The document discusses strategic initiatives for sustainable healthcare in the Middle East. It outlines challenges in the current healthcare systems in GCC countries, including a lack of specialty care and high rates of medical tourism. It then proposes two solutions - implementing lean hospital management models to optimize costs while improving outcomes, and developing specialized training programs to address talent gaps. The top three strategic initiatives highlighted are focusing on knowledge excellence, operational and financial excellence, and building strategic alliances through public-private partnerships.

1. Life Sciences & Healthcare Practice
Middle East
By Stelios Pigadiotis
March, 2016
Top 3 Strategic Initiatives for
Sustainable Results in
Healthcare in Middle East
Stanton Chase

2. 1. Global Healthcare: Challenges & Trends
2. GCC Healthcare: painful realities
3. Substantial opportunities
4. A snapshot on Dubai and Abu Dhabi healthcare models
5. Our Proposed Solution
6. Substantial Benefits of proposed solution
7. Future Leadership Agenda:
• Top 8 enablers for the health ecosystem
• Importance of Alliances
• Top 3 Strategic Initiatives
8. Appendix:
• Research Methodology
• Sources of secondary research
• Recognition of our research: 1st globally on Google search
Overview

3. Global Healthcare: Dramatic Reform
Fee for
Service
Physician
Turf warsSilos
Outcome
Based
Patient
Centric
CollaborationTeamwork
Old Environment New Ecosystem

4. Global Healthcare: Paradigm Shift
Outcome
Patient
Centric
Delivery
Inter-
professional
collaboration
Lean
Hospital
Lower Cost
Customer
Experience
Clinical
Outcomes
Governments
want…
e-Health
m-Health
Prevention
Physician
Hospital
Alignment
Integrated
Continuum of
Care
Healthcare Trends

5. $4b
n
Estimated annual cost
of outbound medical
tourism from UAE (2015)

6. GCC Healthcare: Painful Realities
Economy Sector

7. GCC Healthcare: Drivers for Future Sustainability
Sector
inelastic to
economy
slowdown
Strong
need for
top
physician
and
nursing
talent
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
Ministry of
Health
push for
value
based
system
New PPP
projects to
improve
clinical
outcomes
Aging
population
65+ CAGR
9.2% until
2020
Sector’s
CAGR
10% next
10 years

8. 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<9,00
0
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+

9. Substantial Capacity Gaps for Caregivers in GCC
24
GCC
30
Dubai
38
Germany
Physicians per 10,000 (in 2012)
49
GCC
61
Dubai
115
Germany
Nurses per 10,000 (in 2012)

10. Specialty Areas in GCC where
significant capacity gaps exist:
Neonatology/NICU
Oncology/surgical oncology/prevention
Pediatrics/pediatric surgery
Orthopedics
Neurology/neurosurgery
Cardiology/surgery
Intensive and critical care
Emergency care
Psychiatry
Long term & post acute care (LTPAC)
Home Care (e-Health & m-Health)
Specialty areas of significant capacity gaps
Opportunities
for market
entry or
expansion
of existing
facilities

11. GCC, MENA and Dubai market forecasts
Dubai 2015 2025 CAGR
%
Total
Population
2.6m 5.4m 10.7
Total
Outpatient
10.6m 26.9m 15.4
Total Inpatient 278,000 985,000 25.4
2015
$25 bn
2020
$69 bn
MENA
market
$144bn
GCC Market

12. Current model of Healthcare (Abu Dhabi):
Areas for Improvement
Your Leadership Partner

13. Future model of Healthcare (HAAD)
opportunities
opportunities

14. UAE Healthcare National Agenda 2021 Vision:
Value based opportunities
Other highlighted planned Initiatives:
• Development of a national cancer registry,
• System to monitor hospital wait times,  Value-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  Value-based training modules
• New medical training centre  Value-based training modules
• Nationwide obesity awareness programmes
Emphasis
on NCDs
ailments
Value-based
management model
can substantial
improve KPIs,
addressed by
National Agenda
Your Leadership Partner

15. Key areas of Healthcare Reform
1. Integrated continuum of care for
individuals
2. Drive quality and safety
3. Drive patient experience
4.Attract/retain/train workforce
5.Wellness and prevention – public approach
6. Ensure value for money + Sustainability of
healthcare spending
7. Integrated Health informatics and eHealth
Drive for Value-Based
Healthcare Reform
HAAD Strategy DHA Strategy

16. Our Proposed Solution In Turbulent Times:
Savings Optimization & Invest in Talent Development
Patient
Experience
Clinical
Outcomes
Service
Quality
Lean Hospital Model
Specialized Medical
Education
WHY IMPORTANT?
• Help Medical units save up to
13% - 20% of Operating
expenses which is 80% of sales
• Total waste of 12% of sales
• A $200m healthcare group can
optimize savings of $24m
• Employee engagement
WHY IMPORTANT?
86% disengaged
Cost 12.8% of wages
salaries. 30% of sales
Total Cost 3.8% of sales
$200m healthcare group
$7.7m in lost salaries
1st Solution 2nd Solution
VISION 2016
Outcome-Based Health
Savings
optimizatio
n 15.8% of
Sales

