middle east hospital august 2014 issue
DESCRIPTION
In this issue we look at the growing problem of childhhood Obesity, in the Middle East, resulting in a “double burnden” for the region’s healthcare services. And how the World Health Organisation is attempting to tackle these issues through population-based strategies. Markus Braun of the German Healthcare Export Group speaks to MEH about the success of the group in creating effective partner-ships over 20 years of export net-working. We also interview Ashraf Ismail, Director of the Middle East office of JCI, the leading interna-tional accreditation body that is successfully working to drive up standards in healthcare and patient safety across the region. Also featured is Sidhil, UK manufacturers of the Innov8 hospital bed range; the latest Low model mak-ing a big splash at Arab Health this year, and winning an MEH award. Also profiled is leading Saudi obs-gyne specialist hospital Abdulrah-man Al MisharyTRANSCRIPT
Editor: Guy Rowland
Publisher: Mike Tanousis
Associate Publisher: Chris Silk
MEH Publishing LimitedCompany Number 7059215151 Church RdShoeburynessEssex SS3 9EZUnited KingdomTel: +44 01702 296776Mobile: +44 0776 1202468Skype: mike.tanousis1
Editor: Guy RowlandTel: +44 01223 241307 Mobile : +44 07909 [email protected] Editor: Emrys Baird Tel +44 07961391055 [email protected]
Regional DirectorAbdullah Al ThariArmada Network – HealthcareServices, OlayaMosa Bin Nosair RoadRiyadh. Saudi ArabiaTel : +966 595 99 22 [email protected]
Abu Dhabi & Bahrain office
Ms. Pam PageDirect Phone: +971 4 329 1099UAE Mobile: + 971 50 424 0569USA Mobile: +617 943 [email protected]
UAE distributor
Dr Prem Jagyasi MD & CEOExHealth, P. O. Box. 505131Dubai HealthCare City, UAETel:+971 4 437 0170 [email protected] www.ExHealth.com
MEH agent for Egypt
Dr.Amr SalahMillennium International [email protected]: +2 0222736354Mobile: +2 0122227209
For more information about themagazine contact the publisher oreditor. Or email MEH at:[email protected]
A 201 | 3
4. German Healthcare Export Group
The Medical Technology Network
Exclusive interview with GHEG Chairman, and
senior MEIKO executive Markus Braun
12. Sidhil - British Quality Healthcare for the Middle
East Designer and manufacturer of The
Independence Innov8 Low bed
16. Cover feature - Childhood Obesity in the Middle
East How to address the growing problem of
combined mal nutrition and obesity in the region
20. Joint Commission International:
Ensuring quality and safety through
international accreditation and certification
with Al Ain Hospital, Dubai, case study
26. Abdulrahman Al Mishari Hospital
Award winning Riyadh hospital specialising in
women’s healthcare
30.
eview and MEH photo gallery
38. Cerner Middle East:
Providing information management systems
Interview with Managing Director Greg White
44. Specialist article - Putting patient’s first: the little
BIG things in patient care
By Praveen Pillai
48. Freedom From Torture
Medical foundation for the care of victims of torture
Editor’s intro
In this issue we look at the
growing problem of childhhood
obesity, and the accompaying
issue of malnutri-tion increasingly
common in the Middle East,
resulting in a “double burnden” for
the region’s healthcare services.
And how the World Health
Organisation is attempting to
tackle these issues through
population-based strategies.
Markus Braun of the German
Healthcare Export Group speaks
to MEH about the success of the
group in creating effective
partner-ships over 20 years of
export net-working. We also
interview Ashraf Ismail, Director
of the Middle East office of JCI,
the leading interna-tional
accreditation body that is suc-
cessfully working to drive up
standards in healthcare and
patient safety across the region.
Also featured is Sidhil, UK manu-
facturers of the Innov8 hospital
bed range; the latest Low model
mak-ing a big splash at Arab
Health this year, and winning an
MEH award. Also profiled is
leading Saudi obs-gyne specialist
hospital Abdulrah-man Al Mishari,
also winners of an MEH health
and innovation award.
German Healthcare Export Group
Middle East Hospital
| 4
In the wake of a successful Arab
Health for German companies
MEH interviews the Chairman of
the German Healthcare Export
Group, Markus Braun.
In the German Healthcare Export
Group (GHE) approx. 50 innovative
and strongly growing companies
from the area of medical technology
have come together to encourage
an exchange of their experiences in
export business. Just as important
as the exchange of information and
experiences between members,
are also the GHE’s excellent con-
tacts with ministries and institutions
such as the Germany Trade and In-
vest.
Mr Braun told MEH, “The GHE of-
fers its members a pool of know-
how from which everyone benefits.
“Proven Partnership” is our motto,
and we demonstrate this not only
during the regular meetings of the
GHE, but also in our day to day
work.”
The GHE represents almost the en-
tire medical technology product
range: Whether stethoscopes, CT
equipment or hospital IT, suppliers
from all product segments are rep-
resented in the GHE. But potential
customers from abroad in particular
sometimes find it easier to have
one single contact for all their ques-
tions. This is what the GHE offers
them by channelling their enquiries
and passing them on to the right
person.
The GHE counts members of all
sizes, from global players like
Siemens Healthcare, B. Braun and
Dräeger Medical to medium-scale
enterprises like Meiko, Tunstall or
seca. The more different the sizes
of enterprises, the more varied the
product range: The greater part of
the GHE companies are active in
electrical and medical technology,
followed by those dealing with and
manufacturing medical commodi-
ties and expendable items, physio-
therapy, orthopaedics, laboratory
processing, services and publica-
tions.
Besides, areas like rescue equip-
ment, medicine for emergency pur-
poses, diagnostic products, IT and
communication technology are also
represented in the GHE. Overall,
the German Healthcare Export
Group represents about 80 per cent
of the German export volume in
medical technology.
Mr Braun explained, “Over the
years, the GHE has become a busi-
ness network that promotes direct
communication between the mem-
bers of the GHE. Meetings dealing
with present thematic priorities and
specific country issues take place
three times a year, serving primarily
as experience exchange. There,
member firms can openly discuss
questions of distribution, foreign
markets and other export topics.
Moreover, commercial and scien-
tific experts give lectures on the
chosen topic. The GHE celebrated
its 20-year existence at the MED-
ICA 2011 on 3 consecutive
evenings with invited guests.”
20 years GHE – 20 years of ex-
port networking
The German Healthcare Export
Group (GHE) places great impor-
tance on personal contact with its
member companies and on ex-
changing knowledge and experi-
ences within the Group. In other
words, GHE means networking at
its best. A look at GHE’s history re-
veals how it created this extensive
network of contacts from scratch
over a period of just 20 years.
Mr Braun said, “We bring cus-
tomers and our members together.
We provide information to hospitals
in terms of how to optimise their
processes, build long term relation-
Markus Braun, GHEG Chairman
The Medical Technology Network
Middle East Hospital
| 5
ships with healthcare providers,
and arrange for them to speak to
people in the industry who can help
them with their requirements.
TheMiddle East, USA and Europe
are the most important markets,
and we also work in China and the
rest of Asia, and South America,
that are all now very important de-
veloping markets.”
Strategic focus – The Near and
Middle East
Initially, the Group’s focus was on
individual geographical regions
only. “Because of the war in Iraq,
GHE originally limited its area of in-
terest to the Near- and Middle East.
This, however, changed quite
quickly”, said Witzke. The meetings
held in order to exchange informa-
tion soon started to include areas
like the Far East, Eastern Europe
and South America. However, with
all of these meetings, the practical
benefits they would create for mem-
ber companies always stood in the
foreground.
“Most of us where fully aware of the
value of this exchange of informa-
tion from our everyday jobs.”, em-
phasised Wolfgang Hünlich,
formerly employed by Heraeus and
now working for Thermo Electron
Corporation. Although, initially, the
project did not involve any formal
organisational procedures, these
started to materialise quite quickly
as time went on and led to the print-
ing of stationary, the organisation of
meetings and delegation of respon-
sibilities.
History of the GHE
The GHE was founded in 1991
under the name “German Commu-
nity of Interest for the Export of
Pharmaceutical, Laboratory, Dental
and Medical Technology”
(Deutsche Export-Interessenge-
meinschaft Pharma, Labor, Dental
und Medizintechnik).
At that time - which coincided with
the Second Gulf War – information
coming from the Near East was ex-
tremely sparse, and it was this very
circumstance that that inspired
Heinz-Jürgen Witzke (Beta Verlag)
Middle East Hospital
| 6
German Healthcare Export Group
and Udo Pawelka (then “Sartorius
AG”) to organise a group of compa-
nies that would focus exclusively on
international exports.
