Implementation of Integrated Care in Singapore: A Complex Adaptive System Perspective

​Background
Integrated cae that focuses on organising healthcare services around people and their communities rather than their diseases is promoted as the strategy to overcome and challenges associated with growing complexity in healthcare needs, demands for healthcare services and inadequate supply of services due to fragmentation in the provision of services. While conceptually appears to be simple, integrated care is made up of multicomponent delivery strategies targeting various levels of the healthcare system while engaging various stakeholders in their execution.

Methods
We applied the complex adaptive system (CAS) perspective to two different initiatives that exemplify approaches towards integrating care in Singapore: the Regional Health System (RHS) model, implemented across healthcare institutions at the national level, and CARITAS Integrated Dementia Care implemented in the northern region of Singapore. We adopted an inductive approach in our analysis in which we studied the RHS and CARITAS Integrated Dementia Care according to the components of the CAS. We applied the typical characteristics of CAS: (i) diverse, interdependents and semi-autonomous actors (ii) self-organizing capacity and simple rules (iii) relationship with the bigger system, emergent behaviour and non-linearity in our analysis of key drivers behind the implementation of both the RHS and CARITAS integrated dementia care

Results
By considering the RHS and CARITAS as whole networks each comprising of interacting and adaptive components instead of separate entities within a bigger system, the CAS provided a new mind-set in surfacing issues associated to the implementation of these integrated care networks. In addition to important actors, systems, it informed understanding of relationships and dependencies between different parts of the network - revealing the lack of homogeneity, conformity and difficulties in designing any optimal system in advance given the many moving parts.

Conclusions:

Drawing on the two examples of integrated care netwoeks, this paper highlights the significance of effective collaboration built on a common focus, responsiveness to emergent behaviours, simple rules, the ability to self-organize and adapt in response to unexpected situations in further development of integrated care in the Singapore contact and beyond.

SOURCE:
International Journal of Integrated Care

DOI:
https://dx.doi.org/10.5334/ijic.4174

AUTHOR(S):
Milawaty Nurjono, Joanne Yoong, Philip Yap, Wee Shiou Liang, Hubertus Maria Johannes Vrihoef