Systemic Manpower Modeling for Workforce Accountability: A Governance Framework for Hospital Systems to Enhance Integrated Care and Value-Based Outcomes

Background: Workforce is a central pillar of integrated care and health system performance. Healthcare organizations e.g. hospitals often struggle to align manpower planning with workload, revenue, quality, and safety, particularly when resource requests are handled in silos. Conventional approaches lack mechanisms to account for interdependencies across departments or to ensure systemic accountability, much less provide a systemic model for integrated workforce modeling for healthcare outcomes. This case study describes the development of a systemic manpower governance framework in a large acute hospital system in Singapore, designed to manage workforce needs systemically, enabling broader integrated care and whole health system transformation.

 

Approach: Khoo Teck Puat & Yishun Community Hospital (KTPH & YCH) is a large acute and community hospital system in northern Singapore looking after approximately 1.5 million residents belonging to the National Healthcare Group (NHG) regional population health system. Within the hospital, a Workload & Manpower Review Committee (MRC) was established as a central workforce governance mechanism, supported by three interconnected manpower models: (1) Budgeted – annual targets for workload, revenue, and manpower;

(2) Actual – monthly monitoring and forecast of performance versus budget; and

(3) Supplementary – structured evaluation of new manpower requests using workload projections, ROI analysis, and systemic interdepartmental impact assessments.

 

 Accountability cascaded across the hospitals’ health system levels, from C-suite to divisional leaders to Heads of Departments (HODs), using the Hospital Governance Operating System (HGOS) framework (published elsewhere). The framework embedded systemic checks for interdepartmental impacts, particularly for new services affecting multiple professions, as well as systemic outcomes analysis.

 

Results: Early implementation demonstrated improved clarity and accountability at all systems levels i.e. department (microsystem), executive (mesosystem), and management levels (macrosystem) for aligning manpower with performance. The framework also enabled benchmarking across financial years and enhanced transparency and fairness in manpower allocation, reducing ad-hoc requests, and improving accountability for outcomes and resource use. Importantly, early survey feedback from HODs, Human Resources, and Finance colleagues indicated that the systemic manpower modeling approach was perceived as far more coherent and helpful than prior fragmented methods of addressing manpower requests. This strengthened trust in the process and supported more effective cross-departmental collaboration in managing workload spikes and launching new services. Executive and Management levels were also able to innovate towards more systemic workforce solutioning and investment decision making.

 

Implications: & Conclusions: For integrated care, this framework ensures workforce planning accounts for interdependencies across care pathways and departments, rather than operating in silos. For the workforce pillar, it provides a replicable model of accountability and sustainability for ever larger integrated care systems. For system efficiency and value-based care, it offers a data-driven, transparent method to align workforce resources with quality, safety, productivity, and financial goals of integrated care systems. Finally, for governance and leadership and overall system effectiveness, we further integrated this framework within the hospital’s Integrated Planning Cycle, ensuring full alignment with the hospitals’ strategic priorities and work planning activities. All in all, this illustrates how systemically designed processes can improve decision-making and shared accountability across integrated care (hospital) systems.