Building Capability and Capacity for Improvement in Qatar Wednesday, 11 December - Workshop D6/E6 Mike Richmond Chief of Medical, Academic and Research Affairs State of Qatar The State of Qatar is a sovereign Arab state, located in Western Asia, occupying the small Qatar Peninsula on the northeasterly coast of the much larger Arabian Peninsula. Its sole land border is with Saudi Arabia to the south, with the rest of its territory surrounded by the Arabian Gulf. A strait in the Arabian Gulf separates Qatar from the nearby island state of Bahrain. Population* * As of August 2013 1,865,374 persons Male 1,419,687 76% Female 445,687 24% * Demographics show a skewed population, the majority are male aged 20 to 45 2 1
12/10/2013 Qatar National Health Strategy 2011 2016 Qatar National Vision 20130 Comprehensive World Class Healthcare System Integrated System of Healthcare Preventive Healthcare Skilled National Workforce National Health Policy Affordable Services High Quality Research National Programs (e.g. Cancer, Diabetes, Organ Donation) 3 Increase in demand for healthcare services due to more people, with more chronic disease, living longer 20 Qatar UAE 15 UAE Kuwait Bahrain Rwanda 10 5 All other countries 2010 2005 2000 1995 1990 1985 1980 1975 1970 1965 0 1960 Annual population growth (%) -5 Equatorial Guinea Rwanda -10-15 Kosovo Our population growth has been amongst the fastest in the world - for the last fifty years 4 2
Healthcare Demand and Capacity Percentage change in growth from 2005 280% 260% 240% 220% 200% 180% 160% 140% 120% Qatar population Beds Activity 100% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Country Beds per 1,000* Australia 3.9 Canada 3.2 UK 3 USA 3 Saudi Arabia 2.2 UAE 1.9 Qatar 1.4 5 Projected % increase in treatment demand in GCC countries by 2025 Source: Gulf Cooperation 6 Council Health Care: Challenges and Opportunities. McKinsey 3
HMC Key Statistics 7 Despite A System Under Pressure - Encouraging Outcomes in NICU Women s Hospital 18,000 deliveries annually NICU, 90 beds operates at 100-130% capacity Very low rate of line infection in VLBW (very low birth weight) infants 8 4
Quality Goals and Drivers Quality Goals Primary Drivers Secondary Drivers Reduce Avoidable Deaths Reduce Patient Harm Leadership & Behaviors Measurement & Benchmarking Governance Review Leadership for quality Workforce development Job planning and appraisal Enhancing medical education Data on Harm (IHI Global Trigger Tool) Benchmarking / Dendrite/ ICD-10 Evidence based optimal care CPD for quality Awards for professional excellence Privileging and credentialing Mortality Review Core investigation Committee Never Events (SUI) Access Targets Improve Outcomes Quality Initiatives Best Care Always Collaborative Hospital Acquired Infections Clinical Service Reviews Pressure Ulcers VTE Deteriorating Patient Reduce Length of Stay Patient Partnership & Complaints Review of complaints management system Decentralized complaints service Patient survey Communication Patient Information service Staff safety culture survey Improve Patient Experience Capacity & Culture for Continuous QI Collaborative partnerships Microsystems IHI Fellows HMC Internal Fellowship IHI Open School IHI Mid East Forum CCITP Improve Access to Care Multi-Disciplinary Development Nurse leadership Allied healthcare professional Hospitalist program Transfer burns services Hospital at the weekend Governance & Risk Management 9 Improvement in VTE prophylaxis across HMC Without VTE prophylaxis, 10-40% of patients (and 60% of orthopedic) will develop VTE PE most common cause of preventable death Prevention of PE is the number one patient safety intervention (AHRQ) VTE (in US) second most common cause of increased LOS Second most common medical complication Third most common cause of preventable death in hospital 10 5
Capacity and Capability Development 2013-2014 Open School (> 5000 registrations) Fundamentals in safety (200 PA) HMC Fellowship (12 PA) IHI Forum - 2013 (2800 attendees) Employee Induction (25000 staff) CCITP (150 coaches trained) Best care Always Collaborative ( 150 staff in year one) Microsystems (60 PA) High reliability ward (1 PA) IHI Fellow (2 PA) Clinical Leadership Executive Leadership 11 HMC Academic Health System The Hamad Medical Corporation Campaign IT Campaign Ops Director Fellows & Local Fellows Knowledge from the field: Success and Challenges Collaborative Workstreams Program Managers Multidisciplinary Improvement Teams Local Improvement Campaign Leadership Team Campaign Operations Team (HMC and IHI) Corporate Delivery Team (HMC and IHI) Strategic Guidance and Operations Best Care Always Day-to-day leadership Defining Needs, Managing Operations IHI IAs and Fellows (1-5 staff) Improvement HMC Local Fellowship Capability Program (12 36 staff) IHI Foundations Training Program (~500 staff) The IHI Open School (All HMC staff) Qatar National Health Strategy Building Improvement Capability Human Resources 6
Increasing Capacity & Capability for Quality Improvement IHI Partnership Agreed HMC Quality Strategy agreed HMC-IHI Fellow HMC-IHI Mid commenced HMC-IHI Mid East Forum East Forum Microsystems Open Foundations School enrolled Launch LS-1 LS-2 IHI facilitated leadership retreat HMC-IHI Internal Fellowship IHI Fellow x2 LS-3 Collaborative Teams Review Oct-12 Dec-12 Mar-13 Jun-13 Sep-13 Dec-13 Mar-14 Jun-14 Sep-14 Dec-14 13 LESSONS LEARNED Understanding the magnitude of the challenges Developing a quality and safety strategy Building capability and capacity at all levels Raising senior leadership visibility Understanding the local culture Encouraging huge appetite for change Developing an environment of openness and transparency Realizing the need to fuse all things best, both East and West 7