Experiencing the Complexity of a Healthcare Transformation Journey

| By: Mrs. Tamsin Greulich-Smith, Member, IT Strategy & Management, NUS-ISS

NUS-ISS has been working in partnership with Alexandra Health System (AHS), the Regional Health System for northern Singapore. AHS is responsible for providing healthcare services for the 700,000 strong population stretching from Yishun to Woodlands.

The first hospital to open in the cluster was Khoo Teck Puat Hospital (KTPH), a 590-bed acute care facility. KTPH took in its first patients in 2010. From the outset KTPH has been recognised for its strong innovation culture, which has brought initiatives, such as the Ageing in Place programme. Recognising the need to evolve an improved model of care for the population in the north of Singapore, the hospital collaborated with NUS-ISS in 2014 to design and implement a systematic way to transform the service delivery model of KTPH.

The transformation is aimed at resolving the patient experience challenges as the population ages and there are increased burdens arising from chronic disease management. The project required a systems thinking approach and the engagement of a broad and diverse group of staff to drive the programme forward.

The programme commenced with a deep envisioning exercise, facilitated by a dedicated ISS project team. Mr. Khoong Chan Meng, NUS-ISS’ Director and CEO, and Mrs. Tamsin Greulich-Smith, Member of the IT Strategy & Management Practice and Lead of the NUS-ISS Smart Health Leadership Centre, worked alongside Associate Consultant, Ms. Moni Pang, for the two-year duration of the project. Bringing their combined organisation and service transformation experience to the programme, the NUS-ISS team began by engaging thought leaders from across the cluster to define the challenges and scope. Together, a phased transformation roadmap was developed and NUS-ISS worked closely with the project teams and steering committee to ensure that milestones were achieved.

Capability building was integral to the delivery of the transformation progamme. Just-in-time training workshops were conducted to build capabilities and tackle project objectives simultaneously. The NUS-ISS team mentored the AHS project team members through a complex Business Process Re-Engineering and Design Thinking programme, which allowed AHS staff to design their own transformation blueprint. This mentorship-based consultancy and training model enhanced staff buy-in and ownership of the programme. It also supports the delivery of sustainable outcomes. In addition, the modular nature of the training workshops made it easier for medical staff to participate.

Dr. Ng Yeuk Fan (in checkered) and his colleagues in one of the capacity-building training workshops

Dr. Ng Yeuk Fan, Deputy Director (Special Projects) of AHS, joined the project full-time after the envisioning process to drive articulation of an AHS Transformation 2020 blue print. INNOVATE@ISS spoke to Dr. Ng about his experience during the development of the transformation blueprint.

Q: What were the most challenging aspects of the transformation programme?
It was most challenging for the teams to create sufficient time and “mental space” within which they feel safe and rewarding to explore innovative future states of care that are not bound by current service models, professional and specialty boundaries, existing practices and current resource, as well as policy constraints.

Q: Are there things you would try differently if you did this again?
To borrow from Kotter, I would spend more time building “the guiding coalition” and belabouring a deeper and shared ownership of the actual problem before the team.

Q: In what ways did you find the NUS-ISS team helped you most?
NUS-ISS was instrumental in helping the team appreciate the power of approaching the problem systematically and using effective facilitation. Tamsin and Moni were able to get the most out of the team in articulating their preferred care model while staying on track with the tight timeline.

Q: What benefits do you think the programme has brought so far?
The programme has created a shared language with which everyone involved can understand one another better. Shared understanding is the precursor for shared ownership, and that in turn, makes possible a team approach to problem solving and creating a better future together.

Q: What excites you most about the transformation programme?
The transformation programme managed to bring together people from AHS, KTPH, Yishun Community Hospital (YCH), and Woodlands Integrated Health Campus (WIHC), representing diverse functional units: medical, nursing, allied, pharmacy, community care, population health, operations, IT, informatics and finance. Team leaders, Dr. Terence Tang, Mr. Alvin Ong, Ms. Bong Ai Wei and Ms. Kelly Tan, brought together the narratives of their team members and workshop participants. Through the shared experiences and learning, and with the support of the project sponsors, such as KTPH CEO, Mrs. Chew Kwee Tiang, YCH CEO, Dr. Pauline Tan and AHS CTO, Dr. Wong Sweet Fun, the various functional units are now more ready to work across institutional boundaries, professional and specialty lines, to improve service delivery systematically for people living in the north of Singapore.

Q: What advice would you give others embarking on a transformation journey in healthcare?
No system will ever be ready for transformation. Make use of who and what you have, and just start. Encourage everyone to go in with an open heart and open mind. Enjoy the process.

Alexandra Health Systems (AHS) is currently in the process of piloting parts of the transformation blueprint, and evolving their processes and systems to evolve the future model of care for the region. Stay tuned for future updates here.  

To find out more about the NUS-ISS Smart Health Leadership Centre, click here