Middle East Hospital August 2014 Issue

Editor: Guy Rowland

Publisher: Mike Tanousis

Associate Publisher: Chris Silk

MEH Publishing LimitedCompany Number 7059215151 Church RdShoeburynessEssex SS3 9EZUnited KingdomTel: +44 01702 296776Mobile: +44 0776 1202468Skype: mike.tanousis1

Editor: Guy RowlandTel: +44 01223 241307 Mobile : +44 07909 [email protected] Editor: Emrys Baird Tel +44 07961391055 [email protected]

Regional DirectorAbdullah Al ThariArmada Network – HealthcareServices, OlayaMosa Bin Nosair RoadRiyadh. Saudi ArabiaTel : +966 595 99 22 [email protected]

Abu Dhabi & Bahrain office

Ms. Pam PageDirect Phone: +971 4 329 1099UAE Mobile: + 971 50 424 0569USA Mobile: +617 943 [email protected]

UAE distributor

Dr Prem Jagyasi MD & CEOExHealth, P. O. Box. 505131Dubai HealthCare City, UAETel:+971 4 437 0170 [email protected] www.ExHealth.com

MEH agent for Egypt

Dr.Amr SalahMillennium International [email protected]: +2 0222736354Mobile: +2 0122227209

For more information about themagazine contact the publisher oreditor. Or email MEH at:[email protected]

A 201 | 3

4. German Healthcare Export Group

The Medical Technology Network

Exclusive interview with GHEG Chairman, and

senior MEIKO executive Markus Braun

12. Sidhil - British Quality Healthcare for the Middle

East Designer and manufacturer of The

Independence Innov8 Low bed

16. Cover feature - Childhood Obesity in the Middle

East How to address the growing problem of

combined mal nutrition and obesity in the region

20. Joint Commission International:

Ensuring quality and safety through

international accreditation and certification

with Al Ain Hospital, Dubai, case study

26. Abdulrahman Al Mishari Hospital

Award winning Riyadh hospital specialising in

women’s healthcare

30.

eview and MEH photo gallery

38. Cerner Middle East:

Providing information management systems

Interview with Managing Director Greg White

44. Specialist article - Putting patient’s first: the little

BIG things in patient care

By Praveen Pillai

48. Freedom From Torture

Medical foundation for the care of victims of torture

Editor’s intro

In this issue we look at the

growing problem of childhhood

obesity, and the accompaying

issue of malnutri-tion increasingly

common in the Middle East,

resulting in a “double burnden” for

the region’s healthcare services.

And how the World Health

Organisation is attempting to

tackle these issues through

population-based strategies.

Markus Braun of the German

Healthcare Export Group speaks

to MEH about the success of the

group in creating effective

partner-ships over 20 years of

export net-working. We also

interview Ashraf Ismail, Director

of the Middle East office of JCI,

the leading interna-tional

accreditation body that is suc-

cessfully working to drive up

standards in healthcare and

patient safety across the region.

Also featured is Sidhil, UK manu-

facturers of the Innov8 hospital

bed range; the latest Low model

mak-ing a big splash at Arab

Health this year, and winning an

MEH award. Also profiled is

leading Saudi obs-gyne specialist

hospital Abdulrah-man Al Mishari,

also winners of an MEH health

and innovation award.

German Healthcare Export Group

Middle East Hospital

| 4

In the wake of a successful Arab

Health for German companies

MEH interviews the Chairman of

the German Healthcare Export

Group, Markus Braun.

In the German Healthcare Export

Group (GHE) approx. 50 innovative

and strongly growing companies

from the area of medical technology

have come together to encourage

an exchange of their experiences in

export business. Just as important

as the exchange of information and

experiences between members,

are also the GHE’s excellent con-

tacts with ministries and institutions

such as the Germany Trade and In-

vest.

Mr Braun told MEH, “The GHE of-

fers its members a pool of know-

how from which everyone benefits.

“Proven Partnership” is our motto,

and we demonstrate this not only

during the regular meetings of the

GHE, but also in our day to day

work.”

The GHE represents almost the en-

tire medical technology product

range: Whether stethoscopes, CT

equipment or hospital IT, suppliers

from all product segments are rep-

resented in the GHE. But potential

customers from abroad in particular

sometimes find it easier to have

one single contact for all their ques-

tions. This is what the GHE offers

them by channelling their enquiries

and passing them on to the right

person.

The GHE counts members of all

sizes, from global players like

Siemens Healthcare, B. Braun and

Dräeger Medical to medium-scale

enterprises like Meiko, Tunstall or

seca. The more different the sizes

of enterprises, the more varied the

product range: The greater part of

the GHE companies are active in

electrical and medical technology,

followed by those dealing with and

manufacturing medical commodi-

ties and expendable items, physio-

therapy, orthopaedics, laboratory

processing, services and publica-

tions.

Besides, areas like rescue equip-

ment, medicine for emergency pur-

poses, diagnostic products, IT and

communication technology are also

represented in the GHE. Overall,

the German Healthcare Export

Group represents about 80 per cent

of the German export volume in

medical technology.

Mr Braun explained, “Over the

years, the GHE has become a busi-

ness network that promotes direct

communication between the mem-

bers of the GHE. Meetings dealing

with present thematic priorities and

specific country issues take place

three times a year, serving primarily

as experience exchange. There,

member firms can openly discuss

questions of distribution, foreign

markets and other export topics.

Moreover, commercial and scien-

tific experts give lectures on the

chosen topic. The GHE celebrated

its 20-year existence at the MED-

ICA 2011 on 3 consecutive

evenings with invited guests.”

20 years GHE – 20 years of ex-

port networking

The German Healthcare Export

Group (GHE) places great impor-

tance on personal contact with its

member companies and on ex-

changing knowledge and experi-

ences within the Group. In other

words, GHE means networking at

its best. A look at GHE’s history re-

veals how it created this extensive

network of contacts from scratch

over a period of just 20 years.

Mr Braun said, “We bring cus-

tomers and our members together.

We provide information to hospitals

in terms of how to optimise their

processes, build long term relation-

Markus Braun, GHEG Chairman



| 5

ships with healthcare providers,

and arrange for them to speak to

people in the industry who can help

them with their requirements.

TheMiddle East, USA and Europe

are the most important markets,

and we also work in China and the

rest of Asia, and South America,

that are all now very important de-

veloping markets.”

Strategic focus – The Near and

Middle East

Initially, the Group’s focus was on

individual geographical regions

only. “Because of the war in Iraq,

GHE originally limited its area of in-

terest to the Near- and Middle East.

This, however, changed quite

quickly”, said Witzke. The meetings

held in order to exchange informa-

tion soon started to include areas

like the Far East, Eastern Europe

and South America. However, with

all of these meetings, the practical

benefits they would create for mem-

ber companies always stood in the

foreground.

“Most of us where fully aware of the

value of this exchange of informa-

tion from our everyday jobs.”, em-

phasised Wolfgang Hünlich,

formerly employed by Heraeus and

now working for Thermo Electron

Corporation. Although, initially, the

project did not involve any formal

organisational procedures, these

started to materialise quite quickly

as time went on and led to the print-

ing of stationary, the organisation of

meetings and delegation of respon-

sibilities.

History of the GHE

The GHE was founded in 1991

under the name “German Commu-

nity of Interest for the Export of

Pharmaceutical, Laboratory, Dental

and Medical Technology”

(Deutsche Export-Interessenge-

meinschaft Pharma, Labor, Dental

und Medizintechnik).

At that time - which coincided with

the Second Gulf War – information

coming from the Near East was ex-

tremely sparse, and it was this very

circumstance that that inspired

Heinz-Jürgen Witzke (Beta Verlag)


| 6


and Udo Pawelka (then “Sartorius

AG”) to organise a group of compa-

nies that would focus exclusively on

international exports.

The Group finally changed its name

to “German Healthcare Export

Group” in 1992. This was also the

year that its members elected a

board of directors and an advisory

board, chaired by Wolfgang Hün-

lich. “We wanted to prevent any po-

tential impasses and thus agreed

on five board directors“, explained

Stefan Ohletz, who took over as

chairman from Wolfgang Hünlich in

1995.

The, initially, rather casual meetings

held by the Group became a lot

more professional and the range of

subjects under discussion was ex-

panded to global export. These

days, the Group meets three times

a year to discuss current export is-

sues and to offer its members and

high-profile experts the opportunity

to share their experiences of vari-

ous export markets. However, even

the venues used for the Group’s

meetings have changed. Whereas,

initially, they were often held in ho-

tels, the decision was soon taken to

hold them on the premises of their

member companies – thus also en-

abling member companies to get to

know each other better.

