experience is changing health care in the Middle East
Houston Methodist Global Health Care Services, the international subsidiary
of US-based Houston Methodist Hospital, hosted a roundtable discussion
at the Hyatt Regency in Dubai Healthcare City on 1 November 2015. The
objective of this event was to discuss patient experience in the region
with opinion leaders to understand the best practices, challenges and
their visions of the future. Fourteen health care leaders were in attendance
to offer insight from the hospital, government, regulatory, architecture
and technology perspectives. The following excerpts are highlights from
Dr Sarper Tanli, Vice President, EMEA for Houston
Methodist Global Health Care Services, welcomed the guests and led a round
of introductions. He then presented a brief overview of patient experience
citing the Beryl Institute definition of patient experience as "the sum
of all interactions shaped by an organization's culture that influence
patient perceptions across the continuum of care". "Leadership remains
a critical success factor for patient experience, because it is not a
short journey. It is a long journey for any organization and they can
have their own way of doing and managing the experience in their hospital.
"Houston Methodist Hospital started this patient experience journey around
2004/2005. We really looked at our values and started changing the organization
with the 'ICARE' values that were created. It is now more than 10 years
later and we are still on the journey; and now we can call it a better
The roundtable discussion was an informal meeting
moderated by Dr Tanli who prompted the panelists to further discussion
with probing questions and summarized comments.
What do we see from patient experience trends in the
GCC region? Are we seeing any of these trends occurring or starting in
I would say that there is heavy interest in patient experience in the
GCC. I think we have all the components of the patient experience, but
the question is how do
we get there? How do we ingrain the processes within the organizational
culture? What measurements do we need to have? From our perspective at
Faisal Specialist Hospital and Research Centre, we are addressing cultures
and processes currently. We are exploring and learning and investing in
it. Thanks to Houston Methodist, we have had a lot of training and education
related to patient experience. However, it is an ongoing journey that
we are really working on. We concluded that it is based on our own organization's
culture and leadership and our patient population because we cannot just
copy and paste one process to another.
Dr Moin Fikree
How many of you have done a workshop with patient stakeholders? How many
of you have sat down with them and tried to figure out where you are,
what you are doing and where you are going? Rana Aljebreen We have established
the Patient and Family Advisory Council. This is something that we are
already working on with our patients and to have them as important stakeholders
within the organization to improve our patient experience.
Ali Al Obaidi
We have 2000 employees and 3000 doctors. We introduced in our health system
a concept called "musharaka". Musharaka means participation. From these
musharaka, a lot of ideas come to the table and then a group will do a
feasibility study on some of these suggestions. Out of this musharaka
one of the suggestions was an initiative called "Masool". Masool in Arabic
means responsible. The way our Masool Project works is that we have asked
each of our business units in Abu Dhabi Health Services to have an open
forum on a regular basis with the public. They will have a six-week open
house with the public. In the early days, there were many dissatisfaction
issues and then the public got to know that we were noting everything;
we were taking action. We started to receive lots of constructive feedback
from the public and this led to improvements.
Engr. Assaf Alassaf
Our big challenge in the region is the transitional nature of staff and
how we address patient experience issues. Our big competitors are the
government provider such as King Faisal Specialist Hospital and Research
Centre and National Guard Hospitals. These institutions can hire the staff
we have trained and, if these staff specialize in different areas, the
institutions are able to give them job security, unlike the private sector.
role of patients and families
Dr Sarper Tanli
On another note, patients and families want to be engaged in the decision-making
process. Now in the US, providers are engaging the patients or community
in the design phase. Are there any initiatives like that which include
patients and families? Are the expansions always happening like this?
What do you see from that?
It seems to me it is the more mature private organizations that really
are getting into the patient awareness and consultation. In Qatar, there
is more engagement with client and patient feedback. In the UAE, it is
the same thing; there is more engagement with the end users and also the
patients. The level of engagement varies between each country. The biggest
challenge the region has is the contracts you have to employ which are
two years in duration. I think the success that Houston Methodist has
is nurses have been there 10 to 15 years and it is all about the culture.
