Governance and Leadership Interventions to Enable Systemic Care Integration in a Regional Population Health & Hospital System in Singapore

Background: Yishun Health (YH), a regional population health and hospital system serving 300,000 residents within the northern region of Singapore, has embarked on a multi-year whole system transformation to improve outcomes based on the Unified Care Model (UCM). The UCM is a future state model of our Services Delivery System (SDS) seeking to drive deployment and systemic integration of services models and programs across various specialties, departments and institutions; that impact residents and improve outcomes and value. Governance and Leadership Systems (GLS) of health systems function to ensure that strategic policy frameworks exist, combining with activities that ensure effective oversight, coalition building, regulation, attention to system-design and accountability[1] across all six health system subsystems. GLS interventions needed to be developed to accelerate care and services integration. Methods: Health System Transformation Playbook (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.[2] Guided by Burke-Litwin Casual Model about systemic structures, we applied HSTP-like steps iteratively between 2017 to 2023 to engage leadership to understand governance and performance management challenges (story telling) across aspects to develop understanding of current and desired future-state governance practices and processes (group model building) leading to a suite of governance and leadership interventions. This is driven by future-state models based on levels of agreement and certainty (pathfinding). Results: Future-state governance practices and processes prioritized and being deployed include: (a) Leadership/Strategy: (i) Articulate and cascade organization strategic priorities through leadership engagements, (ii) Develop UCM Performance Framework, (iii) Develop YH Data Strategy (b) Organizational Culture: (i) Deploy “Principles of Engagement and Decision Making” as ‘Simple Rules’ to transform climate and culture. (c) Systems/Structures: (i) Transformation committees supported cross-departments to drive care integration and business structures (ii) Community of practice on performance indicators management, (iii) Data management and analytics taskforce for IT integration, (iv) Regional health office for shared care partnership in community ecosystem development. (d) Management Practices: (i) Systemic population segmentation models, (ii) Case and population-level definitions, for accountability during transitions of care towards a performance management system. (e) Task and Individual Skills: (i) Deploy courses in Systems Thinking, Strengths-Finder, Facilitation to enable capability and capacity in systemic governance. Discussion: It is vital that systemic change is targeted based on the objectives of healthcare systems. GLS activities is a lever to effect behavioral and process changes within organizations that enable care transformation. YH GLS activities arose from use of HSTP and prioritized to tackle challenges while enabling longer-term transformation. HSTP enables systemic re-design of GLS system and processes to accelerate health system transformation. [1]https://www.who.int/health-topics/health-systems-governance#tab=tab_1 [2]Teo KW, Hu Y, Chew KT, Pek WY, Chua HC, Matchar DB and Ng YF (2023) Health System Transformation Playbook and Unified Care Model: an integrated design, systems & complexity thinking approach to health system transformation. Front. Health Serv. 3:1157038. doi: 10.3389/frhs.2023.1157038