Later on, regular meetings were

also often held in various ministerial

offices, including the Berlin offices

of the Department of Trade and In-

dustry, the German Office for For-

eign Trade (bfai) in Cologne and the

Bonn offices of the Ministry of

Health.

In addition to the regular meetings,

members would also help one an-

other in selecting representatives in

certain regions and share their per-

sonal experiences of various export

markets on a one-to-one basis. This

illustrates the fact that the GHE has

now developed into a network of

businesses that is based solely on

direct communication between

member companies.

Trade fairs and Arab Health 2012

Since its foundation, the GHE has

been present at important national

and international trade fairs. For

years, the GHE has been occupy-

ing a large joint stand and adjacent

lounge at MEDICA. Moreover, the

GHE has been appearing at the

Arab Health in Dubai since its es-

tablishment. Visits of delegations to

maintain existing contacts or to


| 8

build up new ones in the pro-

gramme are very common. The last

delegation trip took place in Cairo in

the autumn of 2010.

The GHE always intended to partic-

ipate in medical technology trade

fairs and exhibitions right from the

very start of its conception. “Our

first joint appearance at a medical

trade fair in Hanover was only the

first of a continuous string of GHE

appearances at the most important

of the leading healthcare sector

trade fairs.“, explained Markus

Braun.

For about 20 years, GHE has been

occupying a large joint stand and

adjacent lounge at the MEDICA in

Düsseldorf and has also been mak-

ing an appearance at the ARAB

HEALTH in Dubai for several years

running. Another important trade

fair for GHE members is ChinaMed

in Beijing.

“This year’s Arab Health was a

complete success”, Mr Braun said.

“While the past two years were

somewhat marked by caution due

to the political situation in the entire

Arab area, this year a general up-

lifting spirit also had a positive im-

pact on Arab Health.

”All of the participating GHE mem-

bers were pleased to see a larger

number of visitors and a consider-

ably increased interest in German

medical technology products. Proj-

ects are ramping up again, which

ultimately stands to benefit the en-

tire German medical technology in-

dustry.”

The new booth concept of the GHE

joint booth also received an espe-

cially positive response. Not just the


(GHE) e.V. member companies but

also the numerous guests were ex-

cited about the 390 sqm GHE

booth. The booths, separated by

gauze curtains for the first time and

underscored by the new lighting,

emphasized the common goal of

the GHE member companies in a

very special way: offering top qual-

ity and innovative medical technol-

ogy – made in Germany – for use

in hospitals and medical facilities

throughout the world.


New clinic open at 150 Harley Street, LondonNew clinic open at 150 Harley Street, London

www.snorecentre.com

April2012_Sept2011 14/04/2012 00:16 Page 9


| 10

GHE opened offices in Bonn and

Berlin as a result of the increasing

interest and number of enquiries

from both Germany and abroad.

With these offices, GHE is offering

its international partners single

points of contact that act as inter-

mediaries between individual mem-

bers.

Today, half of the GHE companies

are active in the electronics and

medical technology sector, closely

followed by those dealing with and

manufacturing medical commodi-

ties and consumables, physiother-

apy and orthopaedic technology,

operating theatre equipment and

medical furniture.

However, GHE’s members are also

active in the laboratory technology,

medical services and publishing

sectors. Those working in the res-

cue equipment and emergency

medicine sectors, as well as diag-

nostic, information and communica-

tion technology, complete its list of

member companies.

Being one of the driving forces be-

hind innovative technologies, the

German medical technology sector

not only secures and creates jobs,

but also provides young people with

opportunities for specialised train-

ing. It is one of the largest sub-seg-

ments of the German economy,

internationally competitive and an

industry of the future.

With an export turnover of nearly 9

billion euros, GHE’s member com-

panies play no small part in this

segment’s importance. GHE mem-

ber companies’ contribution to this


segment primarily relates to export

and, with a joint export turnover of

nearly 10.5 billion euros, they make

up nearly 80 percent of German

medical technology segment ex-

ports. Mr Braun adds, “The health-

care sector will most certainly

continue to be a growth market for

the foreseeable future – both na-

tionally and internationally. Its fur-

ther development will not only be

influenced by population growth

and demographic developments,

but also by the rapid advances cur-

rently made in medical technology.

The GHE Group has dedicated it-

self to contributing to increasing the

effectiveness and efficiency of med-

ical technology in order to improve

the quality of health care across the

world.”www.gheg.de


Markus Braun biography

Chairman,BHEG

Markus Braun was born on 1st July 1959

in Stuttgart. After successfully completing

his degree in engineering, he started his

career as a product manager in the optical

industry. He successfully entered the laser

industry business and soon became sales

director South Germany of an international

company. Then he sought new challenges:

At a German producer of fiberopitcs and

electronics he extended his experiences in

Germany, Switzerland and France. After-

wards, he successfully ran a German bu-

reau of a worldwide operating company in

the field of measurement instrumentation.

Since 1998 he has been controlling the

business division “Cleaning and disinfec-

tion techonogly” at MEIKO Maschinenbau

GmbH & Co. KG. In 2004, Braun was ap-

pointed member of the board of trustees of

the Oskar and Rosel Meier foundation, the

owners of MEIKO. Braun has been a mem-

ber of the GHE since 2000. He was elected

chairman in 2003.

| 11



Sidhil - British Quality Healthcare for the Middle East

| 12

With quality, performance and safety

of vital consideration for healthcare

providers in the Middle East, UK hos-

pital bed manufacturer Sidhil re-

cently had the opportunity to

showcase some of their latest prod-

ucts exhibiting these qualities at

Arab Health in Dubai.

Of particular interest to visitors to

the stand was the company’s flag-

ship ward bed, the Independence

Innov8 Low. Introduced in 2011, the

bed is already proving popular with

NHS buyers in the UK, with recent

orders this year including a total of

1100 units for hospital trusts in

Bradford and Northumbria.

The success of the bed was of in-

terest too to Lord Darzi, the United

Kingdom’s Global Ambassador for

Health and Life Sciences, Chair of

NHS Global and United Kingdom

Business Ambassador, who took

the opportunity to stop by Sidhil’s

stand at Arab Health to hear about

the company’s current export drive.

Spearheading the export drive is

Paul Hampton, Sidhil’s Export

Sales Manager, A qualified engi-

neer with a BSc in Design & Manu-

facture, he has worked in

healthcare sales in the Middle East

for many years and has an in-depth

understanding of the specific re-

quirements of the market. “Sidhil’s

products are very competitive with

global suppliers in terms of both

price and functionality,” stated Paul.

“In support of this, we are currently

investing in our distributor network

to provide professional support

services for our customers in the

Middle East.”

The true advantages of the new

Sidhil Independence Innov8 Low

are clearly evident. The bed was

designed to provide total flexibility

in terms of bed specification for ap-

plications from utility ward beds

through to high dependency envi-

ronments, and features a minimum

Lord Darzi and Clive Siddall

The Independence Innov8 Low Bed


platform height of just 218mm – one

of the lowest available on the mar-

ket today.

Electrically operated functions in-

clude auto contouring, giving simul-

taneous adjustment of backrest and

kneebreak, with cardiac chair func-

tion and auto regression avoiding

surface pinching or occupant slid-

ing, as well as Trendelenberg and

reverse Trendelenberg positioning.

Solid platform panels incorporate

ridges for breathability, to simplify

decontamination and to improve in-

fection control.

The Innov8 Low is supplied com-

plete with removable cantilever

style siderails, and features manual

CPR handles on both sides with an

electrical CPR function to flatten the

platform whilst the bed is lowering.

Independence Innov8 beds are re-

liable and easy to maintain, incor-

porating superb ergonomics in

terms of both manual handling and

user comfort. They conform with

WEEE regulations and are CE

marked to Medical Devices Directives.

In addition, Sidhil’s Doherty range

of plinths and couches are already

widely accepted throughout the

Middle East, selling into Oman,

Qatar and Saudi Arabia during

201 , including 150 units to equip

treatment rooms for the Arab

Games in Doha.

Beds, couches and plinths are pro-

duced in the UK at Sidhil’s purpose-

built factory premises, where the

company operates with the very lat-

| 13


| 14

Sidhil - British Quality Healthcare for the Middle East

est high technology manufacturing

and finishing processes, maintain-

ing a constant watching brief on

changes in legislation and nursing

techniques to keep the product

range at the forefront of technology.

