healthcare transition in gcc: current painful realities & proposed strategic actions for ceos in...

Healthcare transition in GCC: current painful realities & proposed strategic actions for CEOs in 2016

by Stelios PigadiotisJanuary, 2016

Research Working Paper

1. Global Healthcare: Challenges & Trends2. GCC Healthcare: painful realities3. A snapshot on Dubai healthcare4. Proposed Solution to prepare for a smooth transition5. Substantial Benefits of proposed solution6. Future CEO Agenda:

• Importance of Alliances• New value adding areas

7. Appendix: • Research Methodology• Sources of secondary research

Overview


Global Healthcare: Dramatic reforms

Fee for Servic

e

Physician

Turf warsSilos

OutcomeBased

Patient Centric

CollaborationTeamwork

Old Environment New Ecosystem


Global Healthcare: Paradigm shift

Outcome Patient Centric Delivery

Inter-professional collaboration

Lean HospitalLower

Cost

Customer Experience

Payerswant…

Wearablesm-Health

Evidence Based

Physician Hospital

Alignment

CollaborationPrimaryAcute

TertiaryPost-Acute

Healthcare Trends


GCC Healthcare: When money is running out...bundle and other painful realities

Economy Sector

Difficulty Attract Specialists

Financial pains & Consolidation

Low Quality in delivery: 30K Emiratis go abroad

Poor practices: commissions to Doctors

Non-competitive government backed economic model

Reduced Government

Spending

2020 “Expo” Vision

Challenges

Opportunities

Mandatory Insurance Schemes

Spending, bed density, # caregivers lower than Western

Economies

Under-developed

Tertiary Health care

system

Cardio- vascular & Diabetes

CAGR 21%&16% until 2025

500,000 Medical

Tourist by 2020

population of <25yr

will be 50%+ of total, by 2020

DHA, Daman push for quality

metrics, reforms

New PPP projects to improve clinical

outcomes

Aging population 65+ CAGR 9.2% until

2020

Evidence-based model

improve outcomes


Dubai snapshot: market insights for 2015 & 2025 (est.)

Income Categories(all figures in AED)

Very Low (VL)

Low-Medium (LM)

Medium-Higher (MH)

Higher (H)

Income per month VL<4,000 4,000<LM<9,000 9,000<MH<25,000 25,000<H

Population (%) 30% 35% 25% 10%

Population (#) 780,000 910,000 650,000 260,000

Outpatient (# ‘000) 2,000 4,000 2,800 1,800

Inpatient (# ‘000) 20 120 84 54

Consultation fee 20-50 125 150-250 250-480

Income per visit 75 180 350 800

Patients per doctor per day 50 35 20 12

Average Doctor Salary 25,000 35,000 45,000 60,000+

Market data 2015 2025

Total Population 2.6m 5.4m

Percent Insured 50% 100%

Market data 2015 2025

Total Outpatient 10.6m 26.9m

Percent Insured 278,000 985,000

Facilities 2015 Number Bed Ratio

Clinical/medical 2,500 50%

Hospitals 250 35%


GCC snapshot: great opportunities

Specialty Areas in GCC with significant capacity gaps exist in:

intensive and critical care

emergency care

neonatology

oncology

pediatrics

orthopedics

rehabilitation

psychiatry

Opportunities for market

entry or expansion of existing facilities


Proposed Idea to prepare for smooth transition: Developing Strategic Pillars for Healthcare Excellence

Patient Experience

Clinical Outcomes

Service Quality

Evidence-based & Lean Hospital Model

Specialized Executive Education

WHY IMPORTANT?• 13% to 20% of operating cost is

due to inefficient practices within Healthcare organizations

• Culture of Continuous Improvement• Inter-professional Collaboration• Improve patient Safety• Improve patient Satisfaction

surveys

WHY IMPORTANT?90% of personnel disengaged

Cost of disengagement 16% of wages (salaries expense avg.

