the multiple facets of healthcare - hospital authority ...€¦ · the multiple facets of...

2017 ©

The Multiple Facets of Healthcare: How would practitioners of science, systems design and

management fulfil their roles in the future of healthcare?

Thomas WK Lew

Chairman, Medical Board

Tan Tock Seng Hospital

SINGAPORE

2017©

NHG: Integrated Health Cluster for 2.2M (~40%) population

TTSH

2017 ©

The Multiple Facets of Healthcare: How would practitioners of science, systems design and management fulfil their roles in the future of

healthcare

2017 ©

Preparing the Future Health Workforce

• Historic Development of Singapore Healthcare • Facets of our Future Challenges

• Defining the Adaptive Challenge

• Embracing Change – Radical & Disruption

• Defining Structure, Vision & Mission

• Creating New Mental Models

• Developing the Workforce• What do they Value? How do we know? • Safety Culture at Work • Engaging Leadership & Motivation at Work • Working in Teams

• Being and Becoming • Consciousness, Developing Cognitive Capacity for Empathy, Embracing

Complexity & Chane

2017 ©

Singapore Healthcare – Heading into uncharted Territories

Timeline Perspectives

❖Post-Independence: Public Health – water, sanitation, nutrition; vaccination; Maternal Health; Child Health; Primary Care

❖Development of treatment capabilities and health facilities for a young population & growing nation

❖Expertise, Deep specialisation; National Centres; Health-financing policies; Corporatization, privatization, Financial Management

❖Repurposing to public health mission; public health as part of the national social services agenda

❖Burning platforms for 21st Century with Demographic Shift – Water, Nutrition, Elderly health and Primary Care

❖Reorganising and bridging the Medical: Social Continuum

FOR A BETTER TOMMOROW

10 Tips to Help Your Patients Keep Their Healthy New Year resolutions

The War on Diabetes

Ang Mo Kio TC char kway teow& sugar-cane juice

Our Medical Staff are doing a lot more public engagement

2017 ©

Cleveland Clinic’s Medical Innovation Summit: Top 10 Innovations 2016

1. Using the microbiome to prevent, diagnose and treat disease

2. Diabetes drugs that reduce cardiovascular disease and death

3. Cellular immunotherapy to treat leukemia and lymphomas

4. Liquid biopsies to find circulating tumor DNA

5. Automated car safety features and driverless capabilities

6. Fast Healthcare Interoperability Resources (FHIR)

7. Ketamine for treatment-resistant depression

8. 3-D visualization and augmented reality for surgery

9. Self-administered HPV test

10. Bioabsorbable stents

Technology will not go away:Managing High-cost or potentially ‘Exponential Technologies is a given’

2017 ©

'When I die, I want someone to know': Fear of dying alone increases among elderly folk (ST, April 2016).

Social Issues for the Elderly

Bukit Batok - Managing Money and Budgeting for the Poor Course – VWO organized 15 February 2014

2017 ©

Self Reflection on 2010 Data:

Do we Really know how our patients’ get by in the community?

2017 ©Venice Beach, Santa Monica, CA

Discriminalization of Drugs : A Health Menace or Human Right?

2017©

N = AllBig Data

Personalized MedicineN = 1

Big Data: A Revolution That Will Transform How We Live, Work, and ThinkViktor Mayer-Schönberger and Kenneth Cukier

Multi- Centre Randomized Control Trial

Single-Centre Trial

2017 ©




2017 ©

Healthcare Future: An Adaptive Challenge

Adaptive work is the process of shifting the values, habits, practices and priorities of the people so that the pathway to progress opens up.

Dean Williams

2017 ©

Healthcare Future: Motivation Needs a Challenge

• Adaptive work is the process of shifting the values, habits, practices and priorities of the people so that the pathway to progress opens up.

• (Dean Williams)

• The challenge demands responses outside the repertoire.

• Adaptive work requires learning.

• The people with the problem are the problem, and they are the solution.

• Problem-solving responsibility shifts to the stakeholders and connected to factions.

• Adaptive work distinguishes what’s precious and essential from what’s expendable.

• The losses often includes people’s loyalties, attachments, and sense of competence.

• Adaptive work is value-laden; conservative as well as progressive.

• Adaptive work requires a longer time frame than technical work.

• Adaptive work generates disequilibrium and work avoidance.

• Adaptive work is experimental.

2017 ©

Healthcare Future: An Adaptive Challenge

In Complex Problems, Getting the answers is not as important as

…….. ”knowing the right questions to ask”

2017 ©

2011 Southcentral Foundation. Modified from Ralph D. Stacey:Stacey Complexity Matrix

Reframing Control

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2017 ©

Daniel Kim. Pegasus Communications Article Volume 3 No 5 (June/July 1993) Levels of Perspectives: “Firefighting” at Multiple Levels.

