From technologies to capabilities: Sustaining system-level digital transformation in Singapore public healthcare - a NASSS-informed policy analysis.

BACKGROUND

Digital transformation has become a central policy concern for health systems seeking to address rising demand, workforce constraints, and increasing care complexity. While digital technologies, automation, and artificial intelligence (AI) offer significant promise, many initiatives struggle to move beyond pilots to achieve sustained, system-wide impact.

OBJECTIVE

This paper applies the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to guide system-level analysis of the digital transformation journey of a large public healthcare system in Singapore. We retrospectively analyse three interrelated programmes: a digital technology driven care transformation programme, a citizen developer-driven workflow automation, and an enterprise level AI deployment platform.

METHODOLOGY: Using a qualitative, retrospective case study approach, we examine how these programmes map across the seven NASSS domains and how interactions between domains shaped adoption, scale-up, and sustainability.

RESULTS

The analysis highlights the importance of organisational capability, governance, and workforce development as primary enablers of sustained digital transformation, often outweighing the characteristics of individual technologies. Defining the intervention at a system level enabled horizontal integration and scalability but also introduced challenges in articulating patient-level value and evaluating impact.

CONCLUSION

Applying NASSS beyond disease, or technology-specific, interventions reveals both its strengths and limitations. While the framework provides a useful structure for understanding complexity, it requires adaptation when applied to institutional or system-level programmes. The findings reaffirm that policymakers and system leaders should focus not only on adopting digital tools, but on building the organisational and human capabilities needed to responsibly scale, embed, and sustain digital innovation over time.