contextual codifiable, explicit easily transferable insight, creates meaning, judgmental, actionable...
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Contextual
Codifiable, explicitEasily transferable
Insight, creates meaning, judgmental, actionable
Human, tacit, transfer requires learning
Data
Information
Knowledge
Wisdom
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.
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.
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 Kingdom’s 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 Ministry’s 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
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%
23
30
2005 2016
364
502
2005 2016
High-level projections based on extrapolation of current indicators
High-level projections based on extrapolation of current indicators
70
51
2005 2016
4054
2005 2016
4054
2005 2016
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%
Examples of Health System Future Pressure Points Partial ListPartial List
Average Body Mass Index (BMI) of Saudi nationals, 15 years and above, is about 30 kg/m2 – 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
Obesity & Cardio-vascular Diseases
Smoking / CancerSmoking / Cancer
Type I and II DiabetesType I and II Diabetes
Blood-borne IllnessesBlood-borne Illnesses
Aging Population
Aging Population
Evolving Patient ExpectationsEvolving Patient Expectations
Life
styl
e Fa
ctor
sO
ther
Ch
roni
c D
isea
ses
Oth
er F
acto
rs
Source: MoH press releases, literature search
Basis of RatingsBasis 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)
96
94
92
91
82
79
76
76
72
70
68
63
59
52
45
32
0 10 20 30 40 50 60 70 80 90 100
France
Netherlands
Germany
Switzerland
UAE
Qatar
Bahrain
Kuwait
Saudi Arabia
Lebanon
Jordan
Oman
Tunisia
Egypt
Morocco
YemenE
A
A
A
A
B
B
B
B
C
C
C
C
D
D
E
Grade
Ministry of Health Capacity Development ProgramMinistry 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
Best-in-Class / Desired Health System PositionSaudi 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:“Gov’t-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 gov’t 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 FundingService Funding
Patient HealthcareDelivery
Regulation
PatientHealthcareDelivery
Service Funding Regulation
Patient
Service Funding
HealthcareDelivery
Regulation
PatientHealthcareDelivery
Service Funding Regulation
Degree of Government Ownership
Degree of Private Sector Ownership Increasing Private Sector ParticipationIncreasing Private Sector Participation
Share of Healthcare Delivery – Number of Beds Comparison (Selected Saudi Cities)(2005)
Illustra
tive
Illustra
tive
JeddahRegion
RiyadhRegion
10%
90%
24%
76%
40%
60%
SouthernRegion
EasternRegion
30%
70%
Observations 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 Participation Private Sector Participation
Source: KSA Ministry of Economy & Planning, Central Department of Statistics, MoH Statistics
MoH Modernization Plan
MOH Sector 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
Damaged roof Split joints, and walls without skirtings
Damaged and Defective Fittings Chipped sanitaryware
Defective roof perimeter Original fitted furniture
Sanitaryware and floor Damaged and Missing Ceilings
Existing defective furniture
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
Existing defective clinical flooring
clinical floor tiling
poor vinyl installation
Existing poor clinical flooring
Existing defective clinical flooring
Temporary room signage
Temporary room signage
Existing temporary door 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
Damaged door leaves
Defective light fittings
Existing emergency lighting defective 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 0LOCATION: LOW CURRENT ROOM NEAR ROYAL KITCHEN PICTURE: BOXES OF OLD OPB PLANCOMMENTS: IMPROPER USAGE/STORAGE OF MATERIALS. IT SHOULD BE PLACE OR STORE IN ENGINEERING DEPT.
BUILDING: M-H LEVEL 0LOCATION: INSIDE ELEC. ROOM NR. ELECT. RM. B24APICTURE: TELEPHONE TERMINAL BOARD COMMENTS: TELEPHONE TERMINAL BOARD IS NOT PROPERLY ORGANIZED.
BUILDING: MH LEVEL 2LOCATION: OPERATING RM. 10PICTURE: STORAGE AREA FOR SURGICAL SUPPLIESCOMMENTS: WHAT A WASTE OF BLDG. OR’s THAT COST AROUND 2.5 TO 4M S.R. AND USED FOR STORAGE!
BUILDING: MH LEVEL 2LOCATION: OPERATING RM. 16PICTURE: STORAGE AREA FOR SURGICAL EQUIPMENTCOMMENTS: TYPICAL HANDLING OF MEDICAL EQUIPMENT AND STORAGE?!
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.
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?
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.
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.
If we “Cannot Measure it”
we “Cannot Manage it”
The development of meaningful measurement criteria:Key Performance Indicators (KPI’s) is a vital step in establishing & improving quality
Environment where Standards and Quality are in alignment.
To meet the Goals and Objectives of the Healthcare Organizations mission.
Contextual
Codifiable, explicitEasily transferable
Insight, creates meaning, judgmental, actionable
Human, tacit, transfer requires learning
Data
Information
Knowledge
Wisdom
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.
Flat roof being recovered Sheet vinyl to Ward areas
Cantilever type fitted furniture Panel mounted clinical wash hand basin
Flat roof with gravel blast Typical fitted furniture
New domestic wc and cistern Corridor suspended ceilingsProposed fitted clinical furniture
Appropriate clinical basin and mixer tap
Appropriate clinical toilet arrangement
Appropriate slip resistant vinyl flooring
Appropriate slip resistant vinyl flooring
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 boardAdditional wall outlets
Compliant Fire Alarm panelNew Designed steam boiler
Accreditation and Quality ControlAccreditation and Quality Control
Regulations for Private InvestmentRegulations for Private Investment
High-level Blueprint for Healthcare System
Healthcare Funding / Health Insurance
Healthcare Funding / Health Insurance
Compensation of ProvidersCompensation of Providers
Competition, and Pricing RegulationsCompetition, and Pricing Regulations
Governmental Control and OversightGovernmental 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
- Pharmaceuticals
- Medical Products
- Sources of Funding
- Requirements for Insurance Coverage
- Tasks and obligations of Insurers
- Sources of Funds
- Rules for Compensation
Source: Booz Allen analysis
Government-Driven Health-Related Initiatives
Cooperative Health Insurance ActCooperative 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
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
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
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
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 SpecialtiesSaudi Council for Health Specialties
Develop the professional practice, promote technical skills, enrich scientific thought, and promote practical applications related to health specialties
Develop the professional practice, promote technical skills, enrich scientific thought, and promote practical applications related to health specialties
Private Health Institutions Legislation
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.
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 ProgramMakkah Region Quality Program
Establish quality standards for public and private sector hospitals and other care delivery institutions – activities limited to Makkah region
Establish quality standards for public and private sector hospitals and other care delivery institutions – activities limited to Makkah region
Source: Booz Allen analysis
Standards
Auditing
Quality System
Accreditation
Quality System
Standards
Auditing