In 2013, the Singapore General Hospital (SGH) Campus initiated a shared electronic system where patient records and documentations were standardized and shared across institutions within the Campus. The project was initiated to enhance quality of health care, improve accessibility, and ensure integrated (as opposed to fragmented) care for best outcomes in our patients. In mitigating the risks of ICT, it was found that familiarity with guiding ethical principles, and ensuring adherence to regulatory and technical competencies in medical social work were important. The need to negotiate and maneuver in a large environment within the Campus to ensure proactive integrative process helped.
ObjectivesThe Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore.DesignAn organisational case study using a realist evaluation approach drawing on Greenhalghet al(2004)’s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities.SettingSingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore.ParticipantsPolicy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions.Primary and secondary outcome measuresOutcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis.ResultsSingapore’s ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together.ConclusionsThe enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN’s success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide.
Academic medicine changes the way care is being delivered to patients. A culturally specific compe tency framework and education plan would be important for medical social workers to continue to meet national demands and global influences on an academic medical center. In translating the Academic Medicine Center (AMC) vision into reality, the medical social services department in an acute hospi tal of Singapore conducted a review of its competency framework for its medical social workers and mapped out the education and training in response to this endeavor. This led to 23 behavioral descriptors and 6 competency clusters at the general level, and 30 behavioral descriptors and 6 competency clus ters at the advanced level. The department also implemented competency-based medical social work education to meet the hospital's aspiration of being an AMC.
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