Contextual codifiable explicit easily transferable
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Insight, creates meaning, judgmental, actionable Human, tacit, transfer requires learning. Wisdom. Knowledge. Information. Contextual Codifiable, explicit Easily transferable. Data.

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Contextual Codifiable, explicit Easily transferable

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Contextual codifiable explicit easily transferable

Insight, creates meaning,

judgmental, actionable

Human, tacit, transfer requires learning

Wisdom

Knowledge

Information

Contextual

Codifiable, explicit

Easily transferable

Data


Contextual codifiable explicit easily transferable

The location & design of treatments areas are changing within the hospital facilities, as free-standing and mobile treatment sites are evolving.

Healthcare benefits, coverage, choices, and costs are continuing to evolve.

Hospitals are being subjected to more pressure to manage costs.

Hospitals and healthcare centers are treating older adults and younger prematurely born infants, both group having higher acuity level.


Contextual codifiable explicit easily transferable

Hospitals are developing technology Planning and construction project management programs to guide their decisions because limited resources are being subjected to competing demands, thus requiring more carefully executed plans

Technology planning and Acquisitionsteams are created to coordinate the absorption of new and replacement technologies that can contribute to a cost-effective delivery of quality care, these teams may also suggest changes in the current delivery system.


Contextual codifiable explicit easily transferable

  • Over the coming years, Saudi Arabia is expecting a significant increase in the demand for healthcare driven by

    • Rapidly growing and maturing population

    • Drive to improve the quality of healthcare services in the Kingdom

  • Today, the Saudi healthcare system is mainly funded by the Government –around 75% of the Kingdom’s overall healthcare expenditures are Government funded

  • The Ministry of Health (MoH) has prepared a plan to fundamentally restructure its activities, and by so doing, the healthcare sector as a whole

    • The Ministry will become a healthcare regulator, plus provider of primary care

    • The Ministry’s hospital assets will be transferred to an independent entity, initially owned by the Government, thus paving the way for more extensive Public Private Partnerships (PPPs) in healthcare

    • A national fund will be established under the Ministry of Finance to pay for healthcare services provided to patients

  • This increasing demand for healthcare, changes in the structure of the healthcare industry, and more extensive private sector participation, are expected to lead to a significant increase in investment opportunities in healthcare


Contextual codifiable explicit easily transferable

Population Growth and Corresponding Healthcare Demand Projections

Saudi Population Growth Projections

(in Millions) (2005 – 2016)

Bed Demand Projections (in 1000s)

(2005 - 2016)

High-level projections based on extrapolation of current indicators

Estimated CAGR (2005-2016) 20%

Projections of Demand for Physicians

(in 1000s) (2005 - 2016)

Estimated Budget allocation

( 1 billion)(2005-2016) 2.4%

Projections of Number of Hospital (2005 - 2016)

Source: Saudi Ministry of Economy & Planning, Central Department of Statistics, MoH Statistics


Contextual codifiable explicit easily transferable

Examples of Health System Future Pressure Points

Partial List

Average Body Mass Index (BMI) of Saudi nationals, 15 years and above, is about 30 kg/m2 – global average BMI is 23; a BMI score greater than 25 are considered overweight

Expenditures on cardiovascular diseases are expected to quadruple in the next 20 years

The spread of tobacco use in Saudi Arabia among adult males represents 24%; smoking among school children and adolescents exceeds 14% among males

Expenditures on cancer treatment is expected to triple in the coming 20 years

Mainly arising from a very high rate of consanguinity – roughly 31% of couples in Saudi Arabia are related by blood

About 25% of the overall Saudi population over 20 years old are diabetic, compared with 5% globally. The Kingdom currently spends in excess of SR 4 billion on diabetes care – spending expected to triple in the coming 20 years

The percentage of elderly people above the age of 60 years old is expected to more than double from the current ~1 million people (4% of the population) to roughly~2.5 million (or 7% of the population) by 2020

Economic development, enhanced patient awareness, more demanding patients, plus the availability of more advanced (and expensive) care will generate upward pressures on healthcare expenditures

