Table 4.

Strengthening Health System Resilience Beyond the Pandemic

Theme	Subtheme	Illustrative Quotes
Leveraging on health IT	•Integration of digital care models into hospital IT ecosystem •Development of mHealth apps to diversify services •Artificial intelligence-enabled hospital platforms that allow for the acquisition of reliable health information	“Inter-linkages between IT systems need to be improved. As of now, the Clinic Management System, or whatever data management system the hospital is using, is not directly linked to the video consult platforms. So, clinicians often need to have 2 computers, one for them to type in the case note, and then another for video consultations. It might be more efficient if there is an integrated platform.” #18 Government Official, M “…mHealth app should allow patients to view, request, and reschedule their appointments. Not only it offers convenience at their fingertips, but it also frees up the workload from clerical staff. Within the app, if we can arrange for medication delivery and e-counseling with the pharmacist, that would be great too.” #50 Doctor, M “Through AI-based platforms, patients can ask the pandemic or non-pandemic–related questions on hospital forum or other platforms like that, and then a moderator can answer their queries and try to match them to the right services if required. At least they don't obtain medical information from unverified sources.” #19 Nurse, F
Reconfiguring existing institutional arrangements	•Public-private partnerships •Close coordination between primary and tertiary care •Round-the-clock support for urgent care	“What Singapore has tried to do was to see how we can arrive at public-private partnerships where we can work directly with private health care providers in providing care. For example, at the community isolation facilities, medical care over there comes under the oversight and provision of a private hospital. Exploring this partnership for non-COVID care will not only reduce the strain on public hospitals during a pandemic but also to maximize efficiency in the delivery of care for chronic patients.” #1 Doctor, M “I think the collaboration between the primary care and tertiary care can be better, for example, some chronic diseases that are being managed at the hospitals can be outsourced to the GPs. I believe this would greatly reduce the hospital's workload during the pandemic.” #11 Doctor, F “We also wanted to provide silent hour support. So silent hour is when the medical teams are not there during off-office hours from 6 pm to the next day 8 am. During the Circuit Breaker period, we saw many urgent yet not emergency cases coming in and choking up the A&E. So, by having 24/7 access to teleconsultation either with a doctor or nurse will help triage and bring in only patients who really need emergency care. This will be very beneficial in the next pandemic by lessening the workload of the hospital.” #18 Government Official, M
Holistic care	•Continuity of social services for selected vulnerable patients •Safeguarding mental health of non-COVID patients	“Because of the cessation of activities, many older patients dare not to go out to exercise anymore. In the past, they used to exercise in groups in the morning. So I think the sudden shift to a sedentary lifestyle worsens their medical and mental health. I think safeguarding the patient's psychological health during a pandemic is equally important too. Maybe the senior activity centers can organize video chatting sessions for the residents to catch up with one another even when they cannot gather physically.” #28 Doctor, F “Social services such as medical escort and befriending services should be allowed to continue to operate even during the Circuit Breaker [period]. Missing out on an appointment or loneliness during lockdown contributes to deterioration of overall well-being in these patients.” #43 Nurse, F