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Contextual Codifiable, explicit Easily transferable Insight, creates meaning, judgmental, actionable Human, tacit, transfer requires learning Data.

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Presentation on theme: "Contextual Codifiable, explicit Easily transferable Insight, creates meaning, judgmental, actionable Human, tacit, transfer requires learning Data."— Presentation transcript:

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4 Contextual Codifiable, explicit Easily transferable Insight, creates meaning, judgmental, actionable Human, tacit, transfer requires learning Data Information Knowledge Wisdom

5 The location & design of treatments areas are changing within the hospital facilities, as free-standing and mobile treatment sites are evolving. Healthcare benefits, coverage, choices, and costs are continuing to evolve. Hospitals are being subjected to more pressure to manage costs. Hospitals and healthcare centers are treating older adults and younger prematurely born infants, both group having higher acuity level.

6 Hospitals are developing technology Planning and construction project management programs to guide their decisions because limited resources are being subjected to competing demands, thus requiring more carefully executed plans Technology planning and Acquisitions teams are created to coordinate the absorption of new and replacement technologies that can contribute to a cost-effective delivery of quality care, these teams may also suggest changes in the current delivery system.

7 Over the coming years, Saudi Arabia is expecting a significant increase in the demand for healthcare driven by – Rapidly growing and maturing population – Drive to improve the quality of healthcare services in the Kingdom Today, the Saudi healthcare system is mainly funded by the Government –around 75% of the Kingdoms overall healthcare expenditures are Government funded The Ministry of Health (MoH) has prepared a plan to fundamentally restructure its activities, and by so doing, the healthcare sector as a whole – The Ministry will become a healthcare regulator, plus provider of primary care – The Ministrys hospital assets will be transferred to an independent entity, initially owned by the Government, thus paving the way for more extensive Public Private Partnerships (PPPs) in healthcare – A national fund will be established under the Ministry of Finance to pay for healthcare services provided to patients This increasing demand for healthcare, changes in the structure of the healthcare industry, and more extensive private sector participation, are expected to lead to a significant increase in investment opportunities in healthcare

8 Saudi Population Growth Projections (in Millions) (2005 – 2016) Bed Demand Projections (in 1000s) (2005 - 2016) Population Growth and Corresponding Healthcare Demand Projections Estimated CAGR (2005-2016) 20% High-level projections based on extrapolation of current indicators Projections of Demand for Physicians (in 1000s) (2005 - 2016) Source: Saudi Ministry of Economy & Planning, Central Department of Statistics, MoH Statistics Projections of Number of Hospital (2005 - 2016) Estimated Budget allocation ( 1 billion)(2005-2016) 2.4%

9 Examples of Health System Future Pressure Points Partial List Average Body Mass Index (BMI) of Saudi nationals, 15 years and above, is about 30 kg/m 2 – global average BMI is 23; a BMI score greater than 25 are considered overweight Expenditures on cardiovascular diseases are expected to quadruple in the next 20 years The spread of tobacco use in Saudi Arabia among adult males represents 24%; smoking among school children and adolescents exceeds 14% among males Expenditures on cancer treatment is expected to triple in the coming 20 years Mainly arising from a very high rate of consanguinity – roughly 31% of couples in Saudi Arabia are related by blood About 25% of the overall Saudi population over 20 years old are diabetic, compared with 5% globally. The Kingdom currently spends in excess of SR 4 billion on diabetes care – spending expected to triple in the coming 20 years The percentage of elderly people above the age of 60 years old is expected to more than double from the current ~1 million people (4% of the population) to roughly~2.5 million (or 7% of the population) by 2020 Economic development, enhanced patient awareness, more demanding patients, plus the availability of more advanced (and expensive) care will generate upward pressures on healthcare expenditures Obesity & Cardio- vascular Diseases Smoking / Cancer Type I and II Diabetes Blood-borne Illnesses Aging Population Evolving Patient Expectations Lifestyle Factors Other Chronic Diseases Other Factors Source: MoH press releases, literature search