Obesity & Cardio-vascular Diseases

Lifestyle Factors

Smoking / Cancer

Type I and II Diabetes

Other

Chronic Diseases

Blood-borne Illnesses

Aging Population

Other Factors

Evolving Patient Expectations

Source: MoH press releases, literature search


Contextual codifiable explicit easily transferable

Grade

A

A

A

A

B

B

B

B

C

C

C

C

D

D

E

E

Healthcare System Quality Rating (2005)

Basis of Ratings

  • A-High quality care, good average health status

    • Overwhelming majority of the population has access to a high standard care

    • Health system is well balanced between primary, secondary and tertiary care

  • B- Good quality care, good average health status

    • Overwhelming majority of the population has access to good care, although services are stretched

    • Healthcare expenditure is high, but insufficient to be close to meeting demand

  • C- Mixed quality of care, mixed average health status

    • Most of the population has access to some form of care, although the quality of that care is mixed

    • Services often very stretched and a lack of doctors and facilities, particularly in rural areas

  • D-Struggling health service, poor average health status

    • Lack of doctors and health facilities

    • Significant variations in access to healthcare

  • E-Dysfunctional health system, extremely poor average health status

    • Short supply of doctors and health facilities, especially outside urban conglomerations

    • Significant variations in access to care, with a large proportion of the population lacking easy access


Contextual codifiable explicit easily transferable

Ministry of Health Capacity Development Program

  • SR44.4 billion (~$12 billion) spending on healthcare and social services, up 13% relative to 2007

  • 79 hospitals under construction

  • 8 new hospitals

  • 250 primary care centers to be developed


Contextual codifiable explicit easily transferable

Patient

Healthcare

Delivery

Service

Funding

Regulation

Degree of Government Ownership

Degree of Private Sector Ownership

Saudi Arabia

Best-in-Class / Desired Health System Position

Level 2:

“Emerging”

Health System

Level 1:

“Gov’t-Sponsored” Health System

Level 3:

“Intermediate”

Health System

Level 4:

“Market-Driven” Health System

Patient

Patient

Patient

Healthcare

Delivery

Healthcare

Delivery

Healthcare

Delivery

Service

Funding

Service

Funding

Service

Funding

Regulation

Regulation

Regulation

  • Widespread private sector healthcare delivery options

  • Public sector provisioning limited to selected patients (e.g. the poor / military)

  • Increasing healthcare regulations

  • Predominance of public sector activities– ‘Command and Control’ model

  • Private sector involvement limited to few care providers

  • Emerging private sector involvement in healthcare and increasing private insurance

  • Decreasing burden on gov’t due to private insurance

  • Mounting pressures for establishing a comprehensive regulatory framework

  • Near-absence of public sector healthcare

  • Government role limited to ensuring oversight, with limited subsidies

  • Comprehensive regulations to ensure fair play

Increasing Private Sector Participation


Contextual codifiable explicit easily transferable

10%

90%

30%

40%

60%

70%

Public Sector Participation

Private Sector Participation

Share of Healthcare Delivery – Number of Beds Comparison (Selected Saudi Cities)(2005)

Observations

Illustrative

24%

  • In Jeddah, private sector participation is considerably more advanced than elsewhere in the Kingdom

  • The health provider system in Jeddah is perceived as being better than other parts of the Kingdom – some patients travel to Jeddah seeking quality care

  • On the other hand, several regions such as in the South remain lacking in terms of private sector presence

76%

Eastern

Region

Riyadh

Region

Jeddah

Region

Southern

Region

Source: KSA Ministry of Economy & Planning, Central Department of Statistics, MoH Statistics


Contextual codifiable explicit easily transferable

MoH Modernization Plan

MOH Sector Modernization Plan

  • Issue regulations to implement the plan

  • Develop preventive and curative primary care activities to be provided by the MOH

  • Establish General Organization for Hospitals, and transfer the hospital assets of MOH to this organization –the hospitals will continue to be Government owned

  • Establish National Health Fund separate from MOH (under MOF), to fund directly healthcare services provided to patients

  • Establish Regional Health Directorates (13), and allocate independent health budget from the Government to each of them

