What’s up with HealthHub?
Investigating what’s happened with polyclinic bookings.
“Impossible to book polyclinic appointments” was one of the Reddit threads in r/Singapore just a few months ago. I thought I was the only one feeling this way until I looked into it.
If you Google “polyclinic bookings Reddit”, all of the threads that appear have similar sentiments. A healthy discontent with the status quo.
Singaporeans lament that it’s gotten harder to book medical appointments under this new-ish system, and it has been this way for a few years. Some of the threads discussing this existed 2 years ago.
So, what exactly has happened?
I’d like to begin by clarifying that this is not intended to be a critique of Synapxe, the agency responsible for HealthHub. I fully acknowledge that they may be grappling with various system constraints and resource limitations, which we’re not and may never be privy to. If you read on, you’ll find out there are different stakeholders they have to answer to besides us, the users of their app.
What I want to explore is purely about design.
I want to understand why the user experience of making a polyclinic appointment has significantly deteriorated over the past decade. Or, why it feels like it had. And “feels” is a key word here.
I want to investigate why Singaporeans are growing increasingly frustrated with this aspect of healthcare from a system design perspective. And to do so, we have to examine what existed before.
A decade ago
To refresh the memory of those who may be too young to recall or have forgotten, polyclinic appointment booking used to be done through these methods:
- By calling
- Through walk-ins
- Through a polyclinic’s website
Two of these methods, walk-ins and calling are still available in limited capacity today.
But back in 2012, one of my favorite methods was booking through a website. You could book at any time of the day. If there was a slot, you can book in the morning and show up at 3pm. It didn’t feel like such a hassle.
In 2013, there was a plan to consolidate all of our health records in one place. An ambitious move that was the brainchild of the Ministry of Health and the Health Promotion Board. This was also a joint effort by the several polyclinic groups and health systems that existed in Singapore.
HealthHub was launched in October 2015, almost 8 years ago. Its launch was covered in local publications such as The Straits Times and Today.
The application and online portal was created with the best intentions in mind: to streamline the documentation of every patient’s health records, answer health questions, and then finally, manage appointments.
Analysing problems
I don’t get sick often and when I did, I mostly go to a private clinic. However, in 2018, I encountered my first significant health issue that required me to use the app. I distinctly recall the experience, and it left me incredibly frustrated.
Not just frustrated, actually furious.
I found myself repeatedly missing opportunities to secure an appointment. And, this went on for days. I had no idea you had to book during a sweet spot to secure an appointment.
Obviously now, most of us are aware that to have a successful booking and to be able to pick a time slot that suits you, you must be on the app at 10pm with fast fingers, praying that your wi-fi connection is secured.
Oh, you can’t enter the app and it’s been 30 minutes? It’s okay, you’re now looking at the home page.
Did the slots run out faster than you can get to the home page? Don’t fear! You can always book at a polyclinic that’s in another area. Everything is booked up? Well, you can try again tomorrow at 10 pm.
What we’re looking at is a system rule that’s been put in place that greatly affects a patient’s experience with the appointment booking journey. From our perspective, it feels like a system designed to prevent us from succeeding.
There doesn’t seem to be enough flexibility to the timing of booking.
Design note 1: Users can only book appointments for the next or same day, never in advance. And only, from 10pm onwards.
Design note 2: Users are never told why this rule is in place.
If you’ve been sick and can’t afford private healthcare, I empathise with you that this is what you have to go through whenever you need to see a doctor.
My assumption of why this rule exists is that there is a shortage of medical staff and slots available. National University Polyclinics somehow validates this assumption. They then proceed to ask me to use another application.
Design note 3: There is another app beside HealthHub for booking an appointment.
My personal experiences aside, I wanted to know what were the main sentiments under these Reddit threads. So, I asked ChatGPT to analyse the 10 threads I came across and all of the comments under these threads.
After a few minutes, we have some patterns we can look at. The AI uncovered eight points to solve for.
I also wanted to examine the major feelings attached with this experience. The reactions are varied.
