AHS concept for better health system:

Experiences from National University

Health System, Singapore
 Before 2005
Healthcare Delivery System in Singapore

NHG Singhealth
Excellent Patient Care - central to MOH mission

Better, Faster, Safer and Cheaper

 2001-5 .. Phase 1: Building Biomedical R&D Capabilities

Institute of
Bioinformatics Bioengineering & Singapore Singapore
Institute Nanotechnology Bioimaging Institute
Consortium for Clinical
Sciences Institute of
Genome
Medical
Institute of
Singapore Biology
Singapore Stem Cell
Institute of Consortium Singapore
Molecular & Bioprocessing
Technology Immunology
Cell Biology Network
Institute

Before 2000 2001 2003 2005 2006 2007

2000
 20056-10 BMS Phase 2

Bringing discoveries from

Bench to Bedside

Bringing clinical insights to lab

Translational & Clinical Research

Speech by Mr Khaw Boon Wan, Minister for Health in
2008

Research was not a priority in MOH. Let the Americans

do the research and we will send our doctors there to learn
the new treatments and procedures after they have been
established..

But in 2006, MOH revised the policy and obtained the

Cabinets approval to include clinical research as part of
MOHs mandate. We assessed that the time had come for
Singapore to do more in the area of clinical research
because such research, if suitably directed, could benefit
healthcare
 National University Health System

Singapores First Academic Health System, comprising

3 centres

3 schools

2008
Education

Research

Patient
Care

3 pillars
Academic Health System:
Easy said than done
 A Questionnaire Survey of attitudes & expectations of
NUS/NUH Physicians
Respondents by Job Title
Ho KY
Academy of Medicine Congress, 2004

Professor
8% A/Prof
17%
19% Asst Prof

6% Senior Consultant
Consultant
Assoc Consultant
Registrar
7% Medical Officer
18%
9% House Officer
5% 1% 10%
Others
 Most important disincentive when considering a
career in academic medicine
In order of % scores
1. Competing pressures from service, teaching and research (46)

2. Uncertainty regarding long-term prospects of academic career

(18)
3. Financial concerns, e.g., lower pay compared with NUH/private
practice (16)
4. The small number of academic appointments available (8)
5. Slower and more stringent appointment/promotion process
compared with NUH (6)
6. Less favorable conditions of employment on appointment when
compared with NUH (in respects other than salary (5)
 Most important obstacle to success in pursuit
of academic medicine
What NUS doctors say
In order of % scores

1. Inadequate protected time (30)

2. Personal conflicts: need for more family time, concern about
financial security (25)
3. Inadequate or uncertain research funding (21)
4. Lack of research culture/environment (19)
5. Lack of critical mass of clinician-researchers to share in
academic work (8)
6. Lack of support from non-academic colleagues (2)
 Teaching Research

Administration
(for senior faculty) ? Patient care
Training
(for junior faculty)
Work, Research, and Academic Career
What NUH doctors say

Doctors in academic posts tend to be under greater

pressure than their colleagues in service posts, i.e., NUH

Strongly agree 8%

Strongly disagree 16%

 MOH
CEO
Departments
Quality, Cost

Teaching
NUS Dean Academia
MOE Research
The greatest challenge is not in developing the
component parts but bringing them together
in an integrated & coherent way, that addresses the
central issues of quality, productivity, cost &
acceptance, in the face of sharply rising demand
How did we fix the challenges?
#1. Unification of Governance
Structure
2008
 #2. RE-ORGANISATION OF
CLINICAL DEPARTMENTAL
STRUCTURE
 CE Executive Group
CEO/CMB/ Dean (FoD)/Dean(SOM)

Chair Chair
Director Director Chair Chair Chair

Cancer Univ Medicine Univ Orthopaedics, Dental

CVS Centre Univ Surgical Hand & Cluster
Centre Cluster CMI
Cluster RC Microsurgery
Cluster

