Professor Ang Chong Lye, Deputy Group CEO of Clinical Services and Informatics, SingHealth, and CEO, SGH, illustrates what a hub and spoke model is and how the network serves to provide key benefits of accessibility, quality and cost-effective care for patients.

"We can have multiple practising sites ... (where) the hubs extend their service to patients at more accessible locations closer to the community."
– Prof Ang Chong Lye, Deputy Group CEO (Clinical Services and Informatics), SingHealth

What does hub and spoke mean?
Termed after a wheel with its hub and multiple spokes centrally connected, the “hub and spoke” model for healthcare means having multiple practising sites where the “hub” is the anchor site of the specialty area and the “spokes” are connecting secondary sites serving that specialty.

Can you give us an example of such model?
The model can be applied across various industries and is best explained by drawing similarities with the airline industry. For example, United Airlines has a hub and command centre in Chicago and hubs in Dallas and other airports where they land. A big hub in Asia is Tokyo, where passengers from Singapore, China and Hong Kong go to Tokyo, en route to the US hubs, then to smaller cities, which are the spokes. These hubs are also where most of their crew are based and trained.

An airline may have landing rights in hundreds of airports but they have three to five big hubs. The undergirding factors are that the airline has common pilots and a common operating system.

Why are we using the hub and spoke model in healthcare?
The main value of the hub and spoke model is in its connectivity: a uniform operating system across institutions, shared language, information technology, instruments and devices, as well as the consistent level of patient care with the same physicians practising across an integrated platform. It means that we can have multiple practising sites for our patients’ easy access. SGH Campus, KKH Campus and NNI are national hubs - anchor sites where specialists practice.

These hubs extend their service to patients at more accessible locations closer to the community. SGH doctors may practise in KKH, satellite clinics, or even Khoo Teck Phuat Hospital beyond SingHealth and eventually Sengkang General Hospital in the near future.

How is it applied in SingHealth?
For SingHealth there are multiple hubs, which are simultaneously the spokes for different specialties. The hubs are where specialists can push the boundaries of science and elevate the practice of Medicine. They are where the operating systems and patient management procedures are developed, supported by IT to manage information.

An example in application, SNEC is the national hub for eye care while the healthcare staff also practise in other sites like KKH, Changi General Hospital (CGH) and their clinic in Balestier. If these sites receive more complex cases, the patients can be transferred to SNEC which has the expertise and sophisticated equipment needed.

NNI’s location in Tan Tock Seng Hospital is a hub, and their spokes are in SGH, KKH and hospitals nationwide where their doctors can reach patients in need of specialist care. Another example is in oncology where NCCS set up a satellite clinic in CGH to receive patients. A patient with a
straightforward case will receive care and follow up in CGH, and a more complex case will be referred to NCCS.

How does this model extend to healthcare training?
This framework also applies to medical training where junior doctors get rotated between the hubs for tertiary and quarternary healthcare training and the spokes for secondary healthcare training. Physicians now get to train residents in multiple sites but with expertise and equipment being costly, it is more efficient to concentrate them in specific areas for both training and patient usage.