Part of the challenge you have in the Middle East is the mentality of
a two-year contract. As soon as they are done, there is no loyalty, they
are going to go find another job somewhere else that is going to pay more.
Ali Al Obaidi
The trends in patient experience or public satisfaction are a moving target.
I think we can manage patient expectations to make them more realistic.
How do we navigate when patient expectation is a moving target, and we
have to find out what their expectations are? In regards to staffing,
sometimes they need mentorship; they need long-term professional development.
If staff feel that they are part of the organization for a longer period
of time because they can achieve other goals and objectives; they may
stay even if they get a better package.
In the Middle East, I don't think we have the right balance. I think we
have, in some facilities, good quality but not patient experience; and
others, the best patient experience, but moderate quality. And that bridge
is not still there.
Dr Moin Fikree
However, perception is a little bit different. Perception comes from expectation
and is correlated to satisfaction. If you have a low expectation and you
exceed those expectations; your perception goes way beyond. If you have
a very high expectation and then you don't meet those expectations, the
satisfaction really goes down. So we have to really divide these two words,
and understand them really well; and what we have to do is surpass expectations.
Because once we surpass expectations it's when the satisfaction really
Okay, so to manage that relationship; to manage the expectations in a
totally different market requires a slightly different purpose for our
commercial unit. We need to make money to invest in the region, in our
facilities and to bring some money back to London. You are under pressure
because your reputation is your brand; Because your name is something
that you cannot fall short of, as the expectations of the patients escalate.
The American Hospital is going back to patient family-centred care. We've
got patients and family members very involved in a number of activities.
For example, we hand-selected patients who had a terrible experience at
the hospital because we wanted to learn from them. Not only did we listen
to the experience, but caregivers also sat in on those sessions because
we wanted the caregivers, physicians, nurses and ancillary service staff
to hear very specifically what that experience meant to those patients.
The other thing we did, which was pretty exciting - we got these patients
involved in operation committees at the hospital. They sat on the Quality
Care Committee. They participated in operations and they were able to
react to what was being discussed from a patient perspective. Another
initiative was getting them directly involved in policy-making. Many of
our policies changed direction as a result.
Dr Sarper Tanli
We were speaking earlier of patient experience versus patient engagement
expectation or perception. The GCC has the highest technological/mobile
phone usage in the world. Could technology have a place for us to be able
to manage such care in terms of overall care coordination; in terms of
medicine; in terms of other aspects of the continuum of care?
What do you think is happening in terms of engaging
patients and families by using technology? I know it is in the early stages,
but it would be great to hear some examples.
Health care is not about sick care anymore, but more about overall continuous
care. Technology can play a very important role. Connectivity has really
taken the patient experience to another level. It is possible to be in
your home, but still connected to your healthcare provider. That healthcare
provider gets your data every day, every week and there might be some
predictive analysis where you only intervene when it is needed based on
the data; based on the predicted evidence.
There is a lot of interest from the private sector
as well as from the Ministry of Health to buy connected solutions and
not solely rely on the technology used in the hospital to provide better
We need to be aware of the patient experience in the digital sphere. We
are seeing all this technology whether it is the Internet of Things or
the sensors or the mobile technology. It is enabling us to always stay
connected with physicians.
In Saudi Arabia, the government has recently invested in e-government
by implementing the Yesser program. They have set standards which are
applicable to healthcare organizations as well as government. It mandates
that we have certain information exchange with patients, such as medical
records and laboratory results, so that patients in distant areas don't
have to travel from outside of Riyadh for results. The challenge that
we face - is that we have all this information out here, but it is getting
the patients to utilize it. Often they can't because of the language barrier
or their literacy level. A lot of our patients are elderly and they can't
read even if it's Arabic. It's really difficult for them to go online.