Negative emotions
- Frustration: Many Singaporeans appear to be frustrated with the current booking system, especially when they are unable to secure an appointment due to high demand. They express dissatisfaction with the difficulty of accessing healthcare services in a timely manner.
- Anxiety: Some individuals express anxiety or concern about falling ill after appointment slots are filled, leaving them with limited options for seeking medical care. This anxiety is related to the uncertainty of obtaining timely healthcare assistance.
- Discontent: There is a sense of discontent among those who find it challenging to navigate the appointment booking process, especially the elderly or less tech-savvy individuals. They may feel left behind or excluded from the digital healthcare system.
- Helplessness: People who are unable to secure appointments, particularly when they are sick, feel a sense of helplessness. They perceive that the system doesn’t cater to those who need immediate medical attention.
- Resignation: Some individuals appear to have accepted the current state of affairs, even if they are not entirely satisfied with it. They may recognize the limitations of the system but have resigned themselves to the situation.
- Skepticism: There is a degree of skepticism among users regarding the fairness of the appointment allocation process. They may question whether the system adequately considers urgent cases.
Positive emotions
- Gratitude: On the flip side, some users express gratitude for the availability of online booking systems, acknowledging that it has improved access to healthcare services compared to the past.
- Understanding: There are users who show understanding of the challenges faced by healthcare providers and the limitations of the system, especially during peak periods.
Overall Design Interventions
Using the limited data pool I had, I wanted to uncover what were the possible design interventions we can put in place. In addition, how feasible and easy they would be to carry out.
Intervention 1: Improved Online Appointment System
This is already being carried out by the constant updates and improvements on the HealthHub and OneNUHS apps.
Intervention 2: Introduce a Waitlist System
This is a suggestion made by several users that could be a good solve if done correctly.
Intervention 3: Provide Additional Training for Elderly Users
There are courses on computer use for the elderly by IMDA. More specifically, there is the Seniors Go Digital Initiative. The elderly can learn to access government digital services. Learning about the success rate for these programmes will be another story altogether. I don’t know what’s the audience reach and if they cover using HealthHub in these courses.
Intervention 4: : Encourage More Doctors to Work in Polyclinics
This solution seems to address a lot of the problems faced by healthcare right now but the execution of this will be hard and will take longer than any of the other interventions. I will delve more into this topic later.
Examining HealthHub
After I’ve got a grasp of the bigger picture, I finally felt it was time to do a quick and simple HealthHub audit, only specific to the polyclinic appointment booking journey.
App ratings
HealthHub’s rating on both the Apple store and Google Play store is the same: 4.7 out of 5. These are out of thousands so that’s actually really high.
I proceeded to scan one-star reviews on both stores to see if there were any challenges users were up against in the past 4 months.
Out of all those, I decided to focus on the appointment system problems. Here were the main frustrations with the appointment system:
1. Crashes at Peak Times:
- Users encountered regular crashes when trying to book appointments, particularly during peak times, such as 10 pm.
- These crashes frustrated users and hindered their ability to secure appointments.
2. “Service Unavailable” Messages:
- The app frequently displayed a “service is unavailable” message, preventing users from proceeding with their appointment bookings.
- Users reported being redirected to this message repeatedly, leading to extended wait times.
3. Inefficient Queueing Process:
- Users described having to queue for extended periods (up to 30 minutes) just to access the time-slot selection page.
- This inefficient queueing process resulted in wasted time and frustration.
4. Walk-In Appointments Required:
- Some users resorted to walking in for appointments because of the app’s unreliability.
- This negated the purpose of having an appointment system, causing inconvenience for both users and healthcare providers.
5. Mismatched Appointments:
- Users reported receiving appointment times that did not align with their preferences or availability.
- This mismatch between user preferences and assigned appointment times caused confusion and inconvenience.
My own audit
These appointment system problems indicate significant issues with the app’s reliability and performance, particularly during crucial booking periods. I wanted to see how my own experience matches up.
As one of the users mentioned, the gateway was extremely awful. Especially at 10. It would just stay on this page forever. I tried it again at 3 am before I was past this page.
