The city-state of Singapore has won many admirers for its modern infrastructure, high quality of life and forward-looking approach.

Two senior city leaders talk about Singapore’s health care system and managing HR change in the public sector.

Health care in Singapore

Goh Aik Guan, Managing Director of Singapore’s MOH Holdings, the holding company of Singapore’s public health care institutions, helps uncover the secrets of success:

• Singapore’s young population is key. “In the absence of the pressures of excessive demand and long queues, we have been able to tweak and evolve our policies and delivery systems with good outcomes,” says Goh.
• The government ensures affordability through a government subsidies system, compulsory individual savings, a national insurance plan and an ultimate safety net to take care of those who have trouble paying their hospital bills.
• The public sector takes 80% of the in-patient market. Says Goh, “In many other countries, the private sector provides the quality level of care and, therefore, the market share is reversed. For us, it’s the other way around.”
• While integrated care remains a challenge, Goh stresses that their integration relates patients and care delivery from one setting to another. “We’ve coined the term ‘right-siting.’ We need to put the patient — whatever their condition — at the right site for their necessary care.”
• To address the IT challenge and enable key information to follow the patient, the government rolled out the National Electronic Health Record (NEHR). It pulls information from all systems in one go and is the critical enabler for the delivery of well-integrated care. It also contributes to cost-effectiveness of health care delivery.

Reforms in focus

Rupert Gwee, a retired senior officer in the Singapore armed forces, is now serving as Director of HR Transformation for the Ministry of Home Affairs (MHA). He identifies several common challenges in HR in the public sector — both in Singapore and overseas:

• HR projects often take several years to complete, which leads to a high risk that project fatigue will set in.
• Such projects can often be the first time the people involved have worked at bringing about large-scale change and doing it while learning on the fly.
• Change management is difficult as HR transformation involves bringing together people across various departments who are more concerned how their jobs are going to be affected.

To drive HR and administrative change, Gwee is seeking to deploy the skills and experience accumulated over a long period working in human resources:

• Communication is key: Gwee seeks to spotlight success stories. “You need to understand the emotional landscape and what the hot buttons are. Think about how to present it — an entrepreneurial approach is key, as you need to understand how people will react.”
• A highly empowered team with policy people embedded into it: “I have found that, to execute a needed change and the resources to do it, you have to go all the way to the top to make sure that everyone pays attention,” says Gwee.
• A different approach: “You need to reframe the problem so they can’t ignore it, even if they have been scarred by previous attempts to fix issues in the past. I try to monetarize the size of the problem.” There is a need to create awareness and buy-in from the top.

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