Evidence-Based Medicine (EBM) & Clinical Practice Guidelines (CPGs) in the Middle Eastern Context.

There has been a lot of fuzz about following Evidence-Based Medicine (EBM) and creating and implementing Clinical Practice Guidelines. It is heard everywhere from hospital management professionals to clinical practitioners. The whole crux of following EBMs and CPGs is to increase patient safety, better treatment outcomes and reduction of cost.  It is a well know fact and is proven with organizations like NICE in UK (National Institute of Clinical Excellence) and Unites States Institute of Medicine in the forefront of developing CPGs.  Especially in countries like UK, which is public funded, this has been developed and implemented to a greater success.  CPGs are the pivot of clinical governance and have great relevance in this ever changing era of healthcare business.

 But in reality, is this being achieved from an organizational level or national level in the Middle East especially in the UAE? There has been some scattered effort from certain countries in the region like The State of Qatar who are rolling out a National Health Strategy (NHS 2.1.2) which aims to develop a national strategy to develop national clinical guidelines creation and implementation. This project itself is lagging behind the planned implementation and little is known regarding the success (if known, to stress the results to be unbiased).

Sadly, for UAE nothing solid in this matter to my knowledge has been thought about or implemented successfully.   The factors are several ranging from the existence of different regulatory organizations in different emirates to the prevalence of a highly non-regulated private sector in terms of clinical management.  Even though most of the secondary and tertiary care organizations (both public and private) are accreditated by JCI, the adherence to CPGs as demanded by JCI standard GLD 11.2 is not judiciously followed. The standard itself demands implementation of GPGs, clinical protocols and clinical bundles to guide clinical care.  The country is driven by EBM, but here it’s not evidence-based medicine, but instead “Experience-Based Medicine” or simply Opinion based medicine that is rooted on their personal experience and expertise. This can be accounted to the multicultural workforce who obtained their clinical education, experience and expertise in different countries.

What needs to done is to have a national vision on a unified national clinical guideline development with implementation with zeal and vigor.  Various regulatory bodies, public health sector entities, private sector as well as insurance providers should be incorporated to achieve this drive. The result of this will be a well regulated health system rooted on greater treatment outcomes achieved with minimal resources at minimal cost.

My next blogs will be concentrated towards this as I will be circulating this blog for expert opinion and views of many professionals working in the UAE health sector.

Knowledge management in Healthcare for Interdepartmental Collaboration, SOP, Care pathways, & Workflow Management

Today I had a chance to see a demo of a knowledge management software relevant in other industries which intrigued me to how effectively this can be used in interdepartmental collaboration, standard operating procedures, establishing care pathways, workflow management, etc in the healthcare setting. In the coming days I will publish a more detailed blog on this topic on the effective use and its implications in quality of healthcare delivery.

Understanding the Scope and Standards of Nursing Practice

The need for transition in healthcare in GCC has increased the pressure on executive level to practice several methodologies to induce cost effectiveness, better clinical outcomes, and increased satisfaction levels of customers.

Outcomes are always linked with patient-centric delivery and the role and effective use of nursing is often underestimated in the private and public sector in GCC,

American Nurses Association has set out scopes and standards of nursing practice which when effectively utilized and practiced can lead to amazing results, both in terms of clinical outcomes as well as profitability, a perfect blend for private sector.

Please find below the link for the the second edition to that though the latest edition can be purchased from Amazon. Its worth reading !

Please share your ideas on the effective use of nursing services, which is not mentioned in this documents that can further enhance patient outcomes and profitability in healthcare.

https://www.iupuc.edu/academics/divisions-programs/nursing/course-descriptions/Website%20-%20ANA%202010%20Nursing%20Scope%20and%20Standards%20of%20Practice.pdf

The state of Mobility in Healthcare-Benchmark Survey 2014

Dear All,

Please find an interesting survey results on the state of mobility in healthcare. Please follow the link




https://s3.amazonaws.com/dive_assets/rlpsys/Healthcare_Survey_2014.pdf

Regards,

Binu. Gopinathan

Social Media as an enhancer of patient experience

Today, I was going through one of the articles in Internet in recognizing the role of social media in hospitals and how it can enhance patient experience.  Different examples were cited from some of the prestigious Canadian healthcare organizations on how they have effectively utilized social media.

