Using Football Analytics to Improve Primary Care Delivery

Issue 52
Nov 2024

ALL IN THE FAMILY

By Dr Wayne Han Lee, Family Physician, Queenstown Polyclinic/Clinical Informatics, National University Polyclinics

The rising population healthcare needs in Singapore comes as 2 underlying challenges. Firstly, the issue of an increasingly ageing population and, concurrently, the rising impact of chronic diseases. These challenges are well documented and are a focus of Singapores Ministry of Health. Recognising these problems, the HealthierSG initiative was developed to address a large unmet need for primary care services and to proactively prevent illness in the Singapore population.

With renewed and increased focus on disease prevention, there will be an increase in patient load as a larger number of well, or pre-disease patients attend primary care services in the short term, thus putting further pressure on the system. There is a large unmet need for primary care services with 80% of primary care provided by GP family doctors and the remaining 20% being seen at government subsidised polyclinics.¹ However the majority of the complex chronic disease patients are still seen at polyclinics despite the discrepancy of total primary care load between private general practitioners and government subsidised polyclinics.²

With limited resources to meet this increasing demand for primary care services, HealthierSG also intends to scale up team-based care to deliver stronger primary care.

80%
of primary care is provided by GP family doctors and the remaining
20%
are being seen at government subsidised polyclinics

This endeavour to optimise care delivery models away from physician/doctor-centric care recognises the idea that merely increasing the number of physicians to meet demand is unlikely to be resource efficient.

This article advocates for an increased focus on stronger support for team-based care in the polyclinics and aggressively expanding the role of nurses, care-coordinators, pharmacists and other allied health professions in the care for chronic disease patients. This advocacy is hypothesised and predicated upon the use of advanced data-driven metrics, which are playing a pivotal role in changing established orthodoxy in the game of football.

About football analytics

The history of football analytics can be traced back over several decades, evolving from simple statistical recording to computerised data collection, to the sophisticated analysis that is used in scouting, match analysis, player development and injury prevention.

This has allowed team managers and coaches to understand the real contributions of each player, analyse and then improve game strategy, as well as recruit players, who possess the skills and abilities that advanced metrics, identified as essential to improving overall team performance.

Football analytics and primary care

In the context of healthcare, particularly in a primary care outpatient setting, relying solely on rudimentary metrics, such as the number of patients seen per hour, to evaluate doctor performance or healthcare efficiency is akin to assessing a football team’s effectiveness merely by the number of shots taken or possession percentage. While these metrics offer some insight, they lack the depth required to fully understand the underlying dynamics and outcomes.

•	*Quality of care versus quantity:* High patient throughput might indicate efficiency on the surface, but without considering the quality of care, patient satisfaction, and long-term health outcomes, it’s an incomplete measure. Much like evaluating a football player’s effectiveness solely on the number of tackles made without considering the context and outcomes of those actions, this can be misleading.
•	*The importance of team dynamics:* In football, a team with more strikers might not necessarily score more goals if the midfield and defense can’t support them effectively, highlighting the importance of a balanced team structure. Similarly, in healthcare, merely increasing the number of doctors without considering the roles of nurses, allied health and other healthcare professionals may not improve patient outcomes. The effectiveness of a healthcare team relies on a well-coordinated effort that includes diagnostics, treatment, patient education, and follow-up care, much like a well-rounded football team.
•	*Data-driven optimisation:* Just as advanced analytics in football have led to more strategic player positions, formations, and tactics based on a deeper understanding of the game, healthcare systems can benefit from a similar approach. Analysing detailed data on patient outcomes, treatment effectiveness, patient demographics, and other factors can help identify the most effective configurations of healthcare teams. This could include factors such as the optimal ratio of healthcare providers to patients, the mix of specialties needed to address the most common health issues in the population served, or strategies for patient engagement and follow-up care.
•	*Long-term versus short-term outcomes:* In football, a focus on long-term development of players and team dynamics often leads to more sustainable success than short-term tactics. Similarly, in healthcare, focusing on long-term patient outcomes, such as managing chronic diseases effectively, preventing hospital readmissions, and promoting healthy lifestyles, may be more beneficial than short-term metrics such as patient throughput.

To truly optimise healthcare systems for better patient outcomes, a move towards more sophisticated, nuanced analytics is needed. This involves not only collecting more comprehensive data but also developing models and metrics that can accurately capture the complexity of healthcare delivery and its impact on patient health. Such an approach can help identify the most effective ways to allocate resources, structure healthcare teams, and prioritise interventions, leading to better healthcare outcomes and more efficient use of resources.

A soccer ball, coach whistle, referee cards and clipboards.

Task shifting and sharing in healthcare

Task shifting and task sharing are innovative strategies designed to address workforce challenges and improve service delivery within healthcare systems, especially in settings facing shortages of healthcare professionals or uneven distribution of healthcare resources.^3,4 These approaches are rooted in the efficient and strategic reallocation of tasks among healthcare workers, leveraging the full spectrum of skills available within the healthcare workforce.