  • Establish Regional Health Councils to ensure coordination of health activities on a regional basis

Source: Balsam – Development of Saudi Healthcare System - 2006


Contextual codifiable explicit easily transferable

Trailing leads are trip hazards

Locked fire exit to Female Surgery

Typical internal corrosion within boiler plant

Air cooled chillers in poor condition

Existing poor clinical flooring

Existing defective clinical flooring

Existing temporary door signage

Existing suspended ceilings

Existing defective furniture

Defective light fittings

Poor shower arrangement

Typical damaged ceilings

Existing clinical wash basin

clinical floor tiling

Defective AHU to Recreation

Existing departmental signage

Damaged toilet fittings

Incomplete theatre ceiling

Existing poor furniture

Cracked lighting diffusers

Poor and missing clinical skirting

Replacement Air Handling Unit

Temporary room signage

Damaged door leaves

Damaged roof

Defective roof perimeter

Original fitted furniture

Split joints, and walls without skirtings

Fire Alarm panel – non compliant

Poor, steep access ramp

Damaged and Defective Fittings

Sanitaryware and floor

Chipped sanitaryware

Damaged and Missing Ceilings

Typical existing DX split condensing unit

Damaged existing roof fans

Existing temporary door signage

Existing clinical wash hand basin

Missing and water stained tiles

Existing clinical flooring

Existing emergency lighting

Existing defective clinical flooring

Missing and water stained tiles

Existing defective clinical flooring

poor vinyl installation

Damaged chilled water pumps

Existing departmental

defective light fittings

Damaged door leaves

Existing clinical ceilings

Existing floor tiling to toilets

Existing poor clinical skirtings

Temporary room signage

Existing defective furniture

Damaged clinical wash hand basin

Old style distribution board

BUILDING: MH LEVEL 2LOCATION: OPERATING RM. 16PICTURE: STORAGE AREA FOR SURGICAL EQUIPMENTCOMMENTS: TYPICAL HANDLING OF MEDICAL EQUIPMENT AND STORAGE?!

BUILDING: O.P.B LEVEL 0LOCATION: LOW CURRENT ROOM NEAR ROYAL KITCHEN PICTURE: BOXES OF OLD OPB PLANCOMMENTS: IMPROPER USAGE/STORAGE OF MATERIALS. IT SHOULD BE PLACE OR STORE IN ENGINEERING DEPT.

BUILDING: MH LEVEL 2LOCATION: OPERATING RM. 10PICTURE: STORAGE AREA FOR SURGICAL SUPPLIESCOMMENTS: WHAT A WASTE OF BLDG. OR’s THAT COST AROUND 2.5 TO 4M S.R. AND USED FOR STORAGE!

BUILDING: O.P.B LEVEL 0 LOCATION: ELECT. ROOM (NO .B5) PICTURE: EXPOSED SECURITY ACCESS CABLES. COMMENTS: IF NOT USE REMOVED OR ARRANGE PROPERLY.

BUILDING: M-H LEVEL 0LOCATION: INSIDE ELEC. ROOM NR. ELECT. RM. B24A

PICTURE: TELEPHONE TERMINAL BOARD COMMENTS: TELEPHONE TERMINAL BOARD IS NOT PROPERLY ORGANIZED.


Contextual codifiable explicit easily transferable

Hospitals are the most complex of building types.

Each hospital has a wide range of services and functional units:

  • clinical laboratories,

  • imaging, emergency rooms, and surgery;

  • hospitality functions, such as food service and housekeeping;

  • inpatient care or bed-related function.


Contextual codifiable explicit easily transferable

  • Every owner wants a cost-effective building. But what

  • does this mean?

    • Is it the lowest first-cost structure that meets the program?

    • Is it the building with the longest life span?

    • Is it the facility in which users are most productive?

    • Is it the design with the lowest operating and

    • maintenancecosts?

    • Is it the building that offers the greatest return on

    • investment?


Contextual codifiable explicit easily transferable

Differs from almost all other types of buildings.

The biological flora that are endemic to all health premises pose a risk to both patients and staff.