2017©

The Oscar office in Manhattan. The firm offers phone calls with physicians with quick callbacks and comparisons of doctors’ fees. It was dreamed up by a group of Harvard Business School tech entrepreneurs and investors and built by whiz-kid engineers and designers from Facebook, Google and Tumblr.

Radical Change & Disruption

2017©

Specialist physicians

Personal physicians

Nurse practitioners

Pharmacists

Clinics

Offices

Homes

Clayton Christensen: Disruptive Innovations – Higher Quality Lower Cost

Retail Clinics

Family care

Disruption breaks the trade-offs. Higher quality and lower costs

Trade-offs are binding: Higher quality requires higher costs


2017 ©


2017©

Vision & Mission

Culture Structure Resources Results

? Culture Structure Resources Confusion

Vision & Mission

? Structure Resources Resistance

Vision& Mission

Culture ? Resources Anxiety

Vision& Mission

Culture Structure ? Frustration

After Ross Wilson : Adapted from Knoster, T, Villa R, & Thousand, J (2000). A framework for thinking about systems change. In R villa & J Thousand (Eds), Paul H Brookes Publishing Co.

Organisational Alignment

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2017 ©

MOH is Planning forBeyond Healthcare 2020

1. Providing appropriate care closer to community & home

2. Increase value & be sustainable

3. Support Singaporeans to lead Healthier lives

2017 ©

NHG: Regional Health System RoadmapVision “Adding Years of Healthy Life”

2017©

Better

Care

(Mission-focused)

1. Deliver Excellent Hospital Care

Outreach &

Population

Health

NCID/

Outbreaks

3. Enable Community

Partnered Care

2. Manage Public Health

& Emergencies

Partnering Primary

Care & Community

Services

Structuring

Transitional

CareNational &

Civil

Emergenci

es

Establishing Intermediate Care

3. Standard

Care

1. Complex

Care

2. Acute Care

Mental Models for Care Delivery

Changi Airport vs Aircraft Carrier

HRO - Acute Care Unpredictable outcomeHigh Risk – gets higher w demandFlat Hierarchy, Broad-based team

Deliberation, Safety and Consistency

2017 ©







• Developing the Workforce• What do they Value? How do we know?

• Engaging Leadership & Motivation at Work

2017©

What Patients Really Want & Value

1. Cure Me

2. Heal Me

3. Don’t Hurt Me

4. Don’t Make Me Waste my Money

5. Respect Me as a Person

2017 ©

HEALTHCARE SYSTEM

What Our Staff Values

Operating Theatre Party 2016 – No Donations needed

NHG EMPLOYEE CLIMATE SURVEY 2010 Slide 38

Employee Climate Survey

2015

Results Presentation

© 2015 Towers Watson. All rights reserved. Proprietary and Confidential.


Values displayed are based on Total Favourable Coloured Cells indicate a statistically significant difference

# Category A B C D E

1 Work Organisation 65 6 -3 -1 3

2 Management 68 4 -4 -2 9

3 Supervision 81 -1 -1 -2 10

4 Working Relationships 78 5 -6 1 8

5 Communication 64 2 -7 1 15

6 Training and Development 83 4 -4 0 6

7 Performance Appraisal 76 5 -4 -5 18

8 Career Advancement 67 2 -4 -2 15

9 Rewards and Recognition 42 9 -3 -6 12

10 Working Conditions and Occupational Health 83 1 -5 4 4

11 Job Satisfaction 70 4 -4 -2 10

12 Hospital Image 66 3 -4 1 7

13 Patient/Customer Focus 68 6 -5 -1 8

14 Employee Engagement 80 4 -4 1 6

15 Confidence in Survey Follow-up 57 6 -6 2 2

16 TTSH Specific Items 60 1 -1 -1 4

A. TTSH: MEDICAL [DR ONLY] 2010 (558)

B. TTSH: DIVISION OF AMBULATORY & DIAGNOSTIC MEDICINE [DR ONLY] 2010

(113)

C. TTSH: DIVISION OF MEDICINE [DR ONLY] 2010 (208)

Category Scores By Division/Department

TTSH: MEDICAL [DR ONLY] 2010 (558)

