Contextual

Codifiable, explicitEasily transferable

Insight, creates meaning, judgmental, actionable

Human, tacit, transfer requires learning

Data

Information

Knowledge

Wisdom

The location & design of treatments areas are changing within the hospital facilities, as free-standing and mobile treatment sites are evolving.Healthcare benefits, coverage, choices, and costs are continuing to evolve.Hospitals are being subjected to more pressure to manage costs.Hospitals and healthcare centers are treating older adults and younger prematurely born infants, both group having higher acuity level.

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

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

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

– Rapidly growing and maturing population

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

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

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

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

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

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

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

Saudi Population Growth Projections (in Millions) (2005 – 2016)

Bed Demand Projections (in 1000s) (2005 - 2016)

Population Growth and Corresponding Healthcare Demand Projections

Estimated CAGR (2005-2016) 20%

23

30

2005 2016

364

502

2005 2016

High-level projections based on extrapolation of current indicators

High-level projections based on extrapolation of current indicators

70

51

2005 2016

4054

2005 2016

4054

2005 2016

Projections of Demand for Physicians(in 1000s) (2005 - 2016)

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

Projections of Number of Hospital (2005 - 2016)

Estimated Budget allocation ( 1 billion)(2005-2016) 2.4%

Examples of Health System Future Pressure Points Partial ListPartial List

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

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

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

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

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

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

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

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

Obesity & Cardio-vascular Diseases

Obesity & Cardio-vascular Diseases

Smoking / CancerSmoking / Cancer

Type I and II DiabetesType I and II Diabetes

Blood-borne IllnessesBlood-borne Illnesses

Aging Population

Aging Population

Evolving Patient ExpectationsEvolving Patient Expectations

Life

styl

e Fa

ctor

sO

ther

Ch

roni

c D

isea

ses

Oth

er F

acto

rs

Source: MoH press releases, literature search

Basis of RatingsBasis of Ratings A-High quality care, good average health status

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

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

B- Good quality care, good average health status– Overwhelming majority of the population has access to

good care, although services are stretched– Healthcare expenditure is high, but insufficient to be close

to meeting demand C- Mixed quality of care, mixed average health status

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

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

D-Struggling health service, poor average health status– Lack of doctors and health facilities– Significant variations in access to healthcare

E-Dysfunctional health system, extremely poor average health status– Short supply of doctors and health facilities, especially

outside urban conglomerations– Significant variations in access to care, with a large

proportion of the population lacking easy access

A-High quality care, good average health status– Overwhelming majority of the population has access to a

high standard care– Health system is well balanced between primary, secondary

and tertiary care B- Good quality care, good average health status

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

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

C- Mixed quality of care, mixed average health status– Most of the population has access to some form of care,

although the quality of that care is mixed– Services often very stretched and a lack of doctors and

facilities, particularly in rural areas D-Struggling health service, poor average health status

– Lack of doctors and health facilities– Significant variations in access to healthcare

E-Dysfunctional health system, extremely poor average health status– Short supply of doctors and health facilities, especially

outside urban conglomerations– Significant variations in access to care, with a large

proportion of the population lacking easy access

Healthcare System Quality Rating (2005)

96

94

92

91

82

79

76

76

72

70

68

63

59

52

45

32

0 10 20 30 40 50 60 70 80 90 100

France

Netherlands

Germany

Switzerland

UAE

Qatar

Bahrain

Kuwait

Saudi Arabia

Lebanon

Jordan

Oman

Tunisia

Egypt

Morocco

YemenE

A

A

A

A

B

B

B

B

C

C

C

C

D

D

E

Grade

Ministry of Health Capacity Development ProgramMinistry of Health Capacity Development Program

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

79 hospitals under construction

8 new hospitals

250 primary care centers to be developed

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

79 hospitals under construction

8 new hospitals

250 primary care centers to be developed

Best-in-Class / Desired Health System PositionSaudi Arabia

Level 4:“Market-Driven” Health System

Near-absence of public sector healthcare

Government role limited to ensuring oversight, with limited subsidies

Comprehensive regulations to ensure fair play

Level 1:“Gov’t-Sponsored” Health System

Widespread private sector healthcare delivery options

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

Increasing healthcare regulations

Emerging private sector involvement in healthcare and increasing private insurance

Decreasing burden on gov’t due to private insurance

Mounting pressures for establishing a comprehensive regulatory framework

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

Private sector involvement limited to few care providers

Level 3:“Intermediate” Health System

Level 2:“Emerging” Health System

Service FundingService Funding

Patient HealthcareDelivery

Regulation

PatientHealthcareDelivery

Service Funding Regulation

Patient

Service Funding

HealthcareDelivery

Regulation

PatientHealthcareDelivery

Service Funding Regulation

Degree of Government Ownership

Degree of Private Sector Ownership Increasing Private Sector ParticipationIncreasing Private Sector Participation

