Health System Transformation Playbook and Unified Care Model: an integrated design, systems & complexity thinking approach to health system transformation

Health system transformation is a complex journey that often results in unintended consequences. Existing methods to drive health system transformation have intrinsic limitations which impede successful implementation in local contexts. The Health System Transformation Playbook is a design-, systems-, and complexity-thinking enabled methodology to systematically design, prioritize and test health system and services transformation actions, anchored on iterative story telling, model building and pathfinding processes that tackles the scale of socially and technologically complex adaptive systems through time. The Unified Care Model and its associated cascade of models are examples of ongoing application of Health System Transformation Playbook in a regional population health system in Singapore. Use of Health System Transformation Playbook enables stewards of health systems to gain a more systematic and coherent understanding of health systems and services planning and organization development, to accelerate transformation towards people-centered, integrated and value-driven health systems.

Clinics in diagnostic imaging (129). Posterior cruciate ligament ganglion cyst

Ganglion cysts arising from the posterior cruciate ligament (PCL) of the knee are rare. We describe a 21-year-old Chinese woman who presented with right knee pain following a twisting injury six months prior. Her pain was exacerbated by squatting, although her range of knee motion was full. Magnetic resonance imaging showed a lobulated, well-defined, T1-hypointense and T2-hyperintense, septated cystic mass arising from the posterior aspect of the PCL. The diagnosis of a PCL ganglion cyst was confirmed by computed tomography-guided aspiration of the cyst. Due to persistent mild knee pain, the patient eventually underwent arthroscopic decompression of the ganglion cyst. The clinical features, diagnosis and management of PCL ganglion cysts are discussed.