Established in 1888, Sidhil has built

up an enviable reputation for per-

formance and quality based on total

commitment to the developing re-

quirements of the healthcare mar-

ket. Today, Sidhil designs,

manufactures and supplies a com-

prehensive selection of products,

popular with both the NHS and pri-

vate healthcare markets in the UK

and now increasingly achieving ac-

ceptance across Europe and world-

wide, with significant sales into the

Middle Eastern countries.Clive Siddall and Paul Hampton receive an MEH Health and Innovation award for Sidhil’sIndependence Innov8 Low hospital bed from Mike Tanousis, MEH Publisher, at Arab Health

April2012_Sept2011 14/04/2012 00:16 Page 15

Special Feature: Childhood Obesity in the Middle East

Overweight and obesity now ranks

as the fifth leading global risk for

mortality. In addition, 44% of the di-

abetes burden, 23% of the is-

chaemic heart disease burden and

between 7% and 41% of certain

cancer burdens are attributable to

overweight and obesity. Obesity

has negative health impacts in

childhood, as well as in the long

term. In addition to a higher risk of

obesity and NCDs later in life, af-

fected children experience adverse

outcomes such as breathing diffi-

culties, increased risk of fractures,

hypertension, early markers of car-

diovascular disease, insulin resist-

ance and psychological effects.

The rise in childhood obesity over

the past decade has been dramatic.

It is estimated that in 2010, 43 mil-

lion children under the age of 5

years will be overweight. Although

current estimates suggest that the

rate of obesity in developed coun-

tries is double that in developing

countries, in terms of absolute num-

bers, prevalence is much higher in

developing countries. There are an

estimated 35 million overweight or

obese children in developing coun-

tries, compared with 8 million in de-

veloped countries.

The World Health Organisation pre-

dicts that by 2015 more than 700

million adults will be classified as

obese. At the same time, more than

a billion people are going hungry.

Tackling Childhood Obesity in

the Middle East

The government, food industry and

the public need to help fight the

growing problem of obesity in the

UAE, nutrition experts at the Global

Alliance for Improved Nutrition

(Gain) have argued. The experts

said there is a "double burden" of

malnutrition in the Middle East: obe-

sity concurrent with undernutrition

.

Mohamed Mansour, Gain's regional

manager, said: "The problem can

only be addressed by partnerships

with governments, organisations,

civil society and the private sector."

He said "micronutrient deficiencies"

— where a person is deficient in

particular vitamin or mineral — are

particularly common in the region

and need to be tackled. Participants

at the forum said the UAE Govern-

ment, the food industry, civil society

and the public must all play a role

in finding solution to the nation's

obesity problem.

In 2010 a government report re-

vealed that 35 per cent of children

in the UAE aged between six and

22 months are anaemic, while 41

per cent of Emirati women in the

country have folic acid deficiency

and 35 per cent of Emirati women

are classified as obese. One solu-

tion, according to Gain, could be to

produce healthier foods, through

fortification of staple items, such as

flour and oil, with vitamins and mi-

cronutrients including iron, folic acid

and zinc.

Gain's chairman, Jay Naidoo, said

people can be obese and malnour-

ished. While there is no outright

hunger in the UAE, there is a "hid-

den hunger", with some people not

getting the right nutrients. Mr

Naidoo described Gain, an alliance

established in 2002 and aimed at

reducing global malnutrition, as a

catalyst which works with local part-

ners in countries around the world,

both in the public and private sec-

tors. "We would like to work with the

UAE in understanding how to tackle

the challenge that they face on obe-

sity," he said. "It's phenomenal to


| 16

see that the Government here has

taken the lead on the matter."

The private sector is also a huge

part of the solution, according to Mr

Naidoo, who added there were al-

ready some companies in the local

food industry that are "committed"

to the cause. Saleh Lootah, the

managing director of Al Islami

Foods and a speaker at the forum,

said the local food industry, along

with the Government, has started

addressing the problem of obesity

and unhealthy eating habits. "It re-

ally is a big issue we all have to

work together on, not only the fam-

ilies, not just the Government, but

everyone," he said. "It's important to

think about how we can take care

of what a child is eating from day

one."

Mr Lootah said that halal food,

which his company produces, does

not only mean that it has been pre-

pared according to Islamic tradition.

"It is not halal to sell something to a

child that may harm him in the fu-

ture," he said. "The food industry

has to take more responsibility." Ac-

cording to Martin Bloem, the chief

of nutrition and HIV/AIDS policy at

the World Food Programme, there

is only a small window of opportu-

nity to ensure that children are pro-

vided with the right nutrients. He

said the first 1,000 days, from con-

ception to the age of two years, are

crucial. According to Mr Naidoo, ig-

noring the nutritional needs of preg-

nant women and children under two

can be linked to problems of obesity

later on, which can lead to prob-

lems such as cardiovascular dis-

ease and diabetes.

"Part of the problem of obesity later

in life is the problem of undernutri-

tion when you're young," he said. "If

we don't deal with it in that period

it'll be too late, the boat has left."

Folic acid, iron, zinc and vitamin A

are vital to ensuring a healthy preg-


| 17

nancy, according to Mr Naidoo, who

also stressed the importance of

breast-feeding in the first six

months. "Dealing with the mother

and the child are at the centre of a

nutrition strategy," he said. "We

have to reach them and target them

as a priority."

Childhood obesity in the UAE

Obesity remains a major health

issue for individuals residing in the

UAE. A study conducted by Forbes

ranked the UAE number 18 on a list

of the world’s fattest countries, es-

timating 68.3% of its citizens to be

overweight; making this small coun-

try one of the top regions plagued

with high obesity rates. The wide-

spread prevalence of obesity in the

UAE is a major cause for concern

as the condition brings with it sev-

eral co-morbidities which affects in-

dividuals, healthcare professionals,

and government officials.

Examples of diseases related to

obesity include: Diabetes (UAE has

the second highest prevalence in

the world), Cardiovascular Disease

and Several Bone and Joint Disorders.

A recent study funded by the

Sheikh Saud Bin Saqr Al Qasimi

Foundation for Policy Research

found only 38 per cent of pupils in

Ras Al Khaimah thought obesity

was a problem in schools. More

than 60 per cent of parents and

teachers were concerned about

pupils' weight and 58 per cent said

it was a problem in their family - but

that message does not seem to be

trickling down to the young.

Kelly Stott, a doctoral student from

the Teachers College at Columbia

University in New York, conducted

the study last year. She interviewed

162 RAK pupils between the ages

of 9 and 18, most of them (102)

Emirati. Another 48 were Indian and

12 were other nationalities. Fifteen

teachers and 41 parents were also

polled. Of these, 42 per cent of par-

ents and 69 per cent of teachers la-

belled obesity a serious issue in the

community.

Aisha Alsiri, the director of nutrition

and school health section at the

Ministry of Education, said most

state-school pupils displayed the

same attitude towards obesity.

"They know the term means being

big," she said. "But they do not un-

derstand that it affects their health.

They don't know it could lead to dis-

eases like diabetes and heart de-

fects." The problem may lie in

school curriculums, Ms Stott said.

"I'm not sure students necessarily

understand the threat that obesity is

to their health as from what I under-

stand this is not being taught in

school," she said. "Perhaps imple-

menting formal curriculums in which

health education is added may help

students better understand the con-

sequences of obesity and its re-

lated diseases."

Ms Stott said her study aimed to

identify barriers to addressing the

issue of childhood obesity. Inappro-

priate nutrition in schools and

restaurants was one of the main

reasons for poor child health. She

said she noticed that Indian pupils

were more likely to bring home-

cooked meals than Emirati children.

Special Feature: Childhood Obesity in the Middle East


| 18

Population-based obesity prevention strategies

Once children (and adults) are

obese, it is often difficult for

them to lose weight through

physical activity and healthy diet.

Preventing weight gain from an

early age, i.e. in childhood, is

therefore recognized as a strat-

egy that will reap health benefits

in the long term.

Experience in several countries has

shown that successful obesity pre-

vention and behaviour change dur-

ing childhood can be achieved

through a combination of popula-

tion-based measures, implemented

both at the national level and as

part of local ‘settings-based’ ap-

proaches, in particular, school and

community-based programmes.

Population-based prevention

strategies seek to change the social

norm by encouraging an increase in

healthy behaviours and a reduction

in health risk. They involve shifting

the responsibility of tackling health

risks from the individual to govern-

ments and health ministries,

thereby acknowledging the fact that

social and economic factors con-

tribute strongly to disease.

