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Strategic Directions for University Hospitals in Saudi Arabia
Khalid Bin Abdulrahman, MD
Professor of Family Medicine & Medical education
Vice Rector for Planning , Development & Quality
Professor Chair, Dr AlKholi Chair for Developing Medical Education in Saudi Arabia
Al Imam Mohammad Ibn Saud Islamic University (IMSIU)
Riyadh, Saudi Arabia
The kingdom of Saudi Arabia is currently witnessing a massive support for its healthcare services. This year’s fiscal budget for healthcare is by far the largest in the history of the kingdom. While pursuing the conventional goals of healthcare delivery systems such as equity, affordability, and availability of services, the ministry of education (MOE), formerly called ministry of higher education (MOHE), is also seeking to achieve certain excellence standards, which are expected to set the bar for other countries in the region to follow suit. There are currently five well established university hospitals around the kingdom, and some of these hospitals have been providing medical services to the public par excellence since 1955. In addition, over 15 new medical colleges have sprung around the country in the last few years bringing with them budding university hospitals. It is estimated that only one of these new facilities are about to open soon while the others are under various stages of construction. The MOE has adopting a promising vision for university hospitals in KSA as follow; “The university hospitals in KSA are the leading medical centers for comprehensive, patient & student centered, health care based on evidence & community health priorities. An attractive environment for trainees, researchers & community partnership”. Almost all, under construction, university hospitals were adopting a paradigm shift in the standard of healthcare and training provided. This current presentation summarizes these standards.
Health Care in Saudi Arabia, the need for transformation
Abdulrahman Alnuaim ;MD,FRCPC,FACP,CPE
Professor of Medicine, Senior Consultant, Health Strategic transformation Centre ,MoH
The current health care model in Saudi Arabia is not sustainable!
The quality of care can be significantly enhanced while the cost is rising. Patients are having significant challenges across their journey with different health facilities and different care givers. There are ,as well, significant efficiency limitation.
The poor outcome, thus, is evident with prevalence of chronic diseases such as Diabetes Mellitus(DM) is among the highest in the world as illustrated in the latest prevalence study of 22% among adult population in SA while obesity is the highest in the world with prevalence of overweight and obesity of over 50%.
There is need to redefine health care value and transform from “Sick Care” where the main focus of care providers is to diagnose and treat sick people, it is reactive and more expensive to “Health Care” where there is system that is focused on proactive care strategies, it is proactive and less expensive.
Future health care delivery system will have emphasis on wellness/ disease prevention. It is patient centered/ personalized care and evidence based medicine.
Saudi Arabia has recently embarked on National Transformation Initiative ,health care is in the core of such initiative.
During presentation ,there will be elaboration on the components of the healthcare transformation ,the process and anticipated outcome
The Different Modalities for Governance of University Hospitals
and Road Map for Decision Making
Dr. Eric de Roodenbeke
CEO of IHF
Addressing the challenge of governance of university hospitals requires to have a common understanding of what governance is actually covering. The world “governance” is used for several purposes, and debating on terminology can distract the discussion from its core objective: setting up a framework that allows university hospitals to perform at their best according to the missions they have to fulfil.
The model developed by A. Preker and A. Harding (World Bank) to better understand behaviour of hospitals is very relevant for this effort to focus attention on best institutional arrangement for university hospitals.
First it is very important to identify and clarify role of the four key stakeholders that will be influencing University Hospitals: Government, owners, payers and clients. In many countries the same stakeholder take several responsibilities and this creates conflict of interest between respective core goals of each stakeholder. International literature demonstrates that such situation is not country specific. The tendency is moving toward having independence between these four functions with entities of different nature in charge of each: stewarding, governing the organization, purchasing the services and utilizing the services.
Stewardship can be also called the “system governance” as it relates to the responsibility to set up goals and principles, rules and modalities of control at the level of a country or an autonomous region or State.