After you make it past the gateway, it’s a straight forward booking system. There are three mini flows you’ll have to go through before booking.
Flows:
- Login
- Selecting a clinic and service
- Symptoms questionnaire
- Booking
Other options if there are no available slots
- They encourage users to try again the next day after 7:30 am
- To go to CHAS GP clinic
- To call NHGP contact centre at 6355 3000
Design note 4: All other options to remedy the situation is done outside the app.
It suddenly makes sense that even though they provide alternatives for people to try, users are frustrated with the app because there is nothing you can do inside the app if there are no available bookings. There is no user flexibility.
My observations
- I got stuck on the gateway screen for hours at 10pm.
- Once I got in, it made me go through the Singpass login twice which is a different experience to when I access other government digital services.
- When I did get in, there were absolutely no more slots. I had to try a different day.
- After I was shown that there was not availability, the alternatives they presented me were frustrating. It was 3 am at that point.
Overall, it’s still a pretty poor experience. If I was sick and was actually trying to book an appointment, I would either just try my luck and walk-in at 8 am when a polyclinic opens or go to a private practice.
Bigger Picture: Beyond the Apps
We cannot just blame the app for the poor experience. We have to look beyond and see what’s actually overloading the system in the background. This will give us a good picture of what other factors we can remedy.
Singapore’s aging population
Singapore is experiencing a demographic shift with a rapidly aging population. While increased life expectancy is undoubtedly a positive development, it presents unique challenges to the healthcare system. As individuals age, their healthcare needs tend to become more complex, leading to higher demand for medical services.
Polyclinics, as primary healthcare providers, are feeling the strain as they must accommodate a growing number of elderly patients with a range of chronic illnesses. This surge in demand may be one of the contributing factors to the difficulty in securing timely appointments. Addressing this challenge requires a holistic approach that considers not only digital solutions but also the broader healthcare infrastructure needed to support an aging society.
But the impact goes far beyond that. An ageing population will totally change the way our society works. From our economy, to our healthcare system, to planning for retirement adequacy. — Lee Hsien Loong
Medical certificate work culture
Singapore has a unique work culture where employees are often required to produce medical certificates (MCs) for minor illnesses, even if it means visiting a polyclinic. This practice not only places an unnecessary burden on the healthcare system but also disrupts the appointment booking process.
Patients seeking MCs for mild ailments contribute to the congestion of polyclinic queues, making it harder for those with genuine healthcare needs to secure appointments. Examining this culture and finding alternatives could alleviate the strain on the polyclinics, making it easier for individuals to access necessary healthcare services without the added bureaucracy.
Overworked and understaffed healthcare system
While Singapore’s healthcare system is well-regarded globally, it faces challenges related to workforce shortages and overwork. Nurses, in particular, play a critical role in polyclinics and hospitals.
The government has been proactive in encouraging more individuals to pursue careers in nursing and healthcare, but these initiatives take time to yield results. Overworked healthcare professionals may struggle to meet the demands of the growing patient population, resulting in longer waiting times for appointments. This issue goes beyond digital solutions and highlights the need for comprehensive workforce planning and support to ensure that patients can access care when needed.
These three key factors shed light on the broader challenges faced by the healthcare system in Singapore.
Not-so-distant Future
More polyclinics
In the near future, Singapore’s healthcare system is poised for transformation. The government’s plans to open new polyclinics by 2030 offer hope for addressing today’s healthcare challenges. However, true progress requires more than infrastructure expansion.
Sustainable healthcare
Sustainable healthcare extends beyond infrastructure; it encompasses nurturing the next generation of healthcare professionals. Encouraging young Singaporeans to pursue careers in public health is important to navigate the overworked and understaffed healthcare landscape.
Addressing these challenges needs a united effort involving policymakers, healthcare providers, and the community. By integrating these aspects with digital enhancements, we can progress toward a more efficient and accessible healthcare ecosystem.
An ecosystem that not only resolves present issues but also foresees future requirements.