30% of sales) e.g. For a $200m healthcare provider

the cost every year is$9.6m in lost salaries

1st Strategic Pillar 2nd Strategic Pillar

VISION 2016Outcome-Based Logic


UAE Healthcare National Agenda 2021 Vision: Impact of Proposed Solution

Other highlighted planned Initiatives: • Development of a national cancer registry, • System to monitor hospital wait times, Outcome-based & Lean Hospital Management systems• A comprehensive national programme to ensure regular health check-ups for every Emirati, • A mobile healthcare programme catering to remote areas, • A national database for all medical facilities to ease the transfer of patients between public and private

hospitals• New medical research and development centre Specialty Training Workshops & Learning Experience• New medical training centre Specialty Training Workshops & New Learning Experience• Nationwide obesity awareness programmes

Emphasis on NCDs ailments

Outcome-based management model

can substantial improve KPIs, addressed by

National Agenda


Benefits of 1st Strategic Pillar


1st Pillar: Long term benefits cannot be ignored

Evidence-based & Lean Kaizen: small incremental improvements Improved bottom line (substantial operating cost reductions) Higher clinical outcomes: minimize medical errors, maximize patient safety (e.g. VTE

fatalities) and improve patient experience/quality of delivery Foster healthcare innovation (rare “commodity” in GCC)

Enriches an accountable care model philosophy Leads to Powerful corporate branding

Secure financial instruments/funds in better terms Positive impact on Payers & public Higher bed ratio Attract easier top physician & nurse talent

Lean & IP fosters employee engagement Save millions from lost salaries Lean & evidence-based management offers organizational flexibility to answer

Tailor offering to client needs (government, private payers or large corporations) Strategic partnerships (e.g. reduce non-adherence for cancer treatment) Physician-hospital alignment

Government & private sector partnership programs (e.g. new government-backed medical training center private sector can assist with new training content)

Increased outcomes help strong positioning in UAE Medical Tourism market (500K by 2020)


1st Pillar: Lean Model Metrics

Create and sustain a system of continuous improvement aligned with strategic goals

Patient Safety

Quality

Accountable Care

Organization

Cost savings

Employee Engagement

• Mortality rate• Caregiver's # of errors• VTE Infection rate• Readmission rate

Customer Satisfaction

Survey

• Personnel satisfaction survey

• Attrition ratio• Employer of choice

• Savings per process• Overall savings• # of annual Kaizen

actions

• Accountable Care Model rating• Free Cash Flow ratio• Bed ratio• Citizenship: Social Responsibility

• Patient safety bundle• D.A.R.T. (impact of

disease mgt programs)


Benefits of 2nd Strategic Pillar


2nd Pillar: Benefits of Healthcare Organization’s Corporate University/Branded L&D Program

1. Align people to strategy and values: Change mindsets (patient centric)2. Attract, Develop & Retain talent (Strong Branding Tool)3. Create a common culture, loyalty and belonging to our organization4. Drive organizational change – Outcome-based, Lean Management, PA on qualitative

metrics and behaviors5. Strengthen corporate processes and standards – new pathways, new teamwork

standards, from monthly bonus to monthly feedback & quality metrics (e.g. ACHP Competency booklet & new metrics expected in near future from UAE Ministry of Health)

6. Listen feedback from caregivers and other personnel on new strategic initiatives7. Vehicle to make learning an ongoing process (Continuing Medical Education for

physicians, nurses, Center of Continuing Education for technical and support personnel)8. Connect caregivers from different functions and geographies9. Disseminate knowledge and expertise across the company10. Attain knowledge to lead future join projects with government to create hospital training

platform (Standardize industry, Evidence-based hospital transition excellence standards)