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

Illustra

tive

Illustra

tive

JeddahRegion

RiyadhRegion

10%

90%

24%

76%

40%

60%

SouthernRegion

EasternRegion

30%

70%

Observations Observations

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

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

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

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

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

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

Public Sector Participation Private Sector Participation

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

MoH Modernization Plan

MOH Sector Modernization Plan MOH Sector Modernization Plan

Issue regulations to implement the plan

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

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

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

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

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

Issue regulations to implement the plan

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

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

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

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

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

Source: Balsam – Development of Saudi Healthcare System - 2006

Damaged roof Split joints, and walls without skirtings

Damaged and Defective Fittings Chipped sanitaryware

Defective roof perimeter Original fitted furniture

Sanitaryware and floor Damaged and Missing Ceilings

Existing defective furniture

Existing defective furniture

Existing poor furniture

Damaged clinical wash hand basin

Existing clinical wash basin

Existing clinical wash hand basin

Damaged toilet fittings

Existing floor tiling to toilets

Poor shower arrangement

Existing clinical flooring

Poor and missing clinical skirting

Existing poor clinical skirtings

Existing defective clinical flooring

Existing defective clinical flooring

clinical floor tiling

poor vinyl installation

Existing poor clinical flooring

Existing defective clinical flooring

Temporary room signage

Temporary room signage

Existing temporary door signage

Existing temporary door signage

Existing departmental signage

Existing departmental

Existing suspended ceilings

Missing and water stained tiles

Incomplete theatre ceiling

Existing clinical ceilings

Typical damaged ceilings

Missing and water stained tiles

Damaged door leaves

Damaged door leaves

Defective light fittings

Existing emergency lighting defective light fittings

Cracked lighting diffusersTypical internal corrosion within boiler plant

Typical existing DX split condensing unit

Defective AHU to Recreation

Damaged chilled water pumps

Replacement Air Handling UnitAir cooled chillers in poor condition

Damaged existing roof fans Old style distribution board

Trailing leads are trip hazards

Fire Alarm panel – non compliant Poor, steep access ramp

Locked fire exit to Female Surgery

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

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

BUILDING: M-H LEVEL 0LOCATION: INSIDE ELEC. ROOM NR. ELECT. RM. B24APICTURE: TELEPHONE TERMINAL BOARD COMMENTS: TELEPHONE TERMINAL BOARD IS NOT PROPERLY ORGANIZED.

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

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

Hospitals are the most complex of building types. Each hospital has a wide range of services and functional units:

clinical laboratories,imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping;inpatient care or bed-related function.

Every owner wants a cost-effective building. But what does this mean?

Is it the lowest first-cost structure that meets the program? Is it the building with the longest life span?

Is it the facility in which users are most productive? Is it the design with the lowest operating and

maintenance costs? Is it the building that offers the greatest return on investment?

Differs from almost all other types of buildings. The biological flora that are endemic to all health premises pose a risk to both patients and staff.

Goals: Running a hospital building over the course of

its useful life. To achieve the intent of the original building

design team. To achieve long-term goals of economy,

energy efficiency, resource conservation, & pollution prevention, while meeting the comfort, health, and safety requirements of Patients, Staff and Visitors.

If we “Cannot Measure it”

we “Cannot Manage it”

The development of meaningful measurement criteria:Key Performance Indicators (KPI’s) is a vital step in establishing & improving quality

Environment where Standards and Quality are in alignment.

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

Contextual

Codifiable, explicitEasily transferable

Insight, creates meaning, judgmental, actionable

Human, tacit, transfer requires learning

Data

Information

Knowledge

Wisdom

George Annas NEJM 354;19:2063-2066

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

Flat roof being recovered Sheet vinyl to Ward areas

Cantilever type fitted furniture Panel mounted clinical wash hand basin

Flat roof with gravel blast Typical fitted furniture

New domestic wc and cistern Corridor suspended ceilingsProposed fitted clinical furniture

Appropriate clinical basin and mixer tap

Appropriate clinical toilet arrangement

Appropriate slip resistant vinyl flooring

Appropriate slip resistant vinyl flooring

Appropriate slip resistant vinyl flooring

Appropriate room signage

Appropriate slip resistant vinyl flooring

washable clinical ceiling

Appropriate circulation ceilings

Appropriate laminated doorsets

Appropriate Pump assembly

Appropriate type fan fittings

New air cooled liquid chillers

Proposed new split DX units

Appropriate boiler plant installation Typical new distribution boardAdditional wall outlets

Compliant Fire Alarm panelNew Designed steam boiler

Accreditation and Quality ControlAccreditation and Quality Control

Regulations for Private InvestmentRegulations for Private Investment

High-level Blueprint for Healthcare System

Healthcare Funding / Health Insurance

Healthcare Funding / Health Insurance

Compensation of ProvidersCompensation of Providers

Competition, and Pricing RegulationsCompetition, and Pricing Regulations

Governmental Control and OversightGovernmental Control and Oversight

- Rules for and Protection of Private Investments

- Rules for and Protection of Foreign Investments and Property

- Legislative Authority - Supervision and Consultation

- Antitrust Laws and Regulations

- Pricing Regulations

- Regulations on Choice of Professional Activity

- Provider Institutions

- Pharmaceuticals

- Medical Products

- Sources of Funding

- Requirements for Insurance Coverage

- Tasks and obligations of Insurers

- Sources of Funds

- Rules for Compensation

Source: Booz Allen analysis

Government-Driven Health-Related Initiatives

Cooperative Health Insurance ActCooperative Health Insurance Act

Regulates the provision of healthcare for non-Saudi residents in the Kingdom Determines the rights and duties of sponsors, beneficiaries, insurers and providers

Regulates the provision of healthcare for non-Saudi residents in the Kingdom Determines the rights and duties of sponsors, beneficiaries, insurers and providers

Saudi Food and Drug Administration

Saudi Food and Drug Administration

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

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

Nat. Center for Health Insurance Standards

Nat. Center for Health Insurance Standards

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

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

Saudi Council for Health SpecialtiesSaudi Council for Health Specialties

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

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

Private Health Institutions Legislation

Private Health Institutions Legislation

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

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

Makkah Region Quality ProgramMakkah Region Quality Program

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

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

Source: Booz Allen analysis

Standards

Auditing

Quality System

Accreditation

Quality System

Standards

Auditing