Population-based prevention

strategies for childhood obesity

thus seek to support and facilitate

increased physical activity and

healthier diets in the context of a

‘social-determinants-of-health’ ap-

proach. Accordingly, it is essential

that interventions for obesity pre-

vention occur across the whole

population, operating in a variety of

settings and at multiple levels of

government.

Although local intervention allows

action to be tailored to meet the

specific context and nature of a

problem, only national guidance

(and funding) can ensure effective-

ness and sustainability of action at

a population level.

The key elements of a population-

based approach to childhood obe-

sity prevention are policy support,

monitoring systems, knowledge

translation and a strategy for inte-

grating evidence into the develop-

ment of multi-level programmes.

Although the importance of obesity

prevention in childhood is now

widely acknowledged, to date inter-

ventions have tended to target only

small populations or population

subgroups, predominantly in devel-

oped countries. Although many of

these interventions have yielded

promising results, there has been

little coordinated action to identify

these and extend their reach to pre-

vent obesity at the population level.

Extract from Population-based Pre-

vention Strategies for Childhood

Obesity, WHO, 201


| 19

Joint Commission International

International Accreditation and

Certification

JCI has been accrediting health

care organizations since 1999--

2009 marked the tenth anniversary

of the first hospital accredited by

JCI, Hospital Israelita Albert Ein-

stein, a private, non-profit, non-gov-

ernmental facility in Sao Paulo,

Brazil. Since then, approximately

470 public and private health care

organizations in 50 countries have

been accredited or certified by JCI.

JCI provides accreditation for hos-

pitals, ambulatory care facilities,

clinical laboratories, care contin-

uum services, home care and long

term care organizations, medical

transport organizations, and pri-

mary care services, as well as cer-

tification for 15 types of clinical care

programs. JCI standards were de-

veloped by international health care

experts and set uniform, achievable

expectations.

Interview with Dr. Ashraf Ismail,

Managing Director, Middle East

International Office

MEH: What is the role of JCI in the

Middle East?

Dr. Ashraf Ismail (AI): JCI’s Middle

East Regional office located in

Dubai is focused on improving the

processes associated with quality

and patient safety. Working on pa-

tient safety initiatives with Ministries

of Health, professional societies

and other significant stakeholders

within the region, we support our

clients with advisory services and

educational resources. We are

committed to safe, high-quality

health care and improved

processes that reduce risk and im-

prove health outcomes for organi-

zations worldwide. There are now

147 JCI accredited organisations in

the Arab world. These are mostly

hospitals, but also laboratories and

primary care centres. We have also

accredited our first medical trans-

port system in Qatar. 56 of these

accredited organisations are based

in the UAE, 43 in Saudi Arabia, and

39 in Turkey. In Qatar all public hos-

pitals are now JCI accredited.

MEH: What do hospitals need to do

in order to gain accreditation?

AI: To get accreditation organisa-

tions need to prepare and educate

themselves using JCI programmes.

We help healthcare providers with

a “baseline survey” to measure the

standard of their performance, and

provide JCR publications to teach

best practise in areas such as infec-

tion control and patient safety.

Our general approach includes ex-

pert assessment and comprehen-

sive gap analysis to pinpoint and

prioritize the changes needed to

achieve goals. We then partner with

hospital staff and leadership to de-

liver measurable results that lead to

lasting improvements. Our advisors

customize their approach to fit the

needs of the organisation.

Through JCI accreditation and cer-

tification, health care organizations

have access to a variety of re-

sources and services that connect

them with the international commu-

nity: an international quality meas-

urement system for benchmarking;

risk reduction strategies and best

practices; tactics to reduce adverse

events, and the annual Executive

Briefing Programs.

MEH: Do you advise organisations

who are building hospitals?

AI: We have created a programme

called “Safe, Healthy Design” which

helps hospital designers and

builders to build hospitals that will

comply with JCI standards, thus

streamlining the accreditation


| 20

International Accreditation and Certification

process when the hospital is com-

pleted. This is very important in the

Middle East where there is a large

investment in healthcare and new

hospitals.

MEH: What are the drivers for hos-

pitals to undergo the accreditation

process?

AI: Medical tourism is one impor-

tant driver in the Middle East, as ac-

creditation makes hospitals more

attractive to patients, as it guaran-

tees a high standard of care. Insur-

ance companies are also more

likely to contract with JCI accredited

hospitals, and will even pay more in

order to obtain the better service,

shorter stays, and higher patient

satisfaction levels accreditation

brings.

A good example of this is in Jordan

where 11 hospitals are now JCI ac-

credited. This has played a big role

in Jordan becoming the top medical

tourism destination in the Middle

East, and the 5th placed destination

worldwide. Medical tourism brought

in $1.2 billion to Jordan in 2011.

Another key driver is government.

The UAE Ministry of Health (MoH)

has set a target for all hospitals in

the Emirates to be JCI accredited.

In Saudi Arabia the MoH is leading

the effort in achieving full accredita-

tion, building on the foundation of

the government’s own national ac-

creditation scheme.

Improving efficiency is also a key

driver towards accreditation. A JCI

accredited hospital will have put in

place measures to encourage a re-


| 21

Joint Commission International

duction in waste, properly managed

length of patient stay, and cut out

mistakes and unnecessary proce-

dures. This also results in signifi-

cant cost savings for the hospital.

MEH: What challenges do you face

in spreading accreditation in the

Arab region?

AI: A major challenge in some

countries is that old and outdated

20th Century infrastructure is still in

place, which represents a barrier to

achieving accreditation. Govern-

ments must decide whether they

can afford to destroy and rebuild old

hospitals in order to enable the ac-

creditation.

Even if the buildings are adequate

the problem of a lack of resources

in countries with a low healthcare

spend can prevent the investment

needed being made. Post-conflict

countries such as Iraq and Libya

need to provide basic and essential

services before they can consider

such an investment.

There are also big human re-

sources challenges in the Middle

East, with the expansion of health-

care services far outstripping the

available medically qualified profes-

sionals. Countries need to import

medical workers but solution cre-

ates its own problems as workers

from different part of the world will

have received varied levels of train-

ing in quality and safety. Local grad-

uates are also often insufficiently

trained in this area, so additional

training of staff is needed in order to

comply with accreditation require-

ments.

MEH: How does accreditation ben-

efit patients?

AI:The public need to know that

they are getting safe and good

quality healthcare. The more ac-

credited organisations there are the

greater the public awareness be-

comes of the benefits of choosing

an accredited hospital for their

treatment. Our aim is to bring stan-

dards in the healthcare industry up

to those in the aviation and space

exploration industries.

Patients must demand that

providers meet these high stan-

dards to ensure their own safety,

and the healthcare industry must

respond to these demands. This is

an ongoing process, and JCI re-

quires organisaitons to respect the

rights and choices of patients. For

example, they must guarantee the

right to a second opinion, and need

patient consent in order to conduct

a procedure.

Our “Speak Up” programme en-

courages patients to question their

healthcare providers about all as-

pects of their service.

www.jointcommissioninternational.org

Dr Ashraf Ismail biography

Managing Director, Middle East International Office

In March 2009, JCI appointed Dr. Ismail as the managing director of

its Middle East office located in Dubai. Dr. Ismail is a physician with

20 years of international experience in hospital accreditation, health

care quality management, performance improvement and develop-

ment of human resources for health.

His contributions in postgraduate quality education and training are

well recognized. As an adjunct professor at George Mason University,

School of Health and Human Services, he teaches a variety of quality

courses for the certificate in quality and outcomes management.

Dr. Ismail is a WHO consultant in accreditation and health care quality.

In 2006, he was appointed as Strategic Planning Advisor to the Minis-

ter of Health in UAE to develop the new strategy of the health sector.

As a quality consultant, he assists health care facilities through the ac-

creditation process. His experience in these areas has extended from

USA to the Middle East. For four years, he was as a quality consultant

to Inova Health System, the largest health system in Northern Virginia.

As a faculty at Johns Hopkins University and Director of JHPIEGO’s

Asia/Near East/Europe Regional office. While he was employed with

USAID in Cairo, Egypt, he implemented the first National Quality Im-

provement Program in the Family Planning Clinics in Egypt


| 22

JCI Case Study: Al Ain Hospital

Al Ain Hospital (AAH) is an acute

care and emergency hospital, lo-

cated in the Al Ain region of the

Emirate of Abu Dhabi, United Arab

Emirates. AAH belongs to the Abu

Dhabi Health Services Company

SEHA PJSC and is managed by the

Medical University of Vienna and

VAMED.