2nd Pillar: Specialized training is a necessity in the new healthcare ecosystem. Example_Areas_1• Emotional intelligence for patient communication excellence• Driving culture of resilience in Healthcare units• Critical Resilience Coaching for Surgery & Critical Care unit teams • Physician personal branding – LinkedIn profile makeover tailor-made for new patient &

caregiver environment• Effective communication with physicians for nurses (specialized tools, among others: SBAR

protocol: Situation, Background, Assessment, Recommendation SBAR/MBTI) • E-Adherence models & Remote Patient Management Systems in new value based healthcare

era• Enhancing Gamification experience, Digital Marketing and social branding in Healthcare• Managing Care for Millennial Patients/Effective Communication skills with Millenials • Intro to Business Plans design for Healthcare Units • Driving Teamwork Excellence in surgery and intensive care units • Enhancing Customer/Patient Care Experience in Hospitals • Achieving 5 star inpatient care experience: Lessons from top-tier Hotel sector• Mastering Multicultural Management for companies in GCC Healthcare sector


• Efficient Leadership for physicians • Effective Supervising skills for Nurses • Develop, performance counsel, and evaluate your team in healthcare• Developing Coaching skills to inspire engagement in a hospital intensive care unit team• Advanced problem solving techniques for healthcare teamwork and process value-

mapping• Emotional Customer Excellence for Ambulance units • Mastering Presentation Skills in Healthcare • Advanced Study: Medical Tourism Strategies• Mentor people to boost individual and team performance & improve outcome-health-based

competencies • Innovate, implement, and manage change in healthcare units• Leading your team in operational improvement actions - Kaizen philosophy & tools e.g.

value stream mapping • Driving efficiency in the value-based healthcare system• MBA case study method, enrich Financial management and strategic decision making in the

context of healthcare unit

2nd Pillar: Specialized training is a necessity in the new healthcare ecosystem. Example_Areas_2


Healthcare Organization L&D Program/Corporate University

University of Medicine

College of Nursing

Technical College

College of Finance & Supporting

Services

HIPO Academy

Customer Service Academy

On-Boarding Academy

TTT & Content writing Academy

Departments Academies

• Classroom Training • Guest Experts Speakers• Practical Training• Job Rotations (specific jobs)• Gamification Experiential Training

Delivery Method• Coaching & Mentoring & Peer Coaching• Career Counseling• E-Learning & MOOC • Teleconferencing• Functional Conferences

2nd Pillar: How an Corporate Executive University structure could look like?


2nd Pillar: How will we know that we are there (KPIs)?

Actions Deliverables

1. Training needs analysis research study2. Corporate Purpose & Values refreshing workshop

3. Develop vision/values, goals, structure, brand of Corporate University (CU)4. Select Advisory Team for CU5. Codify core competencies per corporate value6. Codify general competencies per job family and level7. Design standard internal-training content for every job family (Collages & Academies)8. Select & Train internal employees who will provide content9. Select & Train The Trainer workshop for internal employees 10. Selection of training delivery & learning content by external providers11. Selection of E-learning Content & Platform Design Providers12. Communication Campaign (Actions & rollout plan)13. Design annual budget14. Organize & Communicate participation schedule 15. Pilot phase & Go Live

1 Training Needs Analysis, Gap analysis2 Refresh purpose, vision and values statements

3 Statement of vision/values/goals & CU org/al chart, logo

4 List of members and their responsibilities5 Final core competency list6 List of competencies per job family/stream/function7 Training content for all Colleges and Academies

8 Successful completion of Content writing Academy9 Successful completion of TTT Academy10 Content for specific modules. List of selected providers 11 Final list of providers, Intranet/Mobile/MOOC handbook12 Marketing Plan for CU and actions roll out plan13 Final annual budget 14 Annual plan for participants (department/geography)15 Pilot phase execution, redesign CU document


2nd Pillar: Why setting up a L&D program is vital for a company’s sustainability

Attract, Develop, Retain Talent

(Best employer branding)

Increase employee performance and

satisfaction

Drive Organizational Change (Lean Mgt,

Evidence-based care)

