Abstract
Engaging caregivers as active partners in care is a cornerstone of Strategic Objective 4 in the WHO's Global Patient Safety Action Plan 2021-2030. Despite its recognised importance, caregiver integration in acute care remains inconsistent, with significant gaps in registration processes, role clarity and institutional support. At Singapore General Hospital (SGH), a 1900-bed academic medical centre, caregiver involvement was previously informal and varied across clinical settings. This hospital-wide quality improvement initiative aimed to improve the caregiver-to-admission ratio from 1:6 to 1:4 within 6 months. Caregiver was defined as a family member formally registered through the hospital's Automated Visitor Management System (AVMS) and oriented to participate in basic patient care. A multidisciplinary team co-designed a scalable intervention through staff engagement and collaboration with the SingHealth Patient Advocacy Network (SPAN). Key strategies included simplified electronic registration, admission-based caregiver orientation, policy revisions to enable overnight stays, bedside education and flexible learning tools. These changes were embedded into clinical workflows and supported by infrastructure enhancements. Between April 2024 and March 2025, admission-to-caregiver ratio improved from 1:6 in the pre-implementation period to 1:4 post-implementation (5512 caregivers across 33 191 admissions pre-implementation vs 9592 caregivers across 38 874 admissions post-implementation). In addition, hospital-wide patient experience indicator from the Service Level Tracking (SLT) dashboard was included as a balancing measure. The percentage of patients and families who responded 'Definitely yes' to recommending SGH to family and friends improved from 81.9% pre-implementation to 85.2% post-implementation. The initiative reflects not only SGH's operational readiness and leadership commitment but also a broader paradigm shift: the healthcare team's growing recognition of the value of partnering with families, and the public's increasing willingness to participate in care even within high-acuity hospital environments. This project exemplifies how aligning systems, mindsets and partnerships can bring the WHO's patient safety goals into practical, sustainable action.