Health Care + Design in Singapore

Stepping off the plane into Singapore is like stepping into a new-era showcase of architecture, product, and service design. It’s closer to the feeling of being 14 years into the future rather than only 14 hours.

Dig a little deeper and you find a rich tapestry of diversity and heritage, purposefully interwoven and bonded together by the tenuous survival of a small island city state with few natural resources beyond the ingenuity of its own people and their ability to incorporate new cultures and ideas. Facing a demographic silver tsunami, with the proportion of the country’s population over 65 projected to rise from 10 percent to 31 percent over the next 25 years, Singapore’s health care institutions are applying design thinking to proactively tap into this ingenuity, looking for the breakthrough innovations that will mitigate the potential health care burden of the aging population.

Joined by Ron Amodeo, Dr. Michael Brennan and Dr. Michael Matly, I was part of a multidisciplinary team that represented clinical, business, and design perspectives from the Mayo Clinic Center for Innovation. Our purpose was to not only learn about the context of health care in Singapore, but to offer up our own reflections on the challenges and opportunities presented by applying design and innovation to transform the delivery of care.

Our hosts at Khoo Teck Puat Hospital (KTPH) in the northern region of the country are at the forefront of this movement as the first health care institution in Singapore (and perhaps Asia) to employ a designer as a full-time, embedded staff member in support of a broad innovation initiative across their organization. However, they are certainly not alone in this trend, as Changi Hospital, part of the Eastern Health Alliance, and others are also actively collaborating with design industry partners. Proactive government support has strengthened programs across industries to catalyze design thinking broadly through Design Singapore, Singapore Polytechnic, and National University of Singapore. There has been an increasing awareness and application of design thinking as a new skill set to fortify Singapore’s national resilience, and health care is no exception.

In terms of our own challenges, what can health system practices in a comparatively homogenous, middle income, rural region across multiple U.S. states learn from an acute hospital practice in Asia set within a culturally diverse, densely populated, lower income neighborhood? Plenty. The context of KTPH represents an “extreme user” scenario where the crucible of extremes in space, demographics, manpower, and diversity can amplify insights into the human experience that in other contexts may be more difficult to discern. There are clear echoes between Singapore’s care delivery challenges and our own, particularly around the issues of aging and dying in place, wellness and behavior change, and population health.

Additionally, KTPH is increasing the opportunities for frequent and rapid experimentation through growing partnerships between health care and design, facilitated by Dr. Eugene Shum, director of Medical Affairs and Innovation at KTPH. Singapore Polytechnic students and their prototyping skills have been engaged on projects including room controls, privacy dividers, and a gurney-mounted shelf for monitoring equipment during patient transport. While most of these activities are currently product-based, service-based experimentation in health care will likely grow as increasing numbers of health care staff are exposed to design thinking techniques, and spaces and support for experimentation continue to be established.

KTPH’s ABLE Studio, a venue for care delivery experimentation in a retail space, is an effort spearheaded by Dr. Wong Sweet Fun, senior consultant at KTPH’s Department of Geriatric Medicine, who refers to herself as an accidental innovator. “We didn’t set out to innovate, just to do the right thing,” she says. Rather than simply create a transactional space where medical products are sold on the hospital campus, the organization’s leadership has allowed the ABLE team to start from the lens of supporting the needs of patients. It has iteratively evolved through experiments around providing DIY tips, education, advice, and sharing ideas from KTPH’s own patient community in addition to the home health items for sale on its shelves and online. Started in 2001 as a demonstration Home for Independent Persons, it is on its third major iteration and still evolving.

