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Editor’s intro In this issue we look at the
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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 successfully working to drive up standards in healthcare and patient safety across the region.
4.
German Healthcare Export Group The Medical Technology Network Exclusive interview with GHEG Chairman, and senior MEIKO executive Markus Braun
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Sidhil - British Quality Healthcare for the Middle East Designer and manufacturer of The Independence Innov8 Low bed
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Cover feature - Childhood Obesity in the Middle East How to address the growing problem of combined mal nutrition and obesity in the region
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Joint Commission International: Ensuring quality and safety through international accreditation and certification with Al Ain Hospital, Dubai, case study
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Abdulrahman Al Mishari Hospital Award winning Riyadh hospital specialising in women’s healthcare
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*&& +HDOWKFDUH 5eview and MEH photo gallery
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Cerner Middle East: Providing information management systems Interview with Managing Director Greg White
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Specialist article - Putting patient’s first: the little BIG things in patient care By Praveen Pillai
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Freedom From Torture Medical foundation for the care of victims of torture
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 Mishari, also winners of an MEH health and innovation award.
Editor: Guy Rowland Publisher: Mike Tanousis Associate Publisher: Chris Silk MEH Publishing Limited Company Number 7059215 151 Church Rd Shoeburyness Essex SS3 9EZ United Kingdom Tel: +44 01702 296776 Mobile: +44 0776 1202468 Skype: mike.tanousis1
Editor: Guy Rowland Tel: +44 01223 241307 Mobile : +44 07909 088369 guyrowland@middleeasthospital.com Features Editor: Emrys Baird Tel +44 07961391055 em@middleeasthospital.com
Abu Dhabi & Bahrain office Ms. Pam Page Direct Phone: +971 4 329 1099 UAE Mobile: + 971 50 424 0569 USA Mobile: +617 943 0934 pam.page@worldcongress.com
Regional Director Abdullah Al Thari Armada Network – Healthcare Services, Olaya Mosa Bin Nosair Road Riyadh. Saudi Arabia Tel : +966 595 99 22 11 althari@gmail.com
UAE distributor Dr Prem Jagyasi MD & CEO ExHealth, P. O. Box. 505131 Dubai HealthCare City, UAE Tel:+971 4 437 0170 Prem@Jagyasi.comm www.ExHealth.com
MEH agent for Egypt Dr.Amr Salah Millennium International Group amr.salah@migaegypt.com Tel: +2 0222736354 Mobile: +2 0122227209 For more information about the magazine contact the publisher or editor. Or email MEH at: editorial@middleeasthospital.com
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German Healthcare Export Group 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 contacts with ministries and institutions such as the Germany Trade and Invest. Mr Braun told MEH, “The GHE offers its members a pool of knowhow 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 entire medical technology product range: Whether stethoscopes, CT equipment or hospital IT, suppliers from all product segments are represented in the GHE. But potential customers from abroad in particular sometimes find it easier to have one single contact for all their questions. 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
Markus Braun, GHEG Chairman
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 commodities and expendable items, physiotherapy, orthopaedics, laboratory processing, services and publications. Besides, areas like rescue equipment, medicine for emergency purposes, 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 business network that promotes direct communication between the members 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 scientific experts give lectures on the chosen topic. The GHE celebrated its 20-year existence at the MEDICA 2011 on 3 consecutive evenings with invited guests.” 20 years GHE – 20 years of export networking The German Healthcare Export Group (GHE) places great importance on personal contact with its member companies and on exchanging knowledge and experiences within the Group. In other words, GHE means networking at its best. A look at GHE’s history reveals how it created this extensive network of contacts from scratch over a period of just 20 years. Mr Braun said, “We bring customers and our members together. We provide information to hospitals in terms of how to optimise their processes, build long term relation-
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The Medical Technology Network
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 developing 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 interest to the Near- and Middle East. This, however, changed quite quickly”, said Witzke. The meetings
held in order to exchange information 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 member companies always stood in the foreground. “Most of us where fully aware of the value of this exchange of information from our everyday jobs.”, emphasised 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 responsibilities. History of the GHE The GHE was founded in 1991 under the name “German Community of Interest for the Export of Pharmaceutical, Laboratory, Dental and Medical Technology” (Deutsche Export-Interessengemeinschaft Pharma, Labor, Dental und Medizintechnik). At that time - which coincided with the Second Gulf War – information coming from the Near East was extremely sparse, and it was this very circumstance that that inspired Heinz-Jürgen Witzke (Beta Verlag)
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German Healthcare Export Group
and Udo Pawelka (then “Sartorius AG”) to organise a group of companies 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 Hünlich. “We wanted to prevent any potential 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 expanded to global export. These
days, the Group meets three times a year to discuss current export issues and to offer its members and high-profile experts the opportunity to share their experiences of various export markets. However, even the venues used for the Group’s meetings have changed. Whereas, initially, they were often held in hotels, the decision was soon taken to hold them on the premises of their member companies – thus also enabling 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 Industry, the German Office for Foreign Trade (bfai) in Cologne and the Bonn offices of the Ministry of Health.
