A/Prof. Shamala Thilarajah1, A/Prof Karina Dancza1, Zhen Zhen Chen1, Clara Wong1, A/Prof Clement Yan2, Adj Prof Susan Niam1, Clinical A/Prof Yee Sien Ng1, A/Prof Elizabeth Lynch3, Prof Leonid Churilov4, Wei Kang Tan5, Emelin Tan6, A/Prof Li Khim Kwah1
1Chief Allied Health Officer's Office, Ministry of Health, Singapore, 2Department of Physiotherapy, Sengkang General Hospital, Singapore, 3Caring Futures Institute, Flinders University, Australia, 4University of Melbourne, Australia, 5Health Analytics Division, Ministry of Health, Singapore, 6Department of Respiratory Therapy, Tan Tock Seng Hospital, Singapore
Biography:
Associate Professor Shamala Thilarajah is a physiotherapist, academic and researcher with extensive experience in neurorehabilitation and stroke recovery. She holds positions at the Singapore General Hospital, Singapore Institute of Technology and at the Chief Allied Health Officer's Office, Ministry of Health, Singapore. At the National Allied Health Conference 2025, she is honoured to present, on behalf of CAHOO, the latest findings of their co-production work, contributing to the collective effort to enhance patient care and functional recovery.
Abstract:
Background:
A national quality improvement project using Experience-Based Co-Design (EBCD) was conducted to understand the experiences of clients, caregivers, and staff in community Day Rehabilitation Centres (DRCs) and identify areas for improvement in Singapore’s rehabilitation care.
Methods:
The EBCD process included eight stages: 1) site observations/time-motion studies, 2) interviews, 3) development of a trigger film, 4) staff feedback events, 5) client/caregiver feedback events, 6) joint workshop, 7) small co-design groups, and 8) celebration event. Surveys and case note reviews were also conducted to assess adherence to guideline-based care for stroke, frailty, and hip fracture.
Results:
Over 2.6 years, 80 clients/caregivers and 250 staff from 20 DRCs participated. Data triangulation identified four key themes: 1) Best practice care, 2) Person-centred care, 3) Allied health professional needs, and 4) Service design. While person-centred care was valued, it was challenged by tight scheduling and high turnover. Care partially aligned with guidelines, but some key interventions were inconsistently delivered. Staff sought more time for direct client care, teaching, research, and quality improvement. New care models were proposed, including social connections beyond DRCs, clearer maintenance rehabilitation criteria, and financial incentives. A 12-minute trigger film informed discussions, leading to three co-design workgroups: stroke rehabilitation guidelines, an allied health workplace learning framework, and community rehabilitation recommendations.
Conclusion:
EBCD effectively identified gaps and co-designed system-level solutions for community rehabilitation care in Singapore. Further organisational and individual-level improvements are needed.