Create a common culture, loyalty and

belonging

Strengthen processes, standards

Develop Talent & Leadership and sustain competitive

advantage in today's information economy


Future CEO Agenda initiatives


Future key CEO’s initiative: Emphasis in Alliances

Ministry of Health

Providers

Pharma

PayersUniversities

Financial Institution

sVenture Capital

A smart healthcare organization should aim first to transition into the new mindset and build strategic

Alliances to gain knowledge and first step advantage

Example of Joint Proposal, PPP* Initiative, to Government : “Help develop Efficient Transparent Regulation by establishing a star rating system for healthcare organizations equivalent to Global Star Rating System of Services in UAE”Spillover Effects: Improve Patient decision-making, more transparency better decisions from local or foreign Investors that are vital to the UAE healthcare sector sustainability”*PPP :PublicPrivatePartnership


CEO’s in GCC must focus on new Key Success Factors to survive the waves of change

Financial and Operation Excellence: Evidence-based management Lean Hospital process mapping/improvement Outcomes-based management mindset ADVERTISE ACTIONS!

Knowledge Excellence: Healthcare Organization Corporate University Internal Corporate Research Center for

Healthcare Value Creation COMMUNICATE ACTIONS!

“33% of high-revenue organizations have added new C-level positions in response to the need to address value-based care, compared to 16% of low-revenue organizations”


Appendix


Appendix 1: Research Methodology

• Research Topic:

• Research Methodology:

• Research size & composition:

Healthcare transition in GCC: from fee for service to evidence-based system, current painful realities

Primary (personal interviews and work observations)Secondary research (scholar sources, case study analysis of US, GCC health care, annual reports, benchmark analysis of GCC vs rest of world, scientific research white papers, scientific articles, books)

17 participants of which: 9 CEO, 6 HR Directors and 2 C-Level executives


Appendix 2: Secondary Research Sources_1

Healthcare Organization Corporate University American College of Healthcare Executives (ACHE); American College of Physician Executives (ACPE); American Organization of Nurse Executives (AONE); Healthcare Financial Management Association (HFMA); Healthcare Information and Management Systems Society (HIMSS); Medical Group Management Association (MGMA) and its educational affiliate, the American College of

Medical Practice Executives (ACMPE) Institute for Healthcare Improvement Bank of America/Merrill Lynch Healthcare practice Virginia Mason Institute Association of American Medical Colleges Health Leaders Magazine Health Catalyst Research Alpen Capital Investment Banking Research: “GCC healthcare report” HealthWorksCollective Research “Lean Hospitals” by Mark Graban The Thedacare Center for Healthcare Value Ohio State University Fisher College of Business Ardent Advisory & Accounting LLC: “GCC healthcare sector” NMC Health Annual Reports MEDICLINIC Annual Reports Anglo-Arabian Healthcare Reports



Waha Capital Annual Reports Al Noor Hospitals Group Annual Report “Using Kaizen towards a culture of continues improvement humanizes the healthcare workforce for

better outcomes” by Mark Graban “Value stream mapping the emergency department” by Koelling, Eitel, Mahapatra, Grove, Grado

Department of Industrial and Sustems Engineering Virginia Tech & Emergency Department York Hospital

Healthcare System Process Improvement Conference 2015, Society for Health Systems “Making Hospital Work” Lean Enterprise Institute Redesigning care at the Flinders Medical Centre: clinical process redesign using “lean thinking” by

David I Ben-Tovim, Jane E Bassham, Denise M Bennett, Melissa L Dougherty, Margaret A Martin, Susan J O’Neill, Jackie L Sincock and Michael G Szwarcbord

“Process mapping the patient journey through health care: an introduction” by Timothy M Trebble,1 Navjyot Hansi,1 Theresa Hydes, Melissa A Smith, Marc Baker

“Successfully deploying Lean in healthcare” Philips corporation Healthcare services “Lean Hospital: What does it mean?” By Kristin Furfari, University of Colorado Hospital “Sentara Healthcare: Making Patient Safety an Enduring Organizational Value” Douglas McCarthy and

Sarah Klein issues research, inc. “Lean Health Care: What Can Hospitals Learn from a World-Class Automaker?” By Christopher S. Kim,

David A. Spahlinger, Jeanne M. Kin, John E. Billi “Transforming Health Care: Virginia Mason’s Pursuit of the Perfect Patient Experience” by Gary S.