In addition to the regular meetings, members would also help one another in selecting representatives in certain regions and share their personal 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 occupying a large joint stand and adjacent lounge at MEDICA. Moreover, the GHE has been appearing at the Arab Health in Dubai since its establishment. Visits of delegations to maintain existing contacts or to
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German Healthcare Export Group
build up new ones in the programme are very common. The last delegation trip took place in Cairo in the autumn of 2010. The GHE always intended to participate 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 uplifting spirit also had a positive impact on Arab Health. ”All of the participating GHE members were pleased to see a larger number of visitors and a considerably increased interest in German medical technology products. Projects are ramping up again, which
ultimately stands to benefit the entire German medical technology industry.” The new booth concept of the GHE joint booth also received an especially positive response. Not just the German Healthcare Export Group (GHE) e.V. member companies but also the numerous guests were excited 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 quality and innovative medical technology – made in Germany – for use in hospitals and medical facilities throughout the world.
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New clinic open at 150 Harley Street, London www.snorecentre.com
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German Healthcare Export Group 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 intermediaries between individual members. Today, half of the GHE companies are active in the electronics and medical technology sector, closely followed by those dealing with and manufacturing medical commodities and consumables, physiotherapy 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 rescue equipment and emergency medicine sectors, as well as diagnostic, information and communication technology, complete its list of member companies. Being one of the driving forces behind innovative technologies, the German medical technology sector not only secures and creates jobs, but also provides young people with opportunities for specialised training. It is one of the largest sub-segments of the German economy, internationally competitive and an industry of the future. With an export turnover of nearly 9 billion euros, GHE’s member companies play no small part in this segment’s importance. GHE member companies’ contribution to this
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 exports. Mr Braun adds, “The healthcare sector will most certainly continue to be a growth market for the foreseeable future – both nationally and internationally. Its further development will not only be
influenced by population growth and demographic developments, but also by the rapid advances currently made in medical technology. The GHE Group has dedicated itself to contributing to increasing the effectiveness and efficiency of medical technology in order to improve the quality of health care across the world.” www.gheg.de
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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. Afterwards, he successfully ran a German bureau of a worldwide operating company in the field of measurement instrumentation. Since 1998 he has been controlling the business division â&#x20AC;&#x153;Cleaning and disinfection techonoglyâ&#x20AC;? at MEIKO Maschinenbau GmbH & Co. KG. In 2004, Braun was appointed member of the board of trustees of the Oskar and Rosel Meier foundation, the owners of MEIKO. Braun has been a member of the GHE since 2000. He was elected chairman in 2003.
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Sidhil - British Quality Healthcare for the Middle East
With quality, performance and safety of vital consideration for healthcare providers in the Middle East, UK hospital bed manufacturer Sidhil recently had the opportunity to showcase some of their latest products exhibiting these qualities at Arab Health in Dubai. Of particular interest to visitors to the stand was the company’s flagship 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 interest 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. Lord Darzi and Clive Siddall
Spearheading the export drive is Paul Hampton, Sidhil’s Export Sales Manager, A qualified engineer with a BSc in Design & Manufacture, he has worked in healthcare sales in the Middle East for many years and has an in-depth understanding of the specific requirements 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 applications from utility ward beds through to high dependency environments, and features a minimum
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The Independence Innov8 Low Bed
platform height of just 218mm – one of the lowest available on the market today. Electrically operated functions include auto contouring, giving simultaneous adjustment of backrest and kneebreak, with cardiac chair function and auto regression avoiding surface pinching or occupant sliding, as well as Trendelenberg and reverse Trendelenberg positioning.
