goShadow has extensive experience supporting healthcare organizations across the globe implement quality improvement methods, person-centered care, and alternative payment models  at scale. The goShadow method provides holistic, step-wise, support to organizations as they begin to champion change from the top down and bottom up through extensive human-centered design application and multidisciplinary teamwork. The Singapore Ministry of Health (MOH) saw great success using this method, in tandem with support from the Institute for Healthcare Improvement (IHI) in their effort to bolster their care coordination, patient experiences, clinical outcomes, and cost efficiency through value-based care costing.

The MOH was particularly interested in determining the true cost of two care experiences—community acquired pneumonia and total joint replacement. Both care experiences were previously identified as pain points for patients, large contributors to national health expenditures, and poor health outcomes. 

Singapore’s healthcare landscape is similar to that of the United States.  In the U.S. in 2014, total joint arthroplasty (TJA) accounts for more expenses to Medicare than any other inpatient service. Traditionally, TJA spans many segments of care delivery–from ambulatory, to inpatient, and nursing facilities. In a typical fee-for-service model, the numerous touchpoints a patient moves through causes the cost of care to increase and delivers a fragmented patient experience fraught with redundancies. 

According to the National Institute of Health, “Bundled payments incentivize providers to use a coordinated, multidisciplinary healthcare approach to enhance the quality and efficiency of care and improve patient satisfaction, while controlling cost [13•].”McLawhorn, A. S., & Buller, L. T., 2017). As a result, over the last ten years, the use of bundled payment models have led to a decrease in expenses and an increase in quality and experience of care. The methodology of paying a group of providers to manage a patient’s care rather than individual providers incentivizes collaboration, decreasing redundancies and unnecessary procedures, and ultimately improving the quality and cost of care being provided.  

The Singapore MOH operates as an integrated healthcare system providing all levels of care (primary to quaternary) meaning that they have the ability to deliver highly effective and coordinated care that can reduce cost, maximize efficiency, and deliver ideal experiences for staff, providers, and patients. Similar to any other large and complex healthcare system, care delivery was siloed resulting in waste and patient pain points, specifically in the transition from post-acute to primary care. The MOH was interested in implementing a bundled payment plan which goShadow and IHI provided support and training to do so.

goShadow was responsible for training 20 community and academic hospitals and systems across Singapore who were selected based on voluntary interest and volume. Each team was eager and excited to participate, removing a major barrier when trying to generate buy-in. They saw the potential to design smooth care delivery, improve efficiencies, reduce readmissions, have more ideal clinical outcomes, and improve patient experience. Being that Singapore is so small, each team saw how this collaborative had potential to impact the care of their families who were likely to experience these pathways. 

goShadow provided virtual and in-person support over the course of one year to build internal capacity and training in person-centered tools to support last time teamwork, clinical best practices, and care coordination. Teams were trained how to shadow, analyze and benchmark data, and collect qualitative data from care teams and patients. goShadow provided critical support and expertise for teams to dedicate time to review data, identify key pain points, processes that go well, and brainstorm solutions to implement and test. 

Once solutions were formed and identified as ready to test, small and agile project teams were formed dependent on each hospital's priorities. Small project teams were able to share learnings, barriers, and successes of one another on monthly all-collaborative calls. 

Critical to this collaborative was the training and implementation of goShadow’s suite of tools. Teams used small tests of change (PDSA cycles), shadowing, perception mapping, and did well/do better exercises to collaborate across care settings and put the patient at the center of care by design. Teams were able to identify low hanging fruit to address immediately and larger projects that would require administrative support and complex coordination across the care system.

goShadow was successful in training and coaching teams across the country on 

the value of measuring the larger experience, the ability to analyze quantitative and qualitative data, how to determine shared priorities, workshop tests of change, and enact them iteratively to measure improvement. The sharing of best practices by goShadow and IHI with the MOH resulted in increased integration of person-centered care pathways that are sustainable and proven to deliver ideal outcomes. 

Through engaging care team members at all levels and points along the patient pathway, Singapore’s MOH was able to develop working groups that were representative of all key stakeholders. Involving these stakeholders in every step of care redesign results in solutions that are representative of those who do the work every day. goShadow’s suite of tools come together to improve efficiency and design human-centered processes, making large system-level projects like bundled payment models possible.

If you are interested in a similar collaborative or training that delivers efficient, high quality, person-centered, and co-designed care pathways reach out to info@goshadow.org. 

McLawhorn, A. S., & Buller, L. T. (2017, September). Bundled payments in total joint replacement: Keeping our care affordable and high in quality. Current reviews in musculoskeletal medicine. Retrieved September 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577424/