To better understand the importance of role play it is necessary to consider the key organizational incentives for hospital performance: accountability, decision rights, residual claimant, market exposure and social responsibilities. The best performing organizations are those having decision making power on these five incentives well aligned and at very much under the control of hospitals.
With university hospitals, there is an additional challenge. University hospitals have to fulfil at same time 3 missions of different nature: care, education and research… that are usually under different stewarding bodies and that can create possible tension because of different perspectives.
For this reason before getting to a discussion on recommended modalities for the organizational governance of University hospitals, it is necessary to first explore stewardship (governance of the system). The form of involvement of the stakeholders in the organizational governance will be critical for the performance of University hospitals.
Considering that altogether care, education and research should be fully taken on board, it is necessary for a minimum level of coordination to be in place. This can be organized at central level but that requires very strong implementation capacities. It can be done at the level of the hospital but that requires a high level of autonomy (very significant decision making capacities on the five key organizational incentives) to be able to contract with the stewarding authorities. In such situation the stewarding organizations should have solid capacities to put in place an accountability framework based on clear policy option and expected results.
Once the Stewardship model is in place then it is possible to look closer to the organizational governance. For this University hospitals, like any organizations, are best off when complying with governance gold standards: common interest around shared goals are mobilizing all players.
Autonomy does not mean independence: those who lead serve the organization and not their interest.
Strategic Planning and Managing of the academic medical center of the future.
Mr. Emilio M Williams
This talk will focus on how to develop and plan for the academic medical center of the future, based on the experience of developing the new academic hospital at the University of Chicago Medicine. The talk will also cover different strategic dimensions to inspire new projects in the Kingdom, as well as reviewed different governance structures in place in leading academic medical centers in the US.
The Evolving Role of the Academic Medical Center in the Move from Volume to Value
Mr. Kevin S. Cook
Changing demographics in the United States necessitate a move from a volume-based system of care to a value-based system of care. This presentation will cover how one Academic Medical Center is navigating this changing strategic landscape to create a statewide system of care. Topics included:
- The components of the University of Mississippi Medical Center (UMMC) and its’ Mission.
- The traditional role and strategy of UMMC.
- How the changing economic landscape is forcing a shift in this role and strategy.
- UMMC’s strategic plan going forward to positively transform the system of care in the State of Mississippi.
- The use of technology in this transformation.
Patient Care, Education and Research: Impacting the Community, the Nation and the World.
Mr. Emilio M Williams
Academic Medical Centers have three missions patient care, education and research. Utilizing international standards as a framework, this talk will cover aspect on how we take care of our community patients, with a focus on vulnerable populations, how we train the doctors for the next generation, and how we integrate into our day to day human medical research in a safe and sound manner.
Medical and scientific research within the national universities health care systems and the need to have it consolidated
Dr. Abdullah M. Aldahmash
General Director of Prince Naif Bin Abdulaziz Health Research Center
University affiliated health care systems known to be the most dynamic and evolving health systems. Those qualities are influenced by many factors; one of which is the continuous update and synchronization by most recent scientific and medical research out comes. However, it’s unfortunate that in some systems as the current system in our country the research activities within university health system are very modest, more importantly they are primarily conducted and determined by the individual researcher interest rather than the national needs. Although this might have helped sustain some good reputation, produce some reasonable scientific and medical research publication and created some small pocket of excellence.
Given the fact that nationally there is a great expansion of University health care systems, it’s essential that research within those upcoming new healthcare facilities is well planned with specific goals and generous funding. Also, it would be of great benefit if it was coordinated through a joint board of all concerned Saudi Universities, this eventually can evolve to become the national board for health research.
Financing University Hospitals
Dr. Eric De Roodenbeke
CEO of IHF
Distinction should be made between financing and paying to avoid confusion when addressing the issue of financial sustainability of university hospitals. Through financing we study resource mobilization and utilization while payment systems are developed to optimize behaviour of organization especially in the context of merit goods. Market mechanisms are not most effective for health, education and research.