Solid platform panels incorporate ridges for breathability, to simplify decontamination and to improve infection control. The Innov8 Low is supplied complete 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 reliable and easy to maintain, incorporating 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 produced in the UK at Sidhil’s purposebuilt factory premises, where the company operates with the very lat-
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Sidhil - British Quality Healthcare for the Middle East est high technology manufacturing and finishing processes, maintaining 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 performance and quality based on total commitment to the developing requirements of the healthcare market. Today, Sidhil designs, manufactures and supplies a comprehensive selection of products, popular with both the NHS and private healthcare markets in the UK and now increasingly achieving acceptance across Europe and worldwide, with significant sales into the Middle Eastern countries.
Clive Siddall and Paul Hampton receive an MEH Health and Innovation award for Sidhilâ&#x20AC;&#x2122;s Independence Innov8 Low hospital bed from Mike Tanousis, MEH Publisher, at Arab Health
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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 diabetes burden, 23% of the ischaemic 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, affected children experience adverse outcomes such as breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects. The rise in childhood obesity over the past decade has been dramatic. It is estimated that in 2010, 43 million children under the age of 5 years will be overweight. Although current estimates suggest that the rate of obesity in developed countries is double that in developing countries, in terms of absolute numbers, prevalence is much higher in developing countries. There are an estimated 35 million overweight or obese children in developing countries, compared with 8 million in developed countries. The World Health Organisation predicts 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: obesity 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" â&#x20AC;&#x201D; where a person is deficient in particular vitamin or mineral â&#x20AC;&#x201D; are particularly common in the region and need to be tackled. Participants at the forum said the UAE Government, 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 revealed 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 solution, according to Gain, could be to produce healthier foods, through fortification of staple items, such as flour and oil, with vitamins and micronutrients including iron, folic acid and zinc. Gain's chairman, Jay Naidoo, said people can be obese and malnourished. While there is no outright hunger in the UAE, there is a "hidden 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 partners in countries around the world, both in the public and private sectors. "We would like to work with the UAE in understanding how to tackle the challenge that they face on obesity," he said. "It's phenomenal to
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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 already 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 really is a big issue we all have to work together on, not only the families, 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 prepared according to Islamic tradition. "It is not halal to sell something to a child that may harm him in the future," he said. "The food industry has to take more responsibility." According to Martin Bloem, the chief of nutrition and HIV/AIDS policy at the World Food Programme, there is only a small window of opportunity to ensure that children are pro-
vided with the right nutrients. He said the first 1,000 days, from conception to the age of two years, are crucial. According to Mr Naidoo, ignoring the nutritional needs of pregnant women and children under two can be linked to problems of obesity later on, which can lead to problems such as cardiovascular disease and diabetes. "Part of the problem of obesity later in life is the problem of undernutrition 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-
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Special Feature: Childhood Obesity in the Middle East same attitude towards obesity. "They know the term means being big," she said. "But they do not understand that it affects their health. They don't know it could lead to diseases like diabetes and heart defects." The problem may lie in school curriculums, Ms Stott said.
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 worldâ&#x20AC;&#x2122;s fattest countries, estimating 68.3% of its citizens to be overweight; making this small country one of the top regions plagued with high obesity rates. The widespread prevalence of obesity in the UAE is a major cause for concern as the condition brings with it several co-morbidities which affects individuals, 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 parents and 69 per cent of teachers labelled obesity a serious issue in the community.
"I'm not sure students necessarily understand the threat that obesity is to their health as from what I understand this is not being taught in school," she said. "Perhaps implementing formal curriculums in which health education is added may help students better understand the consequences of obesity and its related diseases." Ms Stott said her study aimed to identify barriers to addressing the issue of childhood obesity. Inappropriate 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 homecooked meals than Emirati children.