Heads
Heads Heads
Heads Heads Heads Heads Heads
Dept of
HRM Paeds Specialist
Dept of GE & Dept of Preventive
Dept of Cardiac Dept Med Clinical
Hepatology Urology Dentistry
Haem-Onc Dept Departments
AR
Div of Div Paeds
Div of Dept of
Endocrinology Surg
Gen Restorative
Dept of Dept of
Surgery * Spine Dentistry
Rad Onc CTVS Div of EMD
Div
Gen Med * Neonatology Dept
Div of Dept of
Div of Div of Colorectal Paed Anaesthesia
Div of Oral and
Nursing CVS Surg Ortho Dept
ID Maxillofacial
Onc Nursing Div
Surgery
Div of Diag Imaging
Nephrology Div of Sports Dept
Associates Div
Hepatobiliary
-Surgical Associates
Surg
Onc Endocrinology Div of ENT
Neurology * Ortho Dept
-Gyn Onc Renal
Trauma
-Paeds Neuro Div of
Div O&G
Others Neurosurg
Onc Div of Dept
-Pathology Resp Med
-Radiology Ophthalmology
Div of
-ID Dept
Div of Plastic & RC
-Others Rheumatology
Pathology
Div of Dept
Fam Med
Lab Med
Dept of Dept
Psych Med
*Div of Gen Med - Comprises Gen Med, Dermatology, Geriatric Medicine
*Div of Neurology - Comprises Neurology and Rehabilitation Medicine
* Div of Gen Surg Comprises Thyroid & Endocrine Surgery, Upper GI
Surgery, Breast Surgery, Trauma Surgery
#3. Clinician recognition
 NUHS Track Systems

Clinical Research

Teaching Admin
 Clinical Tracks
Clinician Track Focus % %
Clinical Acad
Clinician Clinical 90-95 5-10
Excellence Teaching

Clinician- Clinical & 80 20

Educator Teaching Teaching
Excellence
Clinician-Scholar Clinical & 60 40
Academic
Excellence
Clinician- Research 30 70
Scientist Excellence
 Outcome of Restructuring
University Medicine Cluster:
Short-term wins
Clinical Services Indicators: Waiting time
Teaching Indicators: Undergraduate Teaching Feedback
Scores
 Number of Medical Officers Applying to
NUHS as Their First Choice
70

60

50

40

Estab
30
1st Choice

20

10

0
May Nov May Nov May
2007 2008 2009
Research Indicators: Grants
 NUS School of Medicine

Times World University Rankings by Subject 2016-17

Clinical, Pre-Clinical & Health
31st globally
1st in Asia

QS World University Rankings by Subject 2016

Medicine
NUS Singapore
22nd globally
1st in Asia

QS World University Rankings by Faculty 2015

Life Sciences & Medicine
17th globally
1st in Asia
10 years on

30
Working upstream on fundamental solutions for tomorrow
MOH: Regional Healthcare System (RHS)
Working upstream on fundamental solutions for tomorrow
Technology as an enabling force multiplier
Research, Innovation and Enterprise 2020
Objectives
Academic Impact

Excel in areas
where Singapore
has potential to be
internationally
competitive

Health and/or Economic Impact

37
Transformation of the Economic System of Singapore
Future Economy:
Knowledge + Innovation +Enterprise

Innovation Intensive

Knowledge Intensive

Technology Intensive Cannot

Capital Intensive Survive as a
Copy Cat

Skills Intensive

Labour Intensive

1960 1980 2000 2020

The commercialisation of our
research and focusing on
moving upstream to
downstream has to be our
priority
DPM Tharman
26 Nov 16 ST
 National University Health System

10 Years on

5 centres
3 schools

2008 2020

Population

Innovation
Education

Research
Education

Research

Patient
Patient

Health
Care
Care

5 pillars
A Biomedical and Health Corridor

Innovation Chronic Disease

Functional in Prevention
Ageing Healthcare &
Management

Academic Programmes at
Alexandra Campus

41
 National University Health System

10 Years on

5 centres
3 schools

2008 2020

Population

Innovation
Education

Research
Education

Research

Patient
Patient

Health
Care
Care

5 pillars
 2008 NUHS Track Systems

Clinical Research

Teaching Admin
 2016 . :- NUHS RIE TALENTS

Innovators

Basic Science Departments Recognition

Clusters

All Departments
Programs

Researchers Scalers
 Conclusion
Change is necessary ..
Collaboration for Impact
Impact beyond Academic Excellence

Recognition system must reflect this change

Competition is a driver
Collaboration is a strategy

Prof Tan Chorh Chuan

46