The Group finally changed its name
to “German Healthcare Export
Group” in 1992. This was also the
year that its members elected a
board of directors and an advisory
board, chaired by Wolfgang Hün-
lich. “We wanted to prevent any po-
tential impasses and thus agreed
on five board directors“, explained
Stefan Ohletz, who took over as
chairman from Wolfgang Hünlich in
1995.
The, initially, rather casual meetings
held by the Group became a lot
more professional and the range of
subjects under discussion was ex-
panded to global export. These
days, the Group meets three times
a year to discuss current export is-
sues and to offer its members and
high-profile experts the opportunity
to share their experiences of vari-
ous export markets. However, even
the venues used for the Group’s
meetings have changed. Whereas,
initially, they were often held in ho-
tels, the decision was soon taken to
hold them on the premises of their
member companies – thus also en-
abling member companies to get to
know each other better.
Later on, regular meetings were
also often held in various ministerial
offices, including the Berlin offices
of the Department of Trade and In-
dustry, the German Office for For-
eign Trade (bfai) in Cologne and the
Bonn offices of the Ministry of
Health.
In addition to the regular meetings,
members would also help one an-
other in selecting representatives in
certain regions and share their per-
sonal experiences of various export
markets on a one-to-one basis. This
illustrates the fact that the GHE has
now developed into a network of
businesses that is based solely on
direct communication between
member companies.
Trade fairs and Arab Health 2012
Since its foundation, the GHE has
been present at important national
and international trade fairs. For
years, the GHE has been occupy-
ing a large joint stand and adjacent
lounge at MEDICA. Moreover, the
GHE has been appearing at the
Arab Health in Dubai since its es-
tablishment. Visits of delegations to
maintain existing contacts or to
Middle East Hospital
| 8
build up new ones in the pro-
gramme are very common. The last
delegation trip took place in Cairo in
the autumn of 2010.
The GHE always intended to partic-
ipate in medical technology trade
fairs and exhibitions right from the
very start of its conception. “Our
first joint appearance at a medical
trade fair in Hanover was only the
first of a continuous string of GHE
appearances at the most important
of the leading healthcare sector
trade fairs.“, explained Markus
Braun.
For about 20 years, GHE has been
occupying a large joint stand and
adjacent lounge at the MEDICA in
Düsseldorf and has also been mak-
ing an appearance at the ARAB
HEALTH in Dubai for several years
running. Another important trade
fair for GHE members is ChinaMed
in Beijing.
“This year’s Arab Health was a
complete success”, Mr Braun said.
“While the past two years were
somewhat marked by caution due
to the political situation in the entire
Arab area, this year a general up-
lifting spirit also had a positive im-
pact on Arab Health.
”All of the participating GHE mem-
bers were pleased to see a larger
number of visitors and a consider-
ably increased interest in German
medical technology products. Proj-
ects are ramping up again, which
ultimately stands to benefit the en-
tire German medical technology in-
dustry.”
The new booth concept of the GHE
joint booth also received an espe-
cially positive response. Not just the
German Healthcare Export Group
(GHE) e.V. member companies but
also the numerous guests were ex-
cited about the 390 sqm GHE
booth. The booths, separated by
gauze curtains for the first time and
underscored by the new lighting,
emphasized the common goal of
the GHE member companies in a
very special way: offering top qual-
ity and innovative medical technol-
ogy – made in Germany – for use
in hospitals and medical facilities
throughout the world.
German Healthcare Export Group
New clinic open at 150 Harley Street, LondonNew clinic open at 150 Harley Street, London
www.snorecentre.com
April2012_Sept2011 14/04/2012 00:16 Page 9
Middle East Hospital
| 10
GHE opened offices in Bonn and
Berlin as a result of the increasing
interest and number of enquiries
from both Germany and abroad.
With these offices, GHE is offering
its international partners single
points of contact that act as inter-
mediaries between individual mem-
bers.
Today, half of the GHE companies
are active in the electronics and
medical technology sector, closely
followed by those dealing with and
manufacturing medical commodi-
ties and consumables, physiother-
apy and orthopaedic technology,
operating theatre equipment and
medical furniture.
However, GHE’s members are also
active in the laboratory technology,
medical services and publishing
sectors. Those working in the res-
cue equipment and emergency
medicine sectors, as well as diag-
nostic, information and communica-
tion technology, complete its list of
member companies.
Being one of the driving forces be-
hind innovative technologies, the
German medical technology sector
not only secures and creates jobs,
but also provides young people with
opportunities for specialised train-
ing. It is one of the largest sub-seg-
ments of the German economy,
internationally competitive and an
industry of the future.
With an export turnover of nearly 9
billion euros, GHE’s member com-
panies play no small part in this
segment’s importance. GHE mem-
ber companies’ contribution to this
German Healthcare Export Group
segment primarily relates to export
and, with a joint export turnover of
nearly 10.5 billion euros, they make
up nearly 80 percent of German
medical technology segment ex-
ports. Mr Braun adds, “The health-
care sector will most certainly
continue to be a growth market for
the foreseeable future – both na-
tionally and internationally. Its fur-
ther development will not only be
influenced by population growth
and demographic developments,
but also by the rapid advances cur-
rently made in medical technology.
The GHE Group has dedicated it-
self to contributing to increasing the
effectiveness and efficiency of med-
ical technology in order to improve
the quality of health care across the
world.”www.gheg.de
The Medical Technology Network
Markus Braun biography
Chairman,BHEG
Markus Braun was born on 1st July 1959
in Stuttgart. After successfully completing
his degree in engineering, he started his
career as a product manager in the optical
industry. He successfully entered the laser
industry business and soon became sales
director South Germany of an international
company. Then he sought new challenges:
At a German producer of fiberopitcs and
electronics he extended his experiences in
Germany, Switzerland and France. After-
wards, he successfully ran a German bu-
reau of a worldwide operating company in
the field of measurement instrumentation.
Since 1998 he has been controlling the
business division “Cleaning and disinfec-
tion techonogly” at MEIKO Maschinenbau
GmbH & Co. KG. In 2004, Braun was ap-
pointed member of the board of trustees of
the Oskar and Rosel Meier foundation, the
owners of MEIKO. Braun has been a mem-
ber of the GHE since 2000. He was elected
chairman in 2003.
| 11
Middle East Hospital
Middle East Hospital
Sidhil - British Quality Healthcare for the Middle East
| 12
With quality, performance and safety
of vital consideration for healthcare
providers in the Middle East, UK hos-
pital bed manufacturer Sidhil re-
cently had the opportunity to
showcase some of their latest prod-
ucts exhibiting these qualities at
Arab Health in Dubai.
Of particular interest to visitors to
the stand was the company’s flag-
ship ward bed, the Independence
Innov8 Low. Introduced in 2011, the
bed is already proving popular with
NHS buyers in the UK, with recent
orders this year including a total of
1100 units for hospital trusts in
Bradford and Northumbria.
The success of the bed was of in-
terest too to Lord Darzi, the United
Kingdom’s Global Ambassador for
Health and Life Sciences, Chair of
NHS Global and United Kingdom
Business Ambassador, who took
the opportunity to stop by Sidhil’s
stand at Arab Health to hear about
the company’s current export drive.
Spearheading the export drive is
Paul Hampton, Sidhil’s Export
Sales Manager, A qualified engi-
neer with a BSc in Design & Manu-
facture, he has worked in
healthcare sales in the Middle East
for many years and has an in-depth
understanding of the specific re-
quirements of the market. “Sidhil’s
products are very competitive with
global suppliers in terms of both
price and functionality,” stated Paul.
“In support of this, we are currently
investing in our distributor network
to provide professional support
services for our customers in the
Middle East.”
The true advantages of the new
Sidhil Independence Innov8 Low
are clearly evident. The bed was
designed to provide total flexibility
in terms of bed specification for ap-
plications from utility ward beds
through to high dependency envi-
ronments, and features a minimum
Lord Darzi and Clive Siddall
The Independence Innov8 Low Bed
Middle East Hospital
platform height of just 218mm – one
of the lowest available on the mar-
ket today.
Electrically operated functions in-
clude auto contouring, giving simul-
taneous adjustment of backrest and
kneebreak, with cardiac chair func-
tion and auto regression avoiding
surface pinching or occupant slid-
ing, as well as Trendelenberg and
reverse Trendelenberg positioning.
Solid platform panels incorporate
ridges for breathability, to simplify
decontamination and to improve in-
fection control.
The Innov8 Low is supplied com-
plete with removable cantilever
style siderails, and features manual
CPR handles on both sides with an
electrical CPR function to flatten the
platform whilst the bed is lowering.
Independence Innov8 beds are re-
liable and easy to maintain, incor-
porating superb ergonomics in
terms of both manual handling and
user comfort. They conform with
WEEE regulations and are CE
marked to Medical Devices Directives.