Ali Al Obaidi
I think that nursing and medical students need to be brought to the table.
They need to know what kind of things they are going to witness in their
practice. Another thing is that we do not invest enough in analytics.
We gather lots of data, but are we using the data that we have? It's an
opportunity to be harvested.
An area of improvement can be the predictive analytics of the summarized
version of the medical record. There is value here for the physician and
the patient. Unfortunately, we keep investing in the foundation system
and we do not build that predictive analytic layer that will benefit the
physician and the hospital.
There are service standards in the traditional setting and there
will have to be service standards around technology. One of the things
that we have experienced around technology is our oncology physicians
have reached out and asked how they can extend that continuum of care
so that they can ensure that their patients' health is maintained throughout
the course of treatment. Our physicians connected with our research institute
and they're working collaboratively on an app that will allow them to
track patient nutrition so doctors can see their intake.
Engr. Assaf Alassaf
Unfortunately, some physicians are resistant to the change of technology.
They are resistant even though they claim they are not, because they have
smartphones. But instead of using the technology available to them for
patient care, they are making the nurse do it!
Dr Sarper Tanli
I think the policies for the payers shows insurance companies are not
keeping up with technology because their reimbursement model is based
on traditional health care of patients. Now with the Internet of Things
and telehealth there are many new ways of having patient encounters, such
as virtual consultations, but insurance companies are lagging behind on
I think the whole system needs to work in a better way so that the consumers
or patients feel empowered to take care of their own health. When they
do so, the cost burden on health care will be reduced.
I think we as a provider have to become far more transparent than we have
been. We tend to horde our information and not share it with anybody,
particularly when it comes to quality outcomes. One of the things that
we're trying to do is develop a relationship with payers where we put
together operational committees and meet with them on a quarterly basis
to share that information.
Abdulrahman Mohamed Al Jassmi
The main objective is training. We need to bring the patients on board
to be a part of the policy making. This needs the healthcare providers
and the doctors in particular, to be on the same page. You need to train
them and to highlight the importance of patient engagement and to be aware
of the patient expectation and how far this will affect their decisions.
This should come as part of their training; it has to be part of their
curriculum during their internship, medical school and residency.
The future of patient experience
Dr Sarper Tanli
In the next five to ten years what can we do to ensure we are at the forefront
of developing a positive patient experience in health care?
One of the things that we found very important is actually hiring staff
with patient experience in mind. The culture, those behaviours, really
are driven by the people in the hospital and so that's not just nurses
or allied health professionals, but it's also physicians. If you haven't
adopted or incorporated those patient experience questions in your hiring
process you are missing a tremendous opportunity to save yourself all
of those complaints and issues downstream.
I think we touched on realigning the measurement system. In other words,
align my incentives as a physician. I should be paid more if my patient
satisfaction is high.
It is very interesting to listen to this from an architectural standpoint
because we build the buildings. We can do all the spaces and we can make
it nice. But it is pretty interesting because it gets down to the leadership
and how you deal with a patient, how you deal with the doctors and nurses
and how you are going to get all that to work together. And that is the
Dr Moin Fikree
This issue of empowerment of staff at the most beneficial level is a big
issue in implementing patient satisfaction systems. For that to happen,
empowerment needs to be built within the system. You have to have leaders
who understand that and are willing to relinquish their decision making
authority. That is a major culture change in this region. That is not
Dr Tanli thanked the panellists for their time and
insights. He reviewed some key points from the discussion as well. "We
have noted that many staff are transitional which makes it difficult to
implement positive patient experience behaviours. We are faced with the
challenge of elderly patients' inability to use technology. We have physicians
who are resistant to change. We noted that education of healthcare providers
will go some way to improve patient experience. When choosing our doctors,
we should include some questions about patient experience behaviour.
"These are all barriers and suggested solutions that
we've discussed. But we agree that leadership in organizational culture
is at the forefront of any major change and this will be the case with
patient experience as well."
of upload: 13th Jan 2016