Table 3.

Design principles for Yishun Zone Regional Population Health System's future-state integrated service delivery system.

S/N	Existing Practices, Structures and Mental Models	Design Principles for Future-State Integrated Service Delivery System
1	Medicalized approach that addresses clinical issues when disease or crisis sets in, for patients who seek treatment at healthcare institutions	Biopsychosocial (68), needs-(69) and assets-based (70) approach to well-being and health throughout a persons’ life-course, for the entire Yishun Zone population
2	Services provision primarily by healthcare professionals using a clinical and service quality approach	Residents, caregivers and communities drive self-care, and also participate in care planning and co-creation of care delivery with providers that employ strength-based (71) and relationship-based approaches
3	Individual provider needs assessments and care plans formulation	Single integrated needs assessment and care plan to meet residents’ needs
4	Interactions among providers and healthcare institutions are case by case, professional and operational	Interactions among providers and care institutions are based on population needs, and are organizational and strategic
5	Care episode defined from time-of-arrival to time-of-departure from care systems defined by physical boundaries of institutions	Care episode defined from time-of-identification to time-of-resolution of needs, and system boundaries defined by types of needs
6	Coordination achieves efficiency and effectiveness of services delivery within institutions	Coordination achieves efficiency and effectiveness of care systems in discovering and generating health assets while meeting care needs, across all sites and transitions of care
7	Providers and institutions optimize institutional outcomes and their own cost-per-unit of services delivery	Carers and institutions form an integrated care organization and jointly optimize resident-centered outcomes and value for populations