PROGRAMME IN HEALTH SERVICES AND SYSTEM RESEARCH
HSSR established and continues to pursue a mission consisting of three mutually reinforcing priorities:
- Advance the state of the science in health services and systems research.
- Generate improvements in health outcomes and quality of life.
- Promote capacity to do and to use health services research.
For the past decade, HSSR has been a leader in the study of the nature of health and health-related social service needs and strategies for meeting those needs in ways that are effective, scalable, and sustainable. The major research focus in HSSR is the organisation and delivery of health and social services in the context of an ageing population. Our research methodologies include decision science and simulation modelling, survey research, qualitative research, health economics and implementation science and evaluation. Our research is undertaken with the view to how best to achieve the quadruple aim of improved health outcomes, patient satisfaction, provider satisfaction and acceptable costs.
All evidence indicates that our traditional ways of serving human health-related needs must change. And the change must not only be incremental – by merely expanding current services – but fundamental – by establishing new modes of services. These new modes will need to be integrated over the lifespan, address physical and psychosocial needs, and will require shifts from a “medical” perspective in which we are treating diseases, to a population perspective, where we are seeking to optimise health for everyone in an individualised, flexible and sustainable way.
The need for integrated approaches to a rapidly changing population is well appreciated in Singapore at multiple levels, including government, regional health systems and social service organisations. HSSR works at all these levels to facilitate and advance this holistic research agenda. We work closely with stakeholders from SingHealth, the Ministry of Health, the Health Promotion Board, the Ministry of Social and Family Development, the Ministry of National Development, the Ministry of Finance, the Ministry of Education, the National Council of Social Services, to the Agency for Integrated Care, and across a broad spectrum of providers (e.g., restructured hospitals, polyclinics) and community partners (e.g., St. Andrews Community Hospital and Voluntary Welfare Organisations).
Specific strategies employed by HSSR include:
|Developing multi-disciplinary frameworks for the assessment of health and health-related social service needs, analytical approaches to project future needs, and innovative ways to evaluate the impact of public health interventions, preventative programs and alternative care provisions on meeting these needs. This work draws on capabilities within the Programme, including medicine, sociology, economics, public health, public policy, epidemiology, biostatistics and decision science, and psychology as well as across Singapore and internationally.
|Developing multi-disciplinary frameworks for the assessment of health and health-related social service needs, analytical approaches to project future needs and innovative ways to evaluate the impact of public health interventions, preventative programmes and alternative care provisions on meeting these needs.
|Constructing policy simulation models to understand what promotes or inhibits policy success, to guide new data collection and to engage stakeholders in policy development.
|Collecting primary data including:
- population surveys of the epidemiology of health and related social needs and patterns of utilisation, with a special focus on factors influencing successful ageing
- qualitative interviewing to understand individuals’ perceptions and interpretations of modes of service
- implementation trials including those based on behavioural economics and strategies for tailoring to patients in the local context based in the community
|Deepening and expanding our partnerships with health provider organisations (e.g., health care clusters, community hospitals, Voluntary Welfare Organisations) and government entities.
|Educating the next generation of researchers to be capable of not only applying state-of-the-science methods in health services research, but also to serve as connectors between technical experts and decision makers.
In recent years, HSSR has increased its research areas beyond Singapore’s borders and has undertaken research projects in a number of neighbouring countries – including Bangladesh, Cambodia, Indonesia, Pakistan, Sri Lanka and Thailand.
Another recent initiative is the introduction of DEDUCE (Duke Enterprise Data Unified Content Explorer). Developed by Duke University, DEDUCE is a web-based clinical research and quality improvement query tool that enables researchers to pull data from clinical records and other linked electronic sources in an intuitive user-friendly environment. This work provides a foundation for accelerating the practical use of “big data” for clinical and health services research in service to improving clinical care.
We can be extraordinarily proud of our HSSR faculty; by all measures they are highly influential in both theoretical and applied aspects of health services research and are generative. We have a successful PhD programme (including MD/PhD students); we run courses and workshops in health services research, health economics, systems modelling and geriatrics; we mentor learners ranging from second year medical students to clinician researchers aiming to develop careers in health services research. We have collaborative relationships across the island and internationally, including a particularly close relationship with Duke University in the US.
HSSR has grown rapidly since the Programme began in 2008. The number of projects we have undertaken has increased steadily over the years (Figure 1), as has our grant funding (Figure 2) and volume of peer-review publications (Figure 3).
Figure 1: No of cumulative HSSR Grants: 2009 - 2018