Throughout our visit, a recurring theme was the need to completely re-imagine the health care delivery system to meet the demand of Singapore’s silver tsunami with already capacity-strained resources. And the concern (shared by anyone tackling large, systems-based issues) that the inertia of the status quo will stymie those efforts. However, KTPH’s CEO Liak Teng Lit embodies a proactive approach where “everything that is can be better” with a broad service and quality infrastructure in support of a Hassle-Free Hospital and actively encouraging a mindset of “just do it” innovations at the point of care among the staff. At the innovation-themed Quality Conference, KTPH staff displayed concepts that ranged from simply adding a crutches holder to existing chairs and standardizing the organization of supplies on trolleys to more technology-based solutions including an in-room patient console to control room features and deliver patient education. Projects to encourage wellness and community were also highlighted, including a bicycle-driven water fountain and the hospital’s rooftop vegetable garden. On a systems-wide level, we heard emerging philosophies from multiple stakeholders from both KTPH and throughout the Singapore healthcare system that point toward paradigm shifts and resonate with insights from our own work at the Center for Innovation and health care challenges in the U.S.

Nonhospitals. We heard ideas around building a hospital that isn’t a hospital, but a place that the community and patients value for reasons in addition to its ability to deal with catastrophic illness. KTPH is a Health Promoting Hospital with health promoting spaces (gardens, cooking demo lab, and outdoor recreation) and health advocacy courses for all staff to support their role as healthy living ambassadors. As a very nontraditional hospital complex, KTPH’s campus was designed to welcome the neighborhood into its spaces with an open plaza where students come to study, footpaths along an adjoining pond for recreation, and a rooftop vegetable garden tended by community volunteers. As I stood among rows of eggplant, radishes, and okra, I thought about my CFI colleagues — 9,000 miles away in the breadbasket of America — hosting a series of events with residents of Dodge County, Minn., to co-create new services and spaces for Kasson Clinic and engage the community around health and well-being.

Health care, not sick care. We heard shifts in mindset from disease management to health management and an acknowledgement that care needs to extend beyond the walls of the institution and into relevance in people’s daily lives. The KTPH Aging and Dying in Place team shared stories from their field research in people’s homes around the medical, social, and environmental dynamics that, if considered, can proactively identify patients who may being “doing well” on paper, but in reality are at risk for future hospital admissions. The team is experimenting with activities such as opening communication channels for people not currently interacting with the health system — nurses are available for regular, open conversations at a nearby community club for the elderly — as well as identifying and connecting helpful neighbors with elders for simple support. While initially focused on those with frequent admissions, projects like these can begin to create the foundation for proactive, rather than reactive, care models to prevent hospital admissions in the first place. The team at KTPH faces a similar challenge to our own CFI efforts around Care at a Distance and Community Health, as current payment structures and care delivery infrastructures are more often set up to reward fixing what went wrong, rather than support preventing it in the first place.

The non-professional care team. With Singapore’s professional medical resources already capacity-strained, there is not only exploration around new care delivery models, but also hints at care delivery workforces emerging from unexpected areas. Previously under-appreciated resources, including neighbors, domestic workers, caregivers and patients themselves, have the potential to increase the capacity to deliver care and to do so in the non-medical settings in which people spend most of their time. KTPH’s care-giver-focused initiatives include a recent Caregiver’s Time Out event, and ABLE Studio’s caregiver education guides and brainstorm workshops help the elderly innovate in their own homes with their own solutions for safer independent living. At CFI, the important role played by non-professional care team members has been a common thread. We see this theme echoed in our research around Care Plans, observations from Health Leads and Minimally Disruptive Medicine models, insights from our HAIL (Healthy Aging and Independent Living) consortium, and the developments from our Caregivers concept that is currently in prototyping stages.

In our efforts to stay focused, get it done, and do it well, we can sometimes lose sight of how much we gain when we take the time to step out of our work, our office, our world and to look up to see what is going on around us. In doing so, we increase the opportunity for serendipity, discover resonance, and return with a new view of what is possible. On this trip, we may have set out to provide KTPH with insights to support their innovation journey, but we are certainly returning with new knowledge and relationships that will be invaluable to our own.

Many thanks to the Singapore Ministry of Health, Khoo Teck Puat Hospital (KTPH), Eastern Health Alliance, Design Singapore, Singapore Polytechnic, National University of Singapore and others who hosted us with such a warm welcome and inspiring exchange.