The Customer Satisfaction Index of Singapore 2012 (CSISG) noted that nearly all restructured hospitals made significant improvements in delivering customer satisfaction; the exception was the National University Hospital of Singapore (NUHS), which led in 2011 but fell to sixth place last year. Director of the Institute of Service Excellence at SMU (ISES) Ms Caroline Lim said that restructured hospitals drew better service experiences from patient-respondents by managing to shrink the gap between expected and perceived quality in 2012. What is hardest for hospitals is the aligning of medical and non-clinical services to create a "mutually reinforcing system that is rigorous and that does not allow problems to be swept under the carpet", said Ms Lim. On the other hand, ISES Academic Director Marcus Lee said: "Sitting down the various departments to examine a specific service issue enables the various stakeholders to understand each other's operating procedures and constraints, and can lead to a more harmonised way of delivering the service."