In addition, Sidhil’s Doherty range
of plinths and couches are already
widely accepted throughout the
Middle East, selling into Oman,
Qatar and Saudi Arabia during
201 , including 150 units to equip
treatment rooms for the Arab
Games in Doha.
Beds, couches and plinths are pro-
duced in the UK at Sidhil’s purpose-
built factory premises, where the
company operates with the very lat-
| 13
Middle East Hospital
| 14
Sidhil - British Quality Healthcare for the Middle East
est high technology manufacturing
and finishing processes, maintain-
ing a constant watching brief on
changes in legislation and nursing
techniques to keep the product
range at the forefront of technology.
Established in 1888, Sidhil has built
up an enviable reputation for per-
formance and quality based on total
commitment to the developing re-
quirements of the healthcare mar-
ket. Today, Sidhil designs,
manufactures and supplies a com-
prehensive selection of products,
popular with both the NHS and pri-
vate healthcare markets in the UK
and now increasingly achieving ac-
ceptance across Europe and world-
wide, with significant sales into the
Middle Eastern countries.Clive Siddall and Paul Hampton receive an MEH Health and Innovation award for Sidhil’sIndependence Innov8 Low hospital bed from Mike Tanousis, MEH Publisher, at Arab Health
April2012_Sept2011 14/04/2012 00:16 Page 15
Special Feature: Childhood Obesity in the Middle East
Overweight and obesity now ranks
as the fifth leading global risk for
mortality. In addition, 44% of the di-
abetes burden, 23% of the is-
chaemic heart disease burden and
between 7% and 41% of certain
cancer burdens are attributable to
overweight and obesity. Obesity
has negative health impacts in
childhood, as well as in the long
term. In addition to a higher risk of
obesity and NCDs later in life, af-
fected children experience adverse
outcomes such as breathing diffi-
culties, increased risk of fractures,
hypertension, early markers of car-
diovascular disease, insulin resist-
ance and psychological effects.
The rise in childhood obesity over
the past decade has been dramatic.
It is estimated that in 2010, 43 mil-
lion children under the age of 5
years will be overweight. Although
current estimates suggest that the
rate of obesity in developed coun-
tries is double that in developing
countries, in terms of absolute num-
bers, prevalence is much higher in
developing countries. There are an
estimated 35 million overweight or
obese children in developing coun-
tries, compared with 8 million in de-
veloped countries.
The World Health Organisation pre-
dicts that by 2015 more than 700
million adults will be classified as
obese. At the same time, more than
a billion people are going hungry.
Tackling Childhood Obesity in
the Middle East
The government, food industry and
the public need to help fight the
growing problem of obesity in the
UAE, nutrition experts at the Global
Alliance for Improved Nutrition
(Gain) have argued. The experts
said there is a "double burden" of
malnutrition in the Middle East: obe-
sity concurrent with undernutrition
.
Mohamed Mansour, Gain's regional
manager, said: "The problem can
only be addressed by partnerships
with governments, organisations,
civil society and the private sector."
He said "micronutrient deficiencies"
— where a person is deficient in
particular vitamin or mineral — are
particularly common in the region
and need to be tackled. Participants
at the forum said the UAE Govern-
ment, the food industry, civil society
and the public must all play a role
in finding solution to the nation's
obesity problem.
In 2010 a government report re-
vealed that 35 per cent of children
in the UAE aged between six and
22 months are anaemic, while 41
per cent of Emirati women in the
country have folic acid deficiency
and 35 per cent of Emirati women
are classified as obese. One solu-
tion, according to Gain, could be to
produce healthier foods, through
fortification of staple items, such as
flour and oil, with vitamins and mi-
cronutrients including iron, folic acid
and zinc.
Gain's chairman, Jay Naidoo, said
people can be obese and malnour-
ished. While there is no outright
hunger in the UAE, there is a "hid-
den hunger", with some people not
getting the right nutrients. Mr
Naidoo described Gain, an alliance
established in 2002 and aimed at
reducing global malnutrition, as a
catalyst which works with local part-
ners in countries around the world,
both in the public and private sec-
tors. "We would like to work with the
UAE in understanding how to tackle
the challenge that they face on obe-
sity," he said. "It's phenomenal to
Middle East Hospital
| 16
see that the Government here has
taken the lead on the matter."
The private sector is also a huge
part of the solution, according to Mr
Naidoo, who added there were al-
ready some companies in the local
food industry that are "committed"
to the cause. Saleh Lootah, the
managing director of Al Islami
Foods and a speaker at the forum,
said the local food industry, along
with the Government, has started
addressing the problem of obesity
and unhealthy eating habits. "It re-
ally is a big issue we all have to
work together on, not only the fam-
ilies, not just the Government, but
everyone," he said. "It's important to
think about how we can take care
of what a child is eating from day
one."
Mr Lootah said that halal food,
which his company produces, does
not only mean that it has been pre-
pared according to Islamic tradition.
"It is not halal to sell something to a
child that may harm him in the fu-
ture," he said. "The food industry
has to take more responsibility." Ac-
cording to Martin Bloem, the chief
of nutrition and HIV/AIDS policy at
the World Food Programme, there
is only a small window of opportu-
nity to ensure that children are pro-
vided with the right nutrients. He
said the first 1,000 days, from con-
ception to the age of two years, are
crucial. According to Mr Naidoo, ig-
noring the nutritional needs of preg-
nant women and children under two
can be linked to problems of obesity
later on, which can lead to prob-
lems such as cardiovascular dis-
ease and diabetes.
"Part of the problem of obesity later
in life is the problem of undernutri-
tion when you're young," he said. "If
we don't deal with it in that period
it'll be too late, the boat has left."
Folic acid, iron, zinc and vitamin A
are vital to ensuring a healthy preg-
Middle East Hospital
| 17
nancy, according to Mr Naidoo, who
also stressed the importance of
breast-feeding in the first six
months. "Dealing with the mother
and the child are at the centre of a
nutrition strategy," he said. "We
have to reach them and target them
as a priority."
Childhood obesity in the UAE
Obesity remains a major health
issue for individuals residing in the
UAE. A study conducted by Forbes
ranked the UAE number 18 on a list
of the world’s fattest countries, es-
timating 68.3% of its citizens to be
overweight; making this small coun-
try one of the top regions plagued
with high obesity rates. The wide-
spread prevalence of obesity in the
UAE is a major cause for concern
as the condition brings with it sev-
eral co-morbidities which affects in-
dividuals, healthcare professionals,
and government officials.
Examples of diseases related to
obesity include: Diabetes (UAE has
the second highest prevalence in
the world), Cardiovascular Disease
and Several Bone and Joint Disorders.
A recent study funded by the
Sheikh Saud Bin Saqr Al Qasimi
Foundation for Policy Research
found only 38 per cent of pupils in
Ras Al Khaimah thought obesity
was a problem in schools. More
than 60 per cent of parents and
teachers were concerned about
pupils' weight and 58 per cent said
it was a problem in their family - but
that message does not seem to be
trickling down to the young.
Kelly Stott, a doctoral student from
the Teachers College at Columbia
University in New York, conducted
the study last year. She interviewed
162 RAK pupils between the ages
of 9 and 18, most of them (102)
Emirati. Another 48 were Indian and
12 were other nationalities. Fifteen
teachers and 41 parents were also
polled. Of these, 42 per cent of par-
ents and 69 per cent of teachers la-
belled obesity a serious issue in the
community.
Aisha Alsiri, the director of nutrition
and school health section at the
Ministry of Education, said most
state-school pupils displayed the
same attitude towards obesity.
"They know the term means being
big," she said. "But they do not un-
derstand that it affects their health.
They don't know it could lead to dis-
eases like diabetes and heart de-
fects." The problem may lie in
school curriculums, Ms Stott said.
"I'm not sure students necessarily
understand the threat that obesity is
to their health as from what I under-
stand this is not being taught in
school," she said. "Perhaps imple-
menting formal curriculums in which
health education is added may help
students better understand the con-
sequences of obesity and its re-
lated diseases."
Ms Stott said her study aimed to
identify barriers to addressing the
issue of childhood obesity. Inappro-
priate nutrition in schools and
restaurants was one of the main
reasons for poor child health. She
said she noticed that Indian pupils
were more likely to bring home-
cooked meals than Emirati children.
Special Feature: Childhood Obesity in the Middle East
Middle East Hospital
| 18
Population-based obesity prevention strategies
Once children (and adults) are
obese, it is often difficult for
them to lose weight through
physical activity and healthy diet.
Preventing weight gain from an
early age, i.e. in childhood, is
therefore recognized as a strat-
egy that will reap health benefits
in the long term.
