Houston Methodist Roundtable

How patient 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 this discussion.


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 experience."


The roundtable discussion was an informal meeting moderated by Dr Tanli who prompted the panelists to further discussion with probing questions and summarized comments.


Dr SarperTanli
What do we see from patient experience trends in the GCC region? Are we seeing any of these trends occurring or starting in other organizations?

Rana Aljebreen
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 King
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.

The 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?

Randy Edwards
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.

Lina Shadid
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 increases.

Mariano Gonzalez
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.

Peter Makowski
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.

Ozlem Fidanci
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 patient services.

Lina Shadid
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.

Rana Aljebreen
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.

Lina Shadid
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.

Catherine Connolly
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 this.

Ozlem Fidanci
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.

Peter Makowski
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?

Andrew Fisk
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.

Lina Shadid
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.

Randy Edwards
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 big challenge.

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 easy.


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."

 Date of upload: 13th Jan 2016


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