NHG Employee Climate Survey 2010

D. TTSH: DIVISION OF SURGERY [DR ONLY] 2010 (174)

E. TTSH: DIVISION OF INTEGRATIVE AND COMMUNITY CARE [DR ONLY] 2010 (63)



1 Work Organisation 65 6 -3 -1 3

2 Management 68 4 -4 -2 9

3 Supervision 81 -1 -1 -2 10

4 Working Relationships 78 5 -6 1 8

5 Communication 64 2 -7 1 15

6 Training and Development 83 4 -4 0 6

7 Performance Appraisal 76 5 -4 -5 18

8 Career Advancement 67 2 -4 -2 15

9 Rewards and Recognition 42 9 -3 -6 12

10 Working Conditions and Occupational Health 83 1 -5 4 4

11 Job Satisfaction 70 4 -4 -2 10

12 Hospital Image 66 3 -4 1 7

13 Patient/Customer Focus 68 6 -5 -1 8

14 Employee Engagement 80 4 -4 1 6

15 Confidence in Survey Follow-up 57 6 -6 2 2

16 TTSH Specific Items 60 1 -1 -1 4

A. TTSH: MEDICAL [DR ONLY] 2010 (558)

B. TTSH: DIVISION OF AMBULATORY & DIAGNOSTIC MEDICINE [DR ONLY] 2010

(113)

C. TTSH: DIVISION OF MEDICINE [DR ONLY] 2010 (208)

Category Scores By Division/Department



D. TTSH: DIVISION OF SURGERY [DR ONLY] 2010 (174)

E. TTSH: DIVISION OF INTEGRATIVE AND COMMUNITY CARE [DR ONLY] 2010 (63)

Medical Overall vs Medical Depts

Category Scores 2010

Medicine

# Category T MED P Q R S T U V W X Y Z

1 Work Organisation 65 -7 1 -5 -22 -7 -1 3 8 -2 -3 12

2 Management 68 -10 0 -7 -38* -12 4 3 4 4 3 20

3 Supervision 81 -9 -5 -5 3 4 -2 10 8 11 9 9

4 Working Relationships 78 -10 -7 -8 -15 -6 -4 3 -2 2 6 17

5 Communication 64 -20* 3 -9 -25 -8 -7 2 6 14 11 21*

6 Training and Development 83 -5 -5 -10 8 4 -11* 0 8 6 0 10

7 Performance Appraisal 76 -16 -4 -7 -9 -14 -3 13 9 16 20* 18

8 Career Advancement 67 -15 1 -7 -21 -15 0 13 2 10 13 22*

9 Rewards and Recognition 42 -15 4 -2 -29 -3 1 -7 -9 8 18 11

10 Working Conditions and Occupational Health 83 -9 -1 -15 -37* -9 3 -12 3 3 -4 10

11 Job Satisfaction 70 -13 1 -18 -31* 2 -3 17 7 15 -6 19

12 Hospital Image 66 -10 -3 -6 -36* -4 2 3 -14 1 0 19

13 Patient/Customer Focus 68 -10 -1 -10 -30* -10 1 -7 10 4 4 15

14 Employee Engagement 80 -12 3 -13 -47* 6 0 4 5 2 2 14

15 Confidence in Survey Follow-up 57 -12 3 -13 -48* -10 7 -19 2 -7 0 11

16 TTSH Specific Items 60 -2 -7 5 -32* -1 5 -4 2 2 0 10

Int & Comm Care


Category Scores Ranked By Difference From

Benchmark Favourable Scores

Rewards and Recognition

Career Advancement

Performance Appraisal

Employee Engagement

TTSH Specific Items

Communication

Management

Confidence in Survey Follow-up

Patient/Customer Focus

Training and Development

Hospital Image

Work Organisation

Working Conditions and Occupational Health

Supervision

Job Satisfaction

Working Relationships

Coloured Difference Bars indicate a statistically significant difference

Differences From Benchmark


TTSH: MEDICAL 2010 (738)

vs. TTSH: MEDICAL 2006 (306)

45

67

77

80

74

64

70

61

69

81

68

66

83

78

69

77

17

15

14

13

13

13

12

11

10

9

8

8

7

7

6

3

-30 -15 0 15 300 25 50 75 100

Significant Improvements Made!

Medical Overall 2010 vs Medical Overall 2006


Total Favourable ?