Experience in several countries has
shown that successful obesity pre-
vention and behaviour change dur-
ing childhood can be achieved
through a combination of popula-
tion-based measures, implemented
both at the national level and as
part of local ‘settings-based’ ap-
proaches, in particular, school and
community-based programmes.
Population-based prevention
strategies seek to change the social
norm by encouraging an increase in
healthy behaviours and a reduction
in health risk. They involve shifting
the responsibility of tackling health
risks from the individual to govern-
ments and health ministries,
thereby acknowledging the fact that
social and economic factors con-
tribute strongly to disease.
Population-based prevention
strategies for childhood obesity
thus seek to support and facilitate
increased physical activity and
healthier diets in the context of a
‘social-determinants-of-health’ ap-
proach. Accordingly, it is essential
that interventions for obesity pre-
vention occur across the whole
population, operating in a variety of
settings and at multiple levels of
government.
Although local intervention allows
action to be tailored to meet the
specific context and nature of a
problem, only national guidance
(and funding) can ensure effective-
ness and sustainability of action at
a population level.
The key elements of a population-
based approach to childhood obe-
sity prevention are policy support,
monitoring systems, knowledge
translation and a strategy for inte-
grating evidence into the develop-
ment of multi-level programmes.
Although the importance of obesity
prevention in childhood is now
widely acknowledged, to date inter-
ventions have tended to target only
small populations or population
subgroups, predominantly in devel-
oped countries. Although many of
these interventions have yielded
promising results, there has been
little coordinated action to identify
these and extend their reach to pre-
vent obesity at the population level.
Extract from Population-based Pre-
vention Strategies for Childhood
Obesity, WHO, 201
Middle East Hospital
| 19
Joint Commission International
International Accreditation and
Certification
JCI has been accrediting health
care organizations since 1999--
2009 marked the tenth anniversary
of the first hospital accredited by
JCI, Hospital Israelita Albert Ein-
stein, a private, non-profit, non-gov-
ernmental facility in Sao Paulo,
Brazil. Since then, approximately
470 public and private health care
organizations in 50 countries have
been accredited or certified by JCI.
JCI provides accreditation for hos-
pitals, ambulatory care facilities,
clinical laboratories, care contin-
uum services, home care and long
term care organizations, medical
transport organizations, and pri-
mary care services, as well as cer-
tification for 15 types of clinical care
programs. JCI standards were de-
veloped by international health care
experts and set uniform, achievable
expectations.
Interview with Dr. Ashraf Ismail,
Managing Director, Middle East
International Office
MEH: What is the role of JCI in the
Middle East?
Dr. Ashraf Ismail (AI): JCI’s Middle
East Regional office located in
Dubai is focused on improving the
processes associated with quality
and patient safety. Working on pa-
tient safety initiatives with Ministries
of Health, professional societies
and other significant stakeholders
within the region, we support our
clients with advisory services and
educational resources. We are
committed to safe, high-quality
health care and improved
processes that reduce risk and im-
prove health outcomes for organi-
zations worldwide. There are now
147 JCI accredited organisations in
the Arab world. These are mostly
hospitals, but also laboratories and
primary care centres. We have also
accredited our first medical trans-
port system in Qatar. 56 of these
accredited organisations are based
in the UAE, 43 in Saudi Arabia, and
39 in Turkey. In Qatar all public hos-
pitals are now JCI accredited.
MEH: What do hospitals need to do
in order to gain accreditation?
AI: To get accreditation organisa-
tions need to prepare and educate
themselves using JCI programmes.
We help healthcare providers with
a “baseline survey” to measure the
standard of their performance, and
provide JCR publications to teach
best practise in areas such as infec-
tion control and patient safety.
Our general approach includes ex-
pert assessment and comprehen-
sive gap analysis to pinpoint and
prioritize the changes needed to
achieve goals. We then partner with
hospital staff and leadership to de-
liver measurable results that lead to
lasting improvements. Our advisors
customize their approach to fit the
needs of the organisation.
Through JCI accreditation and cer-
tification, health care organizations
have access to a variety of re-
sources and services that connect
them with the international commu-
nity: an international quality meas-
urement system for benchmarking;
risk reduction strategies and best
practices; tactics to reduce adverse
events, and the annual Executive
Briefing Programs.
MEH: Do you advise organisations
who are building hospitals?
AI: We have created a programme
called “Safe, Healthy Design” which
helps hospital designers and
builders to build hospitals that will
comply with JCI standards, thus
streamlining the accreditation
Middle East Hospital
| 20
International Accreditation and Certification
process when the hospital is com-
pleted. This is very important in the
Middle East where there is a large
investment in healthcare and new
hospitals.
MEH: What are the drivers for hos-
pitals to undergo the accreditation
process?
AI: Medical tourism is one impor-
tant driver in the Middle East, as ac-
creditation makes hospitals more
attractive to patients, as it guaran-
tees a high standard of care. Insur-
ance companies are also more
likely to contract with JCI accredited
hospitals, and will even pay more in
order to obtain the better service,
shorter stays, and higher patient
satisfaction levels accreditation
brings.
A good example of this is in Jordan
where 11 hospitals are now JCI ac-
credited. This has played a big role
in Jordan becoming the top medical
tourism destination in the Middle
East, and the 5th placed destination
worldwide. Medical tourism brought
in $1.2 billion to Jordan in 2011.
Another key driver is government.
The UAE Ministry of Health (MoH)
has set a target for all hospitals in
the Emirates to be JCI accredited.
In Saudi Arabia the MoH is leading
the effort in achieving full accredita-
tion, building on the foundation of
the government’s own national ac-
creditation scheme.
Improving efficiency is also a key
driver towards accreditation. A JCI
accredited hospital will have put in
place measures to encourage a re-
Middle East Hospital
| 21
Joint Commission International
duction in waste, properly managed
length of patient stay, and cut out
mistakes and unnecessary proce-
dures. This also results in signifi-
cant cost savings for the hospital.
MEH: What challenges do you face
in spreading accreditation in the
Arab region?
AI: A major challenge in some
countries is that old and outdated
20th Century infrastructure is still in
place, which represents a barrier to
achieving accreditation. Govern-
ments must decide whether they
can afford to destroy and rebuild old
hospitals in order to enable the ac-
creditation.
Even if the buildings are adequate
the problem of a lack of resources
in countries with a low healthcare
spend can prevent the investment
needed being made. Post-conflict
countries such as Iraq and Libya
need to provide basic and essential
services before they can consider
such an investment.
There are also big human re-
sources challenges in the Middle
East, with the expansion of health-
care services far outstripping the
available medically qualified profes-
sionals. Countries need to import
medical workers but solution cre-
ates its own problems as workers
from different part of the world will
have received varied levels of train-
ing in quality and safety. Local grad-
uates are also often insufficiently
trained in this area, so additional
training of staff is needed in order to
comply with accreditation require-
ments.
MEH: How does accreditation ben-
efit patients?
AI:The public need to know that
they are getting safe and good
quality healthcare. The more ac-
credited organisations there are the
greater the public awareness be-
comes of the benefits of choosing
an accredited hospital for their
treatment. Our aim is to bring stan-
dards in the healthcare industry up
to those in the aviation and space
exploration industries.
Patients must demand that
providers meet these high stan-
dards to ensure their own safety,
and the healthcare industry must
respond to these demands. This is
an ongoing process, and JCI re-
quires organisaitons to respect the
rights and choices of patients. For
example, they must guarantee the
right to a second opinion, and need
patient consent in order to conduct
a procedure.
Our “Speak Up” programme en-
courages patients to question their
healthcare providers about all as-
pects of their service.
www.jointcommissioninternational.org
Dr Ashraf Ismail biography
Managing Director, Middle East International Office
In March 2009, JCI appointed Dr. Ismail as the managing director of
its Middle East office located in Dubai. Dr. Ismail is a physician with
20 years of international experience in hospital accreditation, health
care quality management, performance improvement and develop-
ment of human resources for health.
His contributions in postgraduate quality education and training are
well recognized. As an adjunct professor at George Mason University,
School of Health and Human Services, he teaches a variety of quality
courses for the certificate in quality and outcomes management.
Dr. Ismail is a WHO consultant in accreditation and health care quality.
In 2006, he was appointed as Strategic Planning Advisor to the Minis-
ter of Health in UAE to develop the new strategy of the health sector.
As a quality consultant, he assists health care facilities through the ac-
creditation process. His experience in these areas has extended from
USA to the Middle East. For four years, he was as a quality consultant
to Inova Health System, the largest health system in Northern Virginia.
