocular surgery happens within seconds and we only have one chance to make it right.”

I am lucky to have found a friend in my supportive mentor, Adjunct Associate Professor Audrey Chia. We had regular

coffee sessions to discuss and formulate my learning goals prior to each new clinical rotation. Prof Chia checks on my progress and guides me with timely advice. It is important for learners to nurture this bond. Residents from different cohorts in Ophthalmology take time off work to meet over dinner, catch up on life and work with our mentors.

Other mentors who have influenced me through the years are Prof Wong Tien Yin, Medical Director of SNEC, and Associate Professor Lim Boon Leng, SingHealth Residency’s Designated Institutional Official. Prof Wong is a world-class researcher who inspires me. Despite the countless achievements under his belt, he is very down-to-earth and never fails to engage the juniors for feedback. To further sharpen my research skills and proficiencies, he recommended that I join the Khoo Scholars Program.

Prof Lim inspired me with his dynamism. He encouraged me to conduct more residents led initiatives. He demonstrated to me the importance of keeping an open mind in implementing new changes that will enhance the quality of residency training in SingHealth. He gave me the opportunity to join the Singapore Chief Residency Program that has polished my administrative and leadership skills further.

Indeed, the student-mentor relationship is very much worth cultivating. The SingHealth Residents’ Committee has created different platforms for residents to know their mentors better, such as the annual SingHealth Residency Games and the Student Internship Program boot camp. The SingHealth Resident-Student Buddy System provides medical students with the guidance and supervision of residents throughout their clinical attachment.

We hope that residents can achieve the most out of their training. The bonds formed during these years are one of the most important takeaways from their time in Residency. These are our goals as the Residents’ Committee continues to strive for changes to enhance the quality of residency training in SingHealth.

Breaking the “class” divide between care teams and administratorsContinued from cover page

ToMorrow’s MEdiCiNE - ISSUE 15, FEbrUAry 2015PAGE 2

EdiTors-iN-ChiEFTan-Huang Shuo MeiAudrey Lau

EdiTorsJennifer WeeArthur WongStephanie JadeRachel Kelly

JoiNT EdiToriAl TEAMGoh Sai Luan (SGH) sub-editorIchha Oberoi (KKH) sub-editorCaroline Chia (NDCS) sub-editorEdwin Yong (NCCS)Kristie Chiew (NHCS)Dr Thiyagarajan Jayabaskar (SNEC)Eric Lim Wei (SHP)Wee Lai Ming (Duke-NUS)

CliNiCiAN Advisory PANElProf Robert KameiAssoc Prof Darren Koh Liang KhaiAssoc Prof Koo Wen HsinAssoc Prof Lo Yew LongAssoc Prof Nigel Tan Choon KiatProf Tan Kok HianProf Wong Tien Yin

dEsiGNRedstone Communications

CoPywriTiNGHedgehog Communications

FEbrUAry 2015

All rights reserved. Reproduction in whole or part is prohibited without the written permission of SingHealth and the publisher. The views and opinions expressed or implied in the publication are those of the authors or contributors and do not necessarily reflect those of SingHealth and the publisher. Whilst due care has been exercised, both SingHealth and the publisher do not accept responsibility for errors in advertisements or articles, unsolicited manuscripts, photographers or illustrations. Tomorrow’s Medicine reserves the right to edit all materials submitted for publication. While contributors will be given the opportunity to comment on articles for factual accuracy, this policy is about ensuring a consistent and clear writing style throughout.

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Making mentorship countBy Dr Daniel TingOphthalmology Resident Co-chair, Resident Committee (2014), AMRI Khoo ScholarSingHealth Residency

During the years of training

in Residency, it is important to have someone with experience to steady you when you stumble and remind you to be humble when you do well.

If our IT system fails us, our care team will not be able to access patients records promptly to ensure that the right care is administered, and that pertinent information is not overlooked. We will not be able to maximise the use of technology to help us with analytics to improve organisation and patient outcomes. In fact, given our reliance on IT, we will be totally immobilised.

And imagine if our business office gets our patients’ bills wrong, what unhappiness it will cause!

When we administrators get it right, we create an environment that supports our doctors, nurses and allied health professionals. They can then focus on bringing the best care to patients.

