Introduction: Medical training through specialization and even sub-specialization has contributed significantly to clinical excellence in treating single dominant acute conditions. However, the needs of complex patients go beyond single diseases and there is a need to identify a group of generalists who are able to deliver cost effective, holistic care to patients with multiple co-morbidities and multi-faceted needs. The skill sets and philosophy of care of these generalists will be most relevant for hospital in-patients who no longer require subspecialized care, but whose unresolved issues still require attention. Community Hospitals (CHs) are a critical part of Singapore’s shift towards a community-centric care model as the population ages. Community Hospitals of the Future (“CHoF”) represents a series of emerging conversations around approaches to reimagine and redesign care delivery in CH setting in response to changing care needs arising from population shifts. This environmental scan aims to understand how CHs would have to shift in terms of (i) care delivery and resourcing, (ii) information flow, and (iii) financing for CHoF to conceptualize and meet the changing care needs in Singapore.

Methods: Qualitative interviews with CH stakeholders recruited by snowball sampling were conducted to understand the barriers and opportunities of current CHs. Semi-structured interviews were conducted with 10 senior management and management level staff from 6 Community Hospitals in Singapore. Thematic analysis was conducted to inductively elicit themes from the transcripts gathered.

Results: CHs were described as an intermediary between tertiary care and community care, and current efforts to integrate care between CHs and tertiary care were identified. Challenges identified that CHs face included the diverse CH landscape, inefficient use of resources, fragmentation of care, financing regulations, and limitations in manpower and resources. Future opportunities for CHs were also suggested, such as a changing patient profile, increase in resources to CHs to support its expanded scope, the expertise and training needed to provide the additional services needed, shared ownership of patient care, and accompanying shifts in the healthcare ecosystem.

Conclusion: With an ageing population and increasing multi-morbidity, this environmental scan gathers insights from CH stakeholders about the role that CHs can play in Singapore’s healthcare system. Future work includes the conceptualization of CHoF, and exploring other factors required for a successful implementation.

Disclosure of Interest: None Declared
Keywords: care innovation, care transition, integrated care