As a faculty at Johns Hopkins University and Director of JHPIEGO’s
Asia/Near East/Europe Regional office. While he was employed with
USAID in Cairo, Egypt, he implemented the first National Quality Im-
provement Program in the Family Planning Clinics in Egypt
Middle East Hospital
| 22
JCI Case Study: Al Ain Hospital
Al Ain Hospital (AAH) is an acute
care and emergency hospital, lo-
cated in the Al Ain region of the
Emirate of Abu Dhabi, United Arab
Emirates. AAH belongs to the Abu
Dhabi Health Services Company
SEHA PJSC and is managed by the
Medical University of Vienna and
VAMED.
Because many of its patients come
from outside the United Arab Emi-
rates, AAH is dedicated to providing
the highest quality care that re-
spects the diverse cultural back-
grounds of patients and adheres to
international standards and best
practices. “JCI’s accreditation stan-
dards have become a model for
health care standards by many
health systems globally,” says AAH
CEO George Jepson. “The stan-
dards and survey process are de-
signed to be culturally applicable
and in compliance with laws and
regulations in countries outside the
United States.”
The accreditation preparation and
survey experience gave AAH and
staff the knowledge and tools for
measuring and sustaining enhance-
ments in the areas of process im-
provement, patient safety, and
quality improvement:
Process Improvement
• Developing comprehen-
sive, patient-centered processes
throughout the organization
• Establishing a structured
and transparent process to monitor
continuous compliance to the
IPSGs and various types of risk
management activities
• Enhancing interdisciplinary
communication
• Improving documentation
of processes to ensure care conti-
nuity, patient safety and continuous
improvement
Patient Safety
• Adhering to the IPSGs to
create a culture of safety for staff
and patients
• Adopting a holistic ap-
proach to involve patients, families,
staff, and visitors
• Establishing a transparent
reporting system for complaints and
suggestions from employees, pa-
tients and families
Quality Improvement
• Developing a quality man-
agement system based on the JCI
Standards
• Improving monitoring sys-
tems and processes to measure
enhancements to quality and pa-
tient safety in clinical and manage-
rial areas:
• Establishing a periodic re-
view of data analysis to sustain
quality improvements
• Designing an effective and
efficient surveillance system to
monitor, analyze and address data-
driven, sustainable improvements
in infection control
“The newly introduced Strategic
Improvement Plan (SIP) to address
the required action plan for follow
up with an accredited organization
is an excellent initiative towards a
holistic approach for sustainable
improvements,” reports Mr. Jepson.
“Developing the SIPs helped us to
gain deep knowledge into the
measurable elements of JCI’s stan-
dards.”
For a hospital that is dedicated to
clinical excellence for all its pa-
tients, the most important benefit of
JCI accreditation is its enhanced
reputation among stakeholders and
the domestic and international com-
munities.“Making a decision to ob-
tain JCI Accreditation is a journey,
a culture shift, and a visible commit-
ment to improve the quality of pa-
tient care and services,” says Mr.
Jepson.
www.alain-hospital.ae
Middle East Hospital
| 24
Abdulrahman Al Mishari Hospital
Dr. Abdulrahman Al Mishari Hospi-
tal (ARMH) has received an award
from Middle East Hospital (MEH)
magazine for excellence in
women’s healthcare. The award
recognises the great contribution
that the 122 bed Riyadh-based hos-
pital has made in the areas of ob-
stetrics, gynaecology, IVF,
neo-natal and post- natal care.
Hospital Managing Director Mo-
hammed Al Mishari, son of the Hos-
pital’s founder Dr. Abdulrahman Al
Mishari, accepted the award on be-
half of the hospital and its staff. Mr
Al Mishari said:
“It is a great honour to receive this
award from MEH. For 24 years Dr.
Abdulrahman Al Mishari Hospital
has been providing a high quality of
medical care to its patients. It has
dedicated its time to ensure that an
evidence based standard of health
care is achieved and rendered to
our patients and their families. I
would like to thank all the staff at
the hospital for their excellent work
in making this achievement possi-
ble.”
ARMH is a private General Hospital
located in Al Olaya District, Riyadh,
Saudi Arabia. As a result of its com-
mitment to excellence, ARMH
achieved in 2010 the "Diamond" ac-
creditation standard, which is the
highest level of recognition for per-
formance excellence that an organ-
isation can achieve in health care
from Accreditation Canada's Qmen-
tum International Accreditation. The
award was presented in a special
ceremony held at ARMH by MEH
publisher Mike Tanousis (above).
After long years of a dedicated
teaching career, Dr. Abdulrahman
Al Mishari decided to contribute to
the development & infrastructure of
the fast growing economy, by es-
tablishing a private hospital.
In 1987, the Hospital was inaugu-
rated with the Governor of Riyadh
Region, His Royal Highness Prince
Salman Bin Abdulaziz Al Saud,
doing the honour of cutting the rib-
bon. The hospital has now become
one of the most trusted and re-
spected healthcare institutions in
the Kingdom of Saudi Arabia.Today,
together with his children, Hadeel
and Mohammed, Dr. Abdulrahman
Al Mishari’s journey continues.
Their quest for quality and service
excellence is relentless, through
good leadership and passion for
quality.
Middle East Hospital
| 26
Hospital founder Dr. Abdulrahman Al Mishari (l) and his son Mohammed, Managing Director (r) arepresented with an MEH award for excellence in women’s healthcare by Mike Tanousis, MEH publisher
Middle East Hospital
| 27
April2012_Sept2011 14/04/2012 00:17 Page 28
Middle East Hospital
Arab Health
The 201 edition of the Arab
Health Exhibition & Congress
concluded at the Dubai
International Convention &
Exhibition Centre with record
breaking success; having attracted
more exhibitors, visitors and dele-
gates to the event than any other
edition in its 3 year history.
Occupying every hall of the Dubai
World Trade Centre, Arab Health
accommodated over 3,000 exhibit-
ing companies showcasing the very
latest medical breakthroughs and
technological developments in
healthcare, as well as announcing
ground-breaking new partnerships
and collaborations within the Middle
East healthcare sector.
The multi-track Arab Health Con-
gress reached new heights with the
17 accredited conferences featur-
ing more than 500 internationally
renowned speakers. The congress
attracted a sell-out number of dele-
gates and maintains its status as
the largest and most important
event of its kind.
The stimulating business-focused
atmosphere was clearly felt by all
during the four day event with multi-
million dollar deals and partner-
ships being signed onsite, making
Arab Health 2012 the most suc-
cessful event for exhibitors and
visitors alike.
Over the course of the four day
event, 76,101 visitors attended
Arab Health Exhibition and Confer-
ences, making this the largest
healthcare event in the MENA re-
gion and the second largest in
world. With a 15% increase in visi-
Zubair Ansari, King Faisal Hospital, Riyadh (l); Thomas Murray, CEO, American HospitalDubai (c); Fahad Bindayei, King Faisal Hospital (r)
Malem Medical - Enuresis alarms for prevention of bedwetting
| 30
Middle East Hospital
| 31
Middle East Hospital
Arab Health
tor number from last year, the event
has clearly yielded results from sub-
stantial investment in marketing,
content and promotion of the show.
Arab Health successfully delivered
an audience from all major sectors
of the healthcare industry with 44%
of our audience having purchasing
power between $100,000 and $5
million, 5.9% of our audience has
purchasing power of $5 million and
above.
UK Pavilion
The UK Pavilion organiser, ABHI,
brought the largest ever number of
UK healthcare companies to Arab
Health in 2012. The UK Pavilion in
Hall 7 housed 120 of the UK’s most
innovative med-tech companies.
On the second day of Arab Health
2012 companies exhibiting on the
UK Pavilion were visited by Dr
Hanan Al Kuwari, CEO of Hamad
Medical Corporation of Qatar, and
UK Business Ambassador Lord
Darzi of Denham. Speaking on the
subject of UK-Middle East cooper-
ation Lord Darzi said:
“The Middle East has long been a
key trading partner for the UK, not
only because it is one of the largest
markets for medical equipment and
healthcare products, but also be-
cause no other region in the world
faces such rapid growth in demand
for the latest technologies.
“The UK is well placed to meet
these challenges. Its medical tech-
nology sector, which comprises
some 3000 companies is highly di-
versified and innovative. Between
Greg White, Vice President and MD, Cerner Middle East
Carsten Schmidt, IBM, and Ibrahim Ellawi
Hanan Al Kuwari, CEO, Hamad and Lord Darzi, UK government business ambassador
| 32
Middle East Hospital
(l-r) Mark Choufani; Sobhi Baterjee, CEO, Saudi-German HospitalGroup; Jeff Staples, CEO, Sheik Kalifa Medical City; Kasim Ardati,CEO, Bahrain Specialist Hospital
| 33
April2012_Sept2011 14/04/2012 00:18 Page 33
Middle East Hospital
them these businesses produce a
range of products from high-tech
equipment for advanced imaging
and diagnosis, to surgical instru-
ments- testament to the wealth and
breadth of the UK’s capabilities to
deliver a range of healthcare solu-
tions to meet Middle Eastern
needs.”