Because many of its patients come

from outside the United Arab Emi-

rates, AAH is dedicated to providing

the highest quality care that re-

spects the diverse cultural back-

grounds of patients and adheres to

international standards and best

practices. “JCI’s accreditation stan-

dards have become a model for

health care standards by many

health systems globally,” says AAH

CEO George Jepson. “The stan-

dards and survey process are de-

signed to be culturally applicable

and in compliance with laws and

regulations in countries outside the

United States.”

The accreditation preparation and

survey experience gave AAH and

staff the knowledge and tools for

measuring and sustaining enhance-

ments in the areas of process im-

provement, patient safety, and

quality improvement:

Process Improvement

• Developing comprehen-

sive, patient-centered processes

throughout the organization

• Establishing a structured

and transparent process to monitor

continuous compliance to the

IPSGs and various types of risk

management activities

• Enhancing interdisciplinary

communication

• Improving documentation

of processes to ensure care conti-

nuity, patient safety and continuous

improvement

Patient Safety

• Adhering to the IPSGs to

create a culture of safety for staff

and patients

• Adopting a holistic ap-

proach to involve patients, families,

staff, and visitors

• Establishing a transparent

reporting system for complaints and

suggestions from employees, pa-

tients and families

Quality Improvement

• Developing a quality man-

agement system based on the JCI

Standards

• Improving monitoring sys-

tems and processes to measure

enhancements to quality and pa-

tient safety in clinical and manage-

rial areas:

• Establishing a periodic re-

view of data analysis to sustain

quality improvements

• Designing an effective and

efficient surveillance system to

monitor, analyze and address data-

driven, sustainable improvements

in infection control

“The newly introduced Strategic

Improvement Plan (SIP) to address

the required action plan for follow

up with an accredited organization

is an excellent initiative towards a

holistic approach for sustainable

improvements,” reports Mr. Jepson.

“Developing the SIPs helped us to

gain deep knowledge into the

measurable elements of JCI’s stan-

dards.”

For a hospital that is dedicated to

clinical excellence for all its pa-

tients, the most important benefit of

JCI accreditation is its enhanced

reputation among stakeholders and

the domestic and international com-

munities.“Making a decision to ob-

tain JCI Accreditation is a journey,

a culture shift, and a visible commit-

ment to improve the quality of pa-

tient care and services,” says Mr.

Jepson.

www.alain-hospital.ae


| 24

Abdulrahman Al Mishari Hospital

Dr. Abdulrahman Al Mishari Hospi-

tal (ARMH) has received an award

from Middle East Hospital (MEH)

magazine for excellence in

women’s healthcare. The award

recognises the great contribution

that the 122 bed Riyadh-based hos-

pital has made in the areas of ob-

stetrics, gynaecology, IVF,

neo-natal and post- natal care.

Hospital Managing Director Mo-

hammed Al Mishari, son of the Hos-

pital’s founder Dr. Abdulrahman Al

Mishari, accepted the award on be-

half of the hospital and its staff. Mr

Al Mishari said:

“It is a great honour to receive this

award from MEH. For 24 years Dr.

Abdulrahman Al Mishari Hospital

has been providing a high quality of

medical care to its patients. It has

dedicated its time to ensure that an

evidence based standard of health

care is achieved and rendered to

our patients and their families. I

would like to thank all the staff at

the hospital for their excellent work

in making this achievement possi-

ble.”

ARMH is a private General Hospital

located in Al Olaya District, Riyadh,

Saudi Arabia. As a result of its com-

mitment to excellence, ARMH

achieved in 2010 the "Diamond" ac-

creditation standard, which is the

highest level of recognition for per-

formance excellence that an organ-

isation can achieve in health care

from Accreditation Canada's Qmen-

tum International Accreditation. The

award was presented in a special

ceremony held at ARMH by MEH

publisher Mike Tanousis (above).

After long years of a dedicated

teaching career, Dr. Abdulrahman

Al Mishari decided to contribute to

the development & infrastructure of

the fast growing economy, by es-

tablishing a private hospital.

In 1987, the Hospital was inaugu-

rated with the Governor of Riyadh

Region, His Royal Highness Prince

Salman Bin Abdulaziz Al Saud,

doing the honour of cutting the rib-

bon. The hospital has now become

one of the most trusted and re-

spected healthcare institutions in

the Kingdom of Saudi Arabia.Today,

together with his children, Hadeel

and Mohammed, Dr. Abdulrahman

Al Mishari’s journey continues.

Their quest for quality and service

excellence is relentless, through

good leadership and passion for

quality.


| 26

Hospital founder Dr. Abdulrahman Al Mishari (l) and his son Mohammed, Managing Director (r) arepresented with an MEH award for excellence in women’s healthcare by Mike Tanousis, MEH publisher


| 27

April2012_Sept2011 14/04/2012 00:17 Page 28


Arab Health

The 201 edition of the Arab

Health Exhibition & Congress

concluded at the Dubai

International Convention &

Exhibition Centre with record

breaking success; having attracted

more exhibitors, visitors and dele-

gates to the event than any other

edition in its 3 year history.

Occupying every hall of the Dubai

World Trade Centre, Arab Health

accommodated over 3,000 exhibit-

ing companies showcasing the very

latest medical breakthroughs and

technological developments in

healthcare, as well as announcing

ground-breaking new partnerships

and collaborations within the Middle

East healthcare sector.

The multi-track Arab Health Con-

gress reached new heights with the

17 accredited conferences featur-

ing more than 500 internationally

renowned speakers. The congress

attracted a sell-out number of dele-

gates and maintains its status as

the largest and most important

event of its kind.

The stimulating business-focused

atmosphere was clearly felt by all

during the four day event with multi-

million dollar deals and partner-

ships being signed onsite, making

Arab Health 2012 the most suc-

cessful event for exhibitors and

visitors alike.

Over the course of the four day

event, 76,101 visitors attended

Arab Health Exhibition and Confer-

ences, making this the largest

healthcare event in the MENA re-

gion and the second largest in

world. With a 15% increase in visi-

Zubair Ansari, King Faisal Hospital, Riyadh (l); Thomas Murray, CEO, American HospitalDubai (c); Fahad Bindayei, King Faisal Hospital (r)

Malem Medical - Enuresis alarms for prevention of bedwetting

| 30


| 31


Arab Health

tor number from last year, the event

has clearly yielded results from sub-

stantial investment in marketing,

content and promotion of the show.

Arab Health successfully delivered

an audience from all major sectors

of the healthcare industry with 44%

of our audience having purchasing

power between $100,000 and $5

million, 5.9% of our audience has

purchasing power of $5 million and

above.

UK Pavilion

The UK Pavilion organiser, ABHI,

brought the largest ever number of

UK healthcare companies to Arab

Health in 2012. The UK Pavilion in

Hall 7 housed 120 of the UK’s most

innovative med-tech companies.

On the second day of Arab Health

2012 companies exhibiting on the

UK Pavilion were visited by Dr

Hanan Al Kuwari, CEO of Hamad

Medical Corporation of Qatar, and

UK Business Ambassador Lord

Darzi of Denham. Speaking on the

subject of UK-Middle East cooper-

ation Lord Darzi said:

“The Middle East has long been a

key trading partner for the UK, not

only because it is one of the largest

markets for medical equipment and

healthcare products, but also be-

cause no other region in the world

faces such rapid growth in demand

for the latest technologies.

“The UK is well placed to meet

these challenges. Its medical tech-

nology sector, which comprises

some 3000 companies is highly di-

versified and innovative. Between

Greg White, Vice President and MD, Cerner Middle East

Carsten Schmidt, IBM, and Ibrahim Ellawi

Hanan Al Kuwari, CEO, Hamad and Lord Darzi, UK government business ambassador

| 32


(l-r) Mark Choufani; Sobhi Baterjee, CEO, Saudi-German HospitalGroup; Jeff Staples, CEO, Sheik Kalifa Medical City; Kasim Ardati,CEO, Bahrain Specialist Hospital

| 33

April2012_Sept2011 14/04/2012 00:18 Page 33


them these businesses produce a

range of products from high-tech

equipment for advanced imaging

and diagnosis, to surgical instru-

ments- testament to the wealth and

breadth of the UK’s capabilities to

deliver a range of healthcare solu-

tions to meet Middle Eastern

needs.”

