Optimisation of Community Fund Application and Reimbursement Process

Year Submitted: 2025
Published Date: 22 December 2025

Tags: Productivity, Cost Saving, Manhour Saving, Time Saving, Quality Improvement, Job Effectiveness, Lean Methodology, Workflow Redesign, Environmental Sustainability, Paper Waste

About this Content

Aims

1. Analyse the underlying factors contributing to extended form preparation times and cause for multiple clarifications and re-work.

2. Propose actionable solutions to reduce the
a) Time taken for CF application and reimbursement
b) Number of clarifications and
c) Number of re-work

3. Assess CF application process impact on length of stay (LOS)
- Renal patients were selected for this assessment as they represent the highest spending group within CF and are raised as the most challenging to discharge due to the requirement to secure dialysis centre placement prior to discharge.

Background

Newly identified renal patients often delay dialysis and crash-land in acute settings through the Emergency Department to begin dialysis treatment.

Dialysis is a long-term treatment, and families often require subsidies. The most direct subsidy is placement for dialysis with subsidised dialysis centres such as the National Kidney Foundation (NKF). However, placement with subsidised dialysis centres usually takes time. Therefore, upon establishing the need for dialysis and funding assistance, Medical Social Workers (MSWs) at Tan Tock Seng Hospital (TTSH) assist patients to apply for TTSH Community Fund assistance to support patients through private dialysis in the interim until subsidised dialysis placement is secured.

Issues
1. Much information is required from doctors and NOKs for the form, resulting in long turnaround times for completing the form. This is largely due to the long wait for detailed information to be provided.
2. Time is spent by MSWs calculating the exact projected funding required for the number of dialysis sessions, amount of medications, injections and transportation.
3. When the projected amount falls below the claim amount due to unexpected emergencies at the dialysis centres, rework of the entire form is required, from capturing new Medisave information to going through approval by the approving committee.
4. The misalignment in claims and approved items or amounts also results in additional clarifications by Development Fund (DF) to Care and Counselling (CNC) downstream.
5. Finally, as a workaround for funding limits of CF existing forms, MSWs often complete two forms to expedite the approval process:
i) IWantToGoHomeFund Below $2k to expedite discharge, followed by
ii) IWantToGoHomeFund Above $2k or General Needy Patient Fund post-discharge to buy time for subsidised dialysis placement approval

All the above add to MSWs' workload, which is of concern as the no. of new renal patients coming into acute care is set to increase.

Methods

Through Lean methodology of Waste identification in the existing workflow via Current State Mapping, Root-Cause Analysis (RCA) and Collective Ideation, the project team, comprising of both CNC and DF, was able to derive a solution comprising a single form and bundled funding to account for unforeseen medical expenditures, which in turn reduces time spent on filling in the form and for clarifications.

Results

The result was significant productivity increase, which translated to manhours saved. The new process of collapsing 2 forms into 1 was rolled out on 1 Jan 2025 to all CF submissions requiring 1 form for each case. There were 155 such cases in 2024 (both Inpatient & Outpatient), of which 124 were Renal cases which the project focuses on. Using the 124 Renal cases, the projected total manhours saved is 463 hours per year, which translates to a total manhours cost savings of $33,909.30 per year (see Slide 32 on Success Indicators).

Additional annual environmental impact:
1. 16.98 reams of paper saved
2. 0.75 ink cartridges saved
3. 59.96kg CO2e (carbon emissions saved from the reduced use of paper and ink cartridge)
4. $6291.57 (cost saved from reduced use of paper and ink cartridge)

Conclusion

Addressing the aims of the projects,
1. with the redesigned process, re-work and clarifications is much reduced. In fact, letters of funding confirmation can be churned out 1 or 2 days before discharge
2. Cost savings were achieved through productivity gains from manpower (MSWs and porter) as well as reduced use of stationery through the conversion of paper process to digital process.
3. it was found that the process has no impact on LOS both pre-and-post implementation as patients are delayed for discharge due to other factors.

Lessons Learnt

Always question process steps that drain productivity - is the step necessary?
Think of better ways to do things.
Solutions need not be fancy, can be designed through existing tools.
Environment gains can almost always be expected when we reduce unnecessary steps.
Lastly, through this project, both departments co-created the solution and unlocked a more open communication that really benefited work productivity and early access to funds for patients.

Keywords

Community Fund Application

Innovators' Details

Connect with this contributor!

Karen Kwa - karen.sf.kwa@nhghealth.com.sg

Khng Hwee Peng - hwee.peng.khng@nhghealth.com.sg

Jimson Tham - jimson.weihao.tham@nhghealth.com.sg

Quek Wei Lee - wei.lee.quek@nhghealth.com.sg

Elaine Low - elaine.low@nhghealth.com.sg

Keith Lee - keith.jx.lee@nhghealth.com.sg

Lim Hui Pin - hui.pin.lim@nhghealth.com.sg

Project Attachment

20251030-Optimisation-of-Community-Fund-Application-and-Reimbursement-Process-For-CHILD.pdf