17. Benefits of 1st Solution

18. 1st Solution: Long term benefits cannot be ignored
 Evidence-based & Lean Hospital  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 Hospital 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)

19. 1st Solution: 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 rateCustomer
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)

20. Benefits of 2nd Solution

21. 2nd Solution: Benefits of an L&D program for a
value based Health organization
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

22. Physician mindset shift needed, to survive the new
healthcare ecosystem
Physician
Team
Patient
Experience
(Trust)
Lean
Hospital
Engagement
E-health

23. • Efficient Leadership for physicians : Develop caregivers, counsel performance, and
evaluate your team
• Effective Supervising skills for Nurses
• Developing Coaching skills to inspire engagement in a healthcare facility
• Advanced problem solving techniques for healthcare teams 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 Solution: Specialized training is a necessity in the
new healthcare ecosystem. Example_Areas_1
Your Leadership Partner

24. 2nd Solution: Specialized training is a necessity in the
new healthcare ecosystem. Example_Areas_2
• Emotional intelligence skills to drive 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 between physicians and caregivers
• Enhancing Patient Care Experience in Hospitals
• Mastering Multicultural healthcare teams in GCC
Your Leadership Partner

25. Healthcare Organization L&D Program
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 Solution: How a Health Organization’s
Executive University structure could look like?

26. 2nd Solution: 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

27. Future Healthcare Leadership Agenda:
Top 3 Strategic Initiatives

28. Top 8 Enablers for Middle East’s future healthcare
ecosystem: Senior Leaders must develop insights in…
1. Prevention and early detection
2. Centers of Specialized Medical Excellence – New facility design philosophy aims to
improve patient safety and experience
3. Caregiver Top Talent (nice facilities but no trust in their experience)
 Attract and Retain (cultural close physicians)
 Grow local talent
 Engagement  Lean Hospital, teamwork
 New value-based soft behaviors
4. Home Care Solutions (chronic disease mgt, m-health, e-adherence)
5. Healthcare innovation (remote patient management systems, 4D diagnostics, 3D
printing, digital hospital)
6. Patients more powerful  POL, patient surveys, Uber type doctor & medical unit
ranking
7. Public Private Partnerships (PPP)
8. Value-based Regulation

29. Strategies to enhance sustainable results: 2 Top Initiatives
Knowledge Excellence:
 Value-based technical/soft skills for physicians (help
transition old school doctors)
 Align physicians with Hospital value-based goals
 Pharma Reps to offer knowledge experience visits (How to
Grow Sales via Knowledge)
“33% of high-revenue organizations have added
new C-level positions to address value-based care,
compared to 16% of low-revenue organizations”
Operation and Financial Excellence:
 Lower Fatality Rates & higher patient experience
 Outcome-based management mindset
 Lean Hospital – employee engagement
 IRR to Investors (15%-25%)

30. 3rd Top Strategic Initiative: Emphasis in Alliances-PPP
MoH
(PPP)
Providers
Pharma
Payers
Universities
Financial
(VC/PE)
Technology
A smart healthcare organization should build strategic
Alliances to gain knowledge and first step advantage

31. About the Author

32. Stelios Pigadiotis
Client Partner
Life Sciences & Healthcare Practice Leader – Middle East
Stelios Pigadiotis is a Client Partner at Stanton Chase in the Middle East, and
the Regional Practice Leader for the Life Sciences & Healthcare Practice.
Stelios has more than 20 years of notable expertise in strategic consulting and
leadership development across various industries such as Healthcare,
Pharmaceuticals, Financial Services and Business Services.
Known as a doctor’s doctor he has trained more than 4,000 executives in 20+
countries and has developed a specialized resilience coaching methodology for
operating theaters and ICUs. His recent research paper "Healthcare Transition
in GCC: painful realities and proposed future strategies" is ranked 1st globally
by Google Search. He specializes in Lean Hospital Management models and in
developing Leadership Academies for healthcare groups.
Stelios has coached KOL’s in developing their practices to drive sustainable
results. In the pharmaceutical/biotechnology sector he has managed
international post-merger-cultural-integration strategies, high potential
academies and designed sales force excellence actions.
He holds an MBA from ALBA and a Bachelor in International Business and
International Politics from Northeastern University, Boston, USA. He is also a
professional practitioner of Myers-Briggs Type Indicator and Thomas-Kilmann
Conflict Mode Instrument
Specializations:
 Healthcare
 Pharmaceuticals
 Biotechnology
 Healthcare Technology
 Healthcare Supplies
 VC & PE investing in
Healthcare

33. Your Leadership Partner

34. Appendix

35. 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)
25 participants of which: 14 CEO, 6 HR Directors
and 5 C-Level executives or other top management

36. 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

37. Appendix 2: Secondary Research Sources_2
 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

38. Appendix 2: Secondary Research Sources_3
 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

39. Appendix 2: Secondary Research Sources_4
 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

40. Your Trusted Life Science &
Healthcare Leadership Partner
in Middle East
1st ranking article globally out of
540,000 relevant articles, if you
type in Google Search:
healthcare transition in GCC
(During January & February 2016)
Appendix 3: Globally recognized research