Lord Darzi and Dr Al Kuwari spoke

to several UK exhibitors about their

products including bariatric bed

manufacturer Benmor Medical

(Stand 7C51), who were launching

their new “Aurum” bariatric bed at

Arab Health. Also, leading UK man-

ufacturer of powered operating ta-

bles, Eschmann Equipment. Richard Venners, Marketing Director, LEEC (l); Shuaiti Mottaba, Gulf National Kuwait (c);Paul Venners, CEO, LEEC (r)

| 34


Brian de Francesca, TBS, and Abdullah Al Thari, Armada Network, SaudiArabia

Diederik Zeven, Senior Director Middle East, and Marc Kruger, BusinessManager Home Healthcare EMEA, Philips

| 35


| 36

For more than 30 years, Cerner

Corporation has been a visionary

leader in providing information

management systems designed

to improve health care.

Greg White, Vice President and

Managing Director for Middle East

and Africa told MEH, “Our clinical

and health information system ap-

plications enhance the managerial

efficiency and clinical effectiveness

of health care delivery worldwide.

We design all of our solutions to ac-

complish one mission: to connect

the right persons, knowledge and

resources at the right time and the

right place to achieve the right

health outcome.”

Operating in the Middle East for 20

years, Cerner Middle East has a

proven track record in the region,

working with more than 130 client

facilities that range from large gov-

ernment hospital networks to small

health clinics. Mr White said, “With

a history of consistent growth and

proven commitment to the Middle

East, we are currently the leading

health care information technology

provider. We offer a broad range of

health care services including im-

plementation and training, remote

hosting, health care data analysis,

transaction processing for physi-

cian practices and employer health

plan third party administration serv-

ices.

“In the last three to four years we

have experienced rapid growth in

Cerner Middle East


| 38

the region as governments and

hospital groups have invested

heavily in transforming their and

modernising their services and data

systems”, he added.

Cerner solutions combine technol-

ogy with knowledge to deliver vital

data for effective, real-time deci-

sion-making across the enterprise.

Their solutions are licensed by

more than 9,000 facilities world-

wide.

Mr White explained, “Today, the

cornerstone of Cerner’s advanced

technology is Cerner Millennium®.

It is the most powerful set of inte-

grated applications for automating

information across the care contin-

uum. Only Cerner Millennium has

the unified health care architecture

capable of both retrieving and dis-

seminating patient-specific data

from and to virtually every point

within a health care system.

“Cerner Millennium solutions can

be found in United Arab Emirates,

Kingdom of Saudi Arabia, Republic

of Egypt and the State of Qatar, put-

ting Cerner Middle East on the front

lines of health care transformation.

Building on our industry-leading

clinical technology expertise and

vast global experience, we are find-

ing new and innovative ways to de-

liver value to our clients, while

addressing the challenges of each

country we work in.”

Case Study: Abu Dhabi

To seamlessly connect its 21 clinics

to the Abu Dhabi Healthcare Serv-

ices Co. (SEHA) Network, SEHA

Ambulatory Healthcare Services

Health Information Systems

Greg White biography

Greg White, vice president and managing director, Cerner Middle East

and Africa, is responsible for strategy, consulting, sales and operations

for the region.

White is known throughout the health care industry for his innovative

thinking around how to connect communities to improve patient safety

and manage the health of populations. He is currently working with

governments and private healthcare leaders to define national strate-

gies to connect healthcare providers and patients across all care ven-

ues and countries to improve the overall health of the population.

White joined Cerner in August 2004. Prior to his current role, he was

general manager in the Eastern region of the United States. His team

was responsible for delivering results for Cerner clients that lead the

industry in their use of health care information technology to optimize

workflow and transform patient care.

White worked closely with the University of Pittsburgh Medical Center

(UPMC) Children’s Hospital to reach HIMSS Stage 7. This is the high-

est level of automation a hospital can achieve in creating a virtually

paperless patient record environment. For his work with UPMC, and

Carolinas Healthcare System, Cerner recognized White in 2008 with

its National Client Results Executive Award.

Before joining Cerner, White was chief executive officer of Gajema

Software, LLC, a leader in the laboratory information management and

logistics market. Cerner acquired Gajema in 2004. White received a

bachelor’s degree in finance from the University of Alabama


| 39


Cerner Middle East

(AHS) implemented an electronic

health record system.

The fully integrated Cerner system

creates an enterprise-wide, longitu-

dinal electronic health record

(EHR), which clinicians use to offer

patients safer, more efficient care.

The system provides clinicians with

quick access to relevant information

for timely decisions, supporting

common workflow and anticipating

next steps.

“Cerner Millennium® solutions

allow our clinicians to improve pa-

tient safety by standardizing care

and reducing error,” said Robert

Pickton, SEHA chief information of-

ficer. “The unified Cerner Millen-

nium electronic health record

connects all SEHA hospitals and

clinics, providing doctors and

nurses with real-time patient infor-

mation and access to evidence-

based protocols designed to

improve clinician knowledge and

prevent medical errors,” Pickton

said.

Fewer Errors

AHS rules and alerts within the sys-

tem warn clinicians of potential ad-

verse events and medical mistakes.

Integrating health data into a single

enterprise clinical data repository

also helps AHS clinicians reduce

the risk of medical error and im-

prove the overall quality of care.

Clinicians quickly reference pa-

tients’ complete medical history and

current test results during ordering.

And multiple clinicians have access

to the same information at the same

time, which leads to more consis-

tent care across AHS clinics.

Legible Orders

With the digital system, physician

orders are legible so nurses no

longer need to decipher handwrit-

ten prescriptions. The EHR also

has helped AHS eliminate handwrit-

ten identification documents. Pa-

tient demographics gathered at

registration become part of the

EHR and help identify patients in all

applications.

Results in Hours — Not Days

Having access to the most up-to-

date patient information has helped

AHS clinicians optimize workflow

efficiency and performance. For ex-

ample, AHS provides clinicians with

investigation results within hours —

not days — and vital patient infor-

mation in real time. This time saving

has led to a more effective provi-

sion of care based on evidence

rather than best guesses. In addi-

tion, AHS uses the system to opti-

mize result turnaround time due to

connectivity between the EHR and

laboratory medical devices. As a re-

sult, clinicians spend more time with

patients and less time retrieving

paper records.

The EHR “is a real breakthrough,”

providing rapid access to important

patient information, writes Dr. El-

rayah Ahmed of the Zakher Clinic.

With the integrated system, Dr.

Ahmed writes that he can access

this information “very swiftly, effi-

ciently and knowledgeably, regard-

less of the time and place.”

Intuitive Interface, Minimal Clicks

AHS has standardized information

across the healthcare system with

a common user interface and con-

| 40


tent. Through this intuitive visual in-

terface, routine functions are con-

sistent across solutions, eliminating

the need for clinicians to learn mul-

tiple approaches for common tasks.

Additionally, the system uses

process models that match the way

clinicians practice medicine. As a

result, the EHR aids clinicians by

anticipating next steps and provid-

ing access to clinical and adminis-

trative information with minimal

clicks.

Easier for Patients

Better access to comprehensive

patient information helps AHS en-

hance the continuity of care. No

matter which clinic a patient with a

chronic disease visits, clinicians

there will have access to his or her

complete medical record. Sharing

this medical data allows patients to

access care in their own communi-

ties, rather than traveling to a spe-

cialty clinic. Patients no longer need

to provide their medical history at

every visit. Their history is now

available to clinicians enterprise-

wide.

In addition, the patients’ medication

profile, allergies and problems list

are viewable across all AHS facili-

ties, which helps the organization

reduce medication duplication. AHS

clinicians use the EHR to evaluate

medication use and offer patient ed-

ucation.

Security and Confidentiality

The rule-based security model in

the EHR restricts access to infor-

mation on a “need-to-know” basis,

assigning varying security levels to

demographic and individual clinical

data elements. AHS has deter-

mined the level of confidentiality for

each data element, based on the

role of each of its caregivers. The

EHR is fully compliant with security

and confidentiality regulations.

Patient Data is Entered Once

The EHR system connects a variety

of roles and venues, including direct

care, laboratory, radiology, finance,

operations, and registration and

scheduling. This integration re-

duces the time AHS spends enter-

ing patient information. This data is

entered once into the system and is

then shared throughout other com-

ponents of the integrated system.

Enhanced Management and Re-

porting

With the EHR system, financial

management and reporting is much

Cerner Middle East

| 42


more transparent. Specifically, the

system enables AHS to:

• Reduce repeat investiga-

tions — The EHR allows test result

information to be shared across fa-

cilities.

• Review investigation results

in real time at any clinic — AHS has

fewer lost results and repeat tests.

• Compare results trended

across time — Clinicians review

previous results and evaluations of

care, determining the effectiveness

of a treatment.

