Healthcare transition in GCC: Current Painful Realities & Proposed Strategic Actions for CEOs in 2016

Healthcare transition in GCC: current painful realities &
proposed strategic actions for CEOs in 2016
by Stelios Pigadiotis
January, 2016

Research Working Paper
1. Global Healthcare: Challenges & Trends
2. GCC Healthcare: painful realities
3. A snapshot on Dubai healthcare
4. Proposed Solution to prepare for a smooth transition
5. Substantial Benefits of proposed solution
6. 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
Service
Physician
Turf warsSilos
Outcome
Based
Patient
Centric
CollaborationTeamwork
Old Environment New Ecosystem

Global Healthcare: Paradigm shift
Outcome
Patient
Centric
Delivery
Inter-
professional
collaboration
Lean
HospitalLower
Cost
Customer
Experience
Clinical
Outcomes
Payers
want…
Wearables
m-Health
Evidence
Based
Physician
Hospital
Alignment
Collaboration
Primary
Acute
Tertiary
Post-Acute
Healthcare Trends

GCC Healthcare: When money is running out...bundle
and other painful realities
Economy Sector
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 2016
Outcome-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 organization
4. Drive organizational change – Outcome-based, Lean Management, PA on qualitative
metrics and behaviors
5. 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 initiatives
7. 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 geographies
9. Disseminate knowledge and expertise across the company
10. 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 study
2. Corporate Purpose & Values refreshing workshop
3. Develop vision/values, goals, structure, brand of Corporate
University (CU)
4. Select Advisory Team for CU
5. Codify core competencies per corporate value
6. Codify general competencies per job family and level
7. Design standard internal-training content for every job
family (Collages & Academies)
8. Select & Train internal employees who will provide content
9. Select & Train The Trainer workshop for internal employees
10. Selection of training delivery & learning content by external
providers
11. Selection of E-learning Content & Platform Design Providers
12. Communication Campaign (Actions & rollout plan)
13. Design annual budget
14. Organize & Communicate participation schedule
15. Pilot phase & Go Live
1  Training Needs Analysis, Gap analysis
2  Refresh purpose, vision and values statements
3  Statement of vision/values/goals & CU org/al chart, logo
4  List of members and their responsibilities
5  Final core competency list
6  List of competencies per job family/stream/function
7  Training content for all Colleges and Academies
8  Successful completion of Content writing Academy
9  Successful completion of TTT Academy
10 Content for specific modules. List of selected providers
11 Final list of providers, Intranet/Mobile/MOOC handbook
12 Marketing Plan for CU and actions roll out plan
13 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
Institutions
Venture
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 Pigadiotis
MBA, MBTI (master practitioner code # 100926)
M: (+971) 50 9722717
E: info@scout-global.com
L: https://ae.linkedin.com/in/steliospigadiotisscoutglobal

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