Speech by Mr Chan Heng Kee, Permanent Secretary (Health), at the Singapore Healthcare Management Congress, 15 August 2017

Mr Peter Seah, Chairman, SingHealth

SingHealth Board Members

Professor Ivy Ng, Group CEO, SingHealth

Mr Tan Jack Thian, Organising Chairman of the Singapore Healthcare Management Congress 2017

Distinguished Guests,

Colleagues,

Ladies and Gentlemen,

1.           Good morning.  I am delighted to join you at this Singapore Healthcare Management Congress.  I would first like to commend SingHealth for bringing together participants from Singapore and in the region to share insights on hospital operations, enterprise risk management and supply chain management – all important aspects of excellence in healthcare.

What Is Excellent Healthcare

2.           All of us are here today because we are interested to achieve excellence in healthcare. But, what is excellent healthcare?  If I were to ask each of you what healthcare excellence means to you, I am likely to get several different answers.  Some of you may characterise healthcare excellence as outstanding clinical outcomes.  Others may associate it with excellent medical schools, hospitals and doctors.  A few of you may mention being at the frontier of medical science and technology. The policy makers amongst us, including my Ministry of Health colleagues, will likely mention accessibility and affordability of care.

3.           All these are valid views.  Yet, I think that in and by themselves, they are also limiting as definitions of excellence in healthcare. Rather, I believe that healthcare excellence is a complex concept that eludes a single definition.  This morning I will not attempt to offer one definition of healthcare excellence. Instead, I would like to share with you three thoughts on healthcare excellence which I hope can add a useful perspective as we start this Congress this morning.

Excellent Healthcare Delivers Outcomes that Matter to Patients 

4.           First, I believe that healthcare excellence should deliver outcomes that matter to patients.  For many patients, what is important is not being treated by the latest drugs, state-of-the-art interventions or the most specialised professionals.  What is important to patients is the outcome they seek and the outcome they value.

5.           To some patients, this may be about being well enough to live at home, to return to work or to study, or maybe something as simple as enjoying the food or activities they prefer.  To other patients, it may be about regaining their basic functionalities such as walking, without pain, independently. For a small number, it may mean being able to live their final days of their lives with as little pain as possible, among their loved ones in a familiar environment.  So, if we can help patients achieve their goals, we are providing excellent healthcare, even if our treatments may be basic.

6.           To achieve such goals means first assessing what is important to patients. Then looking beyond clinical and lab tests to outcomes that the patients themselves report on. Take for example patients who undergo total knee replacement surgery.  The Singapore General Hospital has been collecting patient reported outcome for total knee replacements for several years now.  Questions which SGH asks their patients include whether they can perform their daily functions that matter the most to them.  With the data, SGH has been able to better monitor and help each of their patient recover from surgery.  SGH has now extended the collection of patient reported outcomes to other surgeries such as spine, foot and ankle surgeries. This is a very good example of valuing and monitoring what is important to our patients. When we are clear what patients value as outcomes, then we can go about assessing how we support patients to achieve those outcomes.

7.           Sometimes, achieving these outcomes may require healthcare providers to take a broader perspective beyond cure. To the immediate setting, to longer-term outcomes post discharge, sometimes outside of their boundaries.  Here, I would like to comment the work of Changi General Hospital’s Integrated Community Care Team. This team helps patients with complex needs after their discharge from Changi General Hospital. The team brings together different healthcare professionals, community coordinators and other partners. Together, they offer patients coordinated nursing services, psycho-social support, rehab care and medical follow-ups. All of them are important for these patients’ recovery because of the many different complex needs.

Excellent Healthcare Needs to Be Scalable and Sustainable

8.           The second point about excellent healthcare I would like to make is that it ought to be scalable and sustainable.  Some countries around the world have what I would call “peaks of excellence” – these are pockets of outstanding innovations, excellent healthcare institutions and doctors. Some healthcare providers have sophisticated practices that work in very unique and limited environments.  With these, they are able to provide the best care. But only for a small privileged limited group. 