Aisha Alsiri, the director of nutrition and school health section at the Ministry of Education, said most state-school pupils displayed the
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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 strategy that will reap health benefits in the long term. Experience in several countries has shown that successful obesity prevention and behaviour change during childhood can be achieved through a combination of population-based measures, implemented both at the national level and as part of local ‘settings-based’ approaches, 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 governments and health ministries, thereby acknowledging the fact that social and economic factors contribute 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’ approach. Accordingly, it is essential that interventions for obesity prevention 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 effectiveness and sustainability of action at a population level. The key elements of a populationbased approach to childhood obesity prevention are policy support, monitoring systems, knowledge translation and a strategy for integrating evidence into the development of multi-level programmes. Although the importance of obesity
prevention in childhood is now widely acknowledged, to date interventions have tended to target only small populations or population subgroups, predominantly in developed countries. Although many of these interventions have yielded promising results, there has been little coordinated action to identify these and extend their reach to prevent obesity at the population level. Extract from Population-based Prevention Strategies for Childhood Obesity, WHO, 201
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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 Einstein, a private, non-profit, non-governmental 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 hospitals, ambulatory care facilities, clinical laboratories, care continuum services, home care and long term care organizations, medical transport organizations, and primary care services, as well as certification for 15 types of clinical care programs. JCI standards were developed by international health care experts and set uniform, achievable expectations. Interview with Dr. Ashraf Ismail, Managing Director, Middle East International Office
health care and improved processes that reduce risk and improve health outcomes for organizations 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 transport 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 hospitals are now JCI accredited.
MEH: What is the role of JCI in the Middle East?
MEH: What do hospitals need to do in order to gain accreditation?
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 patient 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
AI: To get accreditation organisations 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 infection control and patient safety. Our general approach includes expert 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 deliver measurable results that lead to lasting improvements. Our advisors customize their approach to fit the needs of the organisation. Through JCI accreditation and certification, health care organizations have access to a variety of resources and services that connect them with the international community: an international quality measurement 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
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International Accreditation and Certification process when the hospital is completed. 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 hospitals to undergo the accreditation process? AI: Medical tourism is one important driver in the Middle East, as accreditation makes hospitals more attractive to patients, as it guarantees a high standard of care. Insurance 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 accredited. 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 accreditation, building on the foundation of the governmentâ&#x20AC;&#x2122;s own national accreditation scheme. Improving efficiency is also a key driver towards accreditation. A JCI accredited hospital will have put in place measures to encourage a re-
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Joint Commission International duction in waste, properly managed length of patient stay, and cut out mistakes and unnecessary procedures. This also results in significant 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. Governments must decide whether they can afford to destroy and rebuild old hospitals in order to enable the accreditation. 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 resources challenges in the Middle East, with the expansion of healthcare services far outstripping the available medically qualified professionals. Countries need to import medical workers but solution creates its own problems as workers from different part of the world will have received varied levels of training in quality and safety. Local graduates are also often insufficiently trained in this area, so additional training of staff is needed in order to comply with accreditation requirements.