Contextual codifiable explicit easily transferable

  • Goals:

    • Running a hospital building over the course of its useful life.

    • To achieve the intent of the original building design team.

    • To achieve long-term goals of economy, energy efficiency, resource conservation, & pollution prevention, while meeting the comfort, health, and safety requirements of Patients, Staff and Visitors.


Contextual codifiable explicit easily transferable

If we

“Cannot Measure it”

  • we

  • “Cannot Manage it”

    The development of meaningful measurement criteria:

    • Key Performance Indicators (KPI’s) is a vital step in

    • establishing & improving quality


Contextual codifiable explicit easily transferable

Environment where Standards and Quality are in alignment.

To meet the Goals and Objectives of the Healthcare Organizations mission.


Contextual codifiable explicit easily transferable

Insight, creates meaning,

judgmental, actionable

Human, tacit, transfer requires learning

Wisdom

Knowledge

Information

Contextual

Codifiable, explicit

Easily transferable

Data


Contextual codifiable explicit easily transferable

Patient involvement: …they cannot and should not be responsible for their own safety in an environment over which they have no control.

George AnnasNEJM 354;19:2063-2066


Contextual codifiable explicit easily transferable

Appropriate circulation ceilings

Appropriate boiler plant installation

Appropriate Pump assembly

Additional wall outlets

Appropriate slip resistant vinyl flooring

New air cooled liquid chillers

Appropriate slip resistant vinyl flooring

Typical new distribution board

Flat roof being recovered

Flat roof with gravel blast

Sheet vinyl to Ward areas

Typical fitted furniture

Appropriate slip resistant vinyl flooring

Appropriate clinical basin and mixer tap

Cantilever type fitted furniture

New domestic wc and cistern

Panel mounted clinical wash hand basin

Corridor suspended ceilings

Proposed new split DX units

Appropriate room signage

Appropriate laminated doorsets

Appropriate clinical toilet arrangement

Appropriate slip resistant vinyl flooring

Appropriate type fan fittings

washable clinical ceiling

Proposed fitted clinical furniture

Compliant Fire Alarm panel

New Designed steam boiler


Contextual codifiable explicit easily transferable

High-level Blueprint for Healthcare System

Governmental Control and Oversight

  • Supervision and Consultation

  • Legislative Authority

Regulations for Private Investment

Competition, and Pricing Regulations

Accreditation and Quality Control

Healthcare

Funding /

Health Insurance

Compensation of Providers

  • Antitrust Laws and Regulations

  • Pricing Regulations

  • Regulations on Choice of Professional Activity

  • Sources of Funding

  • Requirements for Insurance Coverage

  • Tasks and obligations of Insurers

  • Sources of Funds

  • Rules for Compensation

  • Rules for and Protection of Private Investments

  • Rules for and Protection of Foreign Investments and Property

  • Provider Institutions

  • Pharmaceuticals

  • Medical Products

Source: Booz Allen analysis


Contextual codifiable explicit easily transferable

Government-Driven Health-Related Initiatives

Cooperative Health Insurance Act

  • Regulates the provision of healthcare for non-Saudi residents in the Kingdom

  • Determines the rights and duties of sponsors, beneficiaries, insurers and providers

Saudi Food and Drug Administration

  • Responsibility for regulating activities related to the safety of food and drug for man and animal, and the safety of biological and chemical substance, as well as medical devices

Nat. Center for Health Insurance Standards

  • Establish national standards, unify health industry processes, and play an advocacy and educational (training) role in developing an advanced healthcare delivery system

Saudi Council for Health Specialties

  • Develop the professional practice, promote technical skills, enrich scientific thought, and promote practical applications related to health specialties

Private Health Institutions Legislation

  • Set rules and guidelines that govern the set up and operation of private health institutions, including infrastructure, human resources, medical services, etc.

Makkah Region Quality Program

  • Establish quality standards for public and private sector hospitals and other care delivery institutions – activities limited to Makkah region

Source: Booz Allen analysis


Contextual codifiable explicit easily transferable

Accreditation

Auditing

Standards

Quality System


Contextual codifiable explicit easily transferable

Auditing

Standards

Quality System


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