top 3 strategic initiatives for sustainable results in healthcare in middle east

Life Sciences & Healthcare Practice Middle East

By Stelios PigadiotisMarch, 2016

Top 3 Strategic Initiatives for Sustainable Results in Healthcare in Middle East

Stanton Chase

1. Global Healthcare: Challenges & Trends2. GCC Healthcare: painful realities3. Substantial opportunities4. A snapshot on Dubai and Abu Dhabi healthcare

models5. Our Proposed Solution6. Substantial Benefits of proposed solution7. 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

Global Healthcare: Dramatic Reform

Fee for Service

Physician

Turf warsSilos

Outcome

Based

Patient Centric

Collaboration

Teamwork

Old Environment New Ecosystem

Global Healthcare: Paradigm Shift

Outcome Patient Centric Delivery

Inter-professional collaboratio

n

Lean Hospital

Lower Cost

Customer Experienc

e

Governmentswant…

e-Healthm-Health

Prevention

Physician Hospital

Alignment

Integrated Continuum of

Care

Healthcare Trends

$4bn

Estimated annual cost of outbound medical tourism from UAE (2015)

GCC Healthcare: Painful Realities

Economy Sector

Difficult to Attract

Physicians

Employee disengagement-86%

Low Quality, Expensive Offering

Poor practices: Fraud

Box movers/Results vs Innovation/Knowledge

Public Spending Cuts

2020 “Expo” Vision

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 populatio

n 65+ CAGR 9.2% until 2020

Sector’s CAGR 10%

next 10 years

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+

Substantial Capacity Gaps for Caregivers in GCC

24 GCC

30Dubai

38German

y

Physicians per 10,000 (in 2012)

49GCC

61Dubai

115German

y

Nurses per 10,000 (in 2012)

Specialty Areas in GCC where significant capacity gaps exist:

Neonatology/NICUOncology/surgical oncology/prevention

Pediatrics/pediatric surgeryOrthopedics

Neurology/neurosurgeryCardiology/surgery

Intensive and critical careEmergency 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

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

Current model of Healthcare (Abu Dhabi): Areas for Improvement

Your Leadership Partner

Future model of Healthcare (HAAD)

opportunities

opportunities

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


Key areas of Healthcare Reform

1.Integrated continuum of care for individuals

2.Drive quality and safety 3.Drive patient experience4.Attract/retain/train workforce5.Wellness and prevention – public

approach6.Ensure value for money +

Sustainability of healthcare spending7.Integrated Health informatics and

eHealth

Drive for Value-Based Healthcare

Reform

HAAD Strategy DHA Strategy

Our Proposed Solution In Turbulent Times: Savings Optimization & Invest in Talent Development

Patient Experienc

e

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 wagessalaries. 30% of sales

Total Cost 3.8% of sales$200m healthcare group

$7.7m in lost salaries

1st Solution 2nd Solution

VISION 2016Outcome-Based

Health

Savings optimization 15.8% of

Sales

Benefits of 1st Solution

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)

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 Engageme

nt

• 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 Solution

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

Physician mindset shift needed, to survive the new healthcare ecosystem

Physician

Team

Patient Experience (Trust)

Lean Hospital

Engagement

E-health

• 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


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


Healthcare Organization L&D Program

University of MedicineCollege of NursingTechnical College

College of Finance & Supporting Services

HIPO AcademyCustomer Service Academy

On-Boarding AcademyTTT & 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?

2nd Solution: How will we know that we are there? (KPIs) Actions Deliverables

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

3. Develop vision/values, goals, structure, brand of Corporate University (CU)4. Select Advisory Team for 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 providers11. Selection of E-learning Content & Platform Design Providers12. 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

Future Healthcare Leadership Agenda: Top 3 Strategic Initiatives

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 ranking7. Public Private Partnerships (PPP)8. Value-based Regulation

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%)

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

About the Author

Stelios PigadiotisClient PartnerLife Sciences & Healthcare Practice Leader – Middle EastStelios 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

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)

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

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

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


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

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