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 development 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 Minister of Health in UAE to develop the new strategy of the health sector. As a quality consultant, he assists health care facilities through the accreditation 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 Improvement Program in the Family Planning Clinics in Egypt MEH: How does accreditation benefit patients? AI:The public need to know that they are getting safe and good quality healthcare. The more accredited organisations there are the greater the public awareness becomes of the benefits of choosing an accredited hospital for their treatment. Our aim is to bring standards 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 requires 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 encourages patients to question their healthcare providers about all aspects of their service. www.jointcommissioninternational.org
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JCI Case Study: Al Ain Hospital Al Ain Hospital (AAH) is an acute care and emergency hospital, located 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 Emirates, AAH is dedicated to providing the highest quality care that respects the diverse cultural backgrounds of patients and adheres to international standards and best practices. “JCI’s accreditation standards have become a model for health care standards by many health systems globally,” says AAH CEO George Jepson. “The standards and survey process are designed 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 enhancements in the areas of process improvement, patient safety, and quality improvement: Process Improvement • Developing comprehensive, 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 continuity, patient safety and continuous improvement Patient Safety • Adhering to the IPSGs to create a culture of safety for staff and patients • Adopting a holistic approach to involve patients, families, staff, and visitors • Establishing a transparent reporting system for complaints and suggestions from employees, patients and families Quality Improvement • Developing a quality management system based on the JCI Standards • Improving monitoring systems and processes to measure enhancements to quality and patient safety in clinical and managerial areas: • Establishing a periodic review of data analysis to sustain quality improvements • Designing an effective and
efficient surveillance system to monitor, analyze and address datadriven, 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 standards.” For a hospital that is dedicated to clinical excellence for all its patients, the most important benefit of JCI accreditation is its enhanced reputation among stakeholders and the domestic and international communities.“Making a decision to obtain JCI Accreditation is a journey, a culture shift, and a visible commitment to improve the quality of patient care and services,” says Mr. Jepson. www.alain-hospital.ae
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Abdulrahman Al Mishari Hospital
Hospital founder Dr. Abdulrahman Al Mishari (l) and his son Mohammed, Managing Director (r) are presented with an MEH award for excellence in women’s healthcare by Mike Tanousis, MEH publisher
Dr. Abdulrahman Al Mishari Hospital (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 hospital has made in the areas of obstetrics, gynaecology, IVF, neo-natal and post- natal care. Hospital Managing Director Mohammed Al Mishari, son of the Hospital’s founder Dr. Abdulrahman Al Mishari, accepted the award on behalf 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 possible.” ARMH is a private General Hospital located in Al Olaya District, Riyadh, Saudi Arabia. As a result of its commitment to excellence, ARMH achieved in 2010 the "Diamond" accreditation standard, which is the highest level of recognition for performance excellence that an organisation can achieve in health care from Accreditation Canada's Qmentum 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 establishing a private hospital. In 1987, the Hospital was inaugurated with the Governor of Riyadh Region, His Royal Highness Prince Salman Bin Abdulaziz Al Saud, doing the honour of cutting the ribbon. The hospital has now become one of the most trusted and respected 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.
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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 delegates 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 exhibiting 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.
Zubair Ansari, King Faisal Hospital, Riyadh (l); Thomas Murray, CEO, American Hospital Dubai (c); Fahad Bindayei, King Faisal Hospital (r)
The multi-track Arab Health Congress reached new heights with the 17 accredited conferences featuring more than 500 internationally renowned speakers. The congress attracted a sell-out number of delegates 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 multimillion dollar deals and partnerships being signed onsite, making Arab Health 2012 the most successful event for exhibitors and visitors alike. Over the course of the four day event, 76,101 visitors attended Arab Health Exhibition and Conferences, making this the largest healthcare event in the MENA region and the second largest in world. With a 15% increase in visi-
Malem Medical - Enuresis alarms for prevention of bedwetting
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Arab Health tor number from last year, the event has clearly yielded results from substantial 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 $5 million and above. UK Pavilion The UK Pavilion organiser, ABHI, brought the largest ever number of UK healthcare companies to Arab Health in 2012. The UK Pavilion in Hall 7 housed 120 of the UK’s most innovative med-tech companies. On the second day of Arab Health 2012 companies exhibiting on the UK Pavilion were visited by Dr Hanan Al Kuwari, CEO of Hamad Medical Corporation of Qatar, and UK Business Ambassador Lord Darzi of Denham. Speaking on the subject of UK-Middle East cooperation Lord Darzi said:
Greg White, Vice President and MD, Cerner Middle East
Carsten Schmidt, IBM, and Ibrahim Ellawi
“The Middle East has long been a key trading partner for the UK, not only because it is one of the largest markets for medical equipment and healthcare products, but also because no other region in the world faces such rapid growth in demand for the latest technologies. “The UK is well placed to meet these challenges. Its medical technology sector, which comprises some 3000 companies is highly diversified and innovative. Between
Hanan Al Kuwari, CEO, Hamad and Lord Darzi, UK government business ambassador
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*&& +($/7+&$5(
(l-r) Mark Choufani; Sobhi Baterjee, CEO, Saudi-German Hospital Group; Jeff Staples, CEO, Sheik Kalifa Medical City; Kasim Ardati, CEO, Bahrain Specialist Hospital
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*&& +($/7+&$5( them these businesses produce a range of products from high-tech equipment for advanced imaging and diagnosis, to surgical instruments- testament to the wealth and breadth of the UK’s capabilities to deliver a range of healthcare solutions to meet Middle Eastern needs.” Lord Darzi and Dr Al Kuwari spoke to several UK exhibitors about their products including bariatric bed manufacturer Benmor Medical (Stand 7C51), who were launching their new “Aurum” bariatric bed at Arab Health. Also, leading UK manufacturer of powered operating tables, Eschmann Equipment.
