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How a Systems Approach and Technology can Solve Healthcare’s Wicked Problems

Having a loved one in the hospital is an emotional ordeal. But beyond the worry, there’s another challenge: navigating a maze of processes in the healthcare system that makes caregiving even harder.

Take something as simple as getting updates. Nurses are stretched thin, ward phone lines are constantly busy, and only one registered next of kin is allowed to receive official updates. The result is a frustrating back-and-forth between family members and hospital staff. 

It’s an unnecessary struggle in an already stressful time, says Ms Bethia Chua, Lecturer & Consultant, Digital Health, NUS-ISS. “Our healthcare system (is) filled with dedicated and hardworking professionals who want to do the best for our patients,” she adds, “but in the process, (users of the healthcare system often) find ourselves getting caught in this web of fragmented workflows and unintended inefficiencies.”

How can we rethink these processes to make them less painful for everyone involved? That question is at the heart of the NUS-ISS seminar titled “Untangling the web: Systems approach for healthcare’s wicked problems and digital solutions”. 

(From left to right - A/Prof Ng Yeuk Fan, Director and Head, Corporate Development, Khoo Teck Puat Hospital and Yishun Community Hospital; Mr. Yoann Sapanel, Head, Health Innovation, Institute for Digital Medicine (WisDM),Yong Loo Lin School of Medicine, National University of Singapore; Adj A/Prof Sean Lam, Deputy Director, Health Services Research,SingHealth; Mr. Glenn Neo, Director of Innovation Capabilities Enablement, Synapxe Pte Ltd.; and Ms Shailu, Chief of Digital Health, NUS-ISS) 

Bringing together industry experts, the seminar explores how the healthcare industry can create a more connected, patient-centered system by breaking down silos, rethinking workflows, and leveraging technology.

Change is complex and nonlinear
Ms Shailaja Suresh Kumar (alias Shailu), Chief of Digital Health at NUS-ISS, points out that the success rates of transformation efforts in healthcare remain strikingly low.

“Studies by consulting firms like McKinsey, Bain, and BCG have consistently shown that healthcare transformation success rates range between just 4 to 11 per cent,” she says.

Why is transformation so difficult? “It is both technically as well as socially complex,” says Associate Professor Ng Yeuk Fan, Director and Head, Corporate Development, Khoo Teck Puat Hospital and Yishun Community Hospital.

For example, Assoc Prof Ng says, “(There are) 60 heads of departments, 120 teams and 5,000 people in (Khoo Teck Puat Hospital). They are going to be talking about the complexity of one issue, which is care, from the technological as well as the sociological point of view, from all multiple perspectives.” This overlap of perspectives, priorities, and interpretations makes systemic transformation incredibly challenging. 

Adjunct Associate Professor Sean Lam, Deputy Director of Health Services Research at SingHealth, agrees. He adds that one of the defining characteristics of wicked problems in healthcare is that “we do not even know for sure how the ecosystem will evolve”.

Healthcare transformation exists in a space of continuous change, shaped by new technologies, shifting policies, and evolving patient needs. Pilot programmes help healthcare providers navigate this landscape, he says. “(We want to) roll out something quickly to get feedback from the system helps us resolve some of this uncertainty.”

Design thinking is therefore key, Adj Assoc Prof Lam explains. Instead of waiting for the “perfect” solution, design thinking encourages rapid prototyping, iteration, and real-world feedback to navigate the unknown. Pilots allow healthcare providers to test new ideas, adjust based on insights, and adapt to real-world complexities before scaling up, he adds.

Medicine without meds
As healthcare continues to evolve, digital therapies are beginning to offer promising alternatives to traditional treatments.

One such innovation is Cognitive Behavioral Therapy for Insomnia (CBTi), a digital therapy that has been clinically proven to help people improve their sleep without relying on sleeping pills, shares Mr. Yoann Sapanel, Head, Health Innovation, Institute for Digital Medicine (WisDM) Yong Loo Lin School of Medicine at National University of Singapore.

Accessible via mobile apps or web platforms, CBTi guides users step by step through scientifically backed methods to clear their minds, reshape sleep patterns and achieve better rest. 

While the benefits of CBTi are clear in clinical studies, their real-world economic impact – such as the scalability, accessibility and maintenance of the digital platforms remains uncertain. “From a clinical standpoint, we see the benefits, but then so what? We also (need to) look at the economic side of things because at the end of the day, someone will need to pay for these solutions,” Mr. Sapanel says.

To bridge this gap, he adds, more standardised frameworks are needed – particularly at the government level to guide stakeholders in understanding the costs and economic value of digital therapies. This will ensure that the benefits of innovation extend beyond the initial pilots or trials and are truly sustainable in the real world.

Innovation at scale
In a complex environment like healthcare, transformation requires a structured approach to ensure that innovation is impactful and scalable.

Recognising this, Singapore’s Ministry of Health (MOH) has taken a systems approach to innovation, says Mr. Glenn Neo, Director of Innovation Capabilities Enablement at national healthtech agency Synapxe. MOH created a thriving network of innovation centers across different healthcare clusters, supported by the ministry through grants and resources, he says.

In 2023, Synapxe introduced the HealthX innovation hub. The initiative aims to connect public healthcare entities with industry players including startups – to address Singapore’s most pressing healthcare challenges. HealthX reduces common barriers to innovation while ensuring critical factors like patient safety and cybersecurity are met, Mr Neo explains. 

For startups and industry players, the message is clear: work with the system, not around it. “We (want) startups to come and partner with us; do not see us as gatekeepers,” he says. 

Issues in healthcare are complex and cannot be resolved through fragmented efforts or quick fixes – that was the key takeaway of seminar attendee Dr Devanathan Raghunathan, who is an alumni of NUS-ISS.

“The systems approach offers us the right tools to address these wicked problems,” he says.

“It also helps us prevent adopting a reductionist view,” adds Dr Raghunathan, who is the Director of Save the Children Global Ventures. “There may be no perfect answer to this complexity, but through a systems approach, we can get an approximately right answer.”

Watch the recorded seminar on NUS-ISS' YouTube Channel here. For more information on NUS-ISS' Executive Education Programme in Digital Health, visit here.


 


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