Total

Unfavour-

able

80. TTSH MyCare has made me more aware of the need to cut waste

in my work.-38 * 44 17

81. I believe TTSH MyCare will bring about positive outcomes [e.g.

improved patient care, reduced wait time, etc.].-35 * 47 12

83. MyCare principles [e.g. waste reduction, etc.] are relevant to my

daily work.-29 * 43 7

82. My immediate supervisor is supportive of my participation in

MyCare projects/activities.-28 * 54 3

61. Filling in this survey is a good way to tell management what I

think.-22 * 24 20

49. This hospital/institution periodically monitors and reviews pay to

ensure its competitiveness.-20 * 33 25

70. I have the computer systems support I need to do my job

effectively.-19 * 13 25

12b. This hospital/institution is highly regarded by: The general public -18 * 29 14

57. This hospital/institution rewards staff with good bonuses based

on hospital/institution and individual performance.-18 * 32 19

15. I think this hospital/institution is doing a good job of retaining its

most talented people.-16 * 27 32

* indicates a statistically significant difference



vs. TAN TOCK SENG HOSPITAL 2010 (5277)

Tot Fav

Diff

Bottom 10 Differences From Benchmark

39

42

50

43

56

42

62

57

49

41

0 25 50 75 100

Medical Overall Bottom 10 Scores vs TTSH

Scores (2010)

(TTSH Specific Items)

(TTSH Specific

Items)



(Confidence in Survey Follow-up)

(Rewards & Recognition)

(Work Organisation)

(Hospital Image)

(Rewards &

Recognition)

(Career Advancement)


Job Function/Level Comparison

A. TTSH 2015 (N=6,225)

B. ADMINISTRATION STAFF (N=716)

C. ANCILLARY/TECHNICAL STAFF (N=332)

D. ANCILLARY FRONTLINE/COUNTER STAFF (N=727)

E. ALLIED HEALTH STAFF (N=1,022)

F. MEDICAL STAFF (N=693)

G. NURSING STAFF (N=2,519)

H. NURSING ANCILLARY (N=122)


# Category A B C D E F G H

1 Sustainable Engagement 81 2 4 0 -3 4 -2 8

2 Job Satisfaction 63 2 10 1 -6 8 -3 15

3 Patient/Customer Focus 80 -1 4 2 -4 -2 1 9

4 Management 67 4 9 -1 -6 3 -1 14

5 Organisation Values 83 2 2 1 -1 -3 0 6

6 Work Organisation 78 -3 6 -2 -3 3 1 10

7 Working Conditions and Occupational Health 82 2 6 2 -2 -3 -1 5

8 Communication 65 3 10 1 -6 3 -1 13

9 Empowerment 76 0 5 -2 -4 3 0 11

10 Supervision 73 3 4 -4 -3 12 -3 12

11 Performance Appraisal 70 0 7 1 -4 3 -1 15

12 Career Advancement 63 -3 12 2 -9 3 1 17

13 Rewards and Recognition 63 -3 13 4 -8 -7 3 16

14 Working Relationships 72 3 4 -4 -4 10 -1 8

15 Learning and Development 77 -5 1 -3 -4 8 2 7

16 TTSH MyCare Items 72 1 10 7 -2 -29 3 14

17 TTSH Other Items 71 0 3 1 -5 -2 1 7

A. TAN TOCK SENG HOSPITAL [TTSH] 2015 (N=6,225)

B. TTSH: ADMINISTRATION STAFF 2015 (N=716)

C. TTSH: ANCILLARY/TECHNICAL STAFF 2015 (N=332)

D. TTSH: ANCILLARY FRONTLINE/COUNTER STAFF 2015 (N=727)

By Job Function/LevelE. TTSH: ALLIED HEALTH STAFF 2015 (N=1,022)

F. TTSH: MEDICAL STAFF 2015 (N=693)

G. TTSH: NURSING STAFF 2015 (N=2,519)

H. TTSH: NURSING ANCILLARY 2015 (N=122)



Length of Service Comparison

A. TTSH 2015 (N=6,225)

B. < 1 YEAR (N=800)

C. 1 YEAR TO < 3 YEARS (N=1,043)

D. 3 YEARS TO < 5 YEARS (N=1,153)

E. 5 YEARS TO < 10 YEARS (N=1,617)

F. 10 YEARS OR MORE (N=1,577)


# Category A B C D E F

1 Sustainable Engagement 81 2 -2 -4 -1 4

2 Job Satisfaction 63 6 -3 -7 -4 8

3 Patient/Customer Focus 80 1 -2 -3 -1 4

4 Management 67 7 -2 -6 -3 6

5 Organisation Values 83 2 -1 -3 0 3

6 Work Organisation 78 0 -2 -3 0 5

7 Working Conditions and Occupational Health 82 0 -2 -3 -1 4

8 Communication 65 1 -2 -4 -2 6

9 Empowerment 76 1 -2 -4 -1 4

10 Supervision 73 6 0 -3 -3 3

11 Performance Appraisal 70 -3 -1 -1 -2 5

12 Career Advancement 63 4 -6 -6 -3 9

13 Rewards and Recognition 63 0 -3 -6 -2 8

14 Working Relationships 72 4 -1 -4 -2 4

15 Learning and Development 77 3 -3 -3 -1 4

16 TTSH MyCare Items 72 -6 -5 -4 1 8

17 TTSH Other Items 71 1 -3 -1 -1 3

A. TAN TOCK SENG HOSPITAL [TTSH] 2015 (N=6,225)

B. TTSH: LESS THAN 1 YEAR 2015 (N=800)

C. TTSH: 1 YEAR TO LESS THAN 3 YEARS 2015 (N=1,043)

By Length of ServiceD. TTSH: 3 YEARS TO LESS THAN 5 YEARS 2015 (N=1,153)

