Abstract for: Strategizing towards a Hospital of the Future: A Case Study on Collaborative Long-range Complex System Design

Background: The complex systemic nature of Future Hospital (FH) design in the rapidly ageing city-state of Singapore calls for systems thinking. We apply this approach to answer two research questions: (i) What are the variables that drive the present and future dynamics of the system? (ii) How are these driving variables related? Methods: Causal Loops Diagrams (CLDs) were developed collaboratively by a cross-functional system modelling team, through eight focus group discussions and numerous reviews conducted since September 2023. Network analysis of the resulting CLDs was used to identify dominant variables. Findings: Seven interlocking CLDs (national, cluster, FH top level, outpatient, emergency department, inpatient, and surgeries and procedures) were created to serve as boundary objects for different FH stakeholders, as well as researchers and planners of other FH systems. Important feedback loops and 15 leverage points for redesign were identified. “Need for agility” is the variable with the highest betweenness centrality in the combined network of seven CLDs. A computational model based on the CLDs is being developed. Conclusion: We believe that we address the need for greater openness on FH initiatives by sharing our tools and approach with the research community and soliciting feedback on our work.