Richard Venners, Marketing Director, LEEC (l); Shuaiti Mottaba, Gulf National Kuwait (c); Paul Venners, CEO, LEEC (r)
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Brian de Francesca, TBS, and Abdullah Al Thari, Armada Network, Saudi Arabia
Diederik Zeven, Senior Director Middle East, and Marc Kruger, Business Manager Home Healthcare EMEA, Philips
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*&& +($/7+&$5(
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Cerner Middle East
For more than 30 years, Cerner Corporation has been a visionary leader in providing information management systems designed to improve health care.
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.”
Greg White, Vice President and Managing Director for Middle East and Africa told MEH, “Our clinical and health information system applications enhance the managerial efficiency and clinical effectiveness of health care delivery worldwide. We design all of our solutions to ac-
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 government 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 implementation and training, remote hosting, health care data analysis, transaction processing for physician practices and employer health plan third party administration services. “In the last three to four years we have experienced rapid growth in
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Health Information Systems 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 technology with knowledge to deliver vital data for effective, real-time decision-making across the enterprise. Their solutions are licensed by more than 9,000 facilities worldwide. Mr White explained, “Today, the cornerstone of Cerner’s advanced technology is Cerner Millennium®. It is the most powerful set of integrated applications for automating information across the care continuum. Only Cerner Millennium has the unified health care architecture capable of both retrieving and disseminating 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, putting 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 finding new and innovative ways to deliver 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 Services Co. (SEHA) Network, SEHA Ambulatory Healthcare Services
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 strategies to connect healthcare providers and patients across all care venues 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 highest 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
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Cerner Middle East (AHS) implemented an electronic health record system. The fully integrated Cerner system creates an enterprise-wide, longitudinal 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 patient safety by standardizing care and reducing error,” said Robert Pickton, SEHA chief information officer. “The unified Cerner Millennium electronic health record connects all SEHA hospitals and clinics, providing doctors and nurses with real-time patient information and access to evidencebased protocols designed to improve clinician knowledge and prevent medical errors,” Pickton said. Fewer Errors AHS rules and alerts within the system warn clinicians of potential adverse 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 improve the overall quality of care. Clinicians quickly reference patients’ 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 consistent care across AHS clinics.
Legible Orders With the digital system, physician orders are legible so nurses no longer need to decipher handwritten prescriptions. The EHR also has helped AHS eliminate handwritten identification documents. Patient 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-todate patient information has helped AHS clinicians optimize workflow efficiency and performance. For example, AHS provides clinicians with investigation results within hours — not days — and vital patient information in real time. This time saving has led to a more effective provision of care based on evidence
rather than best guesses. In addition, AHS uses the system to optimize result turnaround time due to connectivity between the EHR and laboratory medical devices. As a result, 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. Elrayah Ahmed of the Zakher Clinic. With the integrated system, Dr. Ahmed writes that he can access this information “very swiftly, efficiently and knowledgeably, regardless of the time and place.” Intuitive Interface, Minimal Clicks AHS has standardized information across the healthcare system with a common user interface and con-
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Cerner Middle East
tent. Through this intuitive visual interface, routine functions are consistent across solutions, eliminating the need for clinicians to learn multiple 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 providing access to clinical and administrative information with minimal clicks. Easier for Patients Better access to comprehensive patient information helps AHS enhance 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 communities, rather than traveling to a specialty clinic. Patients no longer need to provide their medical history at every visit. Their history is now available to clinicians enterprisewide. In addition, the patientsâ&#x20AC;&#x2122; medication profile, allergies and problems list are viewable across all AHS facilities, which helps the organization reduce medication duplication. AHS clinicians use the EHR to evaluate medication use and offer patient education. Security and Confidentiality The rule-based security model in the EHR restricts access to information on a â&#x20AC;&#x153;need-to-knowâ&#x20AC;? basis, assigning varying security levels to demographic and individual clinical
data elements. AHS has determined 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 reduces the time AHS spends entering patient information. This data is entered once into the system and is then shared throughout other components of the integrated system. Enhanced Management and Reporting With the EHR system, financial management and reporting is much
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Health Information Systems 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
more transparent. Specifically, the system enables AHS to: • Reduce repeat investigations — The EHR allows test result information to be shared across facilities. • 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 immediately following a visit, which significantly reduces the delay in coding and claims. The system also helps the organization 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 strategies, improve standards of care and benchmark internationally with mul-
tiple healthcare systems. The system helps these individuals: • Open the restrictive boundary of the paper record with electronic 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 information • Reduce human error inherent with paper handwritten records
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Putting patients first: Little BIG things in patient care perceptions. Arguably, the two main influences are the media and personal experience. While shock headlines may influence some patients 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.