• Improve coding — Coding

takes place within the HER imme-

diately following a visit, which sig-

nificantly reduces the delay in

coding and claims.

The system also helps the organi-

zation immediately identify records

that are insufficient to support

claims.

Optimizing Information

In sum, leaders and clinicians at

AHS use information within the

EHR to optimize business strate-

gies, improve standards of care and

benchmark internationally with mul-

tiple healthcare systems. The sys-

tem helps these individuals:

• Open the restrictive bound-

ary of the paper record with elec-

tronic information sharing

• Fulfill its vision to optimize

health care and provide a complete

service to the residents of Abu

Dhabi

• Offer a safe and efficient

provision of care with shared infor-

mation

• Reduce human error inher-

ent with paper handwritten records

Cerner in the Middle East

1991 – Entered market

2005 – Opened office in Abu

Dhabi, UAE

2007 – Opened new office in

Dubai, UAE

2008 – Opened office in Riyadh,

Saudi Arabia

2012 – Opened office in Doha,

Qatar

Health Information Systems

| 43

In Francis Ford Coppola’s 1972 film

The Godfather, there’s a scene be-

tween Tom Hagen (Robert Duvall)

and Sonny Corleone (James

Caan), which is often repeated in

corporate settings: “This is busi-

ness, not personal". Ironically,

though, that statement is actually

bad business advice, especially in

a healthcare setting.

The “patient-centeredness” which is

the latest buzz-word in health re-

form, combines the best of modern

medicine with old-fashioned care

and ejects "strictly business" out of

the relationship and builds more of

a friendship.

First coined in 1969 by British psy-

choanalyst Enid Balint, the term im-

plied taking into account a patient's

social context to deal with illness.

Patient-centered care seeks to

make patients feel better, both

physically and emotionally. A pa-

tient-centered physician might be

described as someone who "tries to

enter the patient's world, to see the

illness through the patient's eyes."

As calls are made for a more pa-

tient-centred health care system,

it’s becomes critical to define and

measure patient perceptions of

health care quality and to under-

stand more fully what drives those

perceptions. Arguably, the two main

influences are the media and per-

sonal experience. While shock

headlines may influence some pa-

tients to view health care with a

jaundiced eye, those who have

used the service and the way they

feel were treated has always

coloured their opinions of a hospital.

When a patient was admitted to the

Cleveland Clinic for a bone marrow

transplant, he was surprised to get

a hug from a receptionist who saw

the "sheer fear" on her face.

When a nurse at the Celilo Cancer

Centre at the Mid-Columbia Med-

ical Centre in The Dalles, Oregon,

found out that his patient was

scheduled to receive chemotherapy

on her wedding anniversary, he

asked the woman and her husband

what song they'd first danced to on

their wedding day. It was "Save the

Last Dance for Me," and the next

day, when the couple rose from

their chairs after the patient's six-

hour infusion, the song began play-

ing. Right there in the infusion area,

with their arms around each other,

they danced.

More surprises were to come for

the 52-year-old cancer patient. As

she settled into her room, a social

worker came in to offer a menu of

healing services including mas-

sage, reflexology and music ther-

apy. Patients form expectations

prior to their encounter with the

services. They develop perceptions

during the process of service deliv-

ery and then they compare their

perceptions to their expectations in

evaluating the outcome of the serv-

ice encounter. Interestingly, a single

Putting patients first: Little BIG things in patient care


| 44

negative experience, particularly if

it’s perceived as unkind or grossly

insensitive, could tarnish a patient’s

entire experience of care. As

pointed out by one of the patient

“My wounds are healed but the

heart is broken”

• Cleveland Clinic Chief Ex-

ecutive Delos "Toby" Cosgrove, a

heart surgeon by training, says he

had an epiphany several years ago

at a Harvard Business School sem-

inar, where a young woman raised

her hand and told him that despite

the clinic's stellar medical reputa-

tion, her grandfather had chosen to

go elsewhere for surgery because

"we heard you don't have empathy."

Dr. Cosgrove says that in his own

days as a surgeon, he focused so

intently on reducing complications

from cardiac procedures that he

gave little thought to the feelings or

experiences of patients. But after

that incidence, in 2009, Cleveland

Clinic opened an Office of Patient

Experience, and began putting

"caregiver" on the badges of all em-

ployees.

• On rounds with medical stu-

dents, Dr. Arnold P. Gold, professor

of clinical neurology and pediatrics

at Columbia University’s College of

Physicians and Surgeons, wit-

nessed a disturbing incident. A child

was being treated for a neuroblas-

toma, and one of the residents, who

“Unlike in The

Godfather,

business is now

very personal,

especially in

healthcare.”

By Praveen Pillai

knew everything about the tumour,

knew nothing about the child, not

evens the name and was address-

ing the child by case and room

number.

• A patient consults an or-

thopaedist because of knee pain.

The surgeon determines that no op-

eration is indicated and refers her

to a rheumatologist, who finds no

systemic inflammatory disease and

refers her to a physiatrist, who

sends her to a physical therapist,

who administers the actual treat-

ment.

Each clinician has executed his or

her craft with impeccable authority

and skill, but the patient has be-

come a shuttlecock. Although, the

Hippocratic Oath itself enjoins

physicians to maintain their deport-

ment and privileges while keeping

the patient's interests foremost but

probably the patient must have be-


| 45

come a hassled, frustrated, and

may be bankrupt shuttlecock. –

This is loss of caring.

A patient’s perception of how

they've been treated during an

event can have a greater impact on

their future behaviour and loyalty

more than the actual outcome of

the event. Researchers at Rush

University Medical Center com-

pared a year of Rush’s Press

Ganey data with patients’ actual re-

turns to providers. They estimated

that “moving the satisfied group to

a highly satisfied level would yield

an increase in utilization, resulting

in $2.3 million in additional rev-

enues annually from additional re-

peat customers.”

According to Frederick Reichheld,

“raising customer retention rates by

five percentage points could in-

crease the value of an average cus-

tomer by 25 to 100%.” The more

patients we keep from year to year,

the more each is worth. So it’s

even imperative to deal with dis-

gruntled customers and use the op-

portunity to turn a negative situation

into a positive one. Instead of an

upset customer who becomes a

noisy distracter, the goal is to con-

vert him into a brand loyalist who

sings the hospital’s praises.

A hospital patient who consistently

refused to follow medical orders,

gave all the doctors bad reviews in

customer surveys regardless of

quality of care, and eventually

threatened to strip naked in the

hospital lobby and threw a tantrum.

At that point the hospital faced an

ethical dilemma. Should it refuse to

treat the patient further because he

was bad for business, even though

his life depended on future treat-

ment? The hospital's legal team

even advised refusing treatment;

but the doctor, who was often the

recipient of the patient's anger, dis-

agreed noting his oath to always be

there for the patient.

Providing greater information, ac-

cess and autonomy, so often suc-

cessful in consumer settings, does

not necessarily always drive better

care or experience in a healthcare

setting. After years of struggling

with her weight, a New York mother

underwent bariatric surgery. She

was inundated with information

from her medical team about how

she would need to change her be-

haviour. Guidelines around when,

how, and what to eat or not eat —

the rules were overwhelming and

constraining. Before long her

weight had jumped again. For this

woman, an excess of information

(along with an assumption that she

was prepared to absorb it) was part

of the problem, not the solution.

Unfortunately, the laudable era of

openness and encouragement of

patients to voice their dissatisfac-

tion has also led to high and per-

haps unrealistic expectations on

their part. Paradoxically, even

though the effectiveness of medical

technology has improved consider-

ably, with massive gleaming hospi-

tals, expensive computerized

equipment and sophisticated scan-

ning machines which appear very

impressive and re-assuring at times

Putting patients first: Little BIG things in patient care


| 46

of distress, however undoubtedly

personalized service still remains a

stronger value proposition and dif-

ferentiator than ever before.

No doubt clinical transformation

and clinical process improvement

are the essential work required for

health care organizations. But the

success of any clinical transforma-

tion initiative is dependent on how

value is driven through the organi-

zation with the appropriate involve-

ment/integration of people, process

and technology. So while embark-

ing on the journey to service excel-

lence, it's critical that leadership

maps out specific goals and under-

stand how they are going to get

there, assigning specific accounta-

bility for service delivery.

A strategy that involves the right

people using a disciplined process

with the appropriate technology will

not only results in improved patient

safety, better clinical outcomes and

an enhanced patient experience

but it also helps to increase em-

ployee and provider engagement

and retention. In order to have a

culture where patients want to

come for care, where providers

want to practice and where employ-

ees want to work, there needs to be

a spirit of service that prevails in

every encounter.

