Jeremy Lim Director PR by Ucvy1ujY

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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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