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Health Systems

Health Services and Systems Research (HSSR) Singapore Health Systems

Health systems consist of a complex network of people, institutions and resources that constantly interact to shape human health and fulfill the health needs of target populations. At Duke-NUS HSSR, we engage multiple health services research participants (e.g., government entities, practice groups, medical schools, and other signature programs at Duke-NUS) and involve a 'systems' perspective (i.e., one that considers all potential points of leverage) to provide practical insight toward the development and maintenance of high quality health systems in Singapore and other countries.


Most of our work in the area of health systems utilizes System Dynamics (SD). SD is a conceptual framework and methodology that incorporates the principles of feedback to track the behavior of systems over time. SD seeks to address important problems that confound simple cause-and-effect reasoning by formalizing the connections between accumulations in a system and developing methods to understand the resulting system behavior. SD employs knowledge elicitation, group model building, processes to formalize archetypes of behavior and system structure, techniques to analyze model behavior, and tools to test model validity.


Our first application of SD methodology is to identify and implement solutions for addressing a serious and growing problem in Singapore and abroad: how to find and care for older individuals with cognitive impairment (CI) in a way that is effective, humane, and sustainable.  By using SD, we are able to better understand the dynamic interactions among the various institutions and people involved in the care and treatment of patients with cognitive impairment /dementia.


In addition to our work in the area of cognitive impairment/dementia, our Health Systems Design Lab (HSDL) and the Singapore Ministry of Health (MOH) are teamed on research projects to study strategic manpower needs over a 20-year horizon and, with the Centre for Communicable Diseases, to study control of certain vector-borne and human transmissible infectious diseases.


At Duke-NUS HSSR, other forms of modeling are also employed in the health systems context. For example: our two ongoing projects examining the emergency response system in Singapore. One is an observational prospective study looking at response times and survival outcomes for emergency medical services (EMS) before and after implementation of a Systems Status Plan (SSP). The aim of the second project is to develop models to address operational issues regarding system capacity and operational policies that are faced by the Singapore EMS system in particular and other EMS systems in general.

Health Systems Projects

Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore

Description: This project has been funded by the National Medical Research Council through their Singapore Translational Research Investigator Award (STaR Award) scheme. The main objective of this five-year project is to establish a laboratory in Singapore for health systems modeling, focusing on the theory and methods of System Dynamics. The first application of this...

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Cardiac Arrest and Resuscitation Epidemiology in Singapore: Comparison of Outcomes with Implementation of Systems Status Plan (CARE IV)

Description: This is an observational prospective study looking at response times and survival outcomes for emergency medical services (EMS) before and after implementation of a Systems Status Plan (SSP). We will compare response time outcomes for emergency medical services (EMS) before and after implementation of a Systems Status Plan. EMS time responses are thought to be...

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Developing Simulation-based Parameterisation Methods for Models of Sexually Transmitted Infection: Making Policy Recommendations Evidence-Based

One of the main goals of NIHA is to contribute to policy formulation generally in the area of health and in public health in particular. Sexually transmitted infections (STIs) are a major public health concern in Singapore and, especially, in neighbouring countries such as Thailand, and at the moment Singapore does not have the capacity to deploy properly constructed models of STIs to address...

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Integrated Hospital Simulation Model

Description: Access to, and quality of care is strongly dependent on the availability of manpower and infrastructure, which are scarce and expensive. Moreover, hospital operations are complex and cause-and-effect may not be obvious or take a long time to be apparent. In addition, ageing and changes to the healthcare landscape will also influence the demand of various services...

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Defining and evaluating norms for health and social service (HASS) use for population health segments

Background: In view of expected growth of the older population in Singapore, the volume and complexity of needs for health care services is expected to increase, which amplifies stress on the current healthcare system. To address this challenge we consider services utilization in relationship to needs based on “population segmentation” to plan and evaluate new services in...

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