As an avid researcher in patient experience, I totally agree to the fact that social media needs to be incorporated into healthcare and its potential is still undervalued.  We need to think about how we can incorporate social media in enhancing patient experience.  Cited are few examples from my thought and your valuable input will be highly appreciated.

1.       Each individual hospital should form active groups (to include clinicians, patients, and their families) for their specialty services like Ob/Gyn, services dealing with long-term illnesses, genetic diseases, nutrition/dietetics, etc where they participate and discuss various aspects of care where clinician-patient interaction reaches the next level.  If we can incorporate community services to it, fantastic !

2.       Media like Twitter can be utilized for patient notification services.

3.       Social campaigns for preventive medicine can also be effectively carried out through social media. 

Social media like Facebook, Twitter, etc are used by some of the healthcare organizations in UAE as we see small logos under their website, but the question arises if they are using to its full potential? If not why?  One the reasons maybe it’s a new way of thinking.  Patients and clinicians needs to be educated to actively involve and thus changing the way of healthcare delivery.

 

 

 

Relationship between expenditure in service quality improvement initiatives and profitability in healthcare

What is the relationship between expenditure in service quality in healthcare and profitability? A daunting question that arose in my mind which prompted me to explore various research studies based on this question. Quite a lot of data was found from various sources ranging from Mathews and Ketal (1992) showing negative relationship between expenditure on service quality and profitability to studies by Subramanian et al showing very strong positive relationship. A common factor arose from these studies is that variables other than service quality improvement such as pricing, distribution, marketing and advertisement influence profits more than expenditure on service quality improvements like TQM. Interestingly there is striking evidence that expenditure on service quality benefits cannot be experienced short term and accumulate overtime making them less amenable to detection. The literature review also brought to my attention that mere spending in service quality does not actually lead to profits and the relationship between expenditure on service quality and profitability is neither straightforward nor simple. When we think of investing in improvement of service quality the right variable needs to identified and invested upon. It is however evident that the aforementioned service quality benefits accumulated overtime is what healthcare needs now to stay in the business and to increase the market share continuously. Hence expenditure in variables such as pricing distribution, competition, marketing, advertisement, etc should be considered as a short term investment to create a sudden change and expenditure in service quality should be considered as a long term investment, which will benefit the organization in a long run and keep them in business in this ever changing and challenging world of healthcare.

Yours

Binu. Gopinathan

A new world - how do the exisiting healthcare providers sustain

With lots of new initiatives and projects, the healthcare organizations are facing a stiffer challenge to maintain and to increase the market share. New theories are developed, new organizational forms formulated, and all aims to tackle a single challenge: to improve the quality of care and reducing cost. For the existing providers to sustain in the market, the only realistic hope is by substantially improving care delivery by launching a revolution from within. It time for them to seriously think about redesign their service or what we call to do a service reengineering. They must refurbish themselves by revamping the organizational structure, their core clinical processes, management systems, and cultures supporting them so that they excel at performing three discrete tasks simultaneously: rigorously applying scientifically established best practices for diagnosing and treating diseases that are well understood; employing a trial-and-error process to deal with complicated or poorly understood conditions; and capturing and applying knowledge generated by day-to-day care. It should be noted that no single dominant design exists as each organization has its own unique structure, culture, and environment. More important than the specific designs are the four principles on which they are based: focus on the decisions, tasks, and workflows crucial to optimizing patient care; separate high- and low-variability care; reconfigure the supporting infrastructure and practices to match redesigned clinical processes; and design structure and processes to help organizations learn from their daily work. This post will follow with a deeper discussion of SLM's in healthcare. Yours Binu. Gopinathan