E. TTSH: 5 YEARS TO LESS THAN 10 YEARS 2015 (N=1,617)

F. TTSH: 10 YEARS OR MORE 2015 (N=1,577)Values displayed are based on Total Favourable Coloured Cells indicate a statistically significant difference


Age Comparison



1 Sustainable Engagement 81 -4 1 5 13

2 Job Satisfaction 63 -7 1 9 23

3 Patient/Customer Focus 80 -3 0 4 9

4 Management 67 -5 1 7 16

5 Organisation Values 83 -3 1 3 9

6 Work Organisation 78 -3 0 5 12

7 Working Conditions and Occupational Health 82 -4 0 5 11

8 Communication 65 -5 1 6 17

9 Empowerment 76 -3 1 3 11

10 Supervision 73 -2 0 2 12

11 Performance Appraisal 70 -3 0 5 12

12 Career Advancement 63 -7 1 9 21

13 Rewards and Recognition 63 -6 0 11 19

14 Working Relationships 72 -3 0 4 14

15 Learning and Development 77 -2 0 2 10

16 TTSH MyCare Items 72 -6 1 9 15

17 TTSH Other Items 71 -3 1 3 7

A. TTSH 2015 (N=6,225)

B. LESS THAN 30 YEARS OLD 2015 (N=2,349)

C. 30 TO 45 YEARS OLD 2015 (N=2,581)

D. 46 TO 60 YEARS OLD 2015 (N=1,056)

E. ABOVE 60 YEARS OLD 2015 (N=207)

2017 ©

2017 ©

Motivation at Work

Herzberg, F.I. 1987, (1968)'One More Time: How Do You Motivate Employees?' Harvard Business Review, Sep/Oct87, Vol. 65 Issue 5, p109-120.

2017 ©

Work

New learningFeeling

Unique expertise

Direct Communicationswith Authority

Direct Feedback

ControlOver

resources

PersonalAccountability

Self-scheduling

Understand What Motivates You Sensory Ingredients of Job Enrichment

Herzburg HBR

2017 ©

2012: Dr Tan Jia Yi, Orthopaedic HO: Volunteer at Healthserve for transient migrant workers

Harnessing A “broad church”into Clinical Decision Making

Chief ResidentsAllied Health Leads

Polyclinic HODs

2017 ©







• Developing the Workforce• What do they Value? How do we know? • Safety Culture at Work • Engaging Leadership & Motivation at Work • Working in Teams

• Being and Becoming • Consciousness, Developing Cognitive Capacity for Empathy, Embracing

Complexity & Chane

2017 ©

“You’re not as smart as you think you are: Human cleverness arises from distributing knowledge between minds, making people think they know more than they do”

The Knowledge Illusion: Why We Never Think Alone. By Steven Sloman and Philip Fernbach. Macmillan

2017 ©

The Multiple Facets of Healthcare: How would practitioners of science, systems design and management fulfil their roles in the future of healthcare?

1. How are Meetings Conducted?

2. How are projects organised

3. How are decisions made?

4. Who gets to participate?

5. How are conflicts resolved?

6. How are errors in decisions handled?

HIPPO in the Room: Highest Paid Person’s Opinion

2017 ©

Human “Beings” not Human “Do’s”

• Believe that Our Work is important – We will make a Difference • Support & Believe in our Institutions and its Memories

• Pride of purpose & Mastery as a Goals

• Acceptance that our work is Complex • Embrace Complexity

• Be a “Conscious” Organisation

• Developing Capacity & Cognition for Empathy

2017 ©

2017 ©

“Gas Chamber”; By Luc Tuymans (1958- ) Series ‘Holocaust’

“Consciously motivated organizational behavior” alone is not good enough

2017 ©

Conclusion

The Multiple Facets of Healthcare: How would practitioners of science,

systems design and management fulfil their roles in the future of healthcare?

Together

the multiple facets of healthcare - hospital authority ...€¦ · the multiple facets of...

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