I am an administrator who feels very much part of the team. And I think it boils down to 5 simple tenets:

1. Believe in the value of our work; add value.2. Look beyond our daily functional duties - see how the dots

connect, the bigger picture. Be interested, be hungry.3. Be a great partner to our stakeholders. Understand their

needs, appreciate different perspectives, find a win-win.4. Think “Why not?”. See possibilities, not constraints.5. Enjoy what we do - passionately, whole-heartedly. It shows.

dr daniel Ting and his mentor, Assoc Prof ian yeo

Reference: 1. James W. Begun, Kenneth R. White, and Gordon Mosser, “Interprofessional Care Teams: The Role of the Healthcare Administrator,“ Journal of Interprofessional Care, vol. 25, no. 2, March, 2011, pp. 119-123.

Beautifulinsights

volunteers beyond borders: the learning journey of humanitarian medical missions

T o make a difference and answer the call of help in and beyond Singapore shores. It is this passion that drives

many humanitarian medical mission volunteers.

Professor Lee Seng Teik, Emeritus Senior Consultant at the Department of Plastic and Reconstructive Surgery, SGH, has been involved in humanitarian medical missions for over two decades. More recently, Prof Lee has been visiting Cheng Mai County, in Hainan Province, China, to operate on patients with cleft/craniofacial problems. These visits are part of a collaborative project called Hainan Smiles between Singapore and Hainan province. Since 2009, the missions have performed over 150 operations, enriching the lives of patients who may otherwise have been outcast from society.

Professor Anantharaman Venkataraman, Senior Consultant at the Department of Emergency Medicine, SGH, has been actively involved in disaster management training missions. He finds such outreach enriching and rewarding, and an opportunity to give back to society. “You don’t fish for them, you teach them how to fish” he adds.

To facilitate discussion, sharing and understanding of humanitarian medical missions, Prof Lee and Prof Anantharaman co-chaired the first International Conference on Humanitarian Medical Missions (ICHMM) which took place from 30 October to 1 November 2014. The SGH-organised event dedicated to all medical volunteers

working beyond borders created a meaningful platform for like-minded individuals to gather and discuss the future of medical missions abroad.

Navigating such missions can be challenging. To aid budding volunteer teams in launching successful missions, a set of guidelines are expected to be drawn up from the recent conference.

“There are many NGOs around the world doing humanitarian work, bringing medical aid and relief to those who need it. It can be a challenge to coordinate such efforts as tremendous manpower and finances are required. From this conference we aim to draw up guidelines to aid budding volunteer teams in organising successful missions,” added Prof Lee.

SingHealth Institutions are very supportive and proactive in the organisation of such volunteer medical missions in the region and beyond. Multiple missions to share skills, knowledge and experience have been carried out in countries such as Indonesia, Myanmar,

Cambodia, Vietnam and Bangladesh in response to their needs and to help raise the standard of healthcare in the region.

ICHMM Guest-of-Honour, Professor Tommy Koh, Ambassador-At-Large, Ministry of Foreign Affairs, lauded the efforts of SingHealth Institutions in this area. He pointed out that the work of humanitarian medical volunteers leaves a positive legacy in enhancing the skills of medical practices in the host country, “The work which our doctors, dentists, nurses, therapists and other allied professionals do when they go on medical missions is invaluable. Through their kind deeds, they have crossed geographical, political, cultural and linguistic barriers.”

PAGE 3ToMorrow’s MEdiCiNE - ISSUE 15, FEbrUAry 2015

Medical volunteers to develop guidelines for successful missions after sharing at the inaugural International Conference on Humanitarian Medical Missions (ICHMM)

We aim to draw up guidelines to

aid budding volunteer teams in organising successful missions.

- Prof Lee Seng Teik, Co-Chair, ICHMM, Emeritus Senior Consultant, Plastic and Reconstructive Surgery, SGH

Fit for the future

The nuclei can be seen here in blue, cytoskeleton in green, and the mitochondria in red.