Task shifting
This strategy involves redistributing specific tasks from highly qualified health professionals to those with less training and qualifications. The aim is to optimise the available human resources for health by allowing highly skilled workers to focus on more complex and critical aspects of healthcare delivery, while tasks that require less specialised training are handled by other capable members of the healthcare team. For example, routine immunisations and basic health screenings might be shifted from doctors to trained nurses or community health workers.

Task sharing
In contrast to task shifting, task sharing promotes a more collaborative approach, where tasks are shared more broadly among different healthcare professionals, according to their competencies and training, rather than based on their professional titles or traditional roles. This model encourages a team-based approach to healthcare, with an emphasis on maximising the contributions of all healthcare providers in a more integrated and flexible manner. Task sharing can enhance the scope of services offered and improve access to care by utilising the full range of skills within the healthcare team.

Both task shifting and task sharing are deployed with the goal of enhancing healthcare access, improving the quality of care, and making efficient use of available resources. By adjusting the roles within healthcare teams, these strategies aim to address gaps in service delivery, meet the evolving health needs of populations, and ensure that patients receive timely and effective care. Importantly, successful implementation of task shifting and sharing requires appropriate training, supervision, and support systems to maintain the quality of care and ensure the well-being of both healthcare providers and patients.

Task shifting and task sharing in healthcare can thus be likened to assembling a football team that provides excellent value for money, drawing parallels with the strategic allocation of roles and responsibilities on the pitch to maximise both individual and team performance.

Just as a football team does not require world-class strikers playing in defense where their skills may not be best utilised, healthcare systems do not need highly specialised doctors performing tasks that can be competently handled by other healthcare professionals. Task shifting and sharing allow for the optimisation of each team member's unique skills, akin to positioning a player in the role where they can make the most significant impact on the game.

Finding value in diverse roles

Just as a football team does not require world-class strikers playing in defense where their skills may not be best utilised, healthcare systems do not need highly specialised doctors performing tasks that can be competently handled by other healthcare professionals. Task shifting and sharing allow for the optimisation of each team member’s unique skills, akin to positioning a player in the role where they can make the most significant impact on the game. Research studies have shown that task shifting to nurses in situations such as chronic disease management has led to better disease control outcomes.⁵

Maximising team performance, optimising cost effectiveness and accessibility

In healthcare, developing advanced metrics is crucial to identifying which tasks can be shifted or shared without compromising care quality. This approach helps in understanding the impact of each healthcare provider’s role on patient outcomes, optimising the workforce to ensure that highly skilled professionals focus on complex cases while other tasks are efficiently managed by other team members.⁶

Task shifting and sharing therefore is investment in efficiency and accessibility, ensuring that resources are allocated where they are most needed, improving service delivery, and expanding access to care, especially in resource-constrained settings.⁷

Two football players seated on the grass, the left player using a clipboard to explain tactics to the right player.

Application in primary care through expansion of team-based care

A significant portion of chronic disease management involves relatively straightforward cases. Given the extensive body of research on evidence-based management for chronic conditions, optimal protocols can be established and followed for many patients. As such, having doctors manage such non-complex cases may not be the most efficient use of limited physician resources. While nurses manage certain chronic diseases in some polyclinics, the majority of routine, protocol-driven cases continue to be handled by doctors.

There is an opportunity to expand the role of non-physician providers in team-based care models for chronic disease, much like in the data analytics revolution in sports. Advanced analytics could identify opportunities and methods to shift routine chronic care from physicians to other appropriate team members. Further evidence supporting this expanded non-physician role would come as the comparable value of this approach in managing non-complex chronic conditions is demonstrated. With proper protocols and oversight, quality outcomes can be achieved with the efficient use of resources.

Conclusion

The transformation of primary care in Singapore faces significant challenges, underscored by an ageing population and a rising prevalence of chronic diseases. The ongoing initiatives by HealthierSG reflect a concerted effort to adapt and enhance the healthcare landscape. However, to truly optimise outcomes and manage resources efficiently, it is imperative to reevaluate and shift traditional roles within healthcare teams, drawing inspiration from the analytical revolution in football.

Football analytics has shown us the power of data-driven decisions in enhancing team performance and cost-effectiveness. By applying similar advanced metrics in healthcare, particularly in the management of chronic diseases, we can achieve a more effective allocation of tasks—moving routine care away from physicians to capable non-physician team members. This approach, akin to task shifting and sharing in football, allows each healthcare provider to perform roles that maximise their training and skills, enhancing the overall efficiency and effectiveness of healthcare delivery.

As we look to the future, the adoption and expansion of innovative models in primary care can lead to sustainable healthcare systems where quality is maintained without an escalation of resources. Primary care must leverage data-driven insights to ensure that every member of the care team is utilised effectively, ultimately improving patient outcomes and satisfaction in a resource-constrained environment. This shift not only addresses immediate challenges but also sets a foundation for a resilient, adaptable primary care system that can meet the evolving needs of the population.

https://www.moh.gov.sg/home/our-healthcare-system/healthcare-services-and-facilities/primary-healthcare-services.
https://www.thelancet.com/action/showPdf?pii=S2666-6065%2823%2900211-0.
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