NHG Health Manpower Development Plan (HMDP) Award Ceremony

05 Jul 2006

By Ms Yong Ying-I, Permanent Secretary (Health)

Venue: Tan Tock Seng Hospital

Ladies and Gentlemen,

Good afternoon,

I am very pleased to be here at the NHG HMDP Award Ceremony 2006.

The HMDP Award Scheme

The Health Manpower Development Plan (HMDP) programme has been an integral feature of professional training within the public sector. First introduced in 1980 more than 25 years ago, its objective was to develop our national manpower capabilities by systematically building up the clinical capabilities of our healthcare professionals. Most recipients today go overseas to study, learn cutting edge skills, gain operational experience and keep abreast with the latest developments in overseas centres of excellence.

I had heard about the HMDP programme in my previous job at the Ministry of Manpower. As you know, the Minister there is Dr Ng Eng Hen, a HMDP beneficiary. I recall him telling me that he thought this was the single most important manpower programme in the public sector, because it was at the heart of our having been able to build up a first-class healthcare system in Singapore. This includes the private sector clinicians because they were trained in the public sector. Because healthcare is a service sector, the quality of our manpower skills is what determines the success or lack thereof of the healthcare system. Dr Ng had suggested that MOM study how the basic concept could be used in other sectors.

Going Forward

There is no doubt about the core importance of the HMDP programme. But within MOH, we are asking how its structure and implementation can be improved so that it continues to support the strategic development of the healthcare system in Singapore. Is it being used to train people to bring our healthcare system to the next level? This in turn requires us to be clear what the challenges in healthcare at this "next level" are, before we can prepare our people to tackle them. This review is especially timely since it has been 5 years since the HMDP programme was devolved to the clusters and statutory Boards. The devolution was a sound decision as the clusters and statutory boards understand the type of training appropriate to your needs better than we would in HQ. However, decentralisation can also mean that strategic clarity of direction is weakened. So I hope you will let me share some of my thoughts with you on managing the HMPD programme.

Making the Right Investments

First, we need to make the right investments with the money that we collectively have. There is a need to gel the top-down view with the bottom-up one in the granting of training scholarships. The bottom-up view is what the interests of individual personalities and departments are. The top-down view is guiding the allocation of grants so as to meet evolving national needs. In the selection of awardees, the clusters have to bring both together and hopefully find common ground.

HMDP also should not be reactive, taking on different priorities in different years, depending on the crop of applications. Instead, cluster management should guide applications to select programmes and training that will either fill immediate gaps within our healthcare system or are congruent with the clusters - long-term strategic plans and national priorities. Yes of course there is room for individual passions and interests. But the organisation must also have strategic plans that look 5 to 10 years into the future and be able to discuss these with our staff. By getting top-down and bottom-up views, the bulk of HMDP monies can be targeted at funding and driving the development of capabilities that enable us to realise these strategic plans and national priorities.

I think we have done well so far to build a very strong clinical base. But we can do more. The frontiers of knowledge in medicine are advancing rapidly - approaches that may have been the norm a few years ago can fall out of date. Individuals can and do of course try to keep up by attending international seminars. But at the organisational & public sector level we could probably do more in terms of developing clearer clinical strategies about how we want to develop an area of specialty further. We should then send our people out more systematically so that this institutional and national capability is built up. My ministry is studying the feasibility of sending some of our registrars overseas for their advanced specialist training. There are benefits from studying in a different foreign hospital environment and learning international best practices. However, these courses will be expensive and, hence, we need to proceed carefully.

Delivering patient-centric care requires more than just good technical clinical skills. Singaporeans' are becoming more knowledgeable and their expectations are rising. The newspapers regularly feature stories about patients' concerns with our healthcare delivery. It could be patient treatment errors in polyclinic and hospital errors. It could be about weak coordination of workflow so that the patient struggles to find his way around a hugely confusing system. It could be poor service, with unhelpful staff, slow or wrong bills and, of course, lengthy waiting times.

I am prepared to make the case that to deliver a holistic patient experience, we must go beyond training in clinical capabilities. We also need to develop capabilities in management and business development, and groom a core group of clinician administrators who can blend solid clinical knowledge with leadership and management capabilities. I am pleased to see that we have been sending our clinicians to executive and MBA programmes. I am also very pleased to see so many nurses going for Master programmes. We could be more daring and build capabilities in areas like hospitality, workflow management and IT where we clearly lag other sectors in sophistication. These are critical skills required to deliver patient-centric care, as well as support national strategic initiatives such as SingaporeMedicine and a nation-wide EMRX system. And as we grow the pipeline of nurses and allied health professionals with high qualifications, we should also study multi-disciplinary approaches to healthcare provision.

Another area that we need to build new capabilities in is health services research as we shift to a more knowledge-driven approach of long-term care management management. I've discovered that healthcare policy, medical management, and health sciences research are taught in the top Schools of Public Health. But we've typically not sent people to study these subjects in the past. We should start, and start soon.

Developing & Retaining Talent

Let me make a few comments about talent development and retention. The more we train someone, the more marketable and mobile he will become and more likely to leave us. The solution is not longer, more onerous bonds, higher liquidated damages or simply just not training the person. Instead, we need to create a sustainable value proposition for our professionals to remain in the public sector.

I would suggest that we take a more forward looking view of the HMDP. The HMDP should not be seen in isolation as an end in itself. Neither is it a rite of passage or a year's break as reward for good work in the past. Instead, it is about nurturing an individual's potential to contribute to the organisation in the future. The HMDP has to be a part of the individual's career development and part of the organisation's building of bench strength and succession planning. To make this into reality, management needs to be clear how the HMDP training fits into the individual's career plan, and have systematic plans to provide the opportunities for career progression upon the individuals' return so that his potential is indeed nurtured and realised. The award recipients have to be supported post-HMDP, whether in terms of protected time to try out new things or appropriate postings for them to apply their newfound skills. For instance, many HMDP recipients receive training in subspecialty skills for which, if practice is not continuous, the skills will rapidly degenerate. It may also be useful to find out what recipients have to say about the programme, not just in their HMDP report at the point of return but 2-3 years down at the end of their bonds.

Monitoring Outcomes

Now, I've talked about talent development at the individual level. Let me now talk about monitoring achievements and outcomes at the organisational level. In FY 05, NHG spent some $3.3 m on HMDP of which the ministry funded some 57% and NHG paid for the rest from its endowment fund. How do we ensure that our investments bear fruit? How does the HMDP investment in human capital get translated into tangible outcomes? It would be good if the clusters had a framework that monitors and tracks the progress, outcomes and achievements of award recipients over time, for each institution in the cluster. This way of thinking will help us strengthen our HR management and improve our allocation of HMDP funds when the next round of grants comes up.

2006 HMDP Awards

I am delighted that NHG has increased the contribution from your NHG Endowment Fund to almost $2 million this year towards the HMDP awards. This shows NHG's activism in staff training and development. Looking at the list of awards and recipients this year, I am glad to see that they will be attached to top institutions around the world. I am also encouraged to see people studying Clinical Quality leadership and management, and Quality assurance, albeit short programmes.

I congratulate each of the 115 award recipients. I offer you my best wishes for every success in your training and look forward to you being able to contribute even better on your return to Singapore.