10 Basis of Ratings A-High quality care, good average health status –Overwhelming majority of the population has access to a high standard care –Health system is well balanced between primary, secondary and tertiary care B- Good quality care, good average health status –Overwhelming majority of the population has access to good care, although services are stretched –Healthcare expenditure is high, but insufficient to be close to meeting demand C- Mixed quality of care, mixed average health status –Most of the population has access to some form of care, although the quality of that care is mixed –Services often very stretched and a lack of doctors and facilities, particularly in rural areas D-Struggling health service, poor average health status –Lack of doctors and health facilities –Significant variations in access to healthcare E-Dysfunctional health system, extremely poor average health status –Short supply of doctors and health facilities, especially outside urban conglomerations –Significant variations in access to care, with a large proportion of the population lacking easy access A-High quality care, good average health status –Overwhelming majority of the population has access to a high standard care –Health system is well balanced between primary, secondary and tertiary care B- Good quality care, good average health status –Overwhelming majority of the population has access to good care, although services are stretched –Healthcare expenditure is high, but insufficient to be close to meeting demand C- Mixed quality of care, mixed average health status –Most of the population has access to some form of care, although the quality of that care is mixed –Services often very stretched and a lack of doctors and facilities, particularly in rural areas D-Struggling health service, poor average health status –Lack of doctors and health facilities –Significant variations in access to healthcare E-Dysfunctional health system, extremely poor average health status –Short supply of doctors and health facilities, especially outside urban conglomerations –Significant variations in access to care, with a large proportion of the population lacking easy access Healthcare System Quality Rating (2005) E A A A A B B B B C C C C D D E Grade

11 Ministry of Health Capacity Development Program SR44.4 billion (~$12 billion) spending on healthcare and social services, up 13% relative to 2007 79 hospitals under construction 8 new hospitals 250 primary care centers to be developed SR44.4 billion (~$12 billion) spending on healthcare and social services, up 13% relative to 2007 79 hospitals under construction 8 new hospitals 250 primary care centers to be developed

12 Best-in-Class / Desired Health System Position Saudi Arabia Level 4: Market-Driven Health System Near-absence of public sector healthcare Government role limited to ensuring oversight, with limited subsidies Comprehensive regulations to ensure fair play Level 1: Govt-Sponsored Health System Widespread private sector healthcare delivery options Public sector provisioning limited to selected patients (e.g. the poor / military) Increasing healthcare regulations Emerging private sector involvement in healthcare and increasing private insurance Decreasing burden on govt due to private insurance Mounting pressures for establishing a comprehensive regulatory framework Predominance of public sector activities– Command and Control model Private sector involvement limited to few care providers Level 3: Intermediate Health System Level 2: Emerging Health System Service Funding Service Funding Patient Healthcare Delivery Regulation Patient Healthcare Delivery Service Funding Regulation Patient Service Funding Healthcare Delivery Regulation Patient Healthcare Delivery Service Funding Regulation Degree of Government Ownership Degree of Private Sector Ownership Increasing Private Sector Participation

13 Share of Healthcare Delivery – Number of Beds Comparison (Selected Saudi Cities)(2005) Illustrative Jeddah Region Riyadh Region 10% 90% 24% 76% 40% 60% Southern Region Eastern Region 30% 70% Observations In Jeddah, private sector participation is considerably more advanced than elsewhere in the Kingdom The health provider system in Jeddah is perceived as being better than other parts of the Kingdom – some patients travel to Jeddah seeking quality care On the other hand, several regions such as in the South remain lacking in terms of private sector presence In Jeddah, private sector participation is considerably more advanced than elsewhere in the Kingdom The health provider system in Jeddah is perceived as being better than other parts of the Kingdom – some patients travel to Jeddah seeking quality care On the other hand, several regions such as in the South remain lacking in terms of private sector presence Public Sector ParticipationPrivate Sector Participation Source: KSA Ministry of Economy & Planning, Central Department of Statistics, MoH Statistics