In Francis Ford Coppola’s 1972 film The Godfather, there’s a scene between Tom Hagen (Robert Duvall) and Sonny Corleone (James Caan), which is often repeated in corporate settings: “This is business, 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 reform, 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 psychoanalyst Enid Balint, the term implied 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 patient-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 patient-centred health care system, it’s becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those
When a nurse at the Celilo Cancer Centre at the Mid-Columbia Medical 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 sixhour infusion, the song began playing. 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 massage, reflexology and music therapy. Patients form expectations prior to their encounter with the services. They develop perceptions during the process of service delivery and then they compare their perceptions to their expectations in evaluating the outcome of the service encounter. Interestingly, a single
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By Praveen Pillai
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 Executive Delos "Toby" Cosgrove, a heart surgeon by training, says he had an epiphany several years ago at a Harvard Business School seminar, where a young woman raised her hand and told him that despite the clinic's stellar medical reputation, 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 employees.
knew everything about the tumour, knew nothing about the child, not evens the name and was addressing the child by case and room number.
“Unlike in The Godfather, business is now very personal, especially in healthcare.”
• A patient consults an orthopaedist because of knee pain. The surgeon determines that no operation 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 treatment.
• On rounds with medical students, Dr. Arnold P. Gold, professor of clinical neurology and pediatrics at Columbia University’s College of Physicians and Surgeons, witnessed a disturbing incident. A child was being treated for a neuroblastoma, and one of the residents, who
Each clinician has executed his or her craft with impeccable authority and skill, but the patient has become a shuttlecock. Although, the Hippocratic Oath itself enjoins physicians to maintain their deportment and privileges while keeping the patient's interests foremost but probably the patient must have be-
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Putting patients first: Little BIG things in patient care 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 compared a year of Rush’s Press Ganey data with patients’ actual returns 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 revenues annually from additional repeat customers.” According to Frederick Reichheld, “raising customer retention rates by five percentage points could increase the value of an average customer 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 disgruntled customers and use the opportunity to turn a negative situation into a positive one. Instead of an upset customer who becomes a noisy distracter, the goal is to convert 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 treatment? The hospital's legal team even advised refusing treatment; but the doctor, who was often the recipient of the patient's anger, disagreed noting his oath to always be there for the patient. Providing greater information, access and autonomy, so often successful 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 behaviour. 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 dissatisfaction has also led to high and perhaps unrealistic expectations on their part. Paradoxically, even though the effectiveness of medical technology has improved considerably, with massive gleaming hospitals, expensive computerized equipment and sophisticated scanning machines which appear very impressive and re-assuring at times
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By Praveen Pillai
“In business you get what you want by giving other people what they want -- the way they want it.” A. MacDougall of distress, however undoubtedly personalized service still remains a stronger value proposition and differentiator 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 transformation initiative is dependent on how value is driven through the organization with the appropriate involvement/integration of people, process and technology. So while embarking on the journey to service excellence, it's critical that leadership
maps out specific goals and understand how they are going to get there, assigning specific accountability 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 employee 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 employees 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-centered model but often debate rages about patient versus physician centred care, but the reality is health relies on strong doctor-patient alliance... where both parties share information with the common goal of having the best experience possible. And it’s not just about doctors and nurses, but the attitudes and behaviour of frontline staff, allied healthcare professionals, support staff etc. all plays a key role for patient care and efficiency at every stage of the health-care experience. Patient and care givers must therefore meet as equals, bringing different knowledge, needs, concerns, and gravitational pull perhaps like a double helix, whose two strands encircle each other, or — to
return to medicine's roots — the caduceus, whose two serpents intertwine forever. A. MacDougall’s quote, "In business you get what you want by giving 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.