University hospitals are providing multiple services of different nature through the mobilization of shared resources, mostly human resources and capital investments. The challenge of financing hospitals is to identify the production function behind each activity, and to be able to measure unit cost for each of these activities. This challenge can now be overcome with information system and resource mobilization framework. However such approaches requires that there is an agreement on allocating shared resources between activities. This is possible when there is some clarity on roles and responsibilities of the different components of the university hospital. Usually pure academicals component can be well separated from the role of hospitals to support practice and skill building through internship. For research it is also usually possible to separate pure research done in specialized lab with clinical research developed in hospitals. With development of more and more sophisticated simulation tools and online academicals offering, the respective distribution of cost between school and hospital is going to evolve rapidly. With research the issue of intellectual property and the capacity to translate findings into marketable product of service is another challenge that university hospitals have to overcome.
There is limited evidence on the specific cost of University hospitals but studies have been done in several countries to estimate this additional cost. The most detailed study was done in Belgium taking into account all university hospitals. Results show that the teaching and research mission of the hospital represents a cost of almost 25%. Results from studies done around the world indicates figures between 15% and 25%. Such important variation are partly related to weak accounting system to measure precisely the cost of a teaching hospital. Usually these studies identify the opportunity cost considering that staff and equipment are distracted from their initial goal (caring for people) to support teaching and research.
Teaching hospitals are by nature tertiary healthcare centres caring for most complex patient. Often these patients may be on end of life and cost may also vary significantly with approach to end of life care. This is very much related to societal and ethical considerations. Ignoring this may shadow the understanding of high costs of university hospitals.
Because of its tertiary nature, university hospitals have also to face decisions in regard to their portfolio of activities. For complex activities outcomes are better when volume increase while unit costs diminish up to a certain extend. In a context of expansion of most advanced activities, University hospitals require specific subsidies and may need to work also in networks to achieve critical mass of activities to be efficient while reaching international standards for quality outcomes.
In the context of university hospitals it is relevant to put in place multiple modalities of payment systems to ensure that costs are covered while payment system is an incentive for performance. Understanding advantage and limitation of different type of payment system can allow University Hospitals to better negotiate with different payers’ best modalities to cover their different missions.
In complex organizations, there is more to gain by moving toward a sophisticated information system than to operate in a black box mode. Such an approach requires a solid governance system to be able to make choices because at the end of the day, wealthiest country will still have to prioritize expenses on activities while finding best mechanisms to reduce waste.
Experiences of the Saudi Health Insurance Market
Mr. Ali Alkahtani
Before the establishment of the cooperative health insurance law, the Saudi health insurance market faced many challenges among them was the absence of a national insurance regulations to supervise and regulate such a financing model of healthcare. The law enforces the market under one regulatory body (CCHI( in order to assure the healthcare delivery to all private sector employees (Saudi & Non Saudi) and their family members. The law may enroll all Saudi citizens as per a royal decree.
As a result of the implementation, the law supports financing of Saudi healthcare via transferring the cost burden to the private sector by insuring (10.777.681 insureds; 3.187.084 Saudi and 7.590.597 non-Saudi) receiving healthcare through (26 insurers) and (2569 provider) qualified and accredited by CCHI which led to increase the PHI market share to (60.2%(.
It is Time to Uberize Healthcare
Abdullah S Al Amro, MD, FRCPC
After the birth of internet in the early nineties entrepreneurial came up with different disruptive ideas, many died with the dot com bubble and few survived. The most successful transformation using technology is the one looked at consumer needs rather industry needs. Amazon for example made global shopping much more easily available for consumer and more convenient and became one of the most successful venture. The success behand Amazon because Jeff Bezos the founder made clear strategy to transform process and make it easy for end users. The breakthrough Uber made in transforming transportation industry from driver and company driven to consumer focus stimulated entrepreneurial to do so for other industries. The public acceptances and adoption of Uber in transportation is overwhelming. Globally the transformation effort of healthcare did not succeed since it was looking mainly on the industry and not the consumer. We always say Patient first and reality our process does not support what we claim. In the personation we will look into the ways to Uberize healthcare and challenges behind the concept.