This image was created using a super-resolution microscope (ELYRA PS.1, Zeiss) by Mao Wang, a Research Assistant in the Laboratory of Translational Cardiac Biology in Duke-NUS led by Professor Stuart Cook, Director of the National Heart Research Institute Singapore and Deputy Director of the Duke-NUS Cardiovascular and Metabolic Diseases Program.

rethinking health care delivery with innovative models of care

Changing patient demographics and finite resources require a rethink on how we organise and deliver care.

Innovative approaches to improve delivery and quality of care will distinguish us as an Academic Medical Centre. Right-siting has been one of our priorities, helping patients receive the most appropriate care which need not be centred in the hospitals. The role of Patient Navigators is to help patients transit to the right setting. Currently, there are 33 Patient Navigators in SingHealth who coordinate appointments and care points between patients and their team of healthcare professionals. One of these is Nasrifudin Bin Najumudin. “We follow-up with our patients regularly once they are home and are only a phone-call away if they need immediate assistance, be it on health advice or further care coordination with the community care providers,” he shares. By 2018, SingHealth plans to train 400 Patient Navigators.

SingHealth is harnessing big data to provide for more efficient practice and better-informed diagnosis. Advanced information technology platforms such as the SingHealth Electronic Health Intelligence System (eHINTS) have been developed to consolidate patient information from

a range of sources, such as electronic medical records and other databases. Better analytics in patient history can be easily accessed by the healthcare team, allowing them to make well-informed diagnosis and faster decisions.

In addition, eHINTS facilitates clinical research on chronic diseases and helps doctors identity trends to prevent illness and diagnose health problems early. There are plans to use eHINTS in the next few years for predictive modelling, so that doctors can forecast patient needs at different stages of their life.

Technology is also instrumental in medical practices, such as Tele-Monitoring, an app that tracks patients’ vital signs, collects and transmits data to their care team. This is especially beneficial for patients with chronic health issues.

Such innovations go a long way in ensuring that patients remain at the centre of our healthcare system.

Visit www.tomorrowsmed.com for full version and downloads

Academic Medicine Planning

Hainan SmilesOver the past five years, ten medical missions have gone to Cheng Mai County, Hainan Province, China, to operate on patients with cleft/craniofacial problems. Each mission comprised of a multidisciplinary group of 10 to 20 doctors, dental specialists, anaesthetists, speech therapists and nurses from both SGH and the private sector. The aim was to enrich the lives of patients who would have otherwise faced social difficulties due to their physical handicap.

Training for a disasterTo aid the disaster-prone area of South Sulawesi, SingHealth institutions have trained healthcare workers and first responders in managing the initial phase of disasters. The team partnered with Hasanuddin University, one of the largest state-owned Universities in Indonesia, to implement a training programme to improve the management of crisis situations and reduce post disaster casualties.

Training physiotherapists in CambodiaOver the last ten years, Associate Professor Celia Tan, Director, Group Allied Health, SingHealth has been leading teams from SGH and other SingHealth Institutions to train physiotherapists in Cambodia. The programme was specially developed to cover musculoskeletal, neurology, cardiopulmonary and electrotherapy to prepare candidates for independent physiotherapy practice to help their communities.

Making the invisible visible thanks to medical science

human umbilical vein endothelial cells

Snapshot of SingHealth medical missions highlighted at ICHMM

For patients with diseases or conditions caused by gene mutations, genetic diagnosis is essential. It allows us to

provide gene-specific management, offer potential targeted therapies and can be used to counsel such patients and their families in future pregnancies. However, certain kinds of mutations, especially those present in only a small fraction of the body’s cells, also referred to as somatic mutations, may not be discovered by current methods.

Said KKH’s Dr Saumya Shekhar Jamuar, Consultant, Genetics Service, Department of Paediatrics, “The current gold standard of diagnostic gene testing uses a traditional DNA sequencing technique known as the Sanger method. However, with this method, we miss a significant proportion of somatic mutations because we are using a test that’s not designed to look for them.”

Dr Jamuar led a team of researchers who came up with the new technique. The researchers used a “deep sequencing” technique to identify hard-to-find disease-causing gene mutations by focusing on a small subset of genes and sequencing them to greater depths than routinely performed. In their study, these somatic mutations were found in more than a quarter of the patients with identified mutations. If traditional sequencing methods had been used, five of

the eight somatic mutations that the team identified would never have been found.

