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Jeremy Lim, MBBS, MPH, MRCS (Edin), MMEd (surg) Director, Policy and Research Singapore Health Services Hopkins Affiliation: Masters in Public Health, International Health, 2003 Dr. Jeremy Lim leads the SingHealth Centre for Health Services Research. He has written and lectured widely on health policy and maintains a personal and professional interest in public healthcare quality and accessibility for all. A surgeon by training, Jeremy obtained his MPH in International Health from the Bloomberg School of Public Health in 2003. --------------------------- PDO: I noticed on your bio that your previous background before entering the policy arena was in surgery. What motivated you to leave clinical work for a career in health policy? Dr. Lim There were no push factors. I was actually enjoying surgery very much but it was very difficult to do everything well. It would also not be fair to my patients if I could not give them the best possible care due to other commitments which would take away time for enhancing surgical skills, keeping up with the medical literature etc. On balance, I felt that I would be more useful in the policy and management realm and the opportunities to impact at the larger societal level were irresistible. PDO: How did you come to be Director, Policy and Research at Singapore Health Services and how did your graduate training at Hopkins prepare you for your current position? Dr. Lim: After completing the MPH at Hopkins, I returned to surgery and dabbled in policy and healthcare management. It was difficult to balance both and unfair to my colleagues on both sides. Hence as above, I decided to leave surgery knowing that there were many doctors keen on surgery but only a handful willing to throw their lot into administration. Hopkins provided a wonderful education in terms of tools to approach healthcare issues and also different perspectives in healthcare. All in all, the frame of mind emphasizing populations AND (rather than instead of) individuals and the problem solving methods were the most useful. PDO: Your agency has published quite a bit of material investigating various issues related to health care within Singapore. What issues are you most passionate about and what research findings have caught you most by surprise? Dr. Lim: In Singapore, there is very little focus on inequities in health. We have a tiered healthcare system of private and public patients and I am particularly passionate about health outcomes in public patients. Our health system places great emphasis on the central role of the hospital but I was surprised at the magnitude of patient preference for tertiary healthcare across the entire spectrum of health needs, from routine infant check-ups to end-of-life care. Our research suggests that as many as half the patients seen in specialist clinics may be inappropriate and that a quarter of acute oncology beds are taken up by patients best managed in a palliative care setting. Despite these suggestions of 'waste', Singapore spends remarkably little on healthcare (<4% of GDP) but still has very good population health indices. PDO: How would you characterize the demands of your current position? Dr. Lim: Healthcare management is not top-down or autocratic and one really needs to engender buy-in and passion from the ground for one's ideas and objectives. Healthcare professionals in general are very intelligent, passionate about their patients and highly self-motivated; they cannot be ordered or dictated to. In my current position, it is not enough to conduct research pointing to the 'right' things to do; we also need to communicate effectively and engage directly with government officials and clinical leaders to achieve our endpoints, which are not publications and reports, but healthcare system improvements. Hence, my team collectively need to be scientist, advocate, buddy/ friend, policy-maker and executor all rolled into one. PDO: Who do you typically interact with and in what capacity? Dr. Lim: Very wide spectrum of healthcare professionals ranging from clinicians, administrators, policy makers etc. I try to spend time talking to patients and members of the public to better understand their needs and concerns. I try generally to come in from the angle of someone trying to understand so that I can help. PDO: What do you enjoy most about your current position? Dr. Lim: The opportunity to impact in a big way on healthcare and the ability to enable and empower people to do their best for their patients. PDO: What are the biggest challenges you face? Dr. Lim: The biggest challenges relate to implementing what we already know. There are myriad reasons why this is so difficult, ranging from personalities with vested interests, lack of systems thinking, plain old inertia etc and every situation is a little different. We have to correctly identify the issues, the proximal causes and distal effects as well as the 'right' stakeholder and the 'right' approach and timing if we are to be successful in effecting healthcare improvement. PDO: You've had a highly accomplished career thus far. What mark do you hope to leave at Singapore Health and what can you envision your self doing futuristically? Dr. Lim: I would not describe my career as highly accomplished . My hope for SingHealth is that it will harness to the fullest the tremendous talent that we have. In my mind, truly being patient-centric and improving what the Mayo Clinic calls the 'science of healthcare delivery', i.e. translating discovery and innovations into routine clinical practice, are the most crucial steps to take. I'm afraid I don't know what the future will bring, both in healthcare and for myself personally, but I hope that every day will bring challenges and opportunities to stretch myself and contribute back to society. PDO: For graduate students who are looking to get more policy experience while in school, what sorts of activities would you recommend they pursue? Dr. Lim: Hopkins has tremendous talent in the policy arena and students would be advised to tap into the opportunities already present. Read the journals and don't be shy to take the initiative to organize both formal and informal policy forums in areas you are interested in, join or lead study trips etc. If the opportunities are available, intern for a faculty actively involved in policy, e.g. advocating for universal health insurance, advising a presidential candidate etc. PDO: What advice would you give to current graduate students in the International Health program who are actively targeting employment in the policy arena? Dr. Lim: The most important things one would bring to the job would be strong analytical skills, the ability to communicate effectively in both written and oral form and a good network of people to tap on for ideas and advice. Teamwork is vital also as health policy becomes increasingly complex and one would need to demonstrate this. My advice to current students: "Take on an internship if finances permit. There's nothing like getting your hands dirty to know whether you really like the work and the trade-offs and compromising that are inevitable in policy work. The internship will also be useful to help you know more fully whether you'll be good at it." PDO: I see that your research center, the Centre for Health Services Research, has chosen three main areas of focus: Outcomes Research, Health Technology Assessment, and Systems Design. Did the time you spent at Hopkins help inform your center's decision to concentrate on these areas, and if so, how? Dr. Lim: Actually no. It is deliberate that I am director of both policy and health services research. The policy perspective points to which areas of health services research are most pertinent and the research helps to inform policy and guide decision-making. PDO: What advice would you give to incoming Master of Public Health students who plan on working in Southeast Asia on health systems and policy issues? Dr. Lim: Find out as much as you can about the culture, history and philosophy of government in the different countries. Healthcare is a subset of government in most of Southeast Asia and only by placing healthcare correctly in the larger context will one be truly effective. An internship in Southeast Asia would be tremendously helpful. PDO: Did you gain any specific skills or knowledge from any particular courses you took during your MPH year that you have since found particularly helpful in your current work? Did you choose to concentrate your MPH studies in one area? Dr. Lim: The approach to problem solving incorporating framing the right issue, proximal and distal determinants and stakeholder analysis was a very useful tool. I also appreciated very much the course on the history of medicine as so much of policy is dependent on context, past experiences and politics, which history and the social sciences provide very good analytical tools to decipher. I did a lot of classes in humanitarian assistance and healthcare policy and management. PDO: What were the top three lessons you took away from the MPH program? Dr. Lim: a. Make sure the science is right first of all b. Follow the money trail c. Assemble the right team and most of your problems are solved PDO: Completely unrelated, what's the best thing about working/living in Singapore? Dr. Lim: The food is incredible. The thing I miss most when I travel outside Singapore is the food and the low prices make the food twice as delectable (A full meal can be obtained for US$2.00) Also, there aren't many countries where one can walk virtually anywhere in the middle of the night and feel completely safe. Singapore is a great place to raise kids which is a very important consideration to professionals with young children. Professionally, Singapore is small enough and dynamic enough that one can see changes in national policies in a year or two, and that can be immensely gratifying for a policy wonk. Singapore's healthcare system is also perhaps the 'least imperfect' in the world and it is an experience in itself to learn the intricacies and thinking behind it.
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