Lord Darzi and Dr Al Kuwari spoke
to several UK exhibitors about their
products including bariatric bed
manufacturer Benmor Medical
(Stand 7C51), who were launching
their new “Aurum” bariatric bed at
Arab Health. Also, leading UK man-
ufacturer of powered operating ta-
bles, Eschmann Equipment. Richard Venners, Marketing Director, LEEC (l); Shuaiti Mottaba, Gulf National Kuwait (c);Paul Venners, CEO, LEEC (r)
| 34
Middle East Hospital
Brian de Francesca, TBS, and Abdullah Al Thari, Armada Network, SaudiArabia
Diederik Zeven, Senior Director Middle East, and Marc Kruger, BusinessManager Home Healthcare EMEA, Philips
| 35
Middle East Hospital
| 36
For more than 30 years, Cerner
Corporation has been a visionary
leader in providing information
management systems designed
to improve health care.
Greg White, Vice President and
Managing Director for Middle East
and Africa told MEH, “Our clinical
and health information system ap-
plications enhance the managerial
efficiency and clinical effectiveness
of health care delivery worldwide.
We design all of our solutions to ac-
complish one mission: to connect
the right persons, knowledge and
resources at the right time and the
right place to achieve the right
health outcome.”
Operating in the Middle East for 20
years, Cerner Middle East has a
proven track record in the region,
working with more than 130 client
facilities that range from large gov-
ernment hospital networks to small
health clinics. Mr White said, “With
a history of consistent growth and
proven commitment to the Middle
East, we are currently the leading
health care information technology
provider. We offer a broad range of
health care services including im-
plementation and training, remote
hosting, health care data analysis,
transaction processing for physi-
cian practices and employer health
plan third party administration serv-
ices.
“In the last three to four years we
have experienced rapid growth in
Cerner Middle East
Middle East Hospital
| 38
the region as governments and
hospital groups have invested
heavily in transforming their and
modernising their services and data
systems”, he added.
Cerner solutions combine technol-
ogy with knowledge to deliver vital
data for effective, real-time deci-
sion-making across the enterprise.
Their solutions are licensed by
more than 9,000 facilities world-
wide.
Mr White explained, “Today, the
cornerstone of Cerner’s advanced
technology is Cerner Millennium®.
It is the most powerful set of inte-
grated applications for automating
information across the care contin-
uum. Only Cerner Millennium has
the unified health care architecture
capable of both retrieving and dis-
seminating patient-specific data
from and to virtually every point
within a health care system.
“Cerner Millennium solutions can
be found in United Arab Emirates,
Kingdom of Saudi Arabia, Republic
of Egypt and the State of Qatar, put-
ting Cerner Middle East on the front
lines of health care transformation.
Building on our industry-leading
clinical technology expertise and
vast global experience, we are find-
ing new and innovative ways to de-
liver value to our clients, while
addressing the challenges of each
country we work in.”
Case Study: Abu Dhabi
To seamlessly connect its 21 clinics
to the Abu Dhabi Healthcare Serv-
ices Co. (SEHA) Network, SEHA
Ambulatory Healthcare Services
Health Information Systems
Greg White biography
Greg White, vice president and managing director, Cerner Middle East
and Africa, is responsible for strategy, consulting, sales and operations
for the region.
White is known throughout the health care industry for his innovative
thinking around how to connect communities to improve patient safety
and manage the health of populations. He is currently working with
governments and private healthcare leaders to define national strate-
gies to connect healthcare providers and patients across all care ven-
ues and countries to improve the overall health of the population.
White joined Cerner in August 2004. Prior to his current role, he was
general manager in the Eastern region of the United States. His team
was responsible for delivering results for Cerner clients that lead the
industry in their use of health care information technology to optimize
workflow and transform patient care.
White worked closely with the University of Pittsburgh Medical Center
(UPMC) Children’s Hospital to reach HIMSS Stage 7. This is the high-
est level of automation a hospital can achieve in creating a virtually
paperless patient record environment. For his work with UPMC, and
Carolinas Healthcare System, Cerner recognized White in 2008 with
its National Client Results Executive Award.
Before joining Cerner, White was chief executive officer of Gajema
Software, LLC, a leader in the laboratory information management and
logistics market. Cerner acquired Gajema in 2004. White received a
bachelor’s degree in finance from the University of Alabama
Middle East Hospital
| 39
Middle East Hospital
Cerner Middle East
(AHS) implemented an electronic
health record system.
The fully integrated Cerner system
creates an enterprise-wide, longitu-
dinal electronic health record
(EHR), which clinicians use to offer
patients safer, more efficient care.
The system provides clinicians with
quick access to relevant information
for timely decisions, supporting
common workflow and anticipating
next steps.
“Cerner Millennium® solutions
allow our clinicians to improve pa-
tient safety by standardizing care
and reducing error,” said Robert
Pickton, SEHA chief information of-
ficer. “The unified Cerner Millen-
nium electronic health record
connects all SEHA hospitals and
clinics, providing doctors and
nurses with real-time patient infor-
mation and access to evidence-
based protocols designed to
improve clinician knowledge and
prevent medical errors,” Pickton
said.
Fewer Errors
AHS rules and alerts within the sys-
tem warn clinicians of potential ad-
verse events and medical mistakes.
Integrating health data into a single
enterprise clinical data repository
also helps AHS clinicians reduce
the risk of medical error and im-
prove the overall quality of care.
Clinicians quickly reference pa-
tients’ complete medical history and
current test results during ordering.
And multiple clinicians have access
to the same information at the same
time, which leads to more consis-
tent care across AHS clinics.
Legible Orders
With the digital system, physician
orders are legible so nurses no
longer need to decipher handwrit-
ten prescriptions. The EHR also
has helped AHS eliminate handwrit-
ten identification documents. Pa-
tient demographics gathered at
registration become part of the
EHR and help identify patients in all
applications.
Results in Hours — Not Days
Having access to the most up-to-
date patient information has helped
AHS clinicians optimize workflow
efficiency and performance. For ex-
ample, AHS provides clinicians with
investigation results within hours —
not days — and vital patient infor-
mation in real time. This time saving
has led to a more effective provi-
sion of care based on evidence
rather than best guesses. In addi-
tion, AHS uses the system to opti-
mize result turnaround time due to
connectivity between the EHR and
laboratory medical devices. As a re-
sult, clinicians spend more time with
patients and less time retrieving
paper records.
The EHR “is a real breakthrough,”
providing rapid access to important
patient information, writes Dr. El-
rayah Ahmed of the Zakher Clinic.
With the integrated system, Dr.
Ahmed writes that he can access
this information “very swiftly, effi-
ciently and knowledgeably, regard-
less of the time and place.”
Intuitive Interface, Minimal Clicks
AHS has standardized information
across the healthcare system with
a common user interface and con-
| 40
Middle East Hospital
tent. Through this intuitive visual in-
terface, routine functions are con-
sistent across solutions, eliminating
the need for clinicians to learn mul-
tiple approaches for common tasks.
Additionally, the system uses
process models that match the way
clinicians practice medicine. As a
result, the EHR aids clinicians by
anticipating next steps and provid-
ing access to clinical and adminis-
trative information with minimal
clicks.
Easier for Patients
Better access to comprehensive
patient information helps AHS en-
hance the continuity of care. No
matter which clinic a patient with a
chronic disease visits, clinicians
there will have access to his or her
complete medical record. Sharing
this medical data allows patients to
access care in their own communi-
ties, rather than traveling to a spe-
cialty clinic. Patients no longer need
to provide their medical history at
every visit. Their history is now
available to clinicians enterprise-
wide.
In addition, the patients’ medication
profile, allergies and problems list
are viewable across all AHS facili-
ties, which helps the organization
reduce medication duplication. AHS
clinicians use the EHR to evaluate
medication use and offer patient ed-
ucation.
Security and Confidentiality
The rule-based security model in
the EHR restricts access to infor-
mation on a “need-to-know” basis,
assigning varying security levels to
demographic and individual clinical
data elements. AHS has deter-
mined the level of confidentiality for
each data element, based on the
role of each of its caregivers. The
EHR is fully compliant with security
and confidentiality regulations.
Patient Data is Entered Once
The EHR system connects a variety
of roles and venues, including direct
care, laboratory, radiology, finance,
operations, and registration and
scheduling. This integration re-
duces the time AHS spends enter-
ing patient information. This data is
entered once into the system and is
then shared throughout other com-
ponents of the integrated system.
Enhanced Management and Re-
porting
With the EHR system, financial
management and reporting is much
Cerner Middle East
| 42
Middle East Hospital
more transparent. Specifically, the
system enables AHS to:
• Reduce repeat investiga-
tions — The EHR allows test result
information to be shared across fa-
cilities.