“We were seeing patients in the clinic who appeared to have a particular disorder, but the cause could not be identified despite genetic testing. The idea of somatic mutations as a cause of their disorder had been suggested by our group previously, but it had never been systematically studied. So we embarked on our research study to test the sensitivity and diagnostic yield of our deep sequencing method.”

Dr Jamuar, who was a clinical fellow at Boston Children’s Hospital, led the study in gene testing, under the supervision of Dr Christopher A. Walsh, investigator at Howard Hughes Medical Institute and Chief of the Division of Genetics and Genomics at Boston Children’s Hospital.

“I designed and performed the experiments in the study. This involved setting up a test to screen blood samples from 158 patients whose brain malformations remained unexplained. My part included designing the gene-sequencing panel, performing the deep sequencing experiments, analysing the results and performing validation experiments,” Dr Jamuar explained.

“As I had to return to Singapore, other team

members carried out additional experiments and I worked remotely to help the team complete the study.”

Given the sensitivity shown by the new method in detecting somatic mutations, Dr Jamuar is confident that it would be a useful tool for medical geneticists before they need to consider other more costly sequencing methods. While no test offers a single solution for all patients, their complementary strengths give geneticists a more complete set of tools.

“Our research findings have implications on understanding genetic diseases in general, especially for similar disorders like autism and schizophrenia. The research findings will not only offer patients and their families gene-specific prognosis, but provide accurate assessment of recurrence risk for future pregnancies.”

According to Dr Jamuar, KKH is in the process of acquiring the equipment necessary for the new method and has plans to offer this technique of gene testing to patients in the near future.

The finding was reported in the August 21, 2014, issue of the New England Journal of Medicine.

Benedict has two interests – healthcare and IT. Perhaps it was more than luck that his first job with the National Computer Board after graduation was a posting to the Ministry of Health to support healthcare IT.

With an integrated system, he feels that patients will be well looked after: “Nobody wants to be sick. We should do our utmost to let them have a seamless and caring journey through our facilities, and beyond that let them have access to care from outside of hospital premises.”

His vision has the support of his medical colleagues. “I once asked a young doctor who chose to focus on Medical Informatics why he made the choice. His answer illuminated and motivated me to this day – ‘As a doctor, I can treat perhaps hundreds, maybe thousands of patients in my lifetime. By enabling healthcare IT, I can potentially make a difference to millions and millions of patients and citizens.”

Benedict TanGroup Chief Information Officer

oUr PEoPlE, ThEir sToriEsFollow them on facesofhealthcare.tumblr.com

AM•EI EventsOpen to all SingHealth and Duke-NUS staff. For details and registration, contact the Academic Medicine Education Institute (AM•EI) at amei-info@duke-nus.edu.sg. For membership enquiries, email amei-members@duke-nus.edu.sg.

PAGE 4

New gene technique picks up hard-to-find mutations

ToMorrow’s MEdiCiNE - ISSUE 15, FEbrUAry 2015

KKH clinician’s work with boston Children’s Hospital resulted in new tool to identify disease-causing mutations undetected by current gold standards

PROGRAMMES AT KKH CAMPUS

4 Mar2.00pm-5.00pmBedside teaching – Focus on micro-skills

11 Feb9.00am-1.00pmBecoming a leader in Academic Medicine: Honing and developing your skills

10 Mar2.00pm-5.00pmEnhancing and enriching learning through effective facilitation

18 Mar3.00pm-6.00pmStrategies for giving feedback(changed date)

4 Mar2.00pm-5.00pmBedside teaching – Focus on micro-skills

11 Feb9.00am-1.00pmBecoming a leader in Academic Medicine: Honing and developing your skills

10 Mar2.00pm-5.00pmEnhancing and enriching learning through effective facilitation

PROGRAMMES AT SGH CAMPUS

Our research findings have

implications on understanding genetic diseases in general, especially for similar disorders like autism and schizophrenia.

The research findings will not only offer patients and their families gene-specific prognosis, but provide accurate assessment of recurrence risk for future pregnancies.

- Dr Saumya Shekhar Jamuar, Consultant, Genetics Service, Department of Paediatrics, KKH