14 MoH Modernization Plan MOH Sector Modernization Plan Issue regulations to implement the plan Develop preventive and curative primary care activities to be provided by the MOH Establish General Organization for Hospitals, and transfer the hospital assets of MOH to this organization –the hospitals will continue to be Government owned Establish National Health Fund separate from MOH (under MOF), to fund directly healthcare services provided to patients Establish Regional Health Directorates (13), and allocate independent health budget from the Government to each of them Establish Regional Health Councils to ensure coordination of health activities on a regional basis Issue regulations to implement the plan Develop preventive and curative primary care activities to be provided by the MOH Establish General Organization for Hospitals, and transfer the hospital assets of MOH to this organization –the hospitals will continue to be Government owned Establish National Health Fund separate from MOH (under MOF), to fund directly healthcare services provided to patients Establish Regional Health Directorates (13), and allocate independent health budget from the Government to each of them Establish Regional Health Councils to ensure coordination of health activities on a regional basis Source: Balsam – Development of Saudi Healthcare System - 2006

15 Damaged roofSplit joints, and walls without skirtings Damaged and Defective FittingsChipped sanitaryware Defective roof perimeterOriginal fitted furniture Sanitaryware and floorDamaged and Missing Ceilings Existing defective furniture Existing poor furniture Damaged clinical wash hand basin Existing clinical wash basin Existing clinical wash hand basin Damaged toilet fittings Existing floor tiling to toilets Poor shower arrangement Existing clinical flooring Poor and missing clinical skirting Existing poor clinical skirtings Existing defective clinical flooring clinical floor tiling poor vinyl installation Existing poor clinical flooring Existing defective clinical flooring Temporary room signage Existing temporary door signage Existing departmental signage Existing departmental Existing suspended ceilings Missing and water stained tiles Incomplete theatre ceiling Existing clinical ceilings Typical damaged ceilings Missing and water stained tiles Damaged door leaves Defective light fittings Existing emergency lightingdefective light fittings Cracked lighting diffusersTypical internal corrosion within boiler plant Typical existing DX split condensing unit Defective AHU to Recreation Damaged chilled water pumps Replacement Air Handling UnitAir cooled chillers in poor condition Damaged existing roof fans Old style distribution board Trailing leads are trip hazards Fire Alarm panel – non compliant Poor, steep access ramp Locked fire exit to Female Surgery BUILDING: O.P.B LEVEL 0 LOCATION: ELECT. ROOM (NO.B5) PICTURE: EXPOSED SECURITY ACCESS CABLES. COMMENTS: IF NOT USE REMOVED OR ARRANGE PROPERLY. BUILDING: O.P.B LEVEL 0 LOCATION: LOW CURRENT ROOM NEAR ROYAL KITCHEN PICTURE: BOXES OF OLD OPB PLAN COMMENTS: IMPROPER USAGE/STORAGE OF MATERIALS. IT SHOULD BE PLACE OR STORE IN ENGINEERING DEPT. BUILDING: M-H LEVEL 0 LOCATION: INSIDE ELEC. ROOM NR. ELECT. RM. B24A PICTURE: TELEPHONE TERMINAL BOARD COMMENTS: TELEPHONE TERMINAL BOARD IS NOT PROPERLY ORGANIZED. BUILDING: MH LEVEL 2 LOCATION: OPERATING RM. 10 PICTURE: STORAGE AREA FOR SURGICAL SUPPLIES COMMENTS: WHAT A WASTE OF BLDG. ORs THAT COST AROUND 2.5 TO 4M S.R. AND USED FOR STORAGE! BUILDING: MH LEVEL 2 LOCATION: OPERATING RM. 16 PICTURE: STORAGE AREA FOR SURGICAL EQUIPMENT COMMENTS: TYPICAL HANDLING OF MEDICAL EQUIPMENT AND STORAGE?!

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20 Administrative Strategy policy Strategic Planning Committees Clinical Strategic Planning Credentialing Technology Advisory Committee Assessment, Priorities Capital Budget Requests Capital Budget Committee ( Approval process, cash flow, financing targets) Evaluation, Selection, and Preparation Logistic & Material Managements (Negotiation and acquisitions) Technology/Devices Management (site preparation, support, education, service and utilization) Strategy Tactics Principles and Practices of medical technology managements

21 Hospitals are the most complex of building types. Each hospital has a wide range of services and functional units: clinical laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; inpatient care or bed-related function.

