Abstract
Background: Yishun Health (YH) is a regional hospital system caring for 300,000 people in the north of Singapore that has embarked on a multi-year, whole regional health system transformation to improve outcomes. Care and services delivery transformation to enable greater person-centeredness and value-driven integration of care during residents’ episodes of acute medical crisis or complex elective patient care needs is based on the Unified Care Model (UCM) and provides a case study on the use of Health System Transformation Playbook (HSTP).
Methods: HSTP is a design, systems, and complexity-thinking enabled implementation science methodology to design and test health system transformation and care integration actions, anchored on an iterative 3-step process involving storytelling, model building and pathfinding that together tackles the scale of complex adaptive systems through time. The UCM, as well as its interdependent population segmentation model and performance framework are conceptual models arising from YH’s ongoing practice and model building using the HSTP. Facilitated storytelling and group model building sessions involving staff from medical, nursing, allied and operations etc., were conducted using the abovementioned models to iterate and distill “minimally viable services model product components” (MVSPC) i.e., new care processes and enabler processes that exemplify UCM.
Results: The following MVSPC were identified to integrate care towards the UCM and are being deployed through a Episodic Care Transformation Committee:
(i)Ambulatory emergency care unit to avoid admitting patients with lower acuity and without chronic illnesses or social needs.
(ii)Fast-track short-stay wards, with standardized care processes to turnaround patients with higher medical needs but without social needs.
(iii)Higher allied health-resourced wards to reduce length of stay for lower acuity patients with high/complex social needs.
(iv)Real-time patient segmentation “calculator” and inpatient segment-based bed allocation model.
(v)Patient flow center to coordinate transitions of care beyond the hospital.
Discussion: MVSCP were generally not new ideas but the challenge was in ensuring that numerous services model and enabler processes being transformed and implemented at the same time by different teams and at different sites work well together at scale to integrate care for each population segment to produce significant systemic impact. YH’s prioritization of MVSPC were facilitated using HSTP methodology and MVSPC were prioritized to be able to address urgent stakeholder needs while exemplifying a more integrated and transformed crisis and complex care experience for different Episodic Care population segments. The transformation committee is an effective operational decision-making and service planning governance platform to synthesize and coordinate deployment of various MVSPC.
Conclusion: Use of UCM and HSTP engages stakeholders in a more systemic and practice-driven process to effectively iterate and integrate care coherently for different population segments at scale to accelerate health system transformation towards people-centered and value driven care.