From Chits to Clicks

By Valissa Yap

Nurses often juggle many responsibilities in the wards to ensure patients receive the best possible care. Beyond patient care, coordinating shared resources between wards has become a routine part of ward duties, be it a pacemaker needed urgently or supplies to keep a ward stocked until the next stock delivery.  

While borrowing and lending items may seem straightforward, things get complicated when items go missing. Nurses then find themselves spending valuable time chasing paperwork instead of caring for patients. Team Smart Care Wizards set out to redesign the loan tracking process to make it simpler, faster and more reliable.

Root of the Paper Chase

Previously, when a ward borrowed equipment or consumables, staff would fill in a hardcopy loan chit to record the transaction. The lending ward retained the chit, while the borrowing ward either kept its own handwritten record or, in some cases, kept no record at all. This meant that loan information was often inconsistent between wards.

The team found that the paper-based system resulted in recurring problems: loan chits were frequently misplaced or damaged, and partial returns were difficult to document. Chits were also discarded once an item was returned, leaving no permanent record of past transactions. Without this audit trail, it was hard to track outstanding loans or resolve discrepancies when they arose.

Hardcopy loan chits were susceptible to damage and loss, leading to major tracking problems.

Through a four-week time-motion study, the team found that nurses spent an average of 26 minutes on every loan transaction, reviewing records, contacting other wards and resolving discrepancies. Each week, there were an average of 5.5 cases of forgotten loan items, with each case taking about 20 minutes to resolve. The study highlighted four key issues: illegible handwriting, reliance on manual phone call reminders, a single paper record with no shared visibility between wards, and no clear ownership for loan tracking.

A Smarter System

Using existing digital tools available within NHCS, the team overhauled the loan process. They developed an Electronic Loan Chit (E-Loan Chit) system that allows staff to submit a digital form to initiate a loan quickly and easily. The information is automatically captured and displayed on a shared dashboard, accessible on computers and mobile phones, giving staff a real-time view of all active loans. With a permanent digital record in place, the entire loan process became more visible, accountable and transparent.

(L-R) A nurse initiates a digital loan with a quick QR code scan, allowing the transaction to be recorded instantly on the E-loan chit system; Staff can view all loans on the E-loan chit dashboard, giving the wards involved better visibility and accountability.

Manual phone call reminders were replaced with automated weekly email reminders, ensuring loaned items are returned promptly without requiring staff to follow-up individually.

The team continued refining the system, making enhancements to accommodate different loan scenarios, including internal ward loans, external hospital loans and high-value consumables requiring additional approval. The dashboard layout was also redesigned so that key information appears within the first three columns, making it easier to navigate on mobile devices.

To support implementation, the team appointed ward champions to guide their colleagues and provided on-site training, online resources and ongoing support via a dedicated Microsoft Teams channel.

Ward Champions to facilitate with staff onboarding on the new E-loan chit system.

“We wanted the system to be as simple and fuss-free for staff as possible,” said Nurse Clinician (NC) Yang Ruiqin, Ward 56. “Every improvement was user-driven, ensuring the process remained intuitive and practical in a busy ward environment.”

A Meaningful Impact

The impact of the new system was felt immediately. The average time spent tracking and following up on each loan fell from 26 minutes to just over five minutes, and automated weekly reminders eliminated forgotten loan items completely. Together, these improvements translated into almost 612 manpower hours saved each year, freeing nurses to spend more time on direct patient care.

Nurses no longer need to search for missing chits or make repeated phone calls to trace items. With a shared dashboard providing full visibility of loan statuses, collaboration between wards has become smoother, with fewer misunderstandings and greater accountability.

“Previously, we only realised an item hadn’t been returned when we needed it. Now, we can check the dashboard at any time, which makes loan tracking much easier.  It also gives us greater confidence that nothing will be overlooked,” expressed Associate Executive (AE) Siti Raudhah Binte from Cardiothoracic Intensive Care Unit (CTICU).

Beyond a Single Project

The success of the E-Loan Chit system has inspired several spin-off initiatives across NHCS using similar low-code digital platforms to automate routine tasks and increase productivity. More importantly, the project demonstrates that meaningful innovation can come from simply rethinking an everyday process to focus on what truly matters.

Team Smart Care Wizards and their facilitator (L-R): SSN Eugene Wee, Ward 44; Assistant Director Jasmine Lee, Nursing Administration; ANC Kimbell Tan, Nursing Administration; NC Yang Ruiqin, Ward 56; Senior Nurse Manager (SNM) Zhang Ju Xia, Nursing Administration. Not pictured: AE Siti Raudhah Binte CTICU.