22 Every owner wants a cost-effective building. But what does this mean? Is it the lowest first-cost structure that meets the program? Is it the building with the longest life span? Is it the facility in which users are most productive? Is it the design with the lowest operating and maintenance costs? Is it the building that offers the greatest return on investment?

23 Differs from almost all other types of buildings. The biological flora that are endemic to all health premises pose a risk to both patients and staff.

24 Goals: Running a hospital building over the course of its useful life. To achieve the intent of the original building design team. To achieve long-term goals of economy, energy efficiency, resource conservation, & pollution prevention, while meeting the comfort, health, and safety requirements of Patients, Staff and Visitors.

25 If we Cannot Measure it we Cannot Manage it The development of meaningful measurement criteria: Key Performance Indicators (KPIs) is a vital step in establishing & improving quality

26 Environment where Standards and Quality are in alignment. To meet the Goals and Objectives of the Healthcare Organizations mission.

27 Contextual Codifiable, explicit Easily transferable Insight, creates meaning, judgmental, actionable Human, tacit, transfer requires learning Data Information Knowledge Wisdom

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29 George Annas NEJM 354;19:2063-2066 Patient involvement: …they cannot and should not be responsible for their own safety in an environment over which they have no control.

30 Flat roof being recoveredSheet vinyl to Ward areas Cantilever type fitted furniturePanel mounted clinical wash hand basin Flat roof with gravel blast Typical fitted furniture New domestic wc and cisternCorridor suspended ceilings Proposed fitted clinical furniture Appropriate clinical basin and mixer tap Appropriate clinical toilet arrangement Appropriate slip resistant vinyl flooring Appropriate room signage Appropriate slip resistant vinyl flooring washable clinical ceiling Appropriate circulation ceilings Appropriate laminated doorsets Appropriate Pump assembly Appropriate type fan fittings New air cooled liquid chillers Proposed new split DX units Appropriate boiler plant installation Typical new distribution board Additional wall outlets Compliant Fire Alarm panel New Designed steam boiler

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32 Accreditation and Quality Control Regulations for Private Investment High-level Blueprint for Healthcare System Healthcare Funding / Health Insurance Healthcare Funding / Health Insurance Compensation of Providers Competition, and Pricing Regulations Governmental Control and Oversight Rules for and Protection of Private Investments Rules for and Protection of Foreign Investments and Property Legislative Authority Supervision and Consultation Antitrust Laws and Regulations Pricing Regulations Regulations on Choice of Professional Activity Provider Institutions Pharmaceutical s Medical Products Sources of Funding Requirements for Insurance Coverage Tasks and obligations of Insurers Sources of Funds Rules for Compensation Source: Booz Allen analysis

33 Government-Driven Health-Related Initiatives Cooperative Health Insurance Act Regulates the provision of healthcare for non-Saudi residents in the Kingdom Determines the rights and duties of sponsors, beneficiaries, insurers and providers Regulates the provision of healthcare for non-Saudi residents in the Kingdom Determines the rights and duties of sponsors, beneficiaries, insurers and providers Saudi Food and Drug Administration Responsibility for regulating activities related to the safety of food and drug for man and animal, and the safety of biological and chemical substance, as well as medical devices Nat. Center for Health Insurance Standards Establish national standards, unify health industry processes, and play an advocacy and educational (training) role in developing an advanced healthcare delivery system Saudi Council for Health Specialties Develop the professional practice, promote technical skills, enrich scientific thought, and promote practical applications related to health specialties Private Health Institutions Legislation Set rules and guidelines that govern the set up and operation of private health institutions, including infrastructure, human resources, medical services, etc. Makkah Region Quality Program Establish quality standards for public and private sector hospitals and other care delivery institutions – activities limited to Makkah region Source: Booz Allen analysis

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36 Standards Auditing Quality System Accreditation

37 Quality System Standards Auditing

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