Kaplan, MD, Chairman and CEO



AAMC Readiness for Reform: Virginia Mason Medical Center, Applying LEAN Methodology to Lead Quality and Transform Healthcare

“LESSONS FROM THE FIELD: Promising Interprofessional Collaboration Practices” by Robert Wood Johnson Foundation

“SUCCEEDING IN THE RISK ERA: How to Accelerate Progress Toward a Value-Based Future” by Health Leaders Media Intelligence

“PATIENT EXPERIENCE: AUGUST 2015 Cultural Transformation to Move Beyond HCAHPS” by Health Leaders Media Intelligence

“PHYSICIAN ALIGNMENT: Today’s Strategies Require Risk and Clinical Integration” by Health Leaders Media Intelligence

“EXECUTIVE COMPENSATION: Strategies to Align With New Directions” by Health Leaders Media Intelligence

EVIDENCE-BASED-MANAGEMENT in Healthcare by Lynn McVey, Kenneth Fazzino, Jeffrey Palmucci ACHE HEALTHCARE EXECUTIVE: 2016 COMPETENCIES ASSESSMENT TOOL “Essential Soft Skills for Healthcare Leaders in the Era of Reform” by By Mark Madden A Suitable Model for Breaking Bad News: Review of Recommendations” by Arezoo Ebn Ahmady,

Shahid Beheshti,Shabnam Seyedzadeh Sabounchi, Hoori Mirmohammadsadeghi, Angelayalda Rezaei “Communicating Bad News by EPEC” - The Project to Educate Physicians on End-of-life Care comes

from the Institute for Ethics at the American Medical Association. SPIKES protocol for breaking bad news 2015 American Association for Physician Leadership - Meta-Leadership Completion Chart 2015 American Association for Physician Leadership - Health IT Completion Chart 2015 American Association for Physician Leadership - Masters Degree Prerequisite Completion Chart



2015 CERTIFIED PHYSICIAN EXECUTIVE Course Completion Chart The CAHPS Clinician & Group Survey (CG-CAHPS) HealthLeaders Media Roundtable: The Imperative of Alignment “Healthcare Trends and Implications 2012–2017” by American College of Healthcare Executives Guidelines for Teaching Physicians, Interns, and Residents, by US DEPARTMENT OF HEALTH AND

HUMAN SERVICES, Centers for Medicare & Medicaid Services “How to Build Patient Experience the Cleveland Clinic Way”, Interview with Dr James Merlino “MAKING PARTNERSHIPS WORK: M&A, Clinical Affiliations, and Payer Partnerships” HealthLeaders

Media CFO Exchange “Bottom-Line Preservation in the transition to Value-Based Care” Bank of Americ/Merrill Lynch

roundtable “National Health Strategy, 2011-2016, Caring For The Future, Executive Summary” General

Secretariat, Supreme Council of Health “Hospital Value-Based Purchasing Program” US DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services “What value-based purchasing means to your hospital” by Paul Shoemaker, Healthcare Financial

Management “Value-based physician compensation: the building blocks” by Bob Becker The U.A.E. Healthcare Sector U.S.–U.A.E. Business Council


“Do not follow where the path may lead. Go instead where there is no path and leave a trail.” Ralph Waldo Emerson

Thank you

Stelios PigadiotisMBA, MBTI (master practitioner code # 100926)M: (+971) 50 9722717E: [email protected] L: https://ae.linkedin.com/in/steliospigadiotisscoutglobal