Perspectives from healthcare providers and decision-makers on strategies toward a future hospital: qualitative insights from a group modelling process

AIM: Planning for a hospital is a complex and dynamic process, traditionally not informed by evidence. A systems thinking approach can be useful in informing hospital planning decisions. We derived insights from hospital executives and clinicians regarding the key drivers within the present hospital system that affect resource planning targets and leverage points for transformation in a new future hospital. METHODOLOGY: We utilized a qualitative group model building (GMB) process conducted in one of the largest hospitals in Singapore to inform the development of a systems model for the planning of the new brownfield hospital. Participants included hospital executives supporting hospital planning, strategic management, health system planning, data management, and healthcare providers from clinical and allied health domains who were members of the hospital planning committee. Data were gathered through 10 GMB workshops from September 2023 to March 2024 and analysed using thematic analysis. RESULT: A total of 20 participants attended the GMB workshops. Nine themes were identified across four hospital subsystems (Specialist Outpatient Clinic (SOC), emergency department (ED), inpatient, and surgeries & procedures (S&P)). Among these, five themes were linked to potential interventions to optimise hospital operations and patient care, including right-siting of patients (e.g., primary care, community, telehealth) and improving pre- and post-surgical care to reduce length of stay (LOS). Across this dynamic system, the most critical leverage point identified was the reduction of avoidable demand on acute hospital services through efficient patient right-siting and strengthened care transitions, which directly influences ED utilization and inpatient LOS. Four key drivers shaping hospital demand-supply dynamics were identified: ED utilization, extended inpatient LOS, the integration of technological advancements (particularly Artificial Intelligence (AI)), and the expansion of alternative care models. These insights directly culminated in a systems-level causal loop diagram that provided a foundation for identifying key leverage points to guide strategies aimed at better aligning hospital resources with patient demands while mitigating structural inefficiencies. CONCLUSION: We identified four key drivers and five potential strategies across four hospital sub-systems that could be leverage points for hospital redesign and transition to the future mode of operations.