9.           I believe that an excellent healthcare system should be one that delivers good health and healthcare outcomes on a consistent basis.  And to a much wider population, not just a limited group.  It must also be sustainable when it comes to affordability to the patient and cost to the state in the long run.  This is the reason why MOH has identified moving “Beyond Quality to Value” as an important priority for our healthcare system in Singapore.  And why our healthcare clusters are increasingly paying more attention to value-based healthcare.  

10.       By value, I do not mean blindly cutting costs or restricting choices.  Rather, value is defined by patient health outcomes achieved per dollar spent.  There are two aspects of value enhancement which MOH hopes to put more emphasis on working with healthcare providers in Singapore.

11.       The first is health technology assessment. New drugs, devices and tests are becoming more sophisticated. But they can also be very costly, sometimes costing tens of thousands a year or even more.  Assessed against the additional value they deliver, not all of these are necessarily worth the increase in price.  The use of health technology assessments can help us evaluate what their likely costs and benefits are over an extended period of time. This will allows us to know which yield the best returns for the health of our population. And which we should deploy within our system.

12.       Beyond health technology assessment, the second area where I think we can do more is clinical and cost benchmarking. This is sometimes referred to as Value Driven Outcomes. Benchmarking allows us to compare outcomes and cost of care - at the hospital level, at the procedure level and even among clinicians.  This in turn allows us to identify and spread best practices, narrow unnecessary variations and reduce inefficiency. Whether it is health technology assessment or clinical and cost benchmarking, I believe there is scope for us to deploy more of such methods to ensure that excellent healthcare practices are scalable and sustainable.

Excellent Healthcare Combines Medical Sciences with Other Disciplines

13.       Third, I believe that excellent healthcare often combines the best of medical sciences and other disciplines. As we can see from the programme for this event, disciplines like operations research, enterprise risk management and supply chain design can play an important role in the delivery of healthcare. Likewise, the coupling of knowledge of other disciplines with medical sciences can bring about excellent results.

14.       One promising discipline to incorporate into healthcare is behavioural science.  There is now widespread recognition that well designed application of behavioural sciences in healthcare can nudge patients, healthcare professionals and even the public towards positive behaviour. Some commentators have even coined the coupling of behavioural science and healthcare a “match made in heaven”. In Singapore, the Health Promotion Board has been actively incorporating behavioural nudges in their health promotion work.  You can find some of these in initiatives such as their National Steps Challenge and Healthy Pathway@Tampines. I think big and small, there are many more opportunities.

15.       Beside behavioural science, another discipline which I believe healthcare professionals should increasingly pay attention to and deploy is data analytics. With advances in computing power and data tools, and the rise of the Internet of Things, healthcare institutions can now collect and combine rich healthcare, social and even lifestyle data, and analyse them for insights. Some of our public healthcare clusters have already started doing this in their work.  One example is the use of data to predict patients who are more likely to require frequent hospital admissions, and with this data we can proactively reach out to them to offer preventive and early interventions rather than wait for them to be admitted to the hospital. I think these are all very good examples of where we can deploy other sciences and couple them with health and medical science to really make a breakthrough and achieve excellence in healthcare.

Conclusion

16.       Ladies and Gentlemen, delivering excellent healthcare is a worthy goal which all of us aspire towards – whether we are healthcare professionals, administrators, industry players or policy makers.  I think we know that it is a goal that is challenging to define and even more challenging to attain. 

17.       But I think if we can remember to strive towards healthcare that delivers outcomes that matter to patients, if we strive towards healthcare that is scalable and sustainable, and if we work towards healthcare that combines the best of health and medical sciences with other complementary disciplines.  And if we continue to share insights and lessons, and learn from one another, like what we are doing at this Singapore Healthcare Management Congress.  I am confident that each of us will all be able to take steady and positive steps in our individual journey towards achieving healthcare excellence.

18.       On that note, thank you. And I wish you a productive event.