Leon SantosoChief Human Resources Officer · Essays & perspective
The leadership review
Leon Santoso
Chief Human Resources OfficerSingapore / Southeast AsiaVolume 03
International nurse recruitment5 min read
A foreign nurse's recruitment fee belongs on the hospital's books
Hospitals that recruit nurses from abroad should pay every cost of doing so, including fees taken by intermediaries they never meet, and should stop using exit penalties to recover the expense. It is the cheapest way to keep a nurse past the first contract.
Turning the Johor–Singapore nurse flow into a priced internal pathway
In 2022 our Johor Bahru hospital lost 31% of its registered nurses.
NOTE II
Integrating Wiralaksa Hospitals without exporting the Singapore ward
In September 2023 Aravelle completed the acquisition of Wiralaksa Hospitals, five hospitals in Jakarta, Surabaya, Bandung and Medan with 4,900 employees, 1,380 nurses and 410 employed doctors.
I trained as an intensive care nurse, and I still judge a staffing decision by asking who will be standing at the bedside at three in the morning because of it. A recruitment contract, a night roster or a rule about moving between countries is a clinical decision that happens to be drafted in the HR office. I try to make those decisions with the evidence a clinical governance committee would demand, and to show directors what each one costs.
Colleagues in three countries
17,400
Aravelle Health Group, June 2026, including 7,900 nurses
Annual group staff costs
S$1.04bn
2025; separate from the S$41m HR operating budget
Nurse turnover at our Johor Bahru hospital
31% to 16%
2022 compared with 2025, after the cross-border pathway
I treat every nursing roster, recruitment contract and cross-border transfer rule as a patient-safety decision, and I ask a hospital board to fund it on the same evidence it would demand of a clinical one.
I am group chief human resources officer of Aravelle Health Group, a Singapore-listed operator of twelve private hospitals in Singapore, Malaysia and Indonesia. I am responsible for the employment of 17,400 people, including 7,900 nurses and 1,240 doctors, and for group staff costs of S$1.04 billion a year. I report to our group chief executive, Vivienne Quek, prepare the papers our board remuneration committee uses on executive and workforce pay, and report to the clinical governance committee on staffing, licensing and the conditions in which our clinicians work.
I came to this work from the bedside. I was born in Surabaya, trained as a nurse in Singapore under a hospital-sponsored bond and spent seven years in surgical intensive care at Kinloch Bay Hospital before I moved into nursing workforce planning in 2006. I then ran HR for a Malaysian hospital group in Kuala Lumpur, where I watched nurses leave our Johor hospital for Singapore, and for a vaccine plant in Singapore, where I learnt how manufacturing treats a qualification as a record rather than an assumption. I joined Aravelle in 2019.
The questions that occupy me are practical ones. How should a group with hospitals on both sides of the causeway manage a wage gap it cannot close? Who should pay to bring a nurse from Manila or Yangon to Singapore? Why do our newest nurses work the most nights? And how do you keep specialists who are not your employees, or integrate five Indonesian hospitals without exporting a Singapore ward model that does not fit them? I have answers to some of these, each of which cost us money or speed.
A priced pathway across the causeway
From 2023 our Singapore hospitals pay S$14,000 into our Johor Bahru hospital's training budget for each nurse they take through an internal pathway with a right of return. Johor nurse turnover fell from 31% in 2022 to 16% in 2025, and 34 of 40 closed beds reopened.
The hospital pays the recruitment fee
Since 2020 Aravelle has paid every cost of recruiting foreign-trained nurses and dropped the early-exit penalty. First-year attrition among them fell from 26% to 11%, and renewal at the end of the first contract rose from 52% to 79%.
Beginners taken off the night roster
In 2022 we limited first-year nurses to three nights a month and more than doubled the night allowance for senior grades. First-year turnover in our Singapore hospitals fell from 29% to 15% by 2024; 31 senior nurses left over the change.
Indonesian nursing leaders kept in charge
After acquiring Wiralaksa Hospitals in 2023 we kept its heads of nursing rather than installing expatriate directors. Forty-one of 44 nursing leaders remained at twenty-four months, and planned savings arrived a year late.
Current focus
I am working on two things this year. The first is a common clinical career ladder for nurses across all three countries, which has to respect different licensing systems and very different pay levels without implying that a Medan ward sister is worth less than one in Singapore. The second is a retention approach for the specialists who hold practice privileges at our Indonesian hospitals and also practise elsewhere.
Conversations I welcome
I am not looking for another executive role. I would consider one non-executive seat, ideally on a remuneration or nominating committee, at an organisation that does not compete with Aravelle, negotiate with it as a payer or supply it, subject to my chief executive's consent. I take a small number of advisory and speaking conversations on nursing workforce questions each year.
Beyond the page
The record behind the perspective.
In the boardroom
Sennett Lane HospiceDirector; chair of the people committee · July 2020–present
Formation
Diploma in NursingKembangan School of Nursing · 1996
Advanced Diploma in Critical Care NursingKembangan School of Nursing · 1999
Bachelor of Science in Nursing (post-registration, part-time)Merbau Hill University · 2002
Leon brought our committee a scorecard measure that was quietly paying hospital chiefs to leave nursing posts empty, with the finance director's objection stapled to his paper. We changed the measure. He has a nurse's instinct for what a rule does on the ward.
Patricia SeowIndependent director and chair, remuneration committee, Aravelle Health GroupThe full record ↗
Contact
I am not looking for another executive role. I would consider one non-executive seat, ideally on a remuneration or nominating committee, at an organisation that does not compete with Aravelle, negotiate with it as a payer or supply it, subject to my chief executive's consent. I take a small number of advisory and speaking conversations on nursing workforce questions each year.