Teamwork and Health Professionals Capacity Building in University Hospitals
Dr. Abdulrahman AlMoammar
Capacity building means to build and enhance upon your existing capability to provide sustainable patient care. These capabilities include your existing human, capital, infrastructural resource. If the concept is further applied to academic health centre, it adds educational and resource capability in addition of workforce capacity.
Capacity building is never done at a narrow, individualistic level. It deals with training groups of individuals of an organization, enhancing their capability to expand service capacity and benefit the organization at large.
Research has shown that using interdisciplinary team always leads to better care management. In clinical practice, teamwork is not only cost-efficient, it can help build skills that traditional training mechanisms don’t provide. There are now specialized training tools for the purpose. From the perspective of enhancing clinical and educational capacity approaches like empanelment, ‘care-sharing’, care coordination, committee operations, clinical rotation and team-based simulation training add to the skills, care capacity and resident learning. One such model is called the Practice Transformative Model, which helps increase the organizations ability through task shifting, care coordination, strengthens communication and creating stronger synthesis between behavioural and medical care using evidence-based practice.
Such collaborations of intentional knowledge sharing leads to enhanced leadership skills, fosters positive attitudes and joint responsibility towards patient care. In research, this technique is applied at all levels. Linking researcher with practice staff also helps ensure research is close to practice. Assigning researchers to multiple specialty areas of research enables them to understand each other’s perspective and work together produce more cohesive cross-functional research. At the level of the organization, there are collaborations for funding, sharing cross-functional expertise and facilities etc. which leads to a more enriched learning experience and benefits the organizations at large.
At KSUMC, capacity enhancement through various mechanisms is an essential part of its strategy. Team-based care enables a culture of learning, quality and efficiency. Fostering teamwork enhances knowledge sharing, collaborative decision making, breaks silos and makes everyone united towards the goal of quality & excellence.
Commissioning a new University Hospital, Challenges and Tactics
Ahmed AbuAbah, MD, EMHA
Establishing Chief Executive Officer
King Abdulaziz University Hospital
Princess Noura University
By nature, hospitals are complex and dynamic environments that are comprised of multiple clinical microsystems. In order to bring a hospital to life and to ensure that the clinical microsystems function as seamlessly as possible, it must first be commissioned using a systematic and structured approach.
Hospital commissioning is considered to be a complex, lengthy, and huge undertaking that involves multiple stakeholders and a plethora of resources. The commissioning process must be well planned, managed, and monitored.
Located in Riyadh in the Kingdom of Saudi Arabia, King Abdullah bin Abdulaziz University Hospital (KAAUH) is a teaching hospital affiliated with Princess Nourah bint Abdulrahman University (PNU). The hospital is preparing its facilities, people and processes for service rollout this year 2016 with a very clear vision to be a role model for other university hospitals, focusing on the health of women, adolescents, and children. PNU is the first girls’ university in Saudi Arabia. Which was establish based on a royal decree on October 2008 and was opened on May 2011.
In this presentation I will share with the audience some of the challenges that we faced during our commissioning process and what was the tactics we used to overcome those challenges. This will include our commissioning model and governance framework.
Online Medical Education for Capacity Building: Opportunities and Challenges
Prof. Richard E. Scott
CEO, NT Consulting – Global e-Health Inc, Calgary, Alberta, Canada.
Every country, health region, and health facility should possess it’s own e-Health Strategy, each aligning with and building upon one another. Of the 4 primary components of e-health (Health Informatics, Telehealth, e-Commerce, and e-Learning) each may find context-specific application within any single setting. e-Learning (more appropriately termed Technology Enabled / Enhanced Learning, TEEL) has significant potential for medical education and capacity building. But what are ‘medical education’ and ‘capacity building’? Are these linear or cyclical processes? How do they relate to health and healthcare as a whole? What technology opportunities exist and which have been proven of benefit? Finally, what challenges do we still face in leveraging TEEL? This presentation encourages a more ‘strategic’, ‘holistic’, and ‘higher level’ view regarding ‘medical education’ and ‘capacity building’ in order to maximise overall value of TEEL interventions.