• Review investigation results
in real time at any clinic — AHS has
fewer lost results and repeat tests.
• Compare results trended
across time — Clinicians review
previous results and evaluations of
care, determining the effectiveness
of a treatment.
• Improve coding — Coding
takes place within the HER imme-
diately following a visit, which sig-
nificantly reduces the delay in
coding and claims.
The system also helps the organi-
zation immediately identify records
that are insufficient to support
claims.
Optimizing Information
In sum, leaders and clinicians at
AHS use information within the
EHR to optimize business strate-
gies, improve standards of care and
benchmark internationally with mul-
tiple healthcare systems. The sys-
tem helps these individuals:
• Open the restrictive bound-
ary of the paper record with elec-
tronic information sharing
• Fulfill its vision to optimize
health care and provide a complete
service to the residents of Abu
Dhabi
• Offer a safe and efficient
provision of care with shared infor-
mation
• Reduce human error inher-
ent with paper handwritten records
Cerner in the Middle East
1991 – Entered market
2005 – Opened office in Abu
Dhabi, UAE
2007 – Opened new office in
Dubai, UAE
2008 – Opened office in Riyadh,
Saudi Arabia
2012 – Opened office in Doha,
Qatar
Health Information Systems
| 43
In Francis Ford Coppola’s 1972 film
The Godfather, there’s a scene be-
tween Tom Hagen (Robert Duvall)
and Sonny Corleone (James
Caan), which is often repeated in
corporate settings: “This is busi-
ness, not personal". Ironically,
though, that statement is actually
bad business advice, especially in
a healthcare setting.
The “patient-centeredness” which is
the latest buzz-word in health re-
form, combines the best of modern
medicine with old-fashioned care
and ejects "strictly business" out of
the relationship and builds more of
a friendship.
First coined in 1969 by British psy-
choanalyst Enid Balint, the term im-
plied taking into account a patient's
social context to deal with illness.
Patient-centered care seeks to
make patients feel better, both
physically and emotionally. A pa-
tient-centered physician might be
described as someone who "tries to
enter the patient's world, to see the
illness through the patient's eyes."
As calls are made for a more pa-
tient-centred health care system,
it’s becomes critical to define and
measure patient perceptions of
health care quality and to under-
stand more fully what drives those
perceptions. Arguably, the two main
influences are the media and per-
sonal experience. While shock
headlines may influence some pa-
tients to view health care with a
jaundiced eye, those who have
used the service and the way they
feel were treated has always
coloured their opinions of a hospital.
When a patient was admitted to the
Cleveland Clinic for a bone marrow
transplant, he was surprised to get
a hug from a receptionist who saw
the "sheer fear" on her face.
When a nurse at the Celilo Cancer
Centre at the Mid-Columbia Med-
ical Centre in The Dalles, Oregon,
found out that his patient was
scheduled to receive chemotherapy
on her wedding anniversary, he
asked the woman and her husband
what song they'd first danced to on
their wedding day. It was "Save the
Last Dance for Me," and the next
day, when the couple rose from
their chairs after the patient's six-
hour infusion, the song began play-
ing. Right there in the infusion area,
with their arms around each other,
they danced.
More surprises were to come for
the 52-year-old cancer patient. As
she settled into her room, a social
worker came in to offer a menu of
healing services including mas-
sage, reflexology and music ther-
apy. Patients form expectations
prior to their encounter with the
services. They develop perceptions
during the process of service deliv-
ery and then they compare their
perceptions to their expectations in
evaluating the outcome of the serv-
ice encounter. Interestingly, a single
Putting patients first: Little BIG things in patient care
Middle East Hospital
| 44
negative experience, particularly if
it’s perceived as unkind or grossly
insensitive, could tarnish a patient’s
entire experience of care. As
pointed out by one of the patient
“My wounds are healed but the
heart is broken”
• Cleveland Clinic Chief Ex-
ecutive Delos "Toby" Cosgrove, a
heart surgeon by training, says he
had an epiphany several years ago
at a Harvard Business School sem-
inar, where a young woman raised
her hand and told him that despite
the clinic's stellar medical reputa-
tion, her grandfather had chosen to
go elsewhere for surgery because
"we heard you don't have empathy."
Dr. Cosgrove says that in his own
days as a surgeon, he focused so
intently on reducing complications
from cardiac procedures that he
gave little thought to the feelings or
experiences of patients. But after
that incidence, in 2009, Cleveland
Clinic opened an Office of Patient
Experience, and began putting
"caregiver" on the badges of all em-
ployees.
• On rounds with medical stu-
dents, Dr. Arnold P. Gold, professor
of clinical neurology and pediatrics
at Columbia University’s College of
Physicians and Surgeons, wit-
nessed a disturbing incident. A child
was being treated for a neuroblas-
toma, and one of the residents, who
“Unlike in The
Godfather,
business is now
very personal,
especially in
healthcare.”
By Praveen Pillai
knew everything about the tumour,
knew nothing about the child, not
evens the name and was address-
ing the child by case and room
number.
• A patient consults an or-
thopaedist because of knee pain.
The surgeon determines that no op-
eration is indicated and refers her
to a rheumatologist, who finds no
systemic inflammatory disease and
refers her to a physiatrist, who
sends her to a physical therapist,
who administers the actual treat-
ment.
Each clinician has executed his or
her craft with impeccable authority
and skill, but the patient has be-
come a shuttlecock. Although, the
Hippocratic Oath itself enjoins
physicians to maintain their deport-
ment and privileges while keeping
the patient's interests foremost but
probably the patient must have be-
Middle East Hospital
| 45
come a hassled, frustrated, and
may be bankrupt shuttlecock. –
This is loss of caring.
A patient’s perception of how
they've been treated during an
event can have a greater impact on
their future behaviour and loyalty
more than the actual outcome of
the event. Researchers at Rush
University Medical Center com-
pared a year of Rush’s Press
Ganey data with patients’ actual re-
turns to providers. They estimated
that “moving the satisfied group to
a highly satisfied level would yield
an increase in utilization, resulting
in $2.3 million in additional rev-
enues annually from additional re-
peat customers.”
According to Frederick Reichheld,
“raising customer retention rates by
five percentage points could in-
crease the value of an average cus-
tomer by 25 to 100%.” The more
patients we keep from year to year,
the more each is worth. So it’s
even imperative to deal with dis-
gruntled customers and use the op-
portunity to turn a negative situation
into a positive one. Instead of an
upset customer who becomes a
noisy distracter, the goal is to con-
vert him into a brand loyalist who
sings the hospital’s praises.
A hospital patient who consistently
refused to follow medical orders,
gave all the doctors bad reviews in
customer surveys regardless of
quality of care, and eventually
threatened to strip naked in the
hospital lobby and threw a tantrum.
At that point the hospital faced an
ethical dilemma. Should it refuse to
treat the patient further because he
was bad for business, even though
his life depended on future treat-
ment? The hospital's legal team
even advised refusing treatment;
but the doctor, who was often the
recipient of the patient's anger, dis-
agreed noting his oath to always be
there for the patient.
Providing greater information, ac-
cess and autonomy, so often suc-
cessful in consumer settings, does
not necessarily always drive better
care or experience in a healthcare
setting. After years of struggling
with her weight, a New York mother
underwent bariatric surgery. She
was inundated with information
from her medical team about how
she would need to change her be-
haviour. Guidelines around when,
how, and what to eat or not eat —
the rules were overwhelming and
constraining. Before long her
weight had jumped again. For this
woman, an excess of information
(along with an assumption that she
was prepared to absorb it) was part
of the problem, not the solution.
Unfortunately, the laudable era of
openness and encouragement of
patients to voice their dissatisfac-
tion has also led to high and per-
haps unrealistic expectations on
their part. Paradoxically, even
though the effectiveness of medical
technology has improved consider-
ably, with massive gleaming hospi-
tals, expensive computerized
equipment and sophisticated scan-
ning machines which appear very
impressive and re-assuring at times
Putting patients first: Little BIG things in patient care
Middle East Hospital
| 46
of distress, however undoubtedly
personalized service still remains a
stronger value proposition and dif-
ferentiator than ever before.
No doubt clinical transformation
and clinical process improvement
are the essential work required for
health care organizations. But the
success of any clinical transforma-
tion initiative is dependent on how
value is driven through the organi-
zation with the appropriate involve-
ment/integration of people, process
and technology. So while embark-
ing on the journey to service excel-
lence, it's critical that leadership
maps out specific goals and under-
stand how they are going to get
there, assigning specific accounta-
bility for service delivery.