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.
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Freedom from Torture Freedom from Torture, formerly the Medical Foundation for the Care of Victims of Torture, is the only organisation in the UK dedicated solely to the treatment of survivors of torture and organised violence. Its concern for the health and well-being of torture survivors and their families is concentrated towards providing direct care and practical assistance to help those living in the UK begin to rebuild their lives. Since its inception, in 1985, over 50,000 individuals 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 presence in five major UK cities responding to the needs of torture survivors who find themselves dispersed around the country as part of the asylum process. Freedom from Torture’s holistic approach to rehabilitation includes a wide range of physical and psychological therapies which are delivered in an individual or group setting. Caseworker counsellors work with torture survivors in an environment which recognises their practical, medical and legal requirements as inter-connected. Pioneering group-work which brings clients together in a protected social environment to explore their experiences using creative therapy (such as drama, art and music) also has a positive impact on the lives of torture survivors 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 horticulture with psychotherapy and facilitates 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. Freedom 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 allotment 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 worldwide, drawing on the extensive evidence base it has built up over 25 years. The organisation challenges the attitudes of policy makers and the public, working to influence improvements in government policy
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and legislation. The policy and advocacy work is complemented and bolstered through human rights research which provides an evidence base, as well as through orchestrated campaigns and and media work. Crucially for an individual’s protection needs and to help provide supporting evidence to hold torturing States to account, the organisation’s doctors, psychologists and counsellors work to forensically document the effects of torture in Medico-Legal Reports (MLRs) commissioned by lawyers. Such effects include badly healed fractures, lac-
erations and burns, damaged ligaments or chronic bone infections. These reports also document evidence 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 Torture. 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 detained 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 survivors, as well as writing psychiatric reports documenting their psychological well-being.
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Freedom from Torture Dr. Hopkins has a particular interest in working psychotherapeutically with people who have a wide range of emotional problems. Consequently he has dealt with numerous clients suffering from depression, anxiety, psychotic experiences and Post Traumatic Stress Disorder, to name a few.
clear what she meant in regards to her worries of being infected.
One of Dr. Hopkins’ clients, a young woman in her early 20s, was subjected to detention and torture for a period of two years. Dr. Hopkins explained:
Dr. Hopkins provided time and a place of safety for her to express her fears and instead of challenging her delusions he sought to understand them. He also arranged for her to be helped with her housing problem which was having a negative impact on her emotional wellbeing and was acting as a barrier to her rehabilitation.
“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 infect her and she would become a monster like them.” Dr. Hopkins states that these thoughts can be classified as “paranoid delusions” and that the mainstay of her treatment would be antipsychotic medication. Initially she was given a lot of space to talk during therapy sessions before 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 monster-like creatures. The situation became more apparent to Dr. Hopkins as it became
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.”
“It is sometimes just as important to address social welfare concerns such as housing, finances and asylum 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 barbaric behaviour. This had the additional effect of making it clear where he stood in relation to what the guards had done. Describing this approach he explained: “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
Dr William Hopkins
come from, so as to help her emotionally distance herself from these experiences which were at the root of her fears and psychological disturbances.” Gradually her beliefs diminished and after a year in therapy she no longer believed she was being pursued by creatures although she still experienced nightmares. Dr. Hopkins concluded: “In therapy there needs to be regularity and consistency to provide a secure framework and a space where feelings can be explored. Sympathetic listening is an important 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 understanding what has gone on for both therapist and torture survivor. The context of someone’s fears, nightmares, delusions and hallucinations can be very helpful in understanding the reasons why they are in such distress and planning how to help them.”
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