Futuristic View of IT Utilization in the University Healthcare Systems
Dr. Zakiuddin Ahmed
President: eHealth Association of Pakistan & , Healthcare Paradigm
Introduction: Healthcare is the most complex activity there is. On one head there are increasingly challenging healthcare issues, like the double disease burden due to the increase in DM, Heart diseases, Obesity; deteriorating life style; bad eating habits; scarcity of HCPs; etc. On the other hand technology is revolutionizing the way we live. Advancements in information & communication technologies along with Mobiles becoming the most pervasive technology with 7 billion devices offer a unique opportunity of healthcare delivery and management. We are progressively moving towards a value-based healthcare system heavily reliant on technology to
coordinate and deliver care, engage patients and improve outcomes. With the unprecedented need of shifting the focus from treatment to wellness, technology offers unparalleled and most effective opportunities in healthcare and perhaps the only way to provide healthcare to everyone – as their basic right. In an eHealth environment, Information Moves rather than the Physician or the Patient. eHealth / mHealth should be Need Driven and not Technology Driven. We are at the dawn of Citizen Centric / Empowered Patient Healthcare Systems. One of the most important things to remember always is that Its all about the PATIENTS. Patients should remain the center of focus for all stake holders as the ULTIMATE BENEFICIARY
Understand the following
• Difference between Disease & Illness
• 3 A’s of uHealth
• Healthcare Ecosystem
• Double Disease Burden – Metabolic Syndrome
• ePhysician – ePatient scenario
• From Pilot to PoC
• Role of social media / networks
• Patient Education and Awareness – Empowered Patient
• Behavior Change / Remodeling tools for Prevention
• Technology leveraged healthcare
• Glocalization in healthcare – Geography is History
• Hospital care to Home care
• Shift the continuum of Care from Acute care to Prevention & Wellness
• Smart phones or Medical Gadgets
• Future drivers of healthcare
Low-cost Bio-imagers for healthcare screening and diagnostics
Prof. M. Jamal Deen
McMaster University, Canada
"Following the credo that “seeing is believing” and “a picture is worth a thousand words”, low-cost imaging technologies are now ubiquitously deployed in consumer devices – from digital cameras, to laptops and cell phones. Another area where imaging technology is having a significant impact is in the development of high-sensitivity, high-speed bioimagers for applications in medicine, biology, biomolecular sciences and chemistry. In this plenary talk, we will discuss our on-going research work in developing low-cost, miniaturized and sensitive systems towards minimally invasive screening and diagnoses for early stage malignancies. This research is motivated by the premise that the sooner a disease is caught, the higher the chances are for recovery. At present, one of our foci is on minimally invasive endoscopic/brain imaging technologies that require expertise in multiple disciplines such as gastroenterology and neurology, minimally invasive surgery, medical instrument development, photonic, electronic and mechanical engineering, and image processing. More importantly, such a project requires real convergence among engineers, scientists and clinicians who must work collaboratively and synergistically for the realization of these new screening and diagnostic devices. As a specific example, not only do we have to develop optical imagers capable of single photon counting with high temporal resolution to investigate autofluorescence from biological samples, but the optics should be integrated so the system has a small form factor. And for in-vivo applications, biocompatible coatings with good optical transmission properties are required. In addition, the hardware and software should be user-friendly to clinicians. In the talk, we will also highlight the importance of computing as well as data and image processing, some often overlooked areas in bioimaging systems. Finally, we will summarize our current work and recent accomplishments to illustrate not only convergence in general, but specifically convergence to tackle one of the most pressing issues in healthcare worldwide – that of low-cost screening towards early diagnosis of common diseases for better prognosis."