A strategy that involves the right
people using a disciplined process
with the appropriate technology will
not only results in improved patient
safety, better clinical outcomes and
an enhanced patient experience
but it also helps to increase em-
ployee and provider engagement
and retention. In order to have a
culture where patients want to
come for care, where providers
want to practice and where employ-
ees want to work, there needs to be
a spirit of service that prevails in
every encounter.
Health care has been evolving
away from a disease-centered
model and toward a patient-cen-
tered model but often debate rages
about patient versus physician cen-
tred care, but the reality is health re-
lies on strong doctor-patient
alliance... where both parties share
information with the common goal
of having the best experience pos-
sible.
And it’s not just about doctors and
nurses, but the attitudes and be-
haviour of frontline staff, allied
healthcare professionals, support
staff etc. all plays a key role for pa-
tient care and efficiency at every
stage of the health-care experi-
ence. Patient and care givers must
therefore meet as equals, bringing
different knowledge, needs, con-
cerns, and gravitational pull per-
haps like a double helix, whose two
strands encircle each other, or — to
By Praveen Pillai
About the author
Praveen Pillai is a Health care
management professional with
over 11 years of progressive
experience in both national &
international market. He is a
candidate for a doctorate
program in Business
Management. He is a graduate
in Business Economics (MBE)
from School of Economics,
DAVV, INDIA & holds a Masters
diploma in Hospital &
Healthcare management from
Symbiosis INDIA.
return to medicine's roots — the ca-
duceus, whose two serpents inter-
twine forever.
A. MacDougall’s quote, "In busi-
ness you get what you want by giv-
ing other people what they want -
the way they want it," is truly one
that should resonate with all of us
and unquestionably applies to the
patient-centred health care system.
Probably taking little extra steps will
make a BIG difference to patients’
experience of care and may help to
return medicine to its Oslerian and
Hippocratic roots, roots that care for
the patient in all domains.
“In business you
get what you want
by giving other
people what they
want -- the way
they want it.”
A. MacDougall
Middle East Hospital
| 47
Middle East Hospital
Freedom from Torture
Freedom from Torture, formerly the
Medical Foundation for the Care of
Victims of Torture, is the only organ-
isation in the UK dedicated solely to
the treatment of survivors of torture
and organised violence. Its concern
for the health and well-being of tor-
ture survivors and their families is
concentrated towards providing di-
rect care and practical assistance to
help those living in the UK begin to
rebuild their lives. Since its incep-
tion, in 1985, over 50,000 individu-
als have been referred for help.
With its London headquarters now
ranking as one of the world’s
largest torture treatment centres,
the organisation also has a pres-
ence in five major UK cities re-
sponding to the needs of torture
survivors who find themselves dis-
persed around the country as part
of the asylum process.
Freedom from Torture’s holistic ap-
proach to rehabilitation includes a
wide range of physical and psycho-
logical therapies which are deliv-
ered in an individual or group
setting. Caseworker counsellors
work with torture survivors in an en-
vironment which recognises their
practical, medical and legal require-
ments as inter-connected.
Pioneering group-work which
brings clients together in a pro-
tected social environment to ex-
plore their experiences using
creative therapy (such as drama,
art and music) also has a positive
impact on the lives of torture sur-
vivors attempting to overcome their
horrific experiences. In the same
way, psychotherapy groups are
used to encourage survivors to
adopt a self-help approach through
the giving and receiving of support
from fellow group members.
An example of this in practice is
Freedom from Torture’s ‘Natural
Growth Project’ in London. This
unique service combines horticul-
ture with psychotherapy and facili-
tates the growth and healthy
development of clients. For some of
the most physically and mentally
damaged clients, being in the open
and in touch with the elements can
bring instant relief and open the
path to extraordinary change. Free-
dom from Torture therapists and a
horticulturalist have been working
with clients since 1992. More robust
clients work on small pieces of land,
cultivating plants on public allot-
ment plots. For more vulnerable
clients, the private therapy garden
adjoined to the London treatment
centre provides a safe, enclosed
space for psychotherapy.
As well as offering direct clinical
care, Freedom from Torture seeks
to protect and promote the rights of
survivors both in the UK and world-
wide, drawing on the extensive ev-
idence base it has built up over 25
years. The organisation challenges
the attitudes of policy makers and
the public, working to influence im-
provements in government policy
| 48
Middle East Hospital
and legislation. The policy and ad-
vocacy work is complemented and
bolstered through human rights re-
search which provides an evidence
base, as well as through orches-
trated campaigns and and media
work.
Crucially for an individual’s protec-
tion needs and to help provide sup-
porting evidence to hold torturing
States to account, the organisa-
tion’s doctors, psychologists and
counsellors work to forensically
document the effects of torture in
Medico-Legal Reports (MLRs) com-
missioned by lawyers. Such effects
include badly healed fractures, lac-
erations and burns, damaged liga-
ments or chronic bone infections.
These reports also document evi-
dence of the serious psychological
impact of torture.
In November last year Freedom
from Torture published ‘Out of the
Silence: New Evidence of Ongoing
Torture in Sri Lanka’, which was
based on its submission to the UN
Committee Against Torture, the
body which monitors compliance
with the Convention Against Tor-
ture. The report studied the medical
evidence contained in MLRs for 35
Sri Lankans tortured post-May
2009, thus demonstrating that the
practice continued long after the
end of the civil war. The research
showed that people within the Tamil
population who are perceived by
the authorities as having links to the
Liberation Tigers of Tamil Eelam
(LTTE) remain at risk of being de-
tained and tortured.
Dr. William Hopkins has worked at
Freedom from Torture since 2001
as a consultant psychiatrist and
psychotherapist. His role includes
assessing and treating torture sur-
vivors, as well as writing psychiatric
reports documenting their psycho-
logical well-being.
| 49
Middle East Hospital
Dr. Hopkins has a particular interest
in working psychotherapeutically
with people who have a wide range
of emotional problems. Conse-
quently he has dealt with numerous
clients suffering from depression,
anxiety, psychotic experiences and
Post Traumatic Stress Disorder, to
name a few.
One of Dr. Hopkins’ clients, a young
woman in her early 20s, was sub-
jected to detention and torture for a
period of two years. Dr. Hopkins ex-
plained:
“She constantly thought she was
going to be attacked by monsters
who were going to eat her. At night
in particular she would catch
glimpses of these creatures in the
shadows chasing people. Further
she was terrified that they would in-
fect her and she would become a
monster like them.”
Dr. Hopkins states that these
thoughts can be classified as “para-
noid delusions” and that the main-
stay of her treatment would be
antipsychotic medication.
Initially she was given a lot of space
to talk during therapy sessions be-
fore being encouraged to talk about
her time in detention. She spoke of
the physical hardships and how the
prison guards had wanted her to
spy on other prisoners and torture
them. She also explained that she
believed the guards used to be
human beings but were now mon-
ster-like creatures.
The situation became more appar-
ent to Dr. Hopkins as it became
clear what she meant in regards to
her worries of being infected.
He explained: “If she collaborated
with the prison guards by spying on
the other prisoners she would be
released but at the cost of adopting
their values and then, in her eyes,
becoming like them – a monster.”
Dr. Hopkins provided time and a
place of safety for her to express
her fears and instead of challenging
her delusions he sought to under-
stand them. He also arranged for
her to be helped with her housing
problem which was having a nega-
tive impact on her emotional well-
being and was acting as a barrier to
her rehabilitation.
“It is sometimes just as important to
address social welfare concerns
such as housing, finances and asy-
lum issues.”
In order to validate her experience,
Dr. Hopkins made it clear that he
understood her view of the guards
being monsters due to their bar-
baric behaviour. This had the addi-
tional effect of making it clear where
he stood in relation to what the
guards had done.
Describing this approach he ex-
plained:
“I wouldn’t directly challenge her
beliefs that there were creatures
chasing her in London, but I would
make links between her fears now
and how they might be related to
experiences while in detention. At
the same time I would emphasise
that England is a very safe country
compared to the country she had
come from, so as to help her emo-
tionally distance herself from these
experiences which were at the root
of her fears and psychological dis-
turbances.”
Gradually her beliefs diminished
and after a year in therapy she no
longer believed she was being pur-
sued by creatures although she still
experienced nightmares.
Dr. Hopkins concluded:
“In therapy there needs to be regu-
larity and consistency to provide a
secure framework and a space
where feelings can be explored.
Sympathetic listening is an impor-
tant beginning and careful attention
needs to be paid to what is said and
how it is said. An exploration of the
problems can be helpful in under-
standing what has gone on for both
therapist and torture survivor. The
context of someone’s fears, night-
mares, delusions and hallucinations
can be very helpful in understand-
ing the reasons why they are in
such distress and planning how to
help them.”
Freedom from Torture
Dr William Hopkins
| 50