Health care has been evolving

away from a disease-centered

model and toward a patient-cen-

tered model but often debate rages

about patient versus physician cen-

tred care, but the reality is health re-

lies on strong doctor-patient

alliance... where both parties share

information with the common goal

of having the best experience pos-

sible.

And it’s not just about doctors and

nurses, but the attitudes and be-

haviour of frontline staff, allied

healthcare professionals, support

staff etc. all plays a key role for pa-

tient care and efficiency at every

stage of the health-care experi-

ence. Patient and care givers must

therefore meet as equals, bringing

different knowledge, needs, con-

cerns, and gravitational pull per-

haps like a double helix, whose two

strands encircle each other, or — to

By Praveen Pillai

About the author

Praveen Pillai is a Health care

management professional with

over 11 years of progressive

experience in both national &

international market. He is a

candidate for a doctorate

program in Business

Management. He is a graduate

in Business Economics (MBE)

from School of Economics,

DAVV, INDIA & holds a Masters

diploma in Hospital &

Healthcare management from

Symbiosis INDIA.

return to medicine's roots — the ca-

duceus, whose two serpents inter-

twine forever.

A. MacDougall’s quote, "In busi-

ness you get what you want by giv-

ing other people what they want -

the way they want it," is truly one

that should resonate with all of us

and unquestionably applies to the

patient-centred health care system.

Probably taking little extra steps will

make a BIG difference to patients’

experience of care and may help to

return medicine to its Oslerian and

Hippocratic roots, roots that care for

the patient in all domains.

“In business you

get what you want

by giving other

people what they

want -- the way

they want it.”

A. MacDougall


| 47


Freedom from Torture

Freedom from Torture, formerly the

Medical Foundation for the Care of

Victims of Torture, is the only organ-

isation in the UK dedicated solely to

the treatment of survivors of torture

and organised violence. Its concern

for the health and well-being of tor-

ture survivors and their families is

concentrated towards providing di-

rect care and practical assistance to

help those living in the UK begin to

rebuild their lives. Since its incep-

tion, in 1985, over 50,000 individu-

als have been referred for help.

With its London headquarters now

ranking as one of the world’s

largest torture treatment centres,

the organisation also has a pres-

ence in five major UK cities re-

sponding to the needs of torture

survivors who find themselves dis-

persed around the country as part

of the asylum process.

Freedom from Torture’s holistic ap-

proach to rehabilitation includes a

wide range of physical and psycho-

logical therapies which are deliv-

ered in an individual or group

setting. Caseworker counsellors

work with torture survivors in an en-

vironment which recognises their

practical, medical and legal require-

ments as inter-connected.

Pioneering group-work which

brings clients together in a pro-

tected social environment to ex-

plore their experiences using

creative therapy (such as drama,

art and music) also has a positive

impact on the lives of torture sur-

vivors attempting to overcome their

horrific experiences. In the same

way, psychotherapy groups are

used to encourage survivors to

adopt a self-help approach through

the giving and receiving of support

from fellow group members.

An example of this in practice is

Freedom from Torture’s ‘Natural

Growth Project’ in London. This

unique service combines horticul-

ture with psychotherapy and facili-

tates the growth and healthy

development of clients. For some of

the most physically and mentally

damaged clients, being in the open

and in touch with the elements can

bring instant relief and open the

path to extraordinary change. Free-

dom from Torture therapists and a

horticulturalist have been working

with clients since 1992. More robust

clients work on small pieces of land,

cultivating plants on public allot-

ment plots. For more vulnerable

clients, the private therapy garden

adjoined to the London treatment

centre provides a safe, enclosed

space for psychotherapy.

As well as offering direct clinical

care, Freedom from Torture seeks

to protect and promote the rights of

survivors both in the UK and world-

wide, drawing on the extensive ev-

idence base it has built up over 25

years. The organisation challenges

the attitudes of policy makers and

the public, working to influence im-

provements in government policy

| 48


and legislation. The policy and ad-

vocacy work is complemented and

bolstered through human rights re-

search which provides an evidence

base, as well as through orches-

trated campaigns and and media

work.

Crucially for an individual’s protec-

tion needs and to help provide sup-

porting evidence to hold torturing

States to account, the organisa-

tion’s doctors, psychologists and

counsellors work to forensically

document the effects of torture in

Medico-Legal Reports (MLRs) com-

missioned by lawyers. Such effects

include badly healed fractures, lac-

erations and burns, damaged liga-

ments or chronic bone infections.

These reports also document evi-

dence of the serious psychological

impact of torture.

In November last year Freedom

from Torture published ‘Out of the

Silence: New Evidence of Ongoing

Torture in Sri Lanka’, which was

based on its submission to the UN

Committee Against Torture, the

body which monitors compliance

with the Convention Against Tor-

ture. The report studied the medical

evidence contained in MLRs for 35

Sri Lankans tortured post-May

2009, thus demonstrating that the

practice continued long after the

end of the civil war. The research

showed that people within the Tamil

population who are perceived by

the authorities as having links to the

Liberation Tigers of Tamil Eelam

(LTTE) remain at risk of being de-

tained and tortured.

Dr. William Hopkins has worked at

Freedom from Torture since 2001

as a consultant psychiatrist and

psychotherapist. His role includes

assessing and treating torture sur-

vivors, as well as writing psychiatric

reports documenting their psycho-

logical well-being.

| 49


Dr. Hopkins has a particular interest

in working psychotherapeutically

with people who have a wide range

of emotional problems. Conse-

quently he has dealt with numerous

clients suffering from depression,

anxiety, psychotic experiences and

Post Traumatic Stress Disorder, to

name a few.

One of Dr. Hopkins’ clients, a young

woman in her early 20s, was sub-

jected to detention and torture for a

period of two years. Dr. Hopkins ex-

plained:

“She constantly thought she was

going to be attacked by monsters

who were going to eat her. At night

in particular she would catch

glimpses of these creatures in the

shadows chasing people. Further

she was terrified that they would in-

fect her and she would become a

monster like them.”

Dr. Hopkins states that these

thoughts can be classified as “para-

noid delusions” and that the main-

stay of her treatment would be

antipsychotic medication.

Initially she was given a lot of space

to talk during therapy sessions be-

fore being encouraged to talk about

her time in detention. She spoke of

the physical hardships and how the

prison guards had wanted her to

spy on other prisoners and torture

them. She also explained that she

believed the guards used to be

human beings but were now mon-

ster-like creatures.

The situation became more appar-

ent to Dr. Hopkins as it became

clear what she meant in regards to

her worries of being infected.

He explained: “If she collaborated

with the prison guards by spying on

the other prisoners she would be

released but at the cost of adopting

their values and then, in her eyes,

becoming like them – a monster.”

Dr. Hopkins provided time and a

place of safety for her to express

her fears and instead of challenging

her delusions he sought to under-

stand them. He also arranged for

her to be helped with her housing

problem which was having a nega-

tive impact on her emotional well-

being and was acting as a barrier to

her rehabilitation.

“It is sometimes just as important to

address social welfare concerns

such as housing, finances and asy-

lum issues.”

In order to validate her experience,

Dr. Hopkins made it clear that he

understood her view of the guards

being monsters due to their bar-

baric behaviour. This had the addi-

tional effect of making it clear where

he stood in relation to what the

guards had done.

Describing this approach he ex-

plained:

“I wouldn’t directly challenge her

beliefs that there were creatures

chasing her in London, but I would

make links between her fears now

and how they might be related to

experiences while in detention. At

the same time I would emphasise

that England is a very safe country

compared to the country she had

come from, so as to help her emo-

tionally distance herself from these

experiences which were at the root

of her fears and psychological dis-

turbances.”

Gradually her beliefs diminished

and after a year in therapy she no

longer believed she was being pur-

sued by creatures although she still

experienced nightmares.

Dr. Hopkins concluded:

“In therapy there needs to be regu-

larity and consistency to provide a

secure framework and a space

where feelings can be explored.

Sympathetic listening is an impor-

tant beginning and careful attention

needs to be paid to what is said and

how it is said. An exploration of the

problems can be helpful in under-

standing what has gone on for both

therapist and torture survivor. The

context of someone’s fears, night-

mares, delusions and hallucinations

can be very helpful in understand-

ing the reasons why they are in

such distress and planning how to

help them.”

Freedom from Torture

Dr William Hopkins

| 50

Documents

Middle East Hospital August 2014 Issue