MIC@Home Visioning and Solutioning Workshop

Contributed by Yvonne Ng

Singapore is undergoing profound demographic shift, with a quarter of the population predicted to be aged 65 and older by 2030 as compared to 14 per cent in 2019. A rapidly ageing population means more elderly will require hospital care with constant monitoring, but inpatient care brings its own challenges.

Prolonged inpatient care can lead to hospital-acquired infections and physical deconditioning. A greater demand for hospital beds also puts pressure on the healthcare system, which results in higher costs and shortage in clinical manpower.

Mobile Inpatient Care at Home (MIC@Home) provides an opportunity to address these issues by innovating an alternative inpatient care model to deliver hospital-level acute care in the comfort of patients’ homes. MIC@Home allows eligible patients to recover at home, without being isolated in hospitals. This allows a more gradual transition from acute care to recovery outside the hospitals, and encourages an earlier return to independence for patients.

Over the last 3 years, MOH Office for Healthcare Transformation (MOHT) has been working with like-minded clinicians across all three clusters to develop and test this care model.

A National Regulatory and Financing Sandbox went live in April 2022 to scale up the pilots and to simulate mainstream financing for enrolled patients. As we approach steady state of the implementation, it was timely to bring stakeholders together for a visioning and solutioning workshop for MIC@Home to share implementation learnings and experiences, as well as to align visions and action plans moving forward.

107 stakeholders attended the workshop to look at current and anticipated challenges and discuss possible solutions to attain the envisioned future state of MIC@Home.

On 24 November 2022, 107 participants from diverse domains gathered at the workshop to look at the current and anticipated future challenges, and discuss possible solutions and actions required to reach the collective desired future state. Apart from clinicians and leaders from the public healthcare clusters and Integrated Health Information Systems (IHiS), there were also representatives from various Ministry of Health (MOH) divisions including Health Services Group (HSG), Health Regulation Group (HRG), Data Analytics Division (DAD), and Future Systems Office (FSO).

Sharing by A/Prof Michael Montalto on his HITH implementation journey in Australia

The workshop started with a sharing session by A/Prof Michael Montalto, a veteran in the Hospital-at-Home (HaH) field. He shared his experience and main takeaways from his Hospital in the Home (HITH) implementation journey in Australia, which included how the major cost benefit of HITH is in terms of capital efficiency. Instead of building new acute hospital capacity in the constrained healthcare systems, HaH is a safe and effective alternative to inpatient care. However, he cautioned that mission or definition slippage could be a major risk to this care model.

Following the session, participants gathered in breakout groups to discuss the challenges, shared vision, and possible solutions to advance MIC@Home. They collectively brainstormed on how they could address some of the pain points and plan the roadmap towards the envisioned MIC@Home. At the end of the workshop, each of the participants wrote a postcard to describe the desired future state for MIC@Home and how they could make it happen in their respective individual capacities.

Sharing among the participants during the breakout group discussion

Participants showing their handwritten postcards

The most crucial pain point highlighted by the participants was the lack of an interoperable care platform that allows seamless and real-time data flow between service providers. The lack of sufficient manpower and dedicated pool of trained and willing staff for MIC@Home was also pointed out as one of the limiting factors for implementing MIC@Home. Some also felt that staff utilisation and manpower deployment could be optimised through enhanced transdisciplinary training, centralised staff deployment and right-siting of healthcare professionals. Participants also anticipated challenges in obtaining buy-in from all the stakeholders within our healthcare system, especially with ramp-up plans. They expressed that there was still a general lack of awareness about MIC@Home and suggested that trust building and effective communication among patients, public healthcare professionals and supporting private service providers might help to gain their buy-in. The collective ideas and feedback from the workshop were very insightful and they will be useful in our work planning exercise for the coming year as we work towards mainstreaming envisioned MIC@Home care model together. To find out more about what was discussed at the MIC@Home workshop, contact the team at mic.at.home@moht.com.sg