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Healthcare

Hospital COO on medicine as a service industry

By Jianggan Li | 30 June 2009

The biggest change in UAE’s healthcare system recently, according to Brian de Francesca, Chief Operating Officer of Tawam Hospital, is that the management of public hospitals have been contracted out to experienced organisations.

Tawam Hospital, under the Health Authority of Abu Dhabi, entered a management agreement with John Hopkins University in the US in 2006.

Since then, Tawam has been focusing on providing quality, efficient and safe healthcare with the motto of “We treat our patients as we would treat our own family”, according to de Francesca.

The hospital has a “very strong and progressive” information management system. Cerner has been widely adopted to facilitate this evolution. De Francesca explains that there are two reasons for this adoption, namely allowing quick patient information access but also allowing good management visibility.

“As a managing organisation, if we can’t get access to a lot of data, we will not be able to do much,” de Francesca says. Visibility is very important from a managing contract point of view.

De Francesca asserts that the role of government is very important in this sense. The Emirate of Abu Dhabi has chosen to adopt one single HIS (health information system) for the entire healthcare system, which is expected to deliver great benefits in four to five years’ time.

At Tawam hospital, a full PACS (picture archiving and communications system) has been installed, and applications such as tele-radiology, tele-pathology and tablet computers have also been implemented.

Performance-based compensation

From a management point of view, the most significant challenge for Tawam Hospital is the fact that 86 per cent of staff are expatriates.

This corresponds with the demographic profile of UAE – of the 4.8 million residents, only around 20 per cent are Emiratis.

“People do go home – it is very hard to build a good team and let the good DNA pass on,” says de Francesca. “If you want to mature and grow, you have to become a strong organisation which can itself retain knowledge.”

To overcome this challenge, de Francesca says, it is important to first clearly identify the risks the hospital is facing. Retaining talent has therefore been identified as a top issue that needs to be tackled. De Francesca has been assigned with a task to develop a new compensation programme based on performance.

“The current model here and in most hospitals is pay for service - so the greater the volume of patients you turn over, the better you are compensated,” he says. “We will go directly for a pay for performance model.”

De Francesca explains that the ultimate performance is to have no patients, “ensuring the public health is maintained at the best level.”

To achieve this, de Francesca and his management team are looking at some very small areas where quality and the patient experience can be improved. “Things like patient waiting time, average length of stay and reporting quality could have hidden enormous risks,” he says.

People tend to focus too much on reporting the averages, de Francesca reveals, but miss spans and variation. “It is by measuring the variation that people who perform stand out.”

“When you are performer, you want to be measured,” de Francesca says. He doesn’t believe that there will be widespread resistance from clinicians against the new scheme.

The model was first adopted by Geisinger Health System in the American state of Pennsylvania. Geisinger guarantees that 40 processes will be performed for every elective coronary-artery bypass grafting surgery. More importantly, it also promises that patients will not be charged for any related care for 90 days after their operation.

“It has a spectacular management information system that records and guides most aspects of inpatient and outpatient care.” An insider at Geisinger once said that this was the reason the hospital succeeds.

“Medicine is not magic, it is a service business,” de Francesca says. “And as a service business, you need to be able to guarantee your service levels.”

That is also why many hospitals are keen on certification programmes such as those offered by JCI and ISO, he adds.

“We don’t want to make it to the extreme of zero tolerance for error,” de Francesca notes. “It is a production line where you look at failures and work out how to improve the overall quality.”

Management of information

Noting that there is a tremendous number of hospitals that need to catch up in terms of IT, de Francesca cautions that technology should not be used to shorten the time doctors spend with patients.

“Research has shown that the shorter time you spend treating a patient, the more likely you will end up in a law suit,” he says. “One of the greatest challenges for doctors is to get patients telling them the right things.”

Ultimately not every piece of information can be sourced from record, which only gives the history – physicians still need to listen to the patient before they can make an informed decision.

On management of information, de Francesca says that organisations are often not very sure what information they want.

It is very important to ensure that people who make decisions get information that is accurate, relevant and timely. However, too much focus has been dedicated to technical issues and the expansion of facilities, de Francesca notes.

He uses shopping malls as an example. “People always want to make malls bigger and harder to manage, which I never understand. The same thing is happening with many hospitals.”

“What matters to me is the management of information,” he says. “Different systems are unifying and we are getting a lot of information – we need to figure out how we design the systems to manage that enormous amount of data.”

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