Abstract
Background: Khoo Teck Puat Hospital & Yishun Community Hospital (KTPH&YCH) is a regional hospital system of the National Healthcare Group (NHG) in northern Singapore, embarking on a whole hospital system transformation. Effective governance is a cornerstone for care integration in regional hospital systems, with performance management being an activity of the Governance & Leadership Subsystem of health systems. KTPH&YCH’s governance transformation focuses on systemic performance management, aiming to enhance accountability, strategic alignment, and performance transparency.
Approach: The HGOS initiative focused on two areas: aligning hospital system performance with NHG and KTPH&YCH system priorities, and ensuring clear accountability at departmental and operational levels within the hospital system.
The transformation began by identifying six health system indicators based on Quadruple Aims, inclusive of areas concerning patients’ experience of health, staff wellbeing and operational performance for organizational sustainability. Thereafter, Key Result Areas (KRAs) were chosen by senior leaders to reflect NHG and KTPH&YCH system priorities in advancing population health, fostering people and culture, encouraging strategic growth of health system and enforcing operational and financial stability. Driver diagrams mapping KRAs to the health system indicators were co-created with clinical and operational teams with feedback from mid and senior management, visually connecting service delivery drivers to key outcomes.
The second component involved a detailed review of definitions of heads of departments (HOD), cost centers and operational units, which are fundamentals of operations in a regional hospital system. The review assessed the types of cost centers and operational units, mapped them to site-based or microsystem-based (services serving a population of patients) systems of care, and through consultations with HODs, re-assigned them to specific departments for oversight and accountability. Sole and shared accountability structures were further defined to address both site-based and specialty-based outcomes in these systems. Further, the levels of HODs were delineated, ensuring that accountability for results of integrated care could be effectively cascaded from NHG to KTPH&YCH senior management down to all levels of HODs. This structure allowed a clear visualization of how contributions of each HOD flow upwards, supporting their respective higher-level department heads through the impact of departmental actions.
Results: Driver diagrams linking service delivery drivers to KRA facilitated a better understanding among leaders in KTPH&YCH of how service performance impacts the health system indicators, ensuring a strategic focus on outcomes.
Additionally, the realignment of cost centers and operational units, along with clear delineation of HOD definitions and their accountability, has improved the clarity of departmental responsibilities and resource management, as leaders in KTPH&YCH are supported by visualization of departmental outcomes through performance management dashboards. These changes contributed to a more integrated care delivery and better alignment of operational activities with regional hospital system goals.
Implication: The governance transformation within KTPH&YCH established a clear framework for aligning executive leadership, departmental operations, and regional hospital system outcomes that contributes to NHG regional health system outcomes. This approach lays the groundwork for continuous improvements in integrated care delivery and offers valuable